Inspection on 17/10/05 for Yew Tree Lodge

This inspection was carried out on 17th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Yew Tree Lodge 20/03/07

Yew Tree Lodge 25/04/05

Yew Tree Lodge 18/10/04

Yew Tree Lodge 14/04/04

Yew Tree Lodge 18/12/03

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Yew Tree Lodge Stoke Road Hoo Rochester. Kent ME3 9BJ Lead Inspector Robert Pettiford Anne Butts Announced 17 October 2005 9.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Yew Tree Lodge Address Stoke Road Hoo Rochester Kent ME3 9BJ 01634 251312 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr & Mrs S Ali Care Home 28 Category(ies) of OP Old Age (17) registration, with number DE(E) Dementia - over 65 (11) of places Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25 April 2005 Brief Description of the Service: Yew Tree Lodge is a large detached property. The Proprietors live next door and have day-to-day contact with the home, they employ a number of care staff, domestic staff, and a cook. The home is situated in a rural setting on the outskirts of Hoo village. There are transport links with Rochester and Strood, and ample car parking to the rear of the building Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced Inspection at Yew Tree Lodge took place on 25th April 2005 at 9:00am. The Inspectors agreed and explained the inspection process with Mr and Mrs Ali the Registered Providers and the manager. Documentation and records were read, including care plans. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. A tour of premises was also undertaken. The focus of the inspection was to assess Yew Tree Lodge in accordance to the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Service users and healthcare professional were spoken with along with members of staff to comment on the home. What the service does well: What has improved since the last inspection? Care plans have been fully reviewed and updated, and now ensure that all areas of care and support are identified for individual residents and reviews are now held on a regular basis. Systems are in place to ensure that appropriate health care professionals can further support service users. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 6 Social and recreational activities are now being improved with staff being trained in supporting residents with their preferences, and they are currently in the process of implanting a more varied activities programme. Serious shortfalls were noted at the last inspection with regard to staff training. Evidence was seen however during this inspection that training has significantly improved and is seen as a priority within the home. This process is still ongoing with some shortfalls noted. The home is aware of what is required and is working towards ensuring that it meets with the national Minimum Standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 Service users have the information they need to ascertain whether the home can meet their needs. Whilst service users rights are protected by a written contract / statement of terms and conditions, the contract requires some minor amendments. Service users can be confident that their needs will be suitably assessed to ensure that the home can meet their needs. Prospective residents have the benefit of a trial period at the home to assess whether the home can or cannot meet their needs. EVIDENCE: The inspector viewed the current information available to prospective service users. The Statement of Purpose and service users guide for Yew Tree Lodge was seen to include the information outlined in the standards. The Registered Provider stated that a copy of the previous inspection reports are made available to service users and their families upon request. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 9 A written contract / statement was available outlining service users’ rights, responsibilities, and conditions of placement is in place, some minor amendments were seen to be needed. Each service user has been provided with a copy. In the residents’ files sampled the inspector saw that all residents are assessed prior to coming in to the home for the trial period. Residents are also reassessed if they spend a period of time in hospital. These assessments cover the requirement of the standard and are detailed. During the inspection staff were asked about the specialist training that they had had to help with the care a specific residents in there care. Staff confirmed that amongst the list of specialist training were courses on dementia .The other training records showed that staff are given the skills to care for residents and the that staff are doing NVQ’s in Care. The inspector found from talking to both staff and residents in the home that residents are encouraged to visit the home and spend time at the home prior to staying for a trial period. Staff explained that this time is also used to how well the prospective resident gets on with the other residents already living at the home. Staff also explained that if the prospective resident feels comfortable and wants to come to the home then they do so on a four week trial, during which time the assessment continues. A review is held at the end of this time with all the interested parties and if the trial has gone well the resident can choose to be come permanent. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11. Service users benefit from the improved care plans that encompass individual physical; intellectual, emotional, health and social care needs. Service users are protected from harm by the home’s policy and procedures with regard to the administration and dispensing of medication Service users and their families can be confident that their wishes with regards to end of life issues is handled with respect and sensitivity. EVIDENCE: The home provides care and support mainly to residents with dementia, and this service user group are very dependent in needing the support of the home, manager and staff in meeting their needs. The home has been going through a period of change in which it aims to ensure that resident’s needs are fully met. In view of this the manager has recently reviewed care plans and personal files for all residents. She has updated the format in that they are now contain more details and cover all areas of care and relevant background information is obtained for Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 11 residents and relatives are involved in building up a life history so that the home can gain an insight into how to support individual residents. She has implemented plans that are centred on the physical, intellectual, emotional and social needs of the residents. These areas encompass all the needs of the service users and are based on the assessment process. Assessments are in place with appropriate screening tools that assess the level of daily care that the individual resident requires. This is then incorporated into the care plan and serves to guide staff exactly how to care for the individual. The manager is in the process of implementing a key worker system for residents and senior staff supports a small team and designated residents. Key workers are now involved in writing up daily reports, although it is recommended that staff would benefit from training in appropriate report writing. Assessments are reviewed on a monthly basis and any changes are identified within the care plan and this is updated accordingly – it was recommended that key workers are involved in this review process so that they will always be aware of any changing needs of the residents. The health care of the individual is now being more actively promoted and records viewed showed evidence of input from G.P., chiropodist, district nurse and dentist. A system has been implemented where visits from professionals are recorded with details of outcomes and any action to be taken. During the course of the inspection two health care professionals visited the home and some very positive comments were made about the improved outcomes for residents, supportive members of staff and a noticeable improvement on how residents were happier within themselves. Health care records also showed that residents weight, nutritional needs and pressure areas are also fully monitored, reviewed and any concerns acted upon. Care plans detailed how to support residents in delivering their personal care, and are supported by individual risk assessments, including movement and handling and falls risk assessments – although it was identified that not all residents’ files contained the appropriate assessments and it is strongly recommended that this be addressed immediately. The medication storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of “PRN/As Required” Medication were viewed. The Home uses a Monitored Dosage System and regular audits are carried out by the manager. Only authorised staff members undertake the administration of medication following training. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 12 The inspector requested that the need to write up the MAR sheet is reduced to an absolute minimum. If it was necessary in limited circumstances (following a private consultation between the service user and the Doctor or hospital visit) to add items to the sheet, that it is checked and verified by two members of staff. It is also requested that a copy of the prescription be kept to verify correct drug, dosage, and time of administration, to ensure that it had been recorded properly. It is recommended that the home request’s that their practice and storage arrangements be reviewed on a yearly basis by a pharmacist. The inspector requested that the location of the medication room be reconsidered within the plans to extend the home. Issues around dying and death are handled sensitively, and the manager is aware of the need to ensure that residents and families rights and choices are observed in this area. This is discussed at an appropriate time following a resident moving into the home and this is then usually agreed with the next of kin and a policy signed by appropriate parties. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14. Residents are benefiting from an improved activities programme which is aimed at matching their preferences and interests, and are supported in maintaining contact with family and friends, which ensures they continue to receive stimulation and emotional support. EVIDENCE: The home is in the process of improving daily and social activities, and is currently moving forward with a more varied activities programme. A member of staff has completed reminiscent training, and is working with residents in building up an individual person centred plan that is aimed at finding out preferences and past history that will help towards supporting residents in undertaking suitable activities that they will enjoy. Recent new activities have included light exercise programmes, cookery and musical bingo. Residents have the choice as to whether they wish to participate or not. Entertainers also visit the home on a regular basis. A ‘message’ board has also been implemented which contains news items, and information that residents may find of interest about events that are happening around the world. The home has now established links with the local school and residents have been invited to attend their bazaar. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 14 Contact with family and friends is actively promoted and they are involved wherever possible in assessments and reviews. Residents are able to move around the home and choose whether they wish to sit in the ‘quiet’ room or main lounge, or participate in activities. Several residents were spoken to during the inspection and comments included; “The staff are very nice and they look after me” “I’m a bit funny about my food, but they are pretty good in listening to what I want” “I can join in the exercises if I want and everybody is nice to me” Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Service users are protected from the risks of abuse by the home’s policy and procedures with regard to Adult Protection.. EVIDENCE: The home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training is provided in abuse. However not all staff have received training. More courses are planned to ensure all staff receive the training required to protect service users from abuse. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,24,25,26 Service users benefit from living in a clean comfortable home, which is suitable for their needs. EVIDENCE: The Inspector undertook a tour of the home including some service users rooms, with their permission, bathroom/toilet facilities and communal areas. All areas viewed appeared bright, cheerful, and airy. Fixtures and fittings and general decoration were seen to be of a good standard, although some redecoration was in need of being done in a few area’s. This was discussed with the general manager. The home has plans to further extend the building to provide extra bedrooms and facilities. This will give an opportunity for the home to relocate the medication room and address fully the redecoration of all areas within the home. Bedrooms were seen to be personal in nature with each service users expressing their own identity. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 17 The number of toilet and bathroom facilities provided by the Home meets current required standards. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29,30 Service users’ care, social and emotional needs are promoted by the employment of caring staff. Whilst the home has improved the levels of training offered to staff further training opportunities need to be developed to ensure that the care of service users is not compromised in any way. Service users are protected from potential abuse by the home’s robust staff recruitment procedures. EVIDENCE: The staff training records indicated planned and undertaken training. The manager evidenced that individual and group staff training needs had been identified. A wide range of training has been identified for all staff over and above core skills courses. First Aid, Food Hygiene, Health and Safety and other core courses are undertaken to maintain current qualifications and for protection of service users. A serious shortfall was noted at the last inspection with regard to staff training. Evidence was seen however during this inspection that training has significantly improved and is seen as a priority within the home. This process is still ongoing with some shortfalls noted. The home is aware of what is required Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 19 and is working towards ensuring that it meets with the national Minimum Standards. The home has a induction programme which the Manager stated meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. From records viewed by the inspector all staff had received or are receiving induction training. The manager is in the process of updating the training matrix to reflect an overall picture of staff training within Yew Tree Lodge. The manager is to be comment on addressing the training needs within the home. The inspector viewed details of the home’s recruitment procedure and a number of records relating to staff members recruited. The Home undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of I.D and copies of qualification certificates, seeks written references. All staff appointments are subject to a probation period, which is subject to review. The recruitment files sampled were seen to contain all the information as per appendix 2 of the Care Home Regulations 2001. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Service users can be confident that their welfare will be protected with regard to health and safety. EVIDENCE: The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was up-to-date, reflecting that checks and servicing of fire safety equipment had been undertaken at the required frequency. Procedures are available for the reporting of accidents and incidents (Regulation 37). Action has been taken to minimise identified risks to service users including regulation of hot water temperatures. The home employs a consultant to advise the home with regard to environmental risk assessments and health and safety. The home also employs a General Manager who has the delegated responsibility for health and safety within the home. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 21 On evidence seen health and safety is seen as a priority within the home. However some ongoing shortfalls were noted with regard to staff training in health and safety. The manager confirmed that this will be addressed and included within the home’s action plan. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 x 3 x 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x 3 Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5(1) Requirement Timescale for action 17/01/06 2. 18 13(6) 3. 30 18(1) 5.—(1) The registered person shall produce a written guide to the care home (in these Regulations referred to as “the service user’s guide”) which shall include— (b) the terms and conditions in respect of accommodation to be provided for service users, including as to the amount and method of payment of fees; 13.—(6) The registered person 17/01/06 shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. 18.— (1) The registered person 17/01/06 shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; Version 1.40 Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Page 24 (c) ensure that the persons employed by the registered person to work at the care home receive— (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is recommended that staff are trained in appropriate report writing skills and that key workers are involved in the monthly review process.It is also strongly recommended that all residents files are reviewed to ensure that they contain all appropriate assessments so that the home can fully meet the individual needs. Yew Tree Lodge H56-H06 S29005 Yew Tree V245406 171005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent. ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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