Inspection on 20/03/07 for Yew Tree Lodge

This inspection was carried out on 20th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Yew Tree Lodge 17/10/05

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 Sue McGrath Key Unannounced Inspection 20th March 2007 09:30 X10015.doc Version 1.40 Page 1 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 Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 2 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 DS0000029005.V327605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Yew Tree Lodge Address Stoke Road Hoo Rochester Kent ME3 9BJ 01634 251312 01634 254941 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Abida Ali Mr Syed Ikram Ali Mrs Sharon Edmunds Care Home 29 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (4) of places Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. Amendment in registration on the condition that the service user with a date of birth 1 October 1924 occupying the annexe/flat is suitably risk assessed to ensure safety and once they vacate, the registration will change to Older Persons (DE) over 65 (25) and Older Person (OP) (3). 17th October 2005 Date of last inspection 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 two cooks. The home is situated in a rural setting on the outskirts of Hoo village. There are transport links with Rochester and Strood. There is car parking to the rear of the building. Fees are from £416.36 to £450.00 Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 20th March 2007 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. The requirements made at the last inspection had been complied with. Overall this was a positive inspection with good outcomes for service users. What the service does well: It is evident through the inspector talking to members of staff that the emotional health of the service users is of a high priority to the home and that staff are pro-active in maintaining and supporting Service Users with their emotional needs in order to maintain their quality of life. The manager has been instrumental in developing the staff team to work towards improving the quality of care since joining the home. Staff, service users and relatives gave evidence of the manager’s positive contribution towards the home. Many residents were spoken with and all who were able to do so confirmed that the staff were very caring and kind to them at all times. The inspector noted that staff spoke to the residents in a respectful and courteous manner. The home was fresh and clean on the day of the inspection. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about moving into the home. Residents benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: The home’s statement of purpose and service users guides are comprehensive and detailed. It is recommended t hat fire precautions and associated emergency procedures are added to the service user guide to ensure full Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 9 compliance with Schedule One of the Care Home’s Regulations 2001. The manager is also advised to ensure the recent guidance on provision of fee information by care home’s, that is available on CSCI website, is included in the service user guide. These documents are freely available in the main foyer area of the home and are easily accessible by all. The admission process is also comprehensive and ensures the home has sufficient information on the prospective resident prior to admission. The Registered Manager and/or her assistant normally carry out this assessment. Completed paperwork confirmed this is the usual practise. It is also noted that residents are reassessed if they spend a period of time in hospital. This comprehensive assessment process ensures the home can meet the needs of its residents. It was confirmed 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. The manager explained that this time is also used to assess 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 and or their representative can choose to become permanent. Families and/or representatives are included in the review if appropriate. Intermediate care is not provided at Yew Tree Lodge Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from having clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Care plans are regularly updated to ensure changes are recorded and acted upon. Health needs are well met and residents benefit from having full access to all professional health care services as required. Residents are protected by the home’s policies and procedures for dealing with medicines. 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 new Registered Manager Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 11 has introduced new care plans which are comprehensive and detailed however they must not be allowed to become too complicated. There is a danger that too much information or doubling up of information could mean that all of the plans are not fully read by all concerned. Key workers are now involved in writing up daily reports and assessments are reviewed on a monthly basis. Any changes are identified within the care plan and this is updated accordingly. The health care of the individual is actively promoted and records viewed show 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. Health care records also show that residents weight, nutritional needs and pressure areas are fully monitored, reviewed and any concerns acted upon. The home’s system for the administration of medication complies with the guidelines from the Royal Pharmaceutical Society of Great Britain. Only authorised staff members undertake the administration of medication following training. It is expected that a new medical room is to be provided in the planned extension. Staff were seen to be very caring and treat the residents with respect at all times. Comments from relatives confirmed that they are happy with the level of care and compassion shown. Staff also confirm that they always respect the residents dignity especially when delivering personal care. 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 DS0000029005.V327605.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist diets are well catered for. EVIDENCE: The home cares for people with varying degrees of dementia and lifestyles can be very challenging for some. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible gave full support and consideration. The home does endeavour to offer appropriate activities and these are recorded on daily records. A weekly activity chart is on display. Activities are organised by existing care staff with one or two care workers having main responsibility. Activities include one to one sessions, beanbag and rope games, giant connect 4, sensory balls and arts & crafts. Some group reminiscence is Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 13 arranged and giant snakes and ladders are available. Some residents enjoy reading, knitting, watching television or listening to music. Sing-a-long sessions are very popular and some outside entertainers are bought in. Recent decorating of trinket boxes was very popular. A regular Sunday Church service is arranged. It is advised that if a resident does not want to engage in activities, this is recorded as and when it happens. The home has now established links with the local school and residents are invited to attend various events. 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 food is good and I get plenty of choices’ ‘My Son visits me when he can and there are no restrictions’ ‘Everyone is so nice to me here’ The kitchen is clean and tidy and meets with all the requirements of the local Environmental Health Authority. Menus confirm that a varied and balanced diet is offered and specialist diets are well catered for. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by a robust complaints system and service users and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that residents are protected from abuse. EVIDENCE: The home has a comprehensive complaints procedure in place, which includes a whistle blowing policy. It is proactive in responding to complaints and concerns. The home has adopted the Kent and Medway’s Adult Protection Policy and staff have received training in this subject. Staff spoken with displayed a good understanding of the subject and relatives can be confident their loved ones remain safe and secure. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, safe, well-maintained environment and have safe access to comfortable indoor and outdoor communal areas. EVIDENCE: During the walk around the home several improvements were noted. New domestic light fittings have been fitted to replace the old florescent ones. New chandelier type lights have been fitted in the dining room. Some of the upstairs bedrooms have been redecorated and some have new furniture and carpets. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 16 A new nurse call system has recently been installed and a new generator for emergency use has also been installed. A new sluice has been fitted upstairs; the home already has the use of a macerator for the disposal of soiled incontinence pads. Some new double-glazing has been installed. New handrails have been fitted in the corridors. New external fire doors, which are connected to a new fire alarm panel, improve the efficiency of the fire protection system. The owner is working towards upgrading the heating system and this should be completed as part of the proposed new extension. The manager is aware that some of the bedrooms on the lower floor would benefit from some redecoration and hopes to complete this work some time this year. Most bedrooms are personal in nature with each resident expressing their own identity. The number of toilets and bathroom facilities provided by the home meets current required standards. There are sufficient facilities for hand washing in all of the toilets in the home, both for residents and staff. Infection control measures were discussed with the manager who is advised to consult the Infection Control Nurse if any further issues arise. Infection control procedures were discussed in detail both with the manager and staff; both parties displayed a good understanding of infection control and the importance of good hand washing procedures. There is safe access to gardens for the residents to enjoy in the summer. The home is very clean and domestic staff are to be congratulated in maintaining a high level of hygiene. The owners now have planning permission to extend the home and this is an interesting time with the opportunity to provide a dedicated unit. A new medical room, a visitor’s room with full facilities and some new bedrooms are some of the improvements being considered. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 17 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from the support of carefully selected and well trained staff who understand their needs. Residents are protected by the home’s robust recruitment procedures. EVIDENCE: Staff confirmed that recent staffing numbers have been increased and the rota indicated that sufficient staff were on duty on the day of the inspection. The total numbers of staffing hours provided by the home in the pre-inspection questionnaire confirm sufficient staff are employed to meet the needs of the residents. Although the home has an extensive training matrix, which highlights all of the training that has been undertaken, it does not include actual dates, so it is difficult to say if the training is current. However, there has been an improvement in the number of staff who have completed or are completing a National Vocational Qualification in Care. This figures now exceeds the required 50 level. It is recommended that dates of actual training are included in a new matrix; this will assist the home when planning future training if they Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 18 know when refreshers are due. The home does train its staff in specialist dementia care. One personnel file was assessed, this was for the last member of staff to be employed by the home, and was found to contain all of the required information to ensure good recruitment practises and compliance with regulations as per appendix 2 of the Care Home Regulations 2001. The home has an induction programme which the Manager states meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of residents. From records viewed all staff have received or are receiving induction training. Health and safety training is ongoing. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 19 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a home where the manager is competent, enthusiastic and experienced with the care of older people and has a clear vision for the home. Residents benefit from staff who are appropriately supervised by senior members of staff. Sound financial procedures protect residents and current arrangements are sufficient to protect the health, safety and welfare of residents and staff. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has engaged a new Manager since the last inspection. She is due to complete her interview with the Commission to become registered later this month. During the course of the inspection she was able to display her knowledge of the home and of her responsibilities at the home. She was competent and informative. Staff confirmed that recent positive changes made by the new manager had enhanced the home. 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. With the levels of dementia in the home it can be difficult to have constructive residents meetings but the home does take into account staff and families opinions in the running of the home and does manage it in the best interests of the residents. Although the home has started to gather information from families and other stakeholders via annual questionnaires and admission questionnaires, it does not produce any outcomes from this exercise. The owners are advised to make themselves fully familiar with Standard 33 to ensure full compliance. The home prefers not to handle residents monies and only holds a minimal amount to cover the cost of personal expenditure such as hairdressing, chiropody and personal toiletries. A separate account for each resident is maintained. Staff confirm they receive regular supervision and yearly appraisals are starting to happen for this year. Staff say they feel well supported by the owners and manager. The home’s policies and procedures are available in the reception area and are regularly reviewed and updated. From the information received in the pre-inspection questionnaire and evidence seen on the day it is evident that the health, safety and welfare of residents and staff is well protected. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 21 Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 3 Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24 (1)(a)(b) (2)(3) Requirement The results of the quality assurance surveys should be made available to all current and prospective users and their representatives and other interested parties, including the commission. Timescale for action 31/08/07 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 2 3 Refer to Standard OP1 OP12 OP28 Good Practice Recommendations It is recommended that the minor adjustments recommended in the above report are implemented It is recommended that if daily activities are refused it is recorded on the residents care plan. It is recommended that the actual dates of completed training be added to the home’s training matrix. Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Yew Tree Lodge DS0000029005.V327605.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!