Inspection on 24/05/06 for York Lodge

This inspection was carried out on 24th May 2006.

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

York Lodge 24/05/07

York Lodge 25/10/05

York Lodge 26/04/05

York Lodge 05/12/04

York Lodge 20/07/04

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

CARE HOMES FOR OLDER PEOPLE York Lodge Myrtle Road Crowborough East Sussex TN6 1EY Lead Inspector Jennie Williams Unannounced Inspection 24th May 2006 11:20 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 York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 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. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service York Lodge Address Myrtle Road Crowborough East Sussex TN6 1EY 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) 01892 661457 01892 652884 Millcroft and York Lodge Care Homes Ltd Mr Fred Bramble Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-two (22). Service users must be aged sixty-five (65) years or over on admission. Only adults with a dementia type illness are to be accommodated. Date of last inspection 25th October 2005 Brief Description of the Service: York Lodge is a care home providing care for up to twenty-two (22) residents over the age of sixty-five (65) with a dementia type illness. Nursing care is not provided at this establishment. The home is located in a quiet residential area of Crowborough. The town centre is located within walking distance of the home. There is nearby access to public bus routes. There are car-parking facilities at the home for approximately seven cars. York Lodge is a large detached three-storey building. Rooms are located over three floors, all of which are served by a passenger shaft lift. Twenty rooms are for single occupancy of which 18 have en suite facilities. There is one double room that is provided with an en suite. There are two communal toilets located near communal areas and a bathroom located on each floor, two of these being assisted facilities. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Weekly fees range between £357 and £440. There are additional fees; hairdressing (£4 to £22), Chiropody (£15), newspapers and toiletries. This information was provided to the CSCI on the 14 May 2006. Prospective residents/representatives are provided with a Statement of Purpose and Service User Guide that offer information on the services and facilities provided at the home. These documents provide information that CSCI inspection reports are available to read upon request at the home. Residents/relatives know about the service through social service referrals, word of mouth and from living in the area. Information about the home is also obtainable on the CSCI website. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at York Lodge will be referred to as ‘residents’. This unannounced inspection took place over approximately six and a half hours on the 24 May 2006. The Inspector returned to the home on the 26 May 2006 for two and a half hours to assess additional key standards and provide feedback to the Registered Manager. The Inspector spoke with 13 residents, aged 65 years or over of both genders, two relatives/visitors, a visiting health professional and seven staff, including a cleaner, senior carer/cook, the maintenance person and four carers. Ten relative/visitors comment cards were sent to the home prior to inspection, of which eight have been returned. A comment card was sent to a visiting health professional, which was returned. Two residents independently completed resident surveys and an additional six were left at the home, of which none have been returned. Four GP comment cards and eight staff surveys were sent out, of which none have been returned. Three care plans were looked at in detail and specific areas of care needs were looked at in some other care plans. A pre-inspection questionnaire was sampled; three staff files, induction and training records, activities records and some policies and procedures were inspected. The lunchtime meal and activities were observed. Previous requirements at the home were assessed to ensure compliance. The environment and some individual rooms were looked at. The Statement of Purpose, Service User Guide, staff rota, menus and accident forms were inspected. No health and safety records were viewed as this information has been provided in the pre-inspection questionnaire. The head of care was not available throughout the inspection. The Registered Manager was spoken with at the second visit. The first day of the inspection was facilitated by a senior carer/cook who was in charge, who demonstrated sound knowledge in most aspects of running the home. There were 21 residents living at the home at the time of the inspection. What the service does well: Comments received from relatives/visitors were complimentary about the care and activities provided at the home. Staff were observed to interact well with residents whilst ensuring an individual’s privacy and dignity are respected. Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 6 The communal environment is generally well maintained and residents are able to personalise their rooms with small items of furniture if they wish. All relevant recruitment checks are undertaken on new staff members to safeguard residents. The home does not hold any personal allowance for residents. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User Guide has been developed by an external company and does not read as being personalised to the home and is not provided in a suitable format for people suffering from a dementia type illness. The pre-admission assessment needs to be expanded to cover all areas of care needs so that comprehensive care plans can be drawn up using this information, ensuring that all needs of an individual can be met at the home. Urgent action is needed to ensure that all residents have care plans in place and an immediate requirement was made in relation to this. It remains an outstanding requirement that care plans are maintained and up-to-date to ensure that all aspects of health, personal and social care needs of individuals are met. Risk assessments are not suitable or have not been implemented, are not being regularly reviewed and provide no guidance on action to take to reduce the risks to safeguard residents. All assessments forms and care plans must be dated and signed. Care notes provide limited information on the health status of an individual and do not refer to the mental health needs to assist staff in monitoring the well being of residents. Medication procedures require to be more robust to safeguard residents and staff from errors being made. An immediate requirement was made that staff administering medication should receive training from an external company that is competence based and ongoing. Reminiscence and other suitable activities for residents with dementia illnesses should be introduced into the activities programme. Residents will be better safeguarded if there is a clear procedure in place for dealing with allegations of abuse. Clear records of incidents when restraint is required must be maintained to safeguard residents and staff. Extra attention needs to be made to some areas within the home environment as some areas were offensive smelling. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 7 The home needs to ensure that overseas staff employed are competent and have a sound knowledge of the English language to promote good communication between residents and staff. All newly employed staff must receive induction and foundation training that complies with the NTO specifications to equip them to meet the assessed needs of the residents accommodated. An immediate requirement was left at both visits to the home that fire doors are not wedged open, to promote the safety of residents, visitors and staff. Alternative safety measures must be implemented for fire doors that residents wish to remain open. 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. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 8 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 York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 1, 3, 4 & 5 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home, however inadequate pre-admission assessments by the home place some residents at risk of needs not being met. EVIDENCE: The home has a Statement of Purpose and Service User Guide that has been developed by an external company and does not read as though it has been personalised for York Lodge and refers the reader to a lot of other documents/policies and procedures that are kept at the home. As people with dementia are accommodated at the home, this information is not written in a format that is user friendly for prospective residents. All prospective residents have a pre-admission assessment undertaken prior to admission. These assessment forms should be expanded to cover all areas of care and not just if assistance is required or not. One pre-admission assessment viewed did not contain vital medical information about an York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 10 individual. Social services or previous care plans are taken wherever possible, however the home should not be relying on this information to judge their admission criteria on. Some pre assessments were not dated or signed, giving no indication who undertook the assessment or when it was undertaken. It was confirmed that there was no one residing at the home from any minority ethnic communities, social/cultural or religious groups with any specific need or preferences. Some residents spoken to confirmed that they or a family member visited the home prior to moving in. Visitors/relatives spoken with also confirmed that they viewed the home prior to their friend/relative moving in. It was confirmed by the head of care, that the contract states that the first four weeks of being admitted to the home is a trial period. The home does not have dedicated accommodation to provide intermediate care. Respite care is available if there is a spare room available. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 7, 8, 9 & 10 “Quality of this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” There is a risk of residents needs not being met due to care plans not being implemented, completed and reflecting actual current practice. Lack of medication training for staff are placing residents and staff members at risk. EVIDENCE: Some residents have been residing at the home between one to three months and care plans have not been implemented or fully completed. Some of these residents have specific health needs and there were no clear guidelines in place for staff. A pressure sore, which district nurses attend to, was not reflected in tan individual’s care plan. Another resident has required to be restrained twice and there was no care plan nor risk assessments in place. There was evidence that some care plans were reviewed on a monthly basis, however care plans are not updated to reflect these changes. A form is used for the monthly reviews and some sections have recorded ‘no changes’, based on the previous months review. There is a risk of the information of changes in needs not being retained, as care plans are not being updated to reflect these. It was confirmed that it is the key workers responsibility to keep care York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 12 plans up-to-date. Some staff stated that they do not have sufficient time to update/review care plans, although some staff have managed to do this. Care notes written on individuals do not provide sufficient information to monitor their health. It is important that the mental health status of residents is recorded and provides a clear picture of the status of an individual in order to assist staff in the early detection of behavioural changes and any deterioration in health. Health needs are not always being met at the home. A comment card from a visiting health professional identified that there are at times residents with specific medical needs such as diabetes. It was felt that ‘specific medical needs may prove to be more of a challenge in relation to the carers knowledge base and understanding of the condition.’ It was noted that other specific medical needs are not reflected in care plans, so there is no evidence that staff are aware of these needs and that these needs are being met. Six of the relative/visitor comment cards confirmed that if their friend/relative is not able to make decisions, they are consulted about the care. Seven of the relatives/visitors comment cards and one health professionals comment card demonstrated that they are satisfied with the overall care provided. A resident observed to be wearing a hearing aid confirmed that they have regular hearing checks and that the hearing aid is regularly checked to ensure it is working efficiently. Risk assessments are not suitable or have not been implemented, are not being regularly reviewed and provide no guidance on action to take to reduce the risks to safeguard residents. They did not identify the overall risk or provide clear guidance for staff on action to take to reduce risks. There was no clear risk assessments in place paying particular attention to falls. New Medication Administration Record (MAR) charts had been commenced of the week of the inspection so limited entries were available to inspect. MAR charts inspected demonstrated that medication is being signed for at the time of administration. Some staff have not received suitable training to administer medication. On discussion with some staff, they were not aware of what the medication is prescribed for. Staff have received training by the head of care regarding internal procedures for medication administration and staff confirmed that she is always contactable if they have any queries regarding medication issues. It was confirmed that there are policies and procedures in place for all aspects of dealing with medication. The content of these were not read. There are records maintained for all incoming and outgoing medication. Some prescriptions on MAR charts had hand written amendments on them, that had not been signed to show who had made the changes. Any York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 13 handwritten prescriptions on MAR charts should be checked and double signed by two staff who have undertaken medication training, to ensure staff and residents are safeguarded from errors being made. Signature samples need to be kept within the home of staff administering medication. Medication is stored appropriately and there are accurate records of controlled drugs kept. There was a container seen that holds either found/refused medication. This raised concerns regarding the procedures for correct administration. It was confirmed that some residents hide the medication in their mouth and later ‘spit it out’. Staff have become aware of these practices for individuals and are now more observant and ensure the medication has been swallowed. There was prescribed cream located in an individual’s room for whom it had not been prescribed. This was addressed on the day of the inspection. Of the residents that were asked, all felt that their privacy and dignity are respected. Staff were observed to have a good professional rapport with residents and were heard calling residents by their preferred term of address. Staff were observed to knock on resident bedroom doors prior to entering. It was observed that when a partner of a resident visits and stays for lunch once a week, the couple is provided with their own dining table in the conservatory and given privacy. All comment cards received from relatives/visitors demonstrate that they are able to visit their friend/relative in private. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 12, 13, 14 & 15 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ lifestyle within the home is their own choice and residents are provided with sufficient stimulation to fulfil their interests and needs. EVIDENCE: Residents’ routines of daily life are flexible and residents were observed to move freely around the home. One resident had been taken out to church and lunch for the day with relatives. Some residents spoken to confirmed that their lifestyle is their own choice and are able to choose their own routines; such as when to get up and go to bed, whether they wish to participate in activities etc. There is no activities person employed at the home. Staff on duty provide activities for residents. The activities programme is developed on a weekly basis. Activities are provided every morning and afternoon during the week and once a day on the weekend. There is an activities notice board in the dining room, displaying what activities are on for the week. Some of the activities being provided for the week were; I spy, exercise, dominos, drawing, skittles and bingo. A game of skittles was observed to be enjoyed by some of the residents. There had been outings planned for two of the days throughout the week. Relatives and residents were complimentary about the activities York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 15 provided at the home. Staff spoken with also confirmed that there are sufficient activities on offer. Some residents spoke positively about a recent outing into the forest. There are no reminiscence activities or other ‘memory’ activities that are provided to residents. The Registered Manager is aware of this deficit and is currently obtaining relevant information into other suitable activities. He confirmed that such activities are not occurring at present as not all staff have a sound knowledge of the English language to efficiently provide these activities. The provision of activities is not included in the quality assurance survey, however it is regularly addressed at resident/relative meetings. The provision and variety of food is also discussed at this time. There was evidence of this kept within the minutes of these meetings. Visitors are welcomed at the home and there is a visitors book kept by the entrance for all people to sign when entering and leaving the building. Visitors spoken with confirmed that they are always welcomed at the home. Relatives/visitors are encouraged to be involved in resident meetings, which occur approximately every six weeks. All comment cards received from relatives/visitors confirmed that staff/owners welcome them in the home at any time. Residents spoken with were complimentary about the food provided at the home and the menu demonstrates that there is a variety of food offered. The two comment cards received demonstrated that the residents usually like the meals. Residents were observed to be enjoying the lunch time meal. The meal time was observed to be relaxing and unhurried. Staff have lunch at the same time as the residents. They were noted to sit away from the residents, but confirmed that they do sometimes sit and eat with the residents. Staff are available to offer discreet assistance if required. The Inspector had afternoon tea with the residents which included homemade cakes. Residents were observed to be provided with drinks by staff whenever they asked. Residents are weighed on a monthly basis and specialist advice is sought regarding nutrition whenever the need arises. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 16 & 18 “Quality of this outcome area is poor. This judgement has been made using available evidence including a visit to this service.” Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Residents will be better protected with appropriate staff training in adult protection and procedures to support this. EVIDENCE: There is a copy of the complaints procedure on the back of every resident’s bedroom door. There is a suitable complaints procedure in place, however this needs to provide a timescale to inform the complainant of the time within the home will deal with their complaint. Six of the relative/visitors comment cards received showed that they are aware of the home’s complaint procedure. There had been one complaint made directly to the home since the last inspection. It was related to the quality of the soup being provided at the home. This was found to be substantiated. Records were kept of all correspondence and demonstrated that the home investigated the concerns appropriately. No complaint has been made directly to the CSCI since the last inspection. The Protection of Vulnerable Adults (POVA) procedure forwarded to CSCI prior to the inspection only provided an explanation on the types of abuse and no information on the procedure to follow in the event of an allegation being made. A procedure read on the day did not clearly identify that it is not for the home to investigate any allegations. All allegations must be referred to Social York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 17 Services who are the lead authority. It was confirmed that this is an outdated procedure. As requested, the updated procedure for POVA has not been forwarded to the CSCI at the time of writing this report. Some of the staff spoken with confirmed that they had not received any POVA training. There was a training programme on the wall in the office that showed some staff shall be undertaking this training in the near future. There have been no allegations of abuse made since the last inspection. The pre-inspection questionnaire demonstrated that restraint of a resident had occurred twice in the last 12 months. There were not clear records of these incidents being kept. Restraining was recorded on an incident form and there was no record of precipitating factors and other techniques used prior to restraining, nor what physical intervention was required. As mentioned previously, there was also no clear guidance within the individual’s care plan or risk assessments. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 19, 25 & 26 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents live in a homely environment and are provided with comfortable indoor and outdoor communal facilities, however additional work is needed to promote good infection control. EVIDENCE: Residents spoken with are happy with the environment and with their individual rooms. Rooms randomly viewed were seen to be personalised to reflect the individuals’ character and personality. Rooms are located over three floors. There is a passenger shaft lift accessing all floors for those residents unable to mobilise independently on the stairs. There are alarmed gates at the top of every stairway to alert staff if someone is accessing the stairway, ensuring the safety of residents. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 19 There is a call bell system in all rooms at the home. With a resident’s permission, their call bell was tested. The staff responded within an appropriate time. There are grab rails placed throughout the home in areas where residents may require some assistance with mobilisation. Two of the three baths are assisted. There are some bathing/showering facilities in approximately four of the en suites. These are not assisted facilities and residents must be able to mobilise safely to use these. It was noted that plugs were present on the baths. It was confirmed that some residents do overflow their hand basins by leaving the plugs in. Due to the category of registration for residents, it is required that leaving these plugs present when bathrooms are unattended be risked assessed and removed if necessary when not in use. Hot water taps randomly tested confirmed that hot water is being delivered around the recommended temperature 43°C. There were thermostatic controls installed on hot water outlets that are accessible to residents. Radiators were observed to have been guarded or were of guaranteed low surface temperature. The maintenance person was spoken with, who confirmed that staff are very good at reporting any faults they notice, which assists in ensuring all areas within the home are well maintained. The communal areas of the home were clean and maintained, however it was noted that some individual rooms and en suite facilities were offensive smelling. The Inspector noted an odour immediately upon entering the home. It was also noted that there were hand towels in communal areas. This practice does not promote good infection control and suitable measures should be implemented. The residents’ surveys received stated that they usually found the home fresh and clean. The pre-inspection questionnaire demonstrates that there are policies and procedures in place for communicable diseases and infection control. The content of these policies were not read. A cleaner spoken with confirmed that they are provided with enough equipment and sufficient time to clean the home. The Inspector was concerned to note that a sharps container was left in some individual’s rooms, who are attended to by district nurses. This may pose a risk to a resident should an individual gain access to this. The home will address this with the district nurses involved and try to arrange a more suitable disposal/storage procedure. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 20 York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” There are suitable numbers of staff on duty, however there is a risk of some needs not being met due to limited communication for some staff and lack of induction training for new staff. EVIDENCE: The majority of residents/relatives/staff and visitors spoken with all confirmed that they felt there were sufficient numbers of staff on duty at all times. All comment cards received from relatives/visitors confirmed that in their opinion there are always sufficient numbers of staff on duty. Comments received were complimentary about the staff. The rota provided to the Inspector demonstrates that there are usually three carers working during daytime hours, along with a senior member of staff and two carers working a waking night. There are suitable numbers of ancillary staff employed at the home. Staff confirmed that they have received a job descriptions and are clear of their roles. The Inspector was concerned to note that some staff had limited understanding of the English language. This will pose a difficulty for residents with a dementia type illness to communicate effectively with staff. It was confirmed that overseas staff are receiving English lessons once a week. These overseas staff have been recruited through an agency and the Registered Manager confirmed that he has complained to the agency the York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 22 importance of ensuring staff have a good understanding of the English language. It was confirmed that he had spoken with the staff on the phone and felt their English was suitable. The Inspector had difficulties having a conversation with some members of staff. Some residents and visitors have also expressed concerns regarding the level and understanding of English for some staff. There has been nine staff members leaving employment at the home since the last inspection. Staff files inspected demonstrated that all relevant recruitment checks are undertaken. References have been translated into English wherever necessary. The health survey that staff complete needs to be expanded to include current illnesses and not just past health issues. The Registered Manager confirmed that all visiting professionals eg; hairdresser, chiropodist are CRB checked. The home is working towards ensuring at least 50 of staff are National Vocation Qualification (NVQ) level 2 trained. There are 15 care staff employed at the home, of which three have obtained NVQ level 3 qualifications. It was confirmed that an additional eight carers have commenced their NVQ level 2 training and a further three will be commencing NVQ level 2 in October 2006. Some staff spoken with confirmed that they had been working at the home for approximately six months and have not received any induction or foundation training. Staff files viewed showed no evidence that at least four members of staff employed have not been provided with induction or foundation training. It was confirmed by the Registered Manager that a new induction programme is being implemented and accessed through external training departments. Some staff spoken with confirmed that they receive training relevant to their roles. There were records kept of these sessions. The pre-inspection questionnaire demonstrates that some training undertaken by staff within the last 12 months include; first aid, manual handling, dementia and prevention of falls etc. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” A more structured quality monitoring system would enable management to monitor the success of the home in meeting its aims and objectives. Residents’ safety is being put at risk with fire doors being wedged open. EVIDENCE: The Registered Manager is has been managing the home for approximately nine years and works three to four days per week. The pre-inspection questionnaire demonstrates that there are three key people who management responsibilities are allocated to. Staff were complimentary about management at all levels within the home and found them to be approachable and supportive. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 24 The head of care has completed her Registered Manager Award (RMA) course and is currently awaiting these results. She will be commencing NVQ level 4 in care in July 2006. As part of the homes’ quality assurance and quality monitoring systems the home provides questionnaires to staff and residents/relatives every six months. Separate staff and resident meetings are held every six weeks. There are minutes kept of all meetings the identify areas discussed. Relatives are invited to join the relative meetings. It was confirmed that the home will be developing and implementing a questionnaire for visiting health professionals. The pre-inspection questionnaire demonstrates that there are policies and procedures in place, with the majority having been reviewed in September/October 2005. The Inspector requested additional policies and procedures to be forwarded on to the CSCI office, as some could not be located on the day of the inspection. These have not been forwarded at the time of writing this report. There is no quick reference index for the policies and procedures and a considerable amount of time is used to locate the relevant procedure required. The home does not hold any personal allowance for residents. The Registered Manager confirmed that relatives manage the finances for individuals. Staff confirmed that they receive supervision. There is a rota implemented for the supervision of staff and demonstrated that this is undertaken every three months. Records are kept of these sessions. Some staff providing supervision have not been trained for this role. The Registered Manager confirmed that he has had difficulty trying to access this training. The pre-inspection questionnaire shows that all relevant health and safety checks are undertaken. The facilitator confirmed there is always a qualified first aider on duty at all times. Accidents/incidents are being recorded and reported to CSCI as necessary. The Inspector noted door wedges were being used to keep fire doors opened. These wedges were observed to still be in use on the second visit to the home, despite an immediate requirement being left at the home following the first visit. Some individual room doors did not close independently due to carpet holding these doors open. This was highlighted to the maintenance person on the day of the inspection. Suitable safety measures need to be implemented for those residents wishing their room door to remain open. It was confirmed by the Registered Manager that an external company provides fire training once a year and fire drills are undertaken every two months, which includes night staff. Staff spoken with were able to inform the Inspector of where the meeting point was in the event of the fire alarm being activated. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 25 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 2 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5 Requirement That a Service User Guide is made available in a format suitable for intended service users. That a thorough pre assessment is undertaken on all prospective service users and are dated and signed. That all service users have care plans developed and implemented. (Immediate requirement) That the care plan format covers all aspects of health, personal and social care needs. That care plans reflect actual current practice. (Timescale 01.04.06 not met) That daily records about service users are expanded; ensuring mental health needs are reflected. That suitable risk assessments are in place to safeguard staff and service users. That staff administering medication should receive training from an external company that is competence DS0000021294.V291703.R01.S.doc Timescale for action 31/07/06 2. OP3 14(1) 30/06/06 3. OP7 15(1) 30/05/06 4. OP7 15(1) 30/06/06 5. OP7 Schedule 3 (k) 13(4) 13(2) 18(1)(c) 30/06/06 6. 7. OP8 OP9 30/06/06 26/05/06 York Lodge Version 5.1 Page 27 8. 9. 10. 11. OP16 OP18 OP18 OP38 22(4) 13(6) 13(7)(8) 13(4) 12. 13. OP26 OP26 16(2)(k) 13(4)(c) 14. OP30 18(1) 15. OP33 24 16. 17. 18. OP36 OP38 OP38 18(2) 23 23(a) based and ongoing. (Immediate requirement) That the complaints procedure includes a timescale in which complaints will be dealt with. That a copy of the Protection of Vulnerable Adults procedure is forwarded to the CSCI. That clear and thorough records are kept of when a service user is subject to physical restraint. That risk assessments are completed for plugs left in unattended bathrooms, and the plugs be removed if necessary. That individual rooms and en suite facilities are kept free from offensive odours. That hand-drying towels are removed from communal bathrooms and alternative measures implemented. That all staff receive induction and foundation training that complies with the NTO specifications. That the Registered Manager undertakes internal quality monitoring to ensure the aims and objectives of the home are being met. That staff providing supervision are appropriately trained for this role. That fire doors are not wedged open. (Immediate requirement) That fire doors remaining open must be fitted with a suitable fire safety device. (Immediate requirement) 31/07/06 15/07/06 30/06/06 15/07/06 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 26/05/06 30/06/06 York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 28 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. 4. 5. 6. 7. Refer to Standard OP9 OP9 OP12 OP28 OP29 OP29 OP33 Good Practice Recommendations That signature samples of staff administering medication be maintained. That handwritten prescriptions on MAR charts be checked and double signed by two staff who have undertaken medication training. That reminiscence activities or other ‘memory’ activities be provided That the home continues to work towards achieving a 50 ratio of NVQ-trained staff on duty at any one time. (Outstanding recommendation) That the health survey for staff to complete be expanded to include current illnesses and not just past health issues That overseas staff employed are competent and have a sound knowledge of the English language to promote good communication between residents and staff. That a quick reference index for the policies and procedures be implemented. York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI York Lodge DS0000021294.V291703.R01.S.doc Version 5.1 Page 30 - 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. 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