Inspection on 25/10/05 for York Lodge

This inspection was carried out on 25th October 2005.

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 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 24/05/06

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 Mike Flint Announced Inspection 25th October 2005 09:45 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.V249956.R01.S.doc Version 5.0 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.V249956.R01.S.doc Version 5.0 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.V249956.R01.S.doc Version 5.0 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 26th April 2005 Brief Description of the Service: York Lodge is a care home registered to provide personal care and accommodation for 22 older people who are suffering from a dementia type illness. The home is owned by Mr & Dr Bramble, who also own a second registered home in East Sussex. York Lodge is managed by Mr Bramble. It is situated in a quiet residential area a short walk from Crowborough town centre. Crowborough Green is near-by, as are some of the town’s churches. Buses pass close by. York Lodge is a large detached three-story property. Service users accommodation is on three floors, all of which are served by a passenger lift. Communal space includes a dining area, which leads to a small lounge, plus a conservatory overlooking the rear garden. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was carried out over five hours, during a day in October when there were twenty (20) residents. Both the owner/ manager and head of care assisted the Inspector, throughout the inspection. The Inspector met and spoke with a small group of residents in their communal dining area and later visited three residents for private conversations in their own rooms. Duty staff were spoken with individually and the Inspector also met and spoke with three visiting relatives. Six comments cards were completed by relatives and forwarded to the Inspector, prior to the inspection. The inspection included a tour of the premises and an examination of care plans and other records. What the service does well: What has improved since the last inspection? Since the last inspection, conducted in April 2005 there has been an emphasis on staff training, including the National Vocational Qualifications. All new staff are appointed on the understanding that they will undertake NVQ training, after a satisfactory induction period. The premises, in particular the garden, have the appearance of being well maintained and the manager is carrying out regular environmental health and safety checks to ensure this. At the time of the last visit there were several staff vacancies. The senior staff and some carers were providing relief cover on many of the duty shifts. Morale was adversely affected and there appeared to be insufficient dedicated management hours to ensure satisfactory daily operation. New staff have since been appointed and the manager, together with the head of care, is addressing the supervisory and administrative tasks required. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 6 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. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 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 York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 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 the following standard(s): 1, 2, 3, 5 The home has procedures in place to ensure that the needs and expectations of those admitted can be met. EVIDENCE: A suitably detailed Statement of Purpose is available to prospective, or newly admitted residents to inform them about the home and of the services and facilities that are to be provided. All residents receive a copy of the Terms and Conditions of their residency; a contract is also provided if care is to be purchased privately. Pre-admission assessments are completed for all potential users of the service, referred to the home, prior to a trial period being offered. Visits are arranged to assist people in reaching a decision about whether to move in for a trial period. Each of the residents spoken with was able to confirm that they felt their needs were being met. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 9 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 The key worker system currently presents inconsistencies in the recording and reviewing of care plans that necessarily affects the quality of care provided. EVIDENCE: During the inspection, the majority of the residents were seen; private discussions were had with three, each of who had favourably comments to make about the personal care they received; all of the others appeared to be content and well cared for. A suitable system of care planning and risk assessment was in place, though it was apparent that not all of these documents were up to date. The key workers spoken with stated that they had difficulty in finding the time to complete care plans and to carry out reviews. The relatives of one resident, who had been admitted well over a year ago, said they had not been invited to attend a review meeting. The record of medicines administered was up to date and accurately completed. This had been the subject of recommendation for improvement at the time of the last inspection. Staff spoke respectfully about the residents and were knowledgeable about their care needs. During an inspection of the premises staff were observed to knock on residents’ doors before entering their private rooms. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 10 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 The home provides a relaxed and supportive environment that enables residents to pursue their interests and autonomy within a socially orientated setting that is beneficial to their wellbeing. The meals are of good quality, offering both choice and variety and catering for any special dietary needs. EVIDENCE: A varied range of activities is offered, including exercise and art classes, singa-longs, cards games, quizzes and bingo as well as various social events that take place from time to time. Church services are held at the home. A part time co-ordinator is employed on two days each week is employed to arrange and oversee the various activities. Residents are encouraged to retain their individual interests and it was apparent that the routines of daily living were flexible to suit the residents’ needs. Many of the residents have regular contact with family and friends. Visitors are welcome to the home at any reasonable time; visiting arrangements are clearly stated in the information provided, upon a resident’s admission. On entering residents’ rooms it was clear that many bring personal items with them on admission, including furniture. The home has little involvement in residents’ finances. The manager said that wherever possible relatives are asked to assist, or an appointed Power of Attorney. The menu plan is varied and provides an appealing, nutritious and wellbalanced diet. Daily mealtime choices have been introduced into the menu and these are posted up. Records are kept of all meals served. Residents spoken with stated that all their meals are enjoyable. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 11 York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 12 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, 17, 18 Any matters of concern are handled appropriately, reassuring those involved that they are being listened to and that action will be taken, as necessary. EVIDENCE: The home has a written procedure that advises residents, or visitors to the home how to make a complaint; a copy of this is included in the Terms and Conditions and residents’ contract. Residents and relatives spoken with said that the manager and staff were very approachable and responsive, should issues arise that required action. A satisfactory record of complaints and the actions taken was inspected. Residents’ legal rights are protected and all their names are included on the electoral register; postal voting forms are available for those who wish to take part in local, or general elections. None of the residents retain responsibility for their own affairs, having a next-of-kin, or other person acting for them. There are detailed policies and procedures in place relating to adult protection and abuse; staff have received training in these areas of their work. Police checks are carried out for all staff employed in the home. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 13 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, 20, 21, 22, 23, 24, 25, 26 The home provides a pleasant environment that is accessible, safe and well maintained, meeting residents’ individual and collective needs in a comfortable, homely style. EVIDENCE: There is a current vacancy for a maintenance person, nevertheless the home appears to be well maintained; as they become vacant, residents’ private rooms are redecorated. The overall standard of décor and furnishings is domestic in character and of suitable quality. The choice of communal areas includes a spacious lounge/ dining area, a discrete seating area, leading to a large, comfortably furnished sun lounge. The garden with lawns and borders is kept safe and tidy by an employed gardener and is readily accessible to residents. Residents’ private accommodation is satisfactorily furnished; they may furnish their own rooms and many do so. The manager confirmed that as far as possible any adaptations, or equipment would be provided, should this be required, following a review/ re-assessment of any individual resident’s needs. The housekeeper and two assistants keeps all areas, accessed by residents clean, hygienic and free from any odours. Appropriate policies and procedures are in place e.g. infection control and COSHH procedures. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 14 York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 15 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, 30 The staff appear to have a good understanding of the residents’ support needs, evident from the positive relationships, which have been formed between staff and residents, observed during the inspection. EVIDENCE: The duty rota shows that staffing arrangements during the day and at nighttime are satisfactory. There continues to be some staff turnover and the home has carried vacancies for many months, during which time existing staff said they provided relief cover, some working long hours. The head of care confirmed that several new staff have been appointed, including some from overseas, and that only a small number of vacancies remain. Each of the three senior staff, including the cook spoke positively about their work in the home. The home provides a home-specific induction to ensure that all new staff are aware of their roles and responsibilities. Additional to this, induction and foundation training that meets the TOPSS specification has been introduced. All new staff are expected to complete NVQ training in care; many of the existing staff have already qualified, or are working towards this qualification. The manager commented that some of the trained staff have left and this places the home at a disadvantage, when endeavouring to meet the target of 50 trained care staff. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 16 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): 31, 33, 36, 38 There remain a number of quality assurance measures outstanding that the home is required to have in place in order to monitor the success of the home in meeting its aims and objectives. EVIDENCE: The registered manager is experience in running this care home and has established an open and positive approach, maintaining a sense of leadership, which staff and residents understand. The head of care is to undertake management training in order to up date her knowledge and skills with the Registered Managers Award. The requirement has not yet been met that the responsible individual for the organisation that owns the home, Millcroft and York Lodge Care Homes Limited, or a representative on their behalf, should carry out monthly qualitymonitoring visits and record the overall performance of the home, with copy reports forwarded to the Commission. The owner/ manager said that a York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 17 suitable format for recording such visits is already in place at the Company’s other home and that they would be started at York Lodge without delay. The Inspector was encouraged to note that satisfaction survey questionnaires have been distributed to relatives, from time to time, gaining helpful feedback from them and other visitors to the home. Though the home has yet to produce an on-going development plan, setting out aims and goals in respect of improvements in the quality of care. The manager confirmed that formal staff supervisions have commenced and that supervision-skills training has been booked for the manager and the senior staff involved. Care staff at the home receive regular training sessions in safe working practices e.g. moving and handling, first aid, infection control and fire safety. The owner/ manager and head of care are clearly committed to providing these and other job-related training opportunities for staff. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 18 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 19 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. 01 Standard OP7 Regulation 15(1) Requirement That sufficiently detailed care plans are to be recorded and maintained up to date for all residents, to include action that needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the resident are met. That there is an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for residents. That the Responsible Individual for the organisation, or representative on their behalf, carries out and records monthly visits to monitor the performance of the home i.e. by a person who is not directly concerned with the day-to-day conduct of the home. Timescale for action 01/04/06 02 OP33 24(1) 01/04/06 03 OP33 26(2) 01/01/06 York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 01 02 Refer to Standard OP8 OP28 Good Practice Recommendations That the roles and responsibilities of key workers are formally agreed and recorded, and that the system of key working is further developed for the benefit of residents. That the home continues to work towards achieving a 50 ratio of NVQ-trained staff on duty at any one time. York Lodge DS0000021294.V249956.R01.S.doc Version 5.0 Page 21 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.V249956.R01.S.doc Version 5.0 Page 22 - 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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