Inspection on 26/04/05 for York Lodge

This inspection was carried out on 26th April 2005.

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

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

Other inspections for this house

York Lodge 24/05/07

York Lodge 24/05/06

York Lodge 25/10/05

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 Unannounced 26 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service York Lodge Address Myrtle Road Crowborough East Sussex TN6 1EY 01892 661457 01892 652884 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Millcroft and York Lodge Care Homes Ltd Mr Fred Bramble Dr Bozena Bramble Care Home 22 Category(ies) of Dementia - over 65 years of age (DE(E)) 22. registration, with number of places York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is twenty two (22). 2. Service users must be aged sixty-five (65) years or over on admission. 3. Only adults with a dementia type illness are to be accommodated. Date of last inspection 05 December 2004 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 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 H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 7 hours, one day in April, when there were twenty (20) residents. Five of the residents were spoken with individually, as were each of the morning and afternoon duty staff, the head of care and the owner/ manager. The Inspector was able to join the residents and sample the midday meal. The inspection included a full tour of the premises and an examination of records, including care plans and staff files. What the service does well: What has improved since the last inspection? What they could do better: From comments made by staff it was apparent that individual roles and responsibilities were not fully understood by all staff, in particular the role of York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 6 the Head of Care. This had contributed to some frustration and resentment being felt. Other comments referred to long hours being worked and stressful conditions, due to on-going staff shortages and recruitment difficulties. The Inspector was told that staff had agreed to give over their rest room, now used as a smokers lounge for residents. Although staff presented as a team, committed to their work, efforts are needed to improve morale and staff retention. Some serious omissions and inconsistencies were noted in some of the required records to be kept in the home, in particular medications were being administered that had not been signed for and many of the care plans were incomplete and not up to date. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4, 5, 6 The recording of pre-admission assessment for people who are referred to the home provides inadequate information on which to judge the home’s ability to meet individual needs. EVIDENCE: A sample of eight resident’s care plans and admission documents were examined, including those most recently admitted. The pre-admission assessments lacked the detail necessary on which informed decisions about individual care needs might be made. It was noted that Health, or Social Care assessments were not included for all of those residents who were funded by Local Authorities, where these should be available to inform the home’s care planning. The inspector discussed with staff their need for training in respect of dementia care. The records showed that this has not yet been provided for all care staff. Staff confirmed that prospective residents are invited to visit the home with their relatives, or representative prior to making a decision. The service does not offer intermediate care facilities. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 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 standard(s) 7, 8, 9, 10 The quality of care shown in providing individual support to residents in the home maximises their well-being, dignity and respect. Omissions noted in the record of medicines administered demonstrated a lack of adequate monitoring and non-compliance with minimum standards, in respect of the health and well-being of residents. EVIDENCE: During the inspection, all of the residents except one, who was in hospital, were seen; private discussions were had with five, who each commented favourably on the care they received; all of the others appeared to be content and well cared for. However, of the eight resident’s care plans inspected, none were up to date, or complete although risk assessments had been recorded in each case. A timescale within which these records would be brought up to date was agreed with the recently appointed Head of Care. At the time of the inspection a Community Nurse was attending to the needs of a resident, another had been referred for hospice care. The inspector was told that good support was provided, as needed, by the Community Health Care services. Staff spoke respectfully about the residents in their care and were knowledgeable about their care needs. None of the residents have responsibility for their own medicines; many omissions were noted in the York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 10 record of medicines administered, where duty staff had not completed the record sheets with their initials. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Mealtimes and communal activities are well managed providing interest and variation for those living in the home. The home encourages family visits for the enjoyment and emotional well-being of residents. EVIDENCE: A resident said that she was able to be involved in some of the domestic tasks within the home such as laying the table, which gave her a sense of purpose. The activities organiser, who comes in for two half days a week, was observed engaging most of the residents in various arts and crafts activities. The home has a minibus, which the manager said was frequently used for residents’ shopping trips and outings. Residents can have visitors as and when they wish; their choice of whom they wish to see is respected. The five residents spoken with said they were encouraged to look after their own personal care and that they were encouraged to make choices i.e. what to wear, when to get up/ go to bed and what meals they preferred. A four-weekly menu plan is produced. The staff join residents for their midday meal; comments regarding the quality of meal provided were generally positive. Alternative diets are catered for e.g. vegetarian and diabetic. Staff were seen to be on hand to assist residents at meal times. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 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 standard(s) 16, 17, 18 The owner/ manager handles complaints and matters of concern objectively, reassuring those involved that they are being listened to and that appropriate action will be taken. EVIDENCE: Details of how to make a complaint are made available to residents, their relatives and other visitors to the home. Records are kept of any complaints made. A resident spoken with said the owner/ manager was approachable. There are policies and procedures in place relating to adult protection and managing challenging behaviour. Staff receive training in these areas of their work. Police checks for all staff employed in the home were inspected and found to be satisfactory. The home ensures that residents’ legal rights are protected i.e. that all have either a next-of-kin, or an appointee to manage their affairs; Age Concern advocacy service is occasionally contacted for advice, should the need arise. All residents are included on the electoral register; postal voting forms are available for those who wish to take part in local, or general elections. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 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 standard(s) 20, 22, 25, 26 The home’s premises provide are accessible, well-maintained and designed to meet residents’ individual and collective needs in a comfortable and homely surrounds. However, health & safety checks and measures need tightening up for the ultimate safety and well-being of residents. EVIDENCE: Work that had been outstanding, following recommendations made by the local fire service, has been carried out in the basement laundry area. Although hot water controls have been fitted, excessively hot water was noted to be coming through a cold-water tap in a second floor bathroom, which presented a significant risk to residents on that floor. Lighting in the large communal lounge/dining area and the conservatory is domestic in style as is the furnishing and decor, which is well-suited to the needs of the residents. The residents’ private ensuite facilities are fitted with suitable lighting and ventilation. At the time of the inspection, a high standard of cleanliness was noted throughout the home, which was fresh and free from unpleasant odours. The laundering of residents’ personal items and bedding appeared to be satisfactory from what was observed. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 14 The owner/ manager said that, following an assessment of the home by an occupational therapist, the recommended adaptations had been implemented for the benefit of residents e.g. handrails to assist those with poor mobility. The home employs a handyman to carry out general maintenance around the premises. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 A shortage of permanent, qualified care staff has led to minimum standards not being met in terms of the numbers of experienced/ trained staff required on duty at all times, compromising residents’ care, safety and welfare. EVIDENCE: The home has an on-going requirement to ensure that sufficient numbers of staff are on duty at all times. The Inspector was informed of occasions when there had been only two duty carers on day shifts and one waking carer at night; such situations clearly put residents at risk. The Head of Care confirmed that agency staff would in future be employed when sufficient permanent staff are not available to meet the minimum cover required. There is one staff currently trained to NVQ Level 3 in care and there are five who are undertaking this training at either Level 2 or Level 3. The Head of Care also has the NVQ Assessor award. Staff appeared enthusiastic about further training opportunities but said they often found the work very stressful, in particular due to lack of sufficient duty cover. The staff recruitment files were inspected and found to be in order; although these are not normally kept on the premises, due to the confidential nature of information included, it is nevertheless a requirement that the basic details of all those employed at the home are kept on site e.g. in case of emergency, or query by the regulators/ Inspectors. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 16 Records showed that there is on-going staff training in first aid, fire safety, health and safety, moving and handling, food hygiene, managing challenging behaviour and the protection of vulnerable adults. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 38 Past and present staff shortages are hindering progress towards meeting some of the National Minimum Standards and in maintaining a good quality of care. EVIDENCE: The registered manager has owned and managed the home since 1997, prior to that he had extensive experience as a qualified nurse practitioner and manager in the health service, having achieved the Advanced Management in Care certificate. In these respects the owner/manager is suitably qualified and experienced for the purpose. The manager confirmed that he spent several hours at the home on most days of the week. At the time of the inspection duty rotas were not available for inspection; the Inspector was informed that these were being worked on by the Head of Care, who was off site during that morning. Staff spoken with said that they found the owner/ manager approachable, though some expressed uncertainties regarding the role of the recently appointed Head of Care, and York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 18 this appeared to be adversely effecting staff morale. The Head of Care told the Inspector about the management training she was undertaking that is required for her new job, with a view to achieving the Registered Managers Award. Further delegation of responsibilities to senior staff and key workers would enable the Head of Care to address performance monitoring and quality assurance, in the best interests of those using the service. Residents spoken with said that they felt the home was run in their best interests though some commented that there was a shortage of duty staff, apparent at times; responses from a recent satisfaction survey for residents and their relatives, repeated this concern. A staff meeting had been arranged and was held on the afternoon of the inspection. Staff reported that they were able to share their views openly at these meetings, held every six weeks, or so. However, the requirement that staff should receive regular 1:1 supervision with the manager, or a senior staff is not being met; the Inspector recommended that this be introduced as a matter of some urgency, being particularly important for those carers who carry key worker responsibilities. Staff have received recent training in safe working practices. A satisfactory system is in place for recording and carrying out maintenance tasks. However, it is recommended that a detailed environmental health and safety risk assessment is carried out and checked on a regular basis, with records kept. Also that night staff follow good practice guidance and record their night-time checks, for the safety and welfare of the residents, particularly those who are considered to be at risk e.g. from wandering, or falls. The owner had previously informed the Commission that an induction-training package had been purchased that meets the National Training Organisation (NTO) specification. This training has yet to be introduced for new staff, joining the organisation. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 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 x 3 x 3 x x 2 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 x x 2 x 2 York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 03 Regulation 14(1) Requirement That Service users referred through Care Management arrangements must not be admitted before the registered person has obtained a copy of the Health or Social Care assessment. (Previous timescale of 01.02.05. not met) And that the home completes a detailed pre-admission assessment for all referrals, including those who are funded, or self-funded, to ensure that the needs of any person admitted can be provided for at the home. That all new care staff receive training in Dementia care as part of foundation training, and that the manager ensures all existing staff have received similar training as part of their core skills development. (Previous timescale of 01.03.05. not met) 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. Timescale for action 01.06.05. 2. 04 18(1) 01.11.05. 3. 07 15(1) 01.11.05. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 21 4. 09 17(1)(a) Schedule 3 5. 25 13(4) 6. 27 18(1)(a) 7. 28 18(1)(a) 8. 30 18(1c) 9. 33 24(1) The the record of medicines administered to residents is maintained up to date and accurate and that these records are regularly monitored by the registered person to ensure compliance, and that only staff who have received accredited training in medicines administration may discharge this responsibility. That the registered person ensures unnecessary risks to the health or saftey of residents are identified and so far as possible eliminated, in particular respect of safe water temperatures. That the registered person shall ensure at all times that suitably quaified and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of residents i.e. a minimum of three (3) care staff during the waking day and two waking night staff, and that fulltime, dedicated management hours are provided. That further action is taken to ensure the target of 50 of duty care staff are qualified to NVQ at level 2, or above. (Previous timescale of 01.01.05. not met) Induction and foundation training for staff should meet National Training Organisation workforce targets. (Previous timescale of 01.02.05. not met) That the registered person maintains a system for reviewing at appropriate intervals and improving the quality of care at the home, including user/ stakeholder surveys, annual development plans and selfmonitoring. 01.06.05. 01.06.05. 01.06.05. On-going. 01.11.05 01.11.05. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 22 10. 36 18(2) 11. 38 13(4) That the registered person shall ensure that persons working at the home are appropriately supervised, to include formal supervision at least six (6) times annually, covering aspects of care practice, philosophy of care in the home and career development needs. That the registered person ensure all parts of the home to which residents have access are so far as reasonably practicable free from hazards to their safety and that regular checks are carried out and recorded. 01.11.05. 01.11.05. 12. 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. Refer to Standard 08 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. York Lodge H59-H10 S21294 York Lodge V216492 260405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 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. 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