Care Home: Addlestone Lodge

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What the care home does well All residents have a pre-admission assessment prior to moving into the home, which the manager carries out along with a nurse from the home. All residents have detailed care plans and risk assessments, which are regularly reviewed by the nurses in consultation with the resident or their representative.The home has a robust complaints procedure and safeguarding adult`s policy, which protect the residents from harm. Staff have all been trained in safeguarding procedures. The inspector was shown the training programme in place for the home and staff and records confirmed this training took place. The inspector observed that the home has a refurbishment programme in place but work will stop and resume again after the Christmas holiday. What has improved since the last inspection? Following the last inspection in October 2006 four requirements were made and these have all been met. Care plan and risk assessments are now reviewed every month and reflect the changing needs of the residents. Activity provision in the home has been reviewed and this is ongoing, as recent surveys have been sent to the resident and relatives to assess their opinions of the activity provision within the home. The refurbishment plan for the home has started and will continue following the Christmas holiday. Staff employment folders have also now been reviewed to ensure all the preemployment checks are in place. What the care home could do better: No requirements have been made following this inspection. CARE HOMES FOR OLDER PEOPLE Addlestone Lodge Addlestone Lodge Ongar Hill Addlestone Surrey KT15 1BS Lead Inspector Lesley Garrett Unannounced Inspection 30th November 2007 10:45 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 Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Addlestone Lodge Address Addlestone Lodge Ongar Hill Addlestone Surrey KT15 1BS 01932 846268 01932 847197 addlestonelodge@ntlworld.com 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) Addlestone Care Home Ltd Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing care for elderly people from the age of 60 years Date of last inspection 19th October 2006 Brief Description of the Service: Addlestone Lodge is registered with the CSCI (Commission for Social Care Inspection) as a care home with nursing for twenty-eight service users. The property is located in Addlestone in Surrey and accommodation is on three floors accessed by stairs or a lift and comprises of a lounge, dining area, kitchen, laundry, office, bathrooms, toilets and shared and single bedrooms. The home has a patio area, which is accessible, private and secure. Private parking is available. The range of fees charged by the home is £548 - £739 per week. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. For the purpose of the report the individuals using the service are referred to as residents as this is their preferred title. The inspector arrived at the service at 1045 and was in the home for six hours. It was a thorough look at how well the home is doing. It took into account detailed information provided in the Annual Quality Assurance Assessment (AQAA) by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking with some residents living at the home in order to seek their views about the home and the care they receive. Responses to surveys that the Commission had sent out had been received prior to the inspection and these were taken into account also. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, and the home’s safeguarding and complaints policies and procedures. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the service does well: All residents have a pre-admission assessment prior to moving into the home, which the manager carries out along with a nurse from the home. All residents have detailed care plans and risk assessments, which are regularly reviewed by the nurses in consultation with the resident or their representative. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 6 The home has a robust complaints procedure and safeguarding adult’s policy, which protect the residents from harm. Staff have all been trained in safeguarding procedures. The inspector was shown the training programme in place for the home and staff and records confirmed this training took place. The inspector observed that the home has a refurbishment programme in place but work will stop and resume again after the Christmas holiday. What has improved since the last inspection? What they could do better: No requirements have been made following this inspection. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 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 Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents only move into this home following an assessment of their needs and an assurance that these will be met. EVIDENCE: The manager stated that she does all pre-admission assessments and is accompanied by one of the home’s registered nurses. Prior to the assessment the manager said that the home obtains information about the prospective resident and a meeting is held with the registered nurses to check that their needs can be met. Four care plans were sampled and the assessments were in place. The home does not provide intermediate care. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents who use the service have individual plans, which reflect the care and support they require. Their health care needs are fully met. The medication policies and procedures that are in place and implemented by staff protect the residents. The privacy and dignity of the individuals are respected. EVIDENCE: Four individual plans of care were sampled and they contained a good variety of individual plans and risk assessments. They were all reviewed every month and changes made where necessary with risk assessments also in place. The plans also contained daily notes and information regarding other visiting professionals. The inspector observed evidence that both residents and their representatives had also been consulted. One particular care plan sampled demonstrated that the resident had very diverse needs concerning the health and cultural needs. These areas had been assessed by both the manager and other staff and were well documented all staff including those working in the Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 11 kitchen demonstrated a good knowledge of this resident and this showed that there is good communication between the staff at the home. The manager stated that the home has good support from the local general practitioner (G.P.). They will visit the home whenever the home calls. The manager stated that there is also good health care support from other practitioners, which include dietician, opticians, chiropody and the speech and language therapist. Visits from all health care professionals are documented in the individual plans. A GP survey form returned to CSCI stated the home often smelt of urine and patients could not always be seen in private. On the day of inspection there was no apparent offensive odours in communal areas or the bedrooms and the manager stated that all residents could be taken back to their room if the doctor calls. One of the homes nurse’s explained the medication procedures within the home. He stated that they had good support from the local pharmacy for all their medication needs. The inspector observed that blister packs are used and their supplies are delivered every month. The medication is stored in the clinical room and all medication policies and procedures are available for the nurses. The nurse said that arrangements are in place with a clinical waste company for the removal and destruction of unused medicines. The training records confirmed that the nurses had received medication training. The manager said that privacy and dignity is a topic discussed on induction for all new staff. The inspector observed staff knocking on bedroom doors prior to entering and speaking appropriately to the residents. It was observed in the individual plans of care that the preferred name of the service user was documented. During lunchtime it was observed that some of the residents were wearing bibs to eat their lunch. The manager stated that those residents using the bibs had consented to this practice. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s are supported to exercise choice and control in all that they do and the food is of a good quality. EVIDENCE: The manager said that the home does not have an activities organiser but that activities are planned and take place. During a tour of the building an activities board was seen providing information on the activities available within the home. The home has a weekly exercise class, social hours which include quizzes, reminiscence and time for talking together. The manager said that entertainers visit the home every week and one resident told the inspector that these sessions are really enjoyed and that ‘we love singing along with the music’. On the day of the visit the manager was busy organising a visit by the Salvation Army to sing carols as part of their Christmas programme. Displayed on the activities board was a notice and invitation to the home’s Christmas party. Several of the residents told the inspector about this party and said they were looking forward to this as they all get dressed up. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 13 Five surveys returned to the CSCI commented that more activities would be welcomed. One survey said more stimulation is needed instead of watching the television all day’, another ‘not much activities could be more’, ‘I feel we could have activities everyday’ and another said ‘there are only two activities a week’. During the inspection the manager said that she hoped to expand the activities to include those residents who cannot come out of their rooms. A recommendation will be made at the end of the report for the home to look at the activity provision and seek the views of the residents to consider increasing the activities within the home. The manager said that the home does not have a regular church service within the home but a local vicar or priest visits some of the residents or they can attend the church services at the if they wish to do so. The manager stated that relatives and friends are welcome at the home at any time and no restrictions are placed on visitors. On the day of inspection relatives regularly came in and out of the home to see their families and one was taking his wife out for a walk and he said he visited most days and tried to get out for a walk weather permitting. The manager stated and it was observed that the residents are given choices in their lives. One resident told the inspector that she chooses when to go to bed at night and can ring the bell in the morning when she wakes. It was also observed that residents are given the choice to eat in the dining room, their own bedroom or in either of the two lounges. In July 2007 the home had an environmental health visit and requirements were made during that inspection and the manager stated that these have all been completed. The home has two cooks and they have both received food hygiene training. On the day of the inspection one cook was preparing a lunch of cottage pie. The kitchen and all surfaces and equipment were clean and tidy. Special diets are catered for and the cook explained how one particular residents meal was prepared and cooked which reflected her cultural requirements. Fresh fruit is always available and this was observed on the day and homemade cake is served every afternoon. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s who use the service are protected by the homes complaints policies and safeguarding procedures. EVIDENCE: The manager stated that the home keeps a complaints log, which was observed and said they had received one complaint since the last inspection, which has been resolved. No complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The complaints procedure for the home was displayed in the home and is available to all residents and relatives. Survey forms retuned to the CSCI stated that residents were clear on how to complain and that staff listen to their concerns when raised. It was observed that the home has the local authorities procedures for safeguarding adults and the manager stated that the home follows these procedures. The manager stated that the home has had one referral under these procedures since the last inspection and information concerning this referral has been given to the CSCI training records were observed by the inspector, which demonstrated that staff had received training in these procedures. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s who use the service live in a well-maintained environment, which was clean and hygienic. EVIDENCE: The home is currently under going a refurbishment programme and this was demonstrated during the tour of the building. Survey forms retuned stated ‘I am impressed with the refurbishment of the lounge. They have come a long way in eight months’. The residents told the inspector that they had helped the manager to sample and choose the chairs for the lounge, the colours of the walls and the soft furnishings for the communal areas. Two survey forms retuned to the CSCI said that ‘some of the bedrooms could also do with decorating, as they are looking a little grubby’. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 16 The manager said that the programme of refurbishment has not finished. The kitchen is the next area to be refurbished and made bigger. Bedrooms have been personalised with photographs, pictures and plants all on display. One resident told the inspector ‘I like my room I enjoy watching my own television and having all my things around me’. The garden is safe and accessible however one survey form retuned to the Commission said that they would like to sit out there more often. The inspector observed staff using equipment in the home for example portable hoists, walking frames and other mobility aids to assist residents to safely move around the home or from one area to another. The laundry was observed to be neat and tidy but very small. The manager said this is another area that is due to be refurbished. The laundress said she worked Monday to Friday and at the weekends the carers will cover the laundry. She had knowledge of infection control procedures and had received training. There were adequate facilities for washing hands around the home with paper hand towels available. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of people who use the service. EVIDENCE: The manager said that she does the rota for the home and when completing this document takes into consideration the skill mix of her staff. She stated that this ensures a good balance of staff and experience. On the day of the inspection the inspector sampled the staff rotas and found that there was adequate staff on duty to care for the needs of the residents. The manager said that she has one vacancy but this is advertised at the moment. The home benefits from a training officer who ensures that training takes place for all staff. The training officer stated that the home considers, fire awareness, first aid, manual handling, health and safety, infection control, COSHH and safeguarding as mandatory and this training take place at least yearly. The training officer showed the inspector the training plan for the home and staff spoken to on the day all confirmed that the home supplies and encourages a variety of training. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 18 Two recruitment folders were sampled and all pre-employment checks had been completed by the home. The AQAA stated that the home has a recruitment policy, which is updated to reflect changing legislation. The manager told the inspector that 50 of the care staff has a National Vocational Qualification (NVQ) at level 2 and two have level 3. The home has a twelve-week induction programme, which is linked to a national organisation for induction. The induction was sampled and topics covered included privacy and dignity and diversity. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness, has effective quality assurance systems developed by a qualified competent manager. EVIDENCE: The manager told the inspector that her normal role is the assistant operations manager but the registered manager left in April 2007 and she is actively recruiting to fill this vacancy. The nurses at the home take the clinical lead, as the manager does not hold a nursing qualification. The manager said that she is normally the one to carry out Regulation 26 visits to the home but this has been suspended for the period while she is the homes Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 20 manager. The manager has sent survey forms to the residents and relatives in July/August 2007. The topics for the questionnaire included the renovations, activities, food and meal times and communication. The surveys have now been returned and the manager said that she was now analysing the information to then write an action plan. It will be a recommendation at the end of the report that the manager seeks the views of healthcare professionals and any other visitor to the home. The home had a policy on residents money and the manager stated service users’ money is handled by relatives and advocates safeguarding the financial interest of residents. Evidence indicated the home had a policy on COSHH (Control of Substances Hazardous to Health) and products were appropriately stored to promote safety. Observations confirmed health and safety information was displayed in the home and the kitchen appeared clean and hygienic with fridge and freezer temperatures within normal limits to promote food safety. The home had a gas safety certificate, regular fire drills and a Legionella bacteria test to safeguard the welfare of staff and service users. The manager stated that health and safety audits are carried out each month with action plans in place if problems are identified. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 21 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 X X 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations It is recommended that the home seeks the views of health care professionals and all visitors to the home when they send out their next quality assurance surveys. Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Addlestone Lodge DS0000017657.V346908.R01.S.doc Version 5.2 Page 24 - 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. 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