Care Home: Corner Lodge

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What the care home does well The home continues to provide a good standard of care to residents with dementia. Residents are happy living at the home and interact well with staff and relatives are generally very happy with the standards of care at the home. The home overall has a stable staff team that and progression in the development of the staff team and services offered is recognised and the care of residents has improved since the last inspection. One service user commented, "The staff are lovely here you couldn`t ask for better" and another commented "Things have improved for the better I feel" The home provides a safe and well maintained environment and the proprietors regularly invest in improvement of the premises. What has improved since the last inspection? Since the last inspection there has been improvements noted in the following areas: -The service user guide and statement of purpose has been reviewed and updated and is available now in different formats and is accessible to residents. Full and detailed pre admission assessments are now undertaken by the home prior to a service user moving in. Care plans now reflect individual preferences and choices regarding care and are more person centred to evidence that staff appreciate the diversity of individual residents. Appropriate risk assessments are now in place for more dependant residents especially where bedrails are in place and staff maintain appropriate records of such. The home now ensure that residents` individual social care needs are met through assessment and consultation and that their independence and self worth is promoted. The homes complaints procedures is now followed appropriately and the recording and format of the complaints procedure has been developed to make it accessible to more residents in the home. Safeguarding policies and procedures are now followed at all times. All staff receive training in the protection of service users from abuse. Staff rotas are now representative of the home staffing requirements showing contracted hours worked, names and designations, person in charge and staff complement must be in ration to dependency of current service user group. 50% of staff have now achieved NVQ qualifications. The homes recruitment procedures are now more robust and all staff must have an appropriate POVA first or CRB check in place before they start work, so that residents are protected. The staff-training programme now ensures that staff are fully able to meet the needs of residents. Staff now have regular supervision and the staff supervision system has been developed further. The home now ensures that ongoing quality audit systems are in place and that systems within the home protect and safeguard service users. The providers and team at the home are committed to ongoing environmental improvements such as a conservatory, new furniture and new floors being systematically renewed this year. Social activities show a graduated improvement with things like a Wii system being purchased and a computer being provided with broadband for residents. The proprietors are also in the Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 7process of making an application for funding to develop a sensory room and an artists workshop initiative. What the care home could do better: The team need to ensure that :An application for the manager to be registered be made. The home must manage service users monies appropriately. This with specific reference to large amounts of cash being held in the home. Staff must ensure that where possible residents and/or their representatives have input into the care planning system. An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets should be maintained so that possible medication issues can be monitored and good practice is always adhered to. Sufficient staff should be available to optimise residents choices with regard to trips out and meaningful activity opportunities. Any identified convictions or declarations made on application forms should be discussed and documented accordingly prior to making a decision about employment and it is advised that interview records are kept. Dates times and signatures on documentation must be given more prominence on all documentation, so an audit trail is in place for the home. The home must ensure regular fire drills are undertaken by all staff and record the date, time and names of all staff attending. Since the last inspection significant improvements have been made and of the fifteen requirements given at the homes last inspection in May 2008 fourteen of those have been met at this inspection. This is a positive step forward for the home and the proprietors and the manager are positive about its continuum and maintenance. CARE HOMES FOR OLDER PEOPLE Corner Lodge 185-193 Meadow Way Jaywick Sands Clacton on Sea Essex CO15 2HP Lead Inspector Helen Laker Unannounced Inspection 12th September 2008 10:00 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 Corner Lodge DS0000052195.V371214.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. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Corner Lodge Address 185-193 Meadow Way Jaywick Sands Clacton on Sea Essex CO15 2HP 01255 220228 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) cornerlodgecare@aol.com Mr Rahul Jagota Mr Sanjay Jagota Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, over the age of 65 years, who require care by reason of old age (not to exceed 48 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 48 persons) The total number of service users accommodated in the home must not exceed 48 persons Service users must not be admitted to the home under the Mental Health Act 1983 or the Patients in the Community (Amendment) Act 1995 19th May 2008 Date of last inspection Brief Description of the Service: Corner Lodge Residential Home is registered to provide care for older people over the age of 65 years and people over the age of 65 years with Dementia. The home accommodates 48 people in total and at the current time is primarily caring for people with dementia. The home is purpose built over three storeys with a passenger lift. The home has a garden, conservatory and patio to the rear and car parking facilities. There are 44 single and 2 double rooms and the majority have en suite toilets. There is a large dining room and four lounges. The home is situated in the seaside town of Jaywick and is within easy walking distance of the seafront and shops. The current scale of weekly charges is £383.00 to £490.00 depending on level of need. Additional costs are charged for hairdressing, chiropody, aromatherapy, reflexology, newspapers, toiletries and some specialist equipment. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was carried out as part of the annual inspection programme for this home. The proprietors and new manager were available on the day of the inspection. The inspection focused on all of the key standards. A tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment (AQAA) completed by the management of the home and submitted to the CSCI. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is good if improvements or changes be noted as this contributes to the inspection process and indicates the home’s understanding of current requirements, legislation changes and own audited compliance. The home had deteriorated at the homes key inspection in May 2008 and a visit was therefore scheduled sooner than anticipated to complete another key inspection within six months. Ten residents, two relatives and eight staff were spoken with during the inspection. Three staff and one service user previously completed CSCI’s feedback survey sheets. All comments were taken into account when writing the report. From observation residents’ looked happy, relaxed, well groomed and comfortable. What the service does well: What has improved since the last inspection? Since the last inspection there has been improvements noted in the following areas: - Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 6 The service user guide and statement of purpose has been reviewed and updated and is available now in different formats and is accessible to residents. Full and detailed pre admission assessments are now undertaken by the home prior to a service user moving in. Care plans now reflect individual preferences and choices regarding care and are more person centred to evidence that staff appreciate the diversity of individual residents. Appropriate risk assessments are now in place for more dependant residents especially where bedrails are in place and staff maintain appropriate records of such. The home now ensure that residents’ individual social care needs are met through assessment and consultation and that their independence and self worth is promoted. The homes complaints procedures is now followed appropriately and the recording and format of the complaints procedure has been developed to make it accessible to more residents in the home. Safeguarding policies and procedures are now followed at all times. All staff receive training in the protection of service users from abuse. Staff rotas are now representative of the home staffing requirements showing contracted hours worked, names and designations, person in charge and staff complement must be in ration to dependency of current service user group. 50 of staff have now achieved NVQ qualifications. The homes recruitment procedures are now more robust and all staff must have an appropriate POVA first or CRB check in place before they start work, so that residents are protected. The staff-training programme now ensures that staff are fully able to meet the needs of residents. Staff now have regular supervision and the staff supervision system has been developed further. The home now ensures that ongoing quality audit systems are in place and that systems within the home protect and safeguard service users. The providers and team at the home are committed to ongoing environmental improvements such as a conservatory, new furniture and new floors being systematically renewed this year. Social activities show a graduated improvement with things like a Wii system being purchased and a computer being provided with broadband for residents. The proprietors are also in the Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 7 process of making an application for funding to develop a sensory room and an artists workshop initiative. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Corner Lodge DS0000052195.V371214.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 Corner Lodge DS0000052195.V371214.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): 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an assessment system in place that does ensure that they can meet the needs of people they admit to the home. Information available to prospective residents ensures they can make an informed decision about living at the home. EVIDENCE: At the homes last inspection in May 2008 it was noted that the home has a pre-admission assessment system in place. The assessment documentation completed goes on to form part of the care plan. New documentation had recently been introduced and generally it was noted that the manager would undertake most of the pre-admission assessments. Since the last inspection a new manager has been recruited and she confirmed that she now undertook the pre admission assessments. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 10 The assessments of three recent admissions to the home since the last inspection were inspected. All the assessments seen were noted to have been completed prior to the admission date and cover the required areas. These had been completed well and improvements were noted. Sufficient detail was now clear relating to the physical and social side of care needs required individually, with good family and social histories being in place. Information on resident’s personal preferences and their daily routines was also included. Evidence of family involvement was noted. The AQAA submitted prior to the homes last inspection in May 2008 states “Corner Lodge provides essential respite and interim care in which four bedrooms are allocated for this purpose. As with all pre-assessments undertaken at the home the information gained is used to provide as much consistency as possible so the individual will feel at home this is essential when the person finds verbal communication difficult and the need to understand triggers and behaviour to minimse distress and frustation. As noted the assessments form part of the care planning process.” Information seen in the assessments did now tally with the actual care plan. The care team are now more aware of the contents of the assessment and attention to dates times and signatures has been given more prominence but should be maintained. Prospective residents and their families are encouraged to visit the home before making a decision about admissions. On admission the staff generally complete an admission checklist to ensure that all areas are covered and this has been re developed to be a more person centred and an individual process for the new resident. The home does take a few emergency admissions into its local authority contracted beds, and these would be assessed by the manager. As noted at the homes last inspection it is a general trait that some of these residents are happy to become permanent residents at a later stage. One service user recently admitted, who was aware of the service user guide stated ‘ I was told about the home before I came here and it is very nice.’ A service user guide and statement of purpose are available and these have been updated and copies were seen available for service users in large print. A small amendment was noted with regard to dementia care provision and staff qualifications but otherwise the home had now met the standard. We are told that these documents will be continually updated in line with the resident group, respite services and any staff changes. The service user guide is now in different formats and is on computer in a verbalised disc edition. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect good support and assistance with health and personal care enabling appropriate consultation and respect of individual choice. Overall the home’s medication recording procedures were satisfactory at the time of this inspection and did not place service users at risk. EVIDENCE: At the homes last inspection in May 2008 it was noted that there was an existing care planning system in place consisting of an assessment, care plans and risk assessments. Care plans cover the residents identified needs. They are informative and contain sufficient detail to ensure residents needs can be met. Also at the home’s last inspection it was noted that not all paperwork had been completed and previous paperwork available was not sufficiently completed highlighting a support need for staff via training. Progress has now been made in this area and care plans now include information on personal Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 12 preferences and use a much more person centred approach concentrating on strengths, rather than needs and putting support in place to optimise residents’ abilities. A pen picture has been developed which correlates with the residents care plan and ensures staff make reference to the same when recording daily entries. Social histories are also formulated with the help of relatives and a good example of choices being considered with relative involvement in one care plan read “ Prefers the door shut and a light. Can get upset but relative advises a change of topic will usually work” It was suggested at the home’s previous inspection that the more dependant residents who have limited interaction with staff, may benefit from assessments for signs of well being and feeling ill being developed. This is now an integral part of the care planning process. A monthly review system is now in place and undertaken by key workers, and this is generally consistent. This covers medications, changes to daily living routine, mobility, diet and anything else. Those seen complete show a good staff appreciation of residents’ needs and changes, however attention is still required to include dates, times and signatures. This was discussed with the manager on the day of inspection. Individual daily recording sheets are now being used with a folder for each floor. These are being cross-referenced with the care plan to ensure all needs are being met and documented as such. Daily notes now reflect more the residents’ physical and mental wellbeing. Much improvement has been made in the care planning area and this is seen as a positive step forward for the home. Social care plans are now formulated and contain individual information and residents have life histories completed in order to help develop a more person centred approach to the care of the residents. Recordings of social interactions and one to ones where there were gaps before have improved and this is now included as an integral part of residents care plans via the pen picture and entries are made daily. Work is being progressed to involve residents and their relatives in the care planning process, as this still needs to be addressed. The home’s AQAA for this year as stated in the homes last report indicates that ‘the involvement of family and friends in the care planning process is undertaken, sometimes on a daily basis, but missed opportunities fail to provide the documentation as evidence’. This was discussed with the new manager on the day of this inspection, and we are assured changes are being addressed in this area to provide a more holistic consultative process. Staff and residents who commented said that ‘Residents are looked after well’ and ‘staff are kind and caring’. On discussion with the new manager, she stated ‘There were definite changes required but we feel we are achieving that’. Since the last inspection in May 2008 it is clear that improvements have been made with regard to care planning processes and assessments and a more person centred approach was in place. Reviews also form part of the supervision process so residents can be assured that staff have a clear understanding of their care needs and the actions required to meet that need. The inspector notes positively the determination and work the home has made to address processes such as care planning and assessments and it is also Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 13 noted that the manager and proprietors involvement now includes auditing on a regular basis to ensure that care planning is maintained to a good standard. At the time of the inspection there were no residents being cared for in bed. Records show that doctors are asked to see residents in a proactive way and residents have access to the chiropodist, optician. Residents are proactively referred to the falls prevention team and often in order to improve their mobility and regain independence. A range of risk assessments are completed that include manual handling, falls, general and environmental and nutrition. Evidence that these are kept under review were on file and in general do contain sufficient detail. Of the care plans reviewed only one person who had mobility issues did not have an assessment in place. A discussion with the manager was held regarding this and short-term goals, and staff should ensure that identified risks are reflected in the care plan so that the management of the risk is clear. Residents’ weights are being monitored but it was noted that there were still some inconsistencies as to when this is done. A more formalised approach was discussed with the manager so that weights are not just done when a problem is highlighted. This was highlighted at the home’s last inspection also. The home has access to a visiting consultant who is from the residential care team and they visit with specialist nurse. This helps to promote the health of residents in the home. They visit following referrals from the senior staff, manager, district nurse or doctor. Records show that care staff ensure that blood tests are arranged, as requested by the doctor and that residents get to hospital appointments with escorts where required. Residents are also accessing dental services in the community. The team use a blister pack – Monitored Dosage system (MDS) system to manage the majority of the residents’ medication. A local pharmacist completed a medication audit in August 2008. The report and results were seen to be good and reflected what the inspection officer found on the day of inspection. Medication Administration Records (MAR) sheets were neat but there were a few missing signatures and hand written prescriptions. Items are checked in to the home and returns systems are in place. No residents are presently self-administering and no controlled medications were in use and evidence of medication reviews was seen. With the further development of the care plans and the introduction of a more person centred approach this has allowed the team to evidence that they have a good appreciation of the diversity of the residents in the home. Staff approach to privacy is good, staff were seen knocking on doors and interaction between staff and residents was seen and heard to be friendly, caring and respectful. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were supported to take part in meaningful appropriate activities, within the home but require more support to access the wider community. Residents can experience a relaxed environment and feel their rights are respected and recognised in their daily lives and receive an adequate range of food at times to suit their lifestyle. EVIDENCE: At the homes last inspection in May 2008 it was noted that care plans do, in some cases, outline resident choices regarding daily routine and life choices. However these care plans were being improved upon, as some contained very limited information and this is not helped by the lack of life histories. At this inspection it was evidenced that these are now included and daily routines and life choices recorded. An example of this was the time of rising or going to bed being evidenced on the plan. Social care plans are now an integral part of the main care plan to ensure that an individual, person centred approach is taken and that needs are met and residents strengths are optimised. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 15 Records demonstrated a lack of one to one sessions with the emphasis on group or task activities. A recently appointed co ordinator who works two days as a co ordinator and three as a care worker, now has a monthly meeting with residents where she circulates and talks to residents on a one to one basis. The manager informs us that ‘It is considered that patient one to ones be a holistic process and as such information relating to choices can even be gained within a conversation where personal care may be being undertaken or even whilst in dialogue pushing a resident in a wheelchair’. Care staff still have the primary responsibility for social care but the employment of the co ordinator helps enhance the work that they do. A co ordinator is also of value in terms of quality assurance as they are often in a position to obtain individual feedback on services. The AQAA completed for this year acknowledges that ‘We could do more by evidencing more details in the activities in the residents plan of care.’ This is now being done and feedback from residents highlighted a wish to go out a bit more and that at times it was felt more staff could be available to facilitate trips out. Staff spoken to stated that most activities were in house and the manager confirmed that since her appointment in July 2008 not many trips out had been arranged but residents had expressed a wish to go to the pier for fish and chips and the home intends to facilitate that once appropriate transport can be arranged. The home is now reviewing how they provide appropriate activities that meet the needs, wishes and interests of service users, and programmes of activities are displayed on the notice board and a game of musical bingo was participated in by residents on the day of inspection. Activities are available both in the morning and the afternoon. Small group activities for people with similar interests are now being explored and for those with specific needs i.e. dementia. Records for activities show that the following subjects have been offered nail care, darts, noughts and crosses, dominoes, crafts, cake decorating, entertainers and tai chi etc. A programme is displayed in the main hall. The home has bought a Wii interactive game (and been in the local paper as a result), musical bingo, a huge connect four game a percussion set and has a volunteer come in to do dance blitz. The proprietors also have the intention of supplying a broadband connection via a computer suite set up in one of the lounges for residents to use. The last inspection in May 2008 evidenced that the home had had an open day and BBQ and visited Frinton Nurseries and Harbour Lights. Where possible residents help with some household tasks, such as setting tables. This promotes independence and self worth and this type of activity needs to be encouraged further. External therapists visit the home, such as a reflexologist, at a basic charge to the resident. Relatives are encouraged to visit the home and there is recorded evidence that they are invited to events at the home. We are also informed that activities for each day are recorded on the staff handover sheet and the proprietors are in the process of making an application for funding to develop a sensory room and an artists workshop initiative. Relatives confirmed in discussion that the home had a nice friendly atmosphere and they are made welcome. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 16 The menus have been changed to twice weekly and chicken, which is very popular, is always available as an alternative. There is also now a hot option in the evening. This is good as relatives who commented at the home’s last inspection were concerned at the choices of the evening meal. Residents who commented at this inspection said that the food was ‘nice’ or ‘very good’. The menu has also been split into a summer and winter menu and now residents can choose from vegetables and two main meals. The menu looks nutritionally sound and more varied than before. Mealtimes are arranged well and care staff sit and eat with the residents and are therefore able to help those requiring assistance sensitively and maintain their dignity. The tables are nicely laid, condiments are available and residents have choices at mealtimes. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can feel confident about how to complain and can expect to be listened to and their complaints acted upon. Residents can also be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The management have a satisfactory complaints procedure in place that is displayed in the home and contained within the service users guide. The homes AQAA submitted for 2008 acknowledges that exploring the use of different formats may make this system more accessible to residents. The complaints procedure is now on computer in a verbalised disc edition and since the last inspection has been produced in large print and is accessible to residents and all have been given a copy. Residents stated when spoken to “oh yes I have complained but they sort it out and things are ok now” Another stated, “If I need to I look at the copy on the table but haven’t any complaint’s” The new manager has a very open and objective approach to complaints and has implemented processes to ensure all procedures are followed. At the time of the home’s last inspection in May 2008 three POVA safeguarding issues were under investigation. We (as the Commission) noted the determination of the home to address these processes and it was discussed with the proprietors at that time that there needs to be a robust Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 18 system in place that includes their involvement auditing complaints on a regular basis and that this will ensure that complaints and safeguarding issues are kept to a minimum. An audit system of all safeguarding issues and complaints has now been implemented and since the last inspection the home had received four complaints. One was retracted, one upheld and two partially upheld. Documentation and appropriate processes followed were seen. The safeguarding issues ongoing at the last inspection were concluded in June 2008 and have now been closed. The requirement made at the homes last inspection with reference to complaints and protection has now been met. Previously records showed that one CRB check that had warranted further investigation had not been looked into. These issues were discussed and processes and procedures are now in place to ensure that no member of staff now starts work at the home prior to appropriate checks being made and any issues requiring further discussion are recorded, dated and signed. Since the last inspection the complaints and safeguarding policy has been updated and an audit trail is kept of any actions or advice sought regarding safeguarding and complaint issues. This is seen as good practice and it was noted that the last POVA training was undertaken on the 17/07/08 and safeguarding training undertaken by the local authority took place on the 31/07/08. Relatives who commented knew how to make a complaint and whom they would raise issues with. The AQAA stated that ‘The complaints are normally resolved within the home and are clearly recorded. The evidence for this is in the complaints file.’ This now concurs with the evidence available on the day of inspection. Updated policies are in place and it is noted that the home is providing consistent training in this area and adult protection awareness issues are followed up in supervision and meetings for staff. Staff spoken to show a clear understanding of issues related to whistle blowing and adult protection procedures. The team work cohesively with external authorities to resolve matters and now meet the standard relating to complaints and protection. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is homely, clean and safe. Individual rooms were personalised promoting service users independence. EVIDENCE: As the homes last inspection was only in May 2008 there have been no major changes to the environmental standards but there is ongoing refurbishment continuing with the replacement of some flooring in residents rooms and a new staff room being developed since the last inspection. A tour of home was undertaken. The proprietors significantly re-invest into the premises on a regular basis. Last year there had been new lounge and dining furniture, bedroom furniture, all communal areas decorated, over half of the en-suite floors replaced, new non-slip flooring in the dining room and small lounge and two new washing machines. The management have now provided a Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 20 conservatory to the rear of the home to encourage residents to access the garden and replaced double glazed window units. There are also plans to upgrade the shower units in the home. Floors in communal areas have been replaced and the AQAA confirms there is an ongoing maintenance programme in place. The home was seen to be clean and well maintained. It is pleasing to note that the front foyer has a welcoming air with new sofas being supplied and a small seating area having been developed. Residents’ bedrooms were seen to be personalised and ongoing work has been done to make them homely for residents. Residents spoken to liked their rooms. One relative commented “It is very clean here”. Consideration has been given to developing the environment further in relation to the needs of people with dementia, for example, individualising personal doors with photos to help residents identify their rooms. The development of a sensory room and artist’s workshop initiative is also planned, pending a current application for funding. The management now undertake infection control audits to ensure that the correct facilities meet the standards and are in place, for example hand washing. Training records continue to show that although health and safety training is undertaken and that infection control training is now being addressed with the last course being held on the 22nd July 2008 amongst the staff team. Infection control policies and procedures were not specifically inspected on this occasion but storage of COSHH substances was noted to be appropriate. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment processes of the home have sufficient safeguards in place to ensure residents are protected. The home overall provides staff who were appropriately trained and qualified, in sufficient numbers to meet residents’ needs. Recruitment practices meet regulatory requirements set out to protect residents EVIDENCE: Since the homes last inspection in May 2008 staffing rotas have been updated and those for the last four weeks were inspected. They now show the person in charge, the designation of staff, hours worked and numbers of staff on duty. Two staff do still work mirrored shifts of up to 6 in a row with only one day off in between. This was discussed regarding the potential issues arising from it at the homes last inspection, as it was not seen as good practice. The home currently has a few staff vacancies and manages to cover these with their own staff rather than using a staffing agency. Staffing levels are currently being maintained at 7 a.m. in the morning and 7 p.m in the afternoon/evening and 4 waking staff at night. These levels are usually achieved apart from odd days, mainly at weekends or due to sickness. As mentioned previously in this report staff and residents both feel increases in staff would ensure all care and social needs could be met in a less hurried fashion. The proprietors inform us that if Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 22 required, extra staff will be used to cover escort duties and the issues surrounding trips out were discussed. A co ordinator position for the home has also been developed to ensure activities; auditing and administration procedures run more smoothly. Sufficient domestic and kitchen staff are employed to cover the home. Staffing levels and deployment should be kept under regular review. Relatives who commented at the homes previous inspection stated that ‘staff are quick to attend to my relatives needs’, ‘I think the team does its best for the residents and the carers are always very good. The management of the home actively encourage the staff to undertake NVQ qualifications. Records previously submitted show that the home has 12 of the 24 staff now with an NVQ qualification and a further 12 currently undertaking NVQ level 2 and 3. The home now meets the 50 of care staff achieving a recognised qualification. Staff turnover at the home is generally low and the residents benefit from a consistent staff team that they get to know well. Visiting professionals and relatives all comment on how the staff and the residents get on well. Recruitment files were checked and are now all generally sound with all the required checks and documentation in place. Recruitment documentation inspected for one staff member included an application form, employment history, a criminal record declaration, evidence of identity and a photo, two written references, and a POVA first and CRB check. The new manager demonstrated a considered and responsible approach to recruitment issues discussed, and was able to demonstrate examples of when prompt and appropriate action should be taken when alerted to a recruitment concern. In one case this had been done but was not documented sufficiently to evidence a discussion about an issue on an application form. The proprietors are reminded that CRB checks from previous homes are still not acceptable and any identifying convictions or declarations made on application forms should be discussed prior to making a decision about employment. Interview records were discussed and the home is advised to keep them. Overall the home had addressed all issues highlighted at the homes last inspection and the homes current practice reflects a recruitment practice that aims to protect service users. Staff for the home have an understanding/appreciation of the resident group and are willing to undertake training. The new manager confirmed and evidenced the implementation of the Skills for Care induction programme The AQAA identified this as an area for improvement and for the four records reviewed for the most recently recruited staff inductions were evidenced. This was also confirmed in discussion with staff on duty. The home has a much more ordered training programme in place now and identifies training through staff appraisals. An improved staff supervision system now provides an up to date picture of staff needs in the home. Training records showed that the majority of staff are up to date with their mandatory training and there is a clear plan in place for ongoing updates. Additional training that relates to the specialist needs of residents is also being undertaken. For example training in the care of people with dementia and in Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 23 relation to subjects such as diabetes, the promotion of continence, the care of pressure areas to help them to improve the standards of care offered to residents. The training of staff has improved since the last inspection and now now allows for significant positive development of the staff team and in turn the services offered within the home. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 24 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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well-run home. Systems were in place to ensure that residents’ views form part of the monitoring and review of the home. Health and safety practices promote the health, safety and welfare of residents. EVIDENCE: A new manager for the home has been recruited since the last inspection. She has been in post since July 2008 and is suitably experienced to run the home. We are informed that she is a registered nurse (Mental Health) and holds NVQ level 4 and 5 in management. An application for registration with the commission is to be made. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 25 She demonstrated good knowledge and understanding of the service and of care and management practices, and training records show that regular training is attended to update his skills and knowledge. Residents and staff spoken with reported that the manager was supportive and approachable, and it was noted that she spent a fair amount of time working alongside staff in the home, and therefore provided a good level of support and was able to monitor practices. The proprietors have taken on board the result of the homes last inspection due to instability in the management approach and now monitor and work alongside the management of the home as an integral component. Progression in the development of the staff team and services offered are recognised and the care of residents has improved since the last inspection. The home has met all but one of the requirements made at the last inspection, which is a real positive step forward. As also noted in this report the staff team are generally stable and turnover is low. The current overseeing manager is not afraid to address issues in the home and staff spoken to spoke positively about her open management style, her willingness to take and give advice and she is keen to ensure that the standards of care provided to residents remain high. The lack of stable management in the past did not help the home with the continuum of development. The previous AQAA provided by the home which disappointingly mirrored the homes last submission did not outline any specific improvements made in the last twelve months purely identifying only audit processes requiring some attention and no reference to the stability or development of the management was noted. The AQAA formation and submission was discussed with the new manager and she demonstrated a good understanding about the purpose of the AQAA. Service users spoken to have met the new manager and all comments received were positive and complimentary. Staff meetings are now more regular and minutes for both staff and senior meetings were evidenced at this inspection. Supervisions have been commenced and evidence of regular cascaded supervision and appraisal was seen in staff records. Since the last inspection the proprietors have been working on developing the quality assurance systems in the home. The team have been focusing on different areas to obtain feedback, for example menus and these have subsequently changed. The AQAA submitted prior to the homes last inspection stated the same as last year that they need to have a more consistent approach to audit and quality assurance methods. The development of a policy may be required to help the management focus on what they need to do over the course of a year. Steps forward in formal quality monitoring in the home have commenced from September 2008 and take the form of specified areas i.e (complaints and medication) to audit in line with the standards on a monthly basis and a report is formulated upon completion. The home encourages residents and their families or representatives to deal with their financial interests as far as possible. The home does not act as appointee for any residents currently in the home. The home at the time of the last inspection was holding very large sums of personal monies on behalf of Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 26 residents and this was checked at random and found to be correct, these were kept in good order with records and receipts available. Advice was given about obtaining some advice regarding the depositing of the monies in order that residents can earn interest and have choices regarding their finances. Accruing large sums of money to hold in house is not best practice and this was discussed with the proprietors on the day of this inspection. Where residents are able to manage their own personal/financial affairs the home supports them to do this. We are informed that this is being addressed but is a rather more prolonged process than originally anticipated but will be concluded shortly. Health and safety is promoted in the home, environmental and safe working practice risk assessments were seen at the homes last inspection. Hot water temperatures are monitored. At the homes last inspection there were also some valves that required replacing and this has been actioned by the homes maintenance man. The home monitors resident falls and accidents in general, to ensure that residents are being appropriately cared for. The home have had a visit from the local authority to assess health and safety in the home and received a positive report. Safety certification for equipment and facilities in the home were checked at random at the homes inspection in May 2008 and were found to be up to date and in order. Records also show that wheelchair inspections are carried out at this home. The last fire inspection was held in January 2008. Overall the home has progressed well with meeting the standards since the last inspection and both the proprietors and the manager are positive about its continuum and maintenance. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 3 2 3 Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 28 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 OP35 Regulation Reg 20 & 29 Requirement The home must manage service users monies appropriately. This with specific reference to large amounts of cash being held in the home. This is a repeat requirement from the homes last inspection. Timescale of 31/07/08 not met. Timescale for action 30/11/08 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 OP7 OP12 Good Practice Recommendations Staff must ensure that where possible residents and/or their representatives have input into the care planning system. Sufficient staff should be available to optimise residents choices with regard to trips out and meaningful activity opportunities. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 29 3 OP29 4 5 OP31 OP37 Any identified convictions or declarations made on application forms should be discussed and documented accordingly prior to making a decision about employment and it is advised that interview records are kept. An application for registration of the homes manager should be made to ensure the home is run well and in the best interests of the service users. Dates times and signatures on documentation must be given more prominence on all documentation, so an audit trail is in place for the home. Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Corner Lodge DS0000052195.V371214.R01.S.doc Version 5.2 Page 31 - 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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