Care Home: Edgecumbe Lodge Rest Home for the Elderly

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What the care home does well Generally the home was found clean, warm, well lit and free from unpleasant odours. The atmosphere of the home was noted to be relaxed. Service Users looked well cared for in their homely environment. Staff were noted to be interacting with service users in an informal, respectful, personalised and dignified manner. The Home provides varied meaningful and stimulating activities and outings for the service users and ensures that individual interaction is provided as a routine and as necessary.To enable us to find out about how the people living in the home are treated we sent out survey forms to service users, staff and relatives and written below are some of their comments. "Edgecombe Lodge is not a place that encourages people to sit around in chairs all day. They do different things on different days". "Edgecombe Lodge makes sure that the service users are comfortable and are well fed and warm. They seem quite happy whenever I am here". "I would recommend this home to anybody it is a good place to be". "The home provides a feeling of being part of the family and the owners are readily available to talk to. The service users are all treated as individuals". "My relative at 94 keeps well and happy. Visitors are made welcome at any time and I am confident in the standard of care provided." "The home is spotlessly clean, warm and comfortable. Adequate food is always provided". "At Edgecombe Lodge they encourage behaviour which will helps the individual for example, my relative would have locked themselves in their room. Over a year or so they have been gently encouraged in the lounge and even the garden. What has improved since the last inspection? It was pleasing to note that the home has made efforts to ensure that most of the requirements and recommendations were met. The manager stated that the home is working towards meeting the remaining requirements. The manager stated that all the flooring has been replaced with new carpet, to provide the service users with a better environment. A new stair lift has been purchased to assist service users with poor mobility and the passenger lift has been upgraded for service user and staff safety. What the care home could do better: To ensure that care needs of identified service user`s are met it would be better to provide appropriate care plans for identified needs and to provide adequate protection, risk assessment must be undertaken following falls to identified service users. All medication administered must be signed for, to prevent drug errors and to protect individuals living in the home.To ensure that staff are aware of action to be taken in dealing with difficult situations in relation to service users, it could be better to provide staff with training on challenging behaviour. Whilst generic risk assessments were undertaken in different areas of the home, it was agreed that the risk assessments must include the lounges and bedrooms. Ensuring that fire doors are not wedged open would protect the service users from harm in the event of fire outbreak. Service Users would be at less risk if the call bells are placed within easy reach of the individual to enable them to summon assistance in an emergency or if requiring basic needs. Individuals admitted to the home would feel reassured if the home confirms in writing that their needs would be met. CARE HOMES FOR OLDER PEOPLE Edgecumbe Lodge Rest Home for the Elderly 35 Overnhill Road Downend South Glos BS16 5DS Lead Inspector Grace Agu Unannounced Inspection 4th March 2008 09:30 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 Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.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. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Edgecumbe Lodge Rest Home for the Elderly Address 35 Overnhill Road Downend South Glos BS16 5DS 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) 0117 9568856 williamsardar@blueyonder.co.uk Mr William Sardar Mrs Nargis William Sardar Mr William Sardar Care Home 21 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (21) of places Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate 21 service users aged 65 and over requiring personal care only May accommodate 4 service users aged 65 and over for Dementia care. 18th August 2006 Date of last inspection Brief Description of the Service: Edgecumbe Lodge is situated in an established residential area in the south of South Gloucestershire. It is approximately half a mile from the shopping areas of Staple Hill and Downend where doctors surgeries, post offices, banks, library, shops and other facilities exist. There are bus routes on roads at either end of Overnhill Road that take you into Bristol. The home is a large, detached Victorian house on four floors. Despite adaptation for its present use, many features of the original period remain and enhance the sensitively planned alterations. Full use is made of the basement/garden level area and of the top of the attic. Resident’s living here are Older People with some physical frailties. There is a passenger lift accessing all but the top floor, which has a stair lift to it. The stair lift is for the use of visitors and the occasional use of residents. It is the policy of the home not to accommodate those with limited mobility in this area of the home. There are well laid out, mature gardens which are well tended throughout the year. The exterior and interior of the property are in good repair, pleasantly decorated and comfortably furnished. The former garage/workshop is the manager’s office, with tea making facilities and a toilet, making the unit selfcontained. Fees range from £445-£450. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.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 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit which was undertaken as part of a key inspection over eight hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. We also looked at the concern that we received from a relative regarding the process used by the providers to move their relative from to the home due to the individual’s challenging behaviour in order in order to protect the health and safety of the individual and other service users and staff. Our findings can be found in the body of the report. At the last random visit six requirements and six recommendations were made in relation to care planning staffing levels staff recruitment and staff competency, quality assurance and ensuring that staff pay attention to ensuring that service users privacy and dignity is maintained at the home. Other requirements issued included ensuring that medication practices and staff recruitment protects the service users. We met with the deputy matron in the early part of the visit. The deputy matron was very professional and showed knowledge of the inspection process before Mr William Sardar and Mrs Nargis Sardar arrived later in the day and assisted with providing information for the rest of the visit. Whilst touring the building. We spoke with a number of service users, staff and one service user representative and a number of records were viewed. What the service does well: Generally the home was found clean, warm, well lit and free from unpleasant odours. The atmosphere of the home was noted to be relaxed. Service Users looked well cared for in their homely environment. Staff were noted to be interacting with service users in an informal, respectful, personalised and dignified manner. The Home provides varied meaningful and stimulating activities and outings for the service users and ensures that individual interaction is provided as a routine and as necessary. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 6 To enable us to find out about how the people living in the home are treated we sent out survey forms to service users, staff and relatives and written below are some of their comments. “Edgecombe Lodge is not a place that encourages people to sit around in chairs all day. They do different things on different days”. “Edgecombe Lodge makes sure that the service users are comfortable and are well fed and warm. They seem quite happy whenever I am here”. “I would recommend this home to anybody it is a good place to be”. “The home provides a feeling of being part of the family and the owners are readily available to talk to. The service users are all treated as individuals”. “My relative at 94 keeps well and happy. Visitors are made welcome at any time and I am confident in the standard of care provided.” “The home is spotlessly clean, warm and comfortable. Adequate food is always provided”. “At Edgecombe Lodge they encourage behaviour which will helps the individual for example, my relative would have locked themselves in their room. Over a year or so they have been gently encouraged in the lounge and even the garden. What has improved since the last inspection? What they could do better: To ensure that care needs of identified service user’s are met it would be better to provide appropriate care plans for identified needs and to provide adequate protection, risk assessment must be undertaken following falls to identified service users. All medication administered must be signed for, to prevent drug errors and to protect individuals living in the home. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 7 To ensure that staff are aware of action to be taken in dealing with difficult situations in relation to service users, it could be better to provide staff with training on challenging behaviour. Whilst generic risk assessments were undertaken in different areas of the home, it was agreed that the risk assessments must include the lounges and bedrooms. Ensuring that fire doors are not wedged open would protect the service users from harm in the event of fire outbreak. Service Users would be at less risk if the call bells are placed within easy reach of the individual to enable them to summon assistance in an emergency or if requiring basic needs. Individuals admitted to the home would feel reassured if the home confirms in writing that their needs would be met. 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. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.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 Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.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): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of admission is well planned with clear information to enable the resident or their representatives to make decisions about the services provided at the Home. EVIDENCE: The Home’s Statement of Purpose and Service User’s Guide remains in place and provides information to prospective residents in relation to services provided to enable them to make a decision about the Home. Evidence from two newly admitted Service Users records showed that one service user was assessed on the phone due to emergency admission and another resident was assessed at the hospital before admission. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 10 The manager stated that whilst one service user was an emergency admission the individual was assessed at the home to ensure that the needs could be adequately met. The Manager stated at a discussion that the Home has Terms and Conditions for all categories of service users. The Terms and Conditions document has information in relation to services provided. It was agreed that the service users would be reassured if the home confirms in writing to the individual to be admitted to the home that their needs would be met. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.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): 7,8,9.10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home offers support to service users throughout their lives and towards the end, it also protects them by reviewing their health needs, however, it fails to protect them by lack of care planning and unsafe medication practices. EVIDENCE: We looked at four care files and noted that three showed evidence of detailed pre-admission assessment of the needs of the individuals. One came as an emergency admission however this person was assessed at the home. The manager stated that pre-admission assessment is very important as it enables the home to determine if they are able to meet the individual’s needs. The people we spoke with at the home told us they knew the home before they came to live there because it helped them to make the decision. Whilst some of the care files that we looked at had care plans relating to different needs and how the staff were to meet these needs, some care files lacked different care plans in relation to irritability, aggression and challenging behaviour. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 12 We also noted that in one care file the care plans did not reflect the needs of this person. There was evidence of individual risk assessments in some of the care files but some had no risk assessments to enable staff to support the service users in order to minimise accidents. It was agreed that the home manager review all the care files of the service users and ensure that appropriate care plans and risk assessments are put in place to support staff in meeting the needs of all the individuals living in the home. Evidence that these have been undertaken including appropriate documents have been received at the Commission before this report was completed. The care files contained evidence that all of the service users living at the home are registered with a General Practitioner to ensure that healthcare requirements are met, this was confirmed with the information that we received when we spoke with service users. Furthermore information seen in care records made us believe that service users living at the home are also supported by domiciliary services to the home such as district nursing services and chiropody. Service users are supported in other healthcare areas that affect them in their life such as continence and sensory impairments. There are no service users living at the home who require support with pressure area care. The Commission received Regulation 37 Notification for incidents that have required service users to be admitted to hospital through ‘accident and emergency’. Records of these occurrences were reviewed through looking at the records which the home had in place, we were satisfied that individuals were supported appropriately on a health and emotional level. Two individuals spoken with stated that “staff treat me well, staff are wonderful, and very kind, I couldn’t think of any place better than here”. Another person confirmed that staff respect her and always ensure that her privacy is maintained. Care staff were seen knocking at the doors and waiting to be allowed in before going into the service users bedrooms to assist them with personal care. Some service users had private telephones installed in their rooms to enable them to have private conversation with their families, relatives and representatives whenever they wished. We noted whilst touring the building that one individual was sitting far away form the call bell. The person stated that it could be sometimes difficult to Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 13 summon help because of the situation of the call bell. This was discussed with the providers and it was agreed the home make alternative arrangements to enable the individual to Two staff members spoken with were very familiar and were able to identify the core values to be shown to all individuals living at the home. The staff members stated that respect, dignity, rights and privacy support these values. For example, we observed that service users were given their private letters unopened. This is good practice from the staff and was commended. All of the care documentation and other information we looked at showed that good care based on the above values are practiced at the home. One relative states on a comment card “the home provides a supported sympathetic level of care which is appropriate to my relatives needs. Staff are friendly and cheerful and responsive, enabling my relative to retain their dignity in their failing years”. We looked at service users’ medication practices at the home and we noted that arrangements have been made for all services users to be registered with one local doctor’s practice, with the aim of improving care for the individuals living in the home. All medication are reviewed routinely and when necessary as part of this process. We saw the medicines being administered at lunchtime. The medicines administration record sheet was signed when the medicines had been administered. The pharmacy provides a printed medicines administration record sheet each month. Blister packs of medicines indicated that medicines had been given as recorded on the medicines administration record sheet. Some records were seen in service users’ care plans relating to medication. The medicines received into Edgecombe Lodge are recorded on the medicines administration record sheet. Unwanted medicines returned to the pharmacy are recorded in a disposal book. Action has been taken to provide training about medicines for staff, and this is good practice to help staff administer medicines safely. A requirement was issued for all medication administered to be signed and that the service user on self-administration to be risk assessed to ensure that the service user is adequately protected. Evidence that this requirement had been met was received at the Commission before the report was completed. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 14 Staff spoken with demonstrated knowledge of policies and procedures in relation to death and dying. The staff members stated that they are aware of the importance of keeping the information about service users’ confidential. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 15 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. The home enables service users to maintain contact with families, friends, advocates and the community. It also provides them with meaningful activities and some choice in respect of meals. EVIDENCE: The home was able to demonstrate that daily living routines and activities provided are flexible and varied to suit service users’ preferences and capacities. Service users spoken with informed us that they are encouraged to choose their own preferred routines as part of daily living in the home. Individuals living in the home told us that they woke and retired when they wished, that they enjoyed participating in activities of daily living such as enjoying the garden when the weather is good. We saw that the service users’ notice board provided clear information on what regular activities were taking place within the home; individuals living in the home stated that these activities take place on a regular daily basis. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 16 These include armchair exercises and bingo on Mondays, Hair dressing on Tuesdays quizzes, crafts and knitting on Wednesdays. On Thursday there is a mini-bus outing when the weather permits. On Saturday is old films and personal day. One service user stated in the comment card returned to the Commission “ We have quizzes, knitting, exercises, piano players. In good weather we go out in the minibus”. One service user we spoke with stated “I go to church with my friend every Sunday. Church is very important to us and we enjoyed participating with this. We have people from the Baptist church that come and take and take us to the service”. This made us believe that the home recognises that equality and diversity is an important element in care provision. One service user spoken with stated that they are supported to exercise their civic rights by using postal votes. This individual was attending a political party meeting on the day. The person stated that she has been a member of the political party for 65 years and that the greatest thing that happened to them was receiving a kiss from the political leader on her ninetieth birthday during one of the meetings. During the inspection visitors were seen at the home with their relatives. A service user told us that visitors are made welcome by the home and that their families remain an active part of their lives. The inspector viewed the home’s visitors’ book, which records that there are a number of visitors who visit on a regular basis. In care records we saw how staff support service users to maintain relationships with family and friends. We also saw that within the home’s Statement of Purpose it states that visitors are welcome and that the home encourages family support. To enable us to make a judgement about how the service users are enabled to maintain contacts with their families, we sent our comment cards to the relatives and some of the comments are written below. They include: “I live close by so visiting is reasonably easy. The hours of visiting are flexible. Through visiting we are fully informed of decisions”. “The staff are very welcoming whenever we visit”. During the inspection staff were observed asking service users for their views and opinions and service users were encouraged to make choices on aspects that affect their life. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 17 Service users’ rooms contained many of their personal possessions such as small items of furniture, ornaments, pictures, soft furnishings and photographs. One of the service users stated that they deal with their own finances and is supported by their bank with this. Family members would support other service users who require assistance in this area. We noted that lunch was not hurried and the dining areas were a relaxed area in which service users eat. Whilst lunch served on the day of this visit looked nutritious it was agreed that the menu needed to have more choices to enable the service users to choose what they would like to eat without limitation. We saw that service users who required assistance was given in a discreet sensitive way, supporting individuals to maintain levels of independence. Individuals told us that they enjoyed meals and that meals are flexible and that alternatives are available if required. One service user told us in a comment card, “If I don’t like the meal, I can have a choice of something else”. We saw that hot and cold drinks were freely available to service users. The kitchen was seen to be clean and in a hygienic condition. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 18 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): 16,17,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to complain and are confident that the home is able to protect them from abuse EVIDENCE: There is a complaint policy and procedure displayed at the home and in the Service User’s Guide. It contained information about the Commission for Social Care Inspection to enable service users and their relatives to contact the Commission if not satisfied with an outcome of a complaint. The complaint procedure contained details of how complaints would be dealt with and time-scale. Service users spoken with stated that they are able to complain to the manager or the providers if they were not satisfied with any area of the service because the providers are here regularly. Whist there were no recorded complaints at the home incident regarding a service user’s behaviour and subsequent move from the home was well documented. Individuals living in the home told us at a discussion that they have no complaints. One comment card from a service user stated, “ We can speak to any senior carer and they take notice of any complaint. I have spoken to other service users and we have nothing to complain about here”. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 19 The home has a robust policy and procedure for prevention of abuse of vulnerable adults. There is also South Gloucestershire guidance based on the ‘No Secrets’ policy for dealing with suspected abuse. Newly employed staff members had Criminal Record Bureau checks and two suitable references before commencing employment. We looked at the concern we received from a relative in regards to the process used by the providers to prevent their relative from returning to the home due to the individual’s challenging behaviour in order to protect the person and other service users. We looked at the person’s records and we noted that this person was admitted to the home in May 2007 on emergency for a respite and the family decided to extend the stay because they were satisfied with the care that the individual received. Letter from the family was seen in the individuals file. We noted that the home had appropriate care plans in place regarding some of the person’s needs identified on admission to support staff in meeting the service users needs. However there was no care plan indicating that this person can be irritable sometimes. The entries on the care records show that the individual had showed aggression towards other service users and staff on different occasions and was seen by the General Practitioner and the medication was reviewed. The family were involved in the decision-making. The individual was also referred to Bristol Memory Clinic in July 07 and was discharged after assessment. Evidence from the records regarding the most recent incident that led to the individual leaving the home showed that the home manager consulted the GP and other emergency services including the police for assistance in order to protect the person and other service users, however the measures failed. The family were informed of the difficulties the home was having on the day in relation to meeting their relative’s needs. The home however had not contacted social services because the individual was self-funding. The manager stated that the only option available at the time of the incident was to ask the family to seek alternative placement as stated in the Contract because they were unable to meet the individual’s needs. The Commission for Social Care Inspection has received notification from the home in relation to the incident that occurred at the home in order to comply with regulation 37, the inspector saw that information received had been well recorded at the home. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 20 The manager stated that they had learned from this experience and would ensure that a care plan is put in place for any individual with challenging behaviour and staff members would receive training on this subject to ensure that they are able to meet the needs of service users who have developed the condition whilst in their care. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 21 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): 19,20,22,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a safe, clean, well-maintained hygienic environment, comfortable bedrooms and specialist equipment suitable for service users needs. EVIDENCE: There have been no changes in the services and facilities provided at Edgecombe Lodge since the last visit. The location and layout of the home is suitable for its intended purpose. The home is a large Victorian house with accommodation set over three floors. There is a lift for access to the first floor and a stair lift to the upper level. The home is located in a residential area of Downend and fits in well with the local community and local amenities, with good transport links to other areas within South Gloucestershire and Bristol. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 22 The home is comfortable and the furnishings are of a high standard. The home is well maintained and meets the individual and collective needs of the service users at this current time. All areas of the home are accessible and there are handrails to the front of the property, the rear of the property is accessible by ramps. There are extensive, well-maintained grounds surrounding the property There are seating areas available to service users in the garden, a patio area, a pond and, the rear garden is extensive and provides a pleasant area for service users to enjoy during the warmer weather. There are two spacious lounge areas available for service users; there is also a sunroom and two dining areas. Generally, the home was found tidy, clean well lit, warm, comfortable and suitable for its stated purpose. It was well maintained with on going refurbishment. Service users were noted sitting in the lounge relaxed and enjoying each other’s company. Staff were wearing disposable aprons when serving and assisting service users with meals. This demonstrated that infection control and principles of hygiene are being followed at the home. Service users interviewed stated that they felt comfortable at the home. The home has an ongoing refurbishment programme, it was noted whilst touring the building that most bedrooms and the landings have been redecorated. Individuals living in the home stated that during the recent refurbishment, Mr Sardar consulted the service users about the type and colour of the carpet they wanted for the home. One individual told us “ We felt empowered to give our opinion about the running of the home”. Another service user stated in the comment card “ We have just had a lovely Axminster carpet laid throughout the home. The owners asked us about our views whether to get a plain one or patterned. We advised against a plain and I explained that I had an Axminster carpet laid in my flat for 27 years and people were asking me if I had just had a new one when I had to leave the flat to come here”. The laundry was noted to be clean and tidy. There are risk assessments of both laundry and kitchen. The manager stated that the home has recently employed a handyman whose responsibility is to deal with all maintenance work at the home. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 23 The maintenance book was up to date clearly stating jobs/tasks to be carried out, date completed and any relevant comment in relation to outstanding jobs. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 24 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. The home ensures that there are adequate staff numbers with good skills and competency along with training to protect service users. EVIDENCE: Evidence from the staff rota and discussion with the manager showed that the home has a sufficient staffing level to meet the needs of the service users. Individuals spoken with stated that staff attended them promptly when they rang the bell. One individual states, “I would like to say that the carers we have at present are wonderful I have been here since 2005 and never known anyone to refuse me when asked”. The manager stated that they would developed a training matrix to enable the home to identify what courses each staff member has attended and to ensure that relevant courses are provided. Evidence from the records show that staff have attended training to include manual handling update, fire safety First Aid, Protection of Vulnerable Adult from Abuse, infection control and medicine administration. It was also noted that two staff members have completed the National Vocational Qualification (NVQ) at level 2. It was agreed that the home must arrange for staff to Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 25 undertake challenging behaviour training to enable them to support individuals with such conditions if and when it happens. This enables the home to keep up to date and apply current practice in the care of the service users. We saw evidence that Mrs Sardar the home manager has bought a training package from Red productions an organisations which provide training and instruction to care staff in areas of: Foundation, Induction, Manual Handling, Basic emergency first aid, food hygiene, diet and nutrition, fire awareness and administration of medicines to equip staff to fulfil the aims of the home and the changing needs of the service users. At the last key inspection a requirement was issued for the home to ensure that staff employed at the home are able to communicate with the service users. The manager stated at this visit that one staff member with poor English language skill is attending an English language course at Filton College every Wednesday and that the person’s communication in English has improved. Review of records of recently employed staff members showed that statutory required documentation was in place before commencement of employment. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 26 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): 31,32,33,35,36,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from good leadership, and management, its practices adequately protect the health and safety of service users. EVIDENCE: The atmosphere at the Home on the day of inspection was positive and welcoming. Staff were noted interacting with service users in an informal and friendly manner. Staff spoken with stated that staff work as a team and that the Manager is very approachable and would listen. These have enabled staff to provide quality care and support to individuals living in the home. Service Users spoken with made positive comments about the Manager and the deputy Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 27 matron. One service user stated,” the manager is very good, she is always here when you want her.” One relative stated in the comment card ‘ William and Nargis really care about the residents and want them to be happy’. Another comment card states “it is a well run home”. We have a very good deputy matron who is called Mandy whom we have known for many years and I would like to say that the carers we have at present are all wonderful”. “We are very satisfied with the standard of care provided by the management and staff of Edgecombe Lodge. Every effort is made to meet my relative’s needs. Through regular visits and involvement with the home we feel well informed about matters in relation to our relative”. The registered manager came across during the visit as open, positive and committed to providing a quality service for individuals living at the home Staff supervision records were reviewed. Evidence from the records viewed showed that staff has received supervision. Staff spoken with confirmed that they have received regular supervision and yearly appraisal. The staff member stated that they benefited from the exercise. It afforded them the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to service users’ care. Health and Safety records showed that the home had undertaken generic risk assessments of vulnerable areas of the home. It was agreed the risk assessment must include service users bedrooms, lounges and the dining areas to ensure that the service users are adequately protected from potential accidents. Accidents were noted to be properly recorded however we were concerned about the number of accidents to service users at the home between November 07 and February 08. We also noted that some service users have no risk assessment reviews following the accidents. This is not good practice. We discussed our concerns with the home manager and it was agreed that risk assessments of all the service users living in the home are reviewed including the care plans where necessary and the evidence of these sent to the Commission For Social Care Inspection. This evidence has been received and the information seen was satisfactory. The manager stated that they would ensure that all accidents to service users are reviewed in future including the minor ones. The fire logbook was noted up to date and evidence from records and confirmation from some staff showed that staff have attended fire drills. Records indicate that fire alarm systems including fire-fighting equipment have been checked yearly. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 28 Whilst touring the building several fire doors were noted wedged open. The home manager stated that the home proposes to buy ‘door guards’ for all the doors in the home to enable service users who wish to keep their doors open to do so without compromising the safety of other service users, staff and visitors in terms of fire emergencies. A requirement notice has been issued that the fire doors must not be wedged open. Other health and safety measures include Gas boiler inspection, February 2008 Portable Appliance Testing (PAT) August 2007 passenger lift January 2008. Five Yearly Electrical Installation Safety Inspection was undertaken February 2006. We looked at how the home reviews the quality the services that they provide. The Manager stated that the home assesses the quality of its services using different tools. These include employee satisfaction surveys service user/ family surveys and admission to the home surveys. These are analysed and all areas that need to be addressed are dealt with in a professional and constructive manner. Other methods used to review the quality of its service include monthly care plan reviews, Social Services periodic reviews, service users meetings, staff meetings manager regular one to one visits to service users and thank you cards from families. The manager told us that one service user is supported to manage her own finances and that families manage the finances of other service users. Policies and procedure noted at the home include Protection of Vulnerable Adults from Abuse, Concerns and Complaints, Confidentiality, Moving and Handling, Infection Control, Health and Safety. Recruitment and Missing person’s policies were also in place. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 30 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. 2. Standard OP38 OP4 Regulation 13 18 Ensure that individuals admitted receive confirmation in writing that their needs would be met. The registered persons shall make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home: Medication administered must be signed by the staff member to avoid drug errors. 4. OP38 19 Ensure that service users call bells are placed within easy reach of the individual to enable them to summon assistance in an emergency or if requiring basic needs. All care plans must be formally reviewed with service users and their representatives where appropriate. 22/04/08 Requirement Ensure that risk assessment is undertaken following falls to identified service users. Timescale for action 22/04/08 20/04/08 3. OP9 13(2) 20/04/08 5. OP7 15 20/04/08 Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 31 Care plans must be in place for identified service users needs. 6. OP30 15 Provide staff with training on Challenging behaviour to enable them to support individuals who display behaviours that challenge. Undertake generic risk assessments to include the lounges and service users bedrooms. Ensure that fire doors are not wedged open order to protect service users from harm in the event of fire outbreak. 22/04/08 7 OP38 13 22/04/08 8 OP38 13 22/04/08 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 OP4 OP15 Good Practice Recommendations For the home to confirm in writing to the individual to be admitted to the home that their needs would be met. Extend meal choices to service users. Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Edgecumbe Lodge Rest Home for the Elderly DS0000062860.V359997.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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