Care Home: Forest Lodge

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What the care home does well There is a detailed and informative Statement of Purpose and Service Users Guide that gives prospective residents the information required to enable them to make an informed choice about where they live. There are robust admission processes to the home which include a full needs assessment by a competent person and prospective residents and/or representatives are assured in writing that their needs will be met. Some residents were able to confirm that they were visited by the manager prior to admission to the home and two relatives said they they were involved in the admission process. Activities within the home remain creative and fulfilling and enjoyed by the residents in the home and the trips out are extremely beneficial for the people who use the service. The menus evidence a well thought out balanced diet with a varied choice of food in line with residents preferences. Quality assurance systems are in place which enables the service to monitor and improve their service and ensure that the home is run in the best interests of residents. There is an open-house policy which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. Surveys stated ` Very caring staff` ` The staff are very kind` ` Always a warm welcome` What has improved since the last inspection? The home have continued to improve the activities in the home to ensure that the residents recieve mental and physical stimulation. The home have introduced a nutritional tool and have accomplished use of local Primary Care Trust guidelines in nutrional screening to promote the dietary care in the home and promote the well being of the residents. The home have ensured that all staff have the mandatory training required to meet the health and safety of all the people who use the service. Further staff have undertaken specialist training in palliative care, dementia awareness, equality and diversity and nutrition and healthy eating. The home have gained the Hospitality Award and further staff have achieved National Vocational Qualification level 2 & 3. What the care home could do better: Whilst there is a detailed and informative Statement of Purpose and Service Users guide in place, it is not readily available for the residents and relatives to refer to. This was confirmed by several visitors to the home. One relative voiced concerns that she did not know what would happen in the event of a fire or other emergency situation and this worries her. The documents are also in need of updating to ensure the information provided is current and reflects the service provided. The care plans for residents need developing to ensure that a person centred approach is used in meeting the residents` health, social and welfare needs. The involvement of residents and relatives is not evidenced and feedback from three different relatives stated that they would like to be involved and informed of changes and contribute to the health reviews held. The cleanliness of the home does not meet the expectations of residents, visitors and staff. There were comments regarding sticky door handles, and slight odours around the home. Some floor coverings were sticky and unclean. This was confirmed during the site visit. The laundry facilities were seen to be organised, but feedback regarding lost property and clothing was mentioned in many surveys: in particular foot wear and eye glasses. The management structure in the home has been unsettled in the past year. Two appointed managers were in post for six months approximately before moving on. This has impacted on the atmosphere within the home and also on the staff morale, which then impacts on the people using the service. The area manager is aware that this is a problem and confirmed that the managers post has been filled and will be commencing work next week, the newly appointed manager will be suppported by the senior management of the organisation and the staff team. The staff try hard to interact positively with the residents, but from direct observation and feedback from visitors, further training in communicating with people who have a dementia type illness would be beneficial to both residents and staff. The staff surveys indicated that they felt that the communication between staff, residents relatives and health professionals could be improved and this is also the general feedback from people in the home and visiting. The area manager has acknowledged the shortfalls discussed and has stated that these will be adressed immediately. This has been reflected in the report and therefore requirements have not been made at this time. Key inspection report Care homes for older people Name: Address: Forest Lodge Horney Common Nutley Uckfield East Sussex TN22 3EA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 2 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Forest Lodge Horney Common Nutley Uckfield East Sussex TN22 3EA 01825-712514 01825713653 forestlodge@sussexhealthcare.org www.sussexhealthcare.org Sussex Health Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 68 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental Disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Forest Lodge is registered for 68 people aged over 65 years on admission who have dementia or a mental disorder. Nursing care is provided in the home. The home is owned by Sussex Health Care and is located one mile north of Nutley, East Sussex. Due to its rural location there are no local amenities within easy distance of the Care Homes for Older People Page 4 of 28 Over 65 0 0 68 68 Brief description of the care home home. The home is divided into three units, Cedar, Beech and Ash, which are spread over two floors. Each unit has a Registered Nurse and Unit Leader. There are fortyseven single occupancy bedrooms and seven double occupancy bedrooms (two of which are singly occupied) in the home. Twenty-four bedrooms have en-suite facilities. There are additional toilets, shower rooms and bathrooms located throughout the home. There are four lounge areas, three of which are utilised as quiet and/or activity lounges. The home has a good sized dining area. The home has a number of specialist equipment in use such as mobility aids, specialist nursing beds and bath and moving/handling hoists. There is a shaft lift and ramps in the home to ensure that service users have access to all parts of the home. Potential new service users can obtain information relating to the home via the internet, CSCI Inspection Reports, Care Managers, Placing Authorities, by word of mouth and by contacting the home direct. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Forest Lodge will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 29 June 2009. The site visit commenced at 09 30 am. There were sixty two residents living in the home on the day of which six were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections Care Homes for Older People Page 6 of 28 had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with two trained nurses and the area manager. Telephone contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit and four relatives were contacted following receipt of a completed survey. There was a good response to the surveys sent to the relatives, residents and staff. There comments both positive and negative provide an insight in to the lifestyle in the home. 12 responses from staff and ten from relatives were recieved with some asking for a telephone call. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment AQAA was received from the recently resigned manager completed competently and in full prior to this key inspection. The information received in the AQAA was measured against the information gathered on the site visit. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 28 Whilst there is a detailed and informative Statement of Purpose and Service Users guide in place, it is not readily available for the residents and relatives to refer to. This was confirmed by several visitors to the home. One relative voiced concerns that she did not know what would happen in the event of a fire or other emergency situation and this worries her. The documents are also in need of updating to ensure the information provided is current and reflects the service provided. The care plans for residents need developing to ensure that a person centred approach is used in meeting the residents health, social and welfare needs. The involvement of residents and relatives is not evidenced and feedback from three different relatives stated that they would like to be involved and informed of changes and contribute to the health reviews held. The cleanliness of the home does not meet the expectations of residents, visitors and staff. There were comments regarding sticky door handles, and slight odours around the home. Some floor coverings were sticky and unclean. This was confirmed during the site visit. The laundry facilities were seen to be organised, but feedback regarding lost property and clothing was mentioned in many surveys: in particular foot wear and eye glasses. The management structure in the home has been unsettled in the past year. Two appointed managers were in post for six months approximately before moving on. This has impacted on the atmosphere within the home and also on the staff morale, which then impacts on the people using the service. The area manager is aware that this is a problem and confirmed that the managers post has been filled and will be commencing work next week, the newly appointed manager will be suppported by the senior management of the organisation and the staff team. The staff try hard to interact positively with the residents, but from direct observation and feedback from visitors, further training in communicating with people who have a dementia type illness would be beneficial to both residents and staff. The staff surveys indicated that they felt that the communication between staff, residents relatives and health professionals could be improved and this is also the general feedback from people in the home and visiting. The area manager has acknowledged the shortfalls discussed and has stated that these will be adressed immediately. This has been reflected in the report and therefore requirements have not been made at this time. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the services offered at Forest Lodge is available for all prospective residents and their families, it does however need to updated to ensure the information supplied is accurate and current. The home welcome and encourage prospective residents and their representatives to visit the home prior to admission to enable them to assess the suitability of the home and meet the staff and fellow residents. Evidence: There is a folder that contains the Statement of Purpose and Service Users Guide which evidenced they are written in a format that is user friendly and informative to read. The folder however does need to be updated to reflect the current management structure and other information to ensure that residents and their representatives are kept informed. It is located in the reception area of the home and available on request. The AQAA stated that it is provided to all residents living in the home, however this could not be proven whilst talking with residents. One relative confirmed Care Homes for Older People Page 11 of 28 Evidence: that they had been given a copy of the homes documentation when placing their relative in the home. Another relative shared her concerns that she had not recieved any information about the home in respect of fire safety and other emergency situations. It was confirmed whilst talking to relatives and from surveys received that the contract arrangements were clear and understood, the contracts for four residents were viewed and are kept in a locked facility to safeguard personal data. The pre admission documentation for six residents were viewed as part of the inspection process. This assessment is performed usually by the appointed manager and it was confirmed that all prospective residents are visited prior to admission. The format of the document was seen to be appropriate, but not all were competently and consistently completed so as to be able to assess whether the home has the facilities and knowledge to meet their needs. The information contained in these assessments is then used to provide the basis of the care documentation in the home. A weekly team briefing is held and the prospective resident is discussed with staff so all staff are aware and are prepared of the residents expected needs. The prospective residents are seen either in their home or hospital before admission and it was confirmed that wherever possible the family or representative is involved. The area manager acknowledged the shortfalls in the documentation and stated that further training would be provided to ensure a consistent and full assessment is completed on all prospective residents that will ensure that the placements are appropriate and safe. There was no manager available at this visit however the senior nurses were able to confirm that the training provided by organisation enabled them to meet the needs of the people who use their service The Statement of Purpose and the statement of terms and conditions stated that trial visits and respite visits to the home can be arranged to ensure the suitability of the home and to allow prospective residents to meet staff and other residents. The home offer a day care facility for two people at this time which includes meals, activities and personal care as required and agreed by the person and or their representative Medications however are not administrated by the home staff Intermediate care is not provided at Forest Lodge Care home Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide a good framework for the delivery of care which give clear guidance to care staff on all the care needs of all the residents, it does however need to be developed to ensure that person centred care is delivered. The home was found to be meeting residents health and general needs with accessed additional specialist support when needed. Medication practices in the home promote and protect the health needs of residents and on the whole the privacy and dignity of residents are promoted. Evidence: Six care plans were viewed in depth as part of the inspection process: two from each unit Cedar, Beech, and Ash. The care documentation for the two people who receive day care were also viewed. The care plan format used is still not achieving a person centred approach, in that the staff are still using the generically produced plans without personalising them to suit each individual resident. This means that everybody is getting the same care, no matter what their health, social or welfare needs and personality are. This was discussed in full and two further care plans were produced that had been personalised and these were found to be more individually tailored to Care Homes for Older People Page 13 of 28 Evidence: meet those residents needs. The area manager confirmed that all staff have received personalised care plan training and that this would be the first area to be reviewed by the newly appointed manager who commences work next week. The home continue to use separate wound care folders, bowel management and nutritional folders and these were seen to be appropriately completed and up to date for those who have wounds and are nutritionally at risk. The residents who are physically very frail and who are dependent on being assisted to eat, drink and turn in bed each have a fluid/ turn chart that is signed and completed by the staff, these were seen to be completed in full. It was noted however that despite being a very warm day, extra soft drinks were not being offered to any resident throughout the visit. Risk assessments for health and mobility needs are in place and evidence regular review: these include environmental risks to individual residents. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation in the nurses station, which allows for the residents to be cared for in a consistent manner. The care plans do not evidence family or service users involvement in the formation of the care plans or any involvement in the reviews. One relative felt that she was not kept informed of changes in her relatives health and care needs, and another mentioned that they were not kept informed of weight loss, what was being eaten and if they need nutritional extras. Care staff record the care they have given to their allocated residents and whilst these detail personal care they do not reflect residents mental health status- whether they were happy or sad, whether they were agitated or calm which is an important part of dementia care. These shortfalls were discussed in full and acknowledged by the area manager and extra training for staff will be provided by the organisation and the documentation will be monitored closely, therefore a requirement has not been made at this time. All residents are registered with a local GP practice and there was evidence of involvement from other health care professionals, such as dentists and opticians with domiciliary visits arranged as required, which ensures that their health needs are monitored and met. There are two clinical rooms, one on each floor that are kept locked when not in use thus ensuring the safety of residents and in ensuring medications are kept safe. There are policies and procedures in place for the storing administrating disposal and receipt of medication. A self-administering policy is in place but there were no residents at this time self-administering their medication. The home also have a policy in place for covert administration as agreed and discussed within a multi disciplinary group. Care Homes for Older People Page 14 of 28 Evidence: Guidelines for as required (PRN) medication are in place, these were up to date and evidence regular review and risk management. The medication administration charts were viewed and were found completed to a good standard, systems have been put in place to regularly audit the charts to ensure that staff are completing them properly. There were items in the fridge that were out of date and the use of a Shock Kit needs to be reviewed and underpinned with appropriate guidelines and instructions for use by the General Practitioner. Staff were unable to discuss the use and method of use. Photographs of residents are available to aid identification but as discussed, dating the photograph and regular updating of photographs would be beneficial as some residents bear little resemblance to the photograph. The residents living in Forest lodge have varying degrees of dementia and mental health needs, the home staff assist residents with maintaining their independence in their daily living and daily routines underpinned by robust risk assessments. The residents in the home were dressed in appropriate clean clothing and residents personal hygiene in respect of their nails and hair was seen to be good, which is evidenced that the staff were maintaining their dignity. Comments from families included: Always clean and dressed well Sometimes not changed after spilling a drink, so her clothes looked stained Very concerned about foot wear, light shoes have gone missing and no pair of slippers, but los of single mismatched ones, I am very grateful to the home my relative is happier and this is a huge weight off my mind. The surveys received Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are supported and enabled to make a range of choices about their lives as well as maintaining links with friends and relatives. Evidence: Forest Lodge has an activity programme that is displayed in the home on a weekly basis. It demonstrates that there are activities everyday, including weekends. Due to special circumstances there were no activity personal working during this site visit and so it was not possible to make a judgement on what was observed and so the information was taken from surveys received, verbal discussion with staff and the area manager and available documentation. The staff did do karoke singing with some residents in the small lounge in the afternoon, but little one to one interaction was observed in the larger lounge. The organisation have employed a team of three activity co-ordinators at Forest Lodge who ensure that a wide range of social activities are offered, with residents making a choice daily on whether they want to take part or not. The AQAA stated that residents are consulted regularly on the activities and their suggestions are then included in the Care Homes for Older People Page 16 of 28 Evidence: programme. The home offer trips out at least twice a week in the homes minibus, these include trips to Brighton for fish and chips, visiting Beach Head and various other local beauty spots. The activity co-ordinators maintain notes on the activities attended and enters them in to the main care plan monthly. The home also arranges fetes and relatives are encouraged to be involved. Feedback recieved in the surveys state that activities are well organised and enjoyed by residents. There is evidence of representatives of different faiths visiting the home and feedback from one relative confirmed that her relative received communion regularly. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents living in the home. There is a certain amount of flexibility to the daily routine and residents preferences are taken into account and recorded in the care documentation: it would be beneficial if these preferences are reviewed regularly to reflect the residents health and mental health changes. The dining room is large and has plenty of natural light, it is furnished with a range of tables so residents can sit on their own if they wish to or choose to have company. Residents were seen being assisted with their meals in a helpful and discreet manner. There are some residents that eat in their bedrooms and staff were seen to be assisting those as necessary. The menus were viewed and displayed a varied and nutritious variety of food. There was evidence that an alternative choice for all meals was available and fresh fruit is also readily available. The mid-day meal was nutritious and attractively presented. It was confirmed that a vegetarian option is available if requested. At the last key inspection it was stated that pictorial menus are being devised to enable residents to indicate their choice, from talking to the catering staff this has not yet been completed or implemented. Staff were seen asking residents what they wanted in case they had changed their mind. All meals are home cooked with an alternative option available for each mealtime. Medical therapeutic or religious diets are provided as required. Environmental Health Officer visited the home in March and there was a positive report available. From talking to Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practice in the home ensures that complaints are responded to with residents and their representatives being confident that they are listened to and demonstrated that robust procedures are followed. Practice in the home ensures that adult protection issues are responded to when identified. Evidence: The home has a clear complaints procedure and a copy of this is readily available in the home. A system of recording complaints was demonstrated to the inspector during her visit to the home. Most relatives and visiting professionals spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. Two relatives did state that they did not feel reassured that their complaints were taken seriously. This was relayed to the area manager and will be investigated within their policy. The home has relevant guidelines on the protection of vulnerable adults and all staff have received appropriate training. The management team has a clear understanding of adult protection guidelines. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Forest Lodge provides a comfortable and safe environment for those living there and visiting. Residents and relatives are enabled and encouraged to personalise their room and rooms are homely and in the main reflect the residents personalities and interests. Evidence: Forest Lodge provides a safe and comfortable environment for its residents and for those visiting. The home has an on-going refurbishment programme and when rooms become vacant they are routinely decorated and refurnished. It is acknowledged by area manager that the communal areas of the home are in need of redecorating and brightening in order to create an environment that can enhance, stimulate and soothe people who suffer from a dementia type illness and also encourage independence by using colours and themes. There are large gardens that are enjoyed by the residents and their relatives. The security of the gardens have recently been reviewed and improved to ensure the safety of the residents. There are adequate communal bathrooms and shower rooms in the home with specialist equipment which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is Care Homes for Older People Page 19 of 28 Evidence: provided e.g handrails in bathrooms, hoists wheelchairs and lifts to all areas of the home. Call bells are provided in all areas of the home, which enable residents or staff to summon assistance when required. There are various communal sitting areas, two of which have sensory equipment which residents would benefit from if they were accessible to them. They were locked during the whole site visit. It was stated that the activities take place in the large sitting room which also has television and music equipment and a further lounge area where residents could sit and relax in quiet. Further seating areas are provided in the gardens, which encourage the residents to enjoy the good weather. There was evidence of residents being encouraged to personalise their rooms with their own belongings and bits of furniture The bedrooms are comfortably furnished and most were pleasantly decorated with neutral colours, some furniture though is shabby and not fit for purpose. Policies and procedures for infection control are in place and are updated regularly. The communal areas of the home were adequately clean and mainly free from offensive odours on the day of the inspection. However some flooring was found tacky underfoot, furniture and door handles were sticky and there was some areas that had a distinct mal odour. The surveys of five staff members and four relatives all said that the cleanliness of the home is in need of improving to ensure that the residents live in a clean and hygienic environment. Resident chairs need to be checked regularly for food debris as some were distinctly grubby. The staff were observed following the organisations policies and procedures for infection control measures whilst attending to residents and in dealing with soiled laundry and incontinence aids. There were gloves and aprons freely available in the home and staff are to be reminded of the organisational policies in the use of protective clothing when dealing with the residents food. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient suitably trained staff on duty to ensure that residents receive the level of care they need. Staff training ensures they are aware of their roles and are able to provide the support and care the residents need. Evidence: A staffing rota was in place and evidenced that the staffing levels are consistent and that the skill mix and numbers of staff are sufficient to meet the health needs of the residents. It was confirmed by the area manager that the organisational policies ensure that there is flexibility to the staffing levels and they are adjusted according to the changing needs of the residents. Care staff spoken to said that the levels of staff on duty were sufficient to give the care required but were stretched when the activity co ordinators were not in to work to help supervise and interact with the residents. The recruitment files of four employees were viewed and evidenced that the home management team follow robust procedures when employing staff that support and protect the residents. They contained the required information and demonstrated that the appropriate induction training had been completed in respect of the job they were to undertake in Care Homes for Older People Page 21 of 28 Evidence: the home. A number of the current staff team are from abroad and all necessary visa and Home Office related documents were found to have been obtained and kept on file. Job descriptions were not evidenced in individual files but it was verbally confirmed that these are given to staff with their terms and condition of employment so as to underpin their role in the home. Staff from differing denominations were spoken with and confirmed that the organisation provides good training which enables them to competently perform their role in meeting the health, welfare and social needs of the people who live in the home. This was also confirmed by the records provided. All staff are encouraged to undertake a Nation Vocational Qualification (NVQ) whilst working in the home and the AQAA stated that the home employ 24 care staff of which 13 have an NVQ in care. A large number of senior care staff employed by the home are Registered Nurse whom qualified in their home country English classes are held in the home and are attended by the staff to ensure that communication Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of residents and staff are generally well promoted and protected. Evidence: There is no registered manager in post at present and the home have had two appointed managers who have both resigned after six months. The area manager confirmed that a newly appointed manager will be commencing work next week. The deputy manager is currently on maternioty leave and therefore the residents, relatives and staff are feeling the effects of no clear leadership and management structure at present and this is affecting the morale and communication between differing staff levels. This lack of management structure therefore impacts negatively on the positive outcomes for those living and visiting Forest Lodge. This was acknowledged by the area manager and systems will be put into place immediately to support the newly appointed manager and ensure that the home benefits from an effective management structure to meet its stated purpose, aims and objectives. Care Homes for Older People Page 23 of 28 Evidence: The feedback from residents, relatives and staff indicated that they do not feel fully supported and that they would like a permanent manager to stay for longer than just a few months. The formal quality assurance and quality monitoring systems in the home enable the management to objectively evaluate the service and ensure it is run in residents best interests. Regulation 26 visits are undertaken monthly by the area manager and these form part of the quality assurance systems in the home. Resident and relative meetings are held and are minuted and available to all. The staff mentioned the staff meetings and how beneficial they were and the staff felt that areas of improvement they put forward were acted for the benefit of the residents. Residents financial interests are safeguarded by the homes policies and procedures. All staff spoken with were aware that they must not be involved in any financial matters of the residents, they also said that they would not accept money or gifts from residents or relatives. The staff training records show that all staff are kept updated on the Health and Safety policies, the organisations policy and procedure manual is available to all and clearly defined. Staff were able to discuss the training they received and said that they were kept up to date with changes to policies in connection with fire safety and health and safety. There is a rolling programme for training and those who miss due to holiday or illness will be put forward to the next available course. Most of the training is provided inhouse by suitably qualified trainers. The home has a comprehensive set of policies and procedures which govern the running of the home. It was confirmed that regular supervision sessions take place and all staff spoken with confirmed that the supervision sessions are beneficial. Throughout the inspection good practice was observed in regards to ensuring the safety and well being of the residents when being moved around the building. However verbal and written feedback raised concern in respect of the safe transferring of residents whilst in wheelchairs. These concerns have been passed to the area manager to investigate. The accident forms were seen and had been correctly completed with appropriate referrals made as necessary. The provision of well stocked first aid boxes were seen but they need to be placed in areas that they can be accessed easily when required. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 23 That the registered person ensures that parts of the home are kept clean and reasonably decorated and meet the aims and objectives set out in the Statement of Purpose. That the home is clean, hygienic and pleasant for those living, working and visiting the home. 08/09/2009 2 31 12 That the registered person 08/09/2009 ensures that there are suitable and robust management systems in the home whilst the managers post is vacant and that there are clear lines of accountability within the home at this time. This is to ensure that the service users live in a home that is well managed. Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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