Care Home: Howard Lodge

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What the care home does well What has improved since the last inspection? The requirements raised at the last inspection had all been addressed - as had the majority of the recommendations. Risk Assessments have been improved, staff recruitment is properly conducted with all checks in place prior to employment, and concerns around the hot water outflow temperatures have been addressed, including the introduction of a tighter checking routine. There is clearly a greater involvement of residents and relatives in the planning of care packages and engagement in the home. As this was the inspector`s first visit to the home, it is more difficult to state what other aspects at the home had improved, but the AQAA and the developing facilities at the home indicate a positive investment and clear focus on improve g quality for the future. CARE HOMES FOR OLDER PEOPLE Howard Lodge 5 Warren Road Purley Surrey CR8 1AF Lead Inspector David Pennells Unannounced Inspection 22nd August 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 Howard Lodge DS0000066326.V369689.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. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Howard Lodge Address 5 Warren Road Purley Surrey CR8 1AF 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) 020 8668 1165 020 8763 9909 heena107@hotmail.com Ms Heena Patel (Howard Lodge Limited) Ms Heena Patel Care Home 21 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (21) of places Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: - Old age, not falling within any other category - Code OP (of the following age range: 65 years and over) (maximum number of places: 21) - Dementia - Code DE(E) (of the following age range: 65 years and over) (maximum number of places: 5) 2. The maximum number of users who can be accommodated is: 21 19th July 2006 Date of last inspection Brief Description of the Service: Howard Lodge is an independent residential care home registered to provide personal care for up to twenty-one older people. A variation has been granted to allow the home to accommodate a maximum of five people over the age of 65 years who have additional dementia needs. The house is a large detached Edwardian property situated in a pleasant suburban area of Purley. The home is within easy walking distance of local shops, bus routes and a main line railway station. The home consists of seventeen single occupancy bedrooms and two doubles, eleven of which have their own en-suite facilities. On the ground floor there are two spacious lounges, a conservatory and wood panelled dinning room. Sufficient numbers of suitably adapted bathroom and toilet facilities, including en-suites, are conveniently located near or within service users bedrooms and the communal areas. The home has a separate kitchen, laundry facilities, and two offices, of which the manager uses one. The garden and patio area are generally well maintained and there is space for parking vehicles in the front drive or on the road toll-free immediately outside. Fees charged for the service range from £455.00 to £540.00 per week. Extra charges may be payable for some extras such as hairdressing, newspapers and chiropody but this detail would be discussed prior to admission. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We visited the home for a long day, arriving at 9.30am - prior to the registered manager’s arrival - and spent time with the people living at the home prior to concentrating on the administrative side of the inspection. Lunch was sampled, the premises were toured, and suppertime was observed. We spent more time with those living at the home prior to leaving at 7.00pm, following a feedback session with the registered manager / proprietor. We are grateful to those living at the home, to staff, and to Ms Patel for the welcome, cooperation and hospitality shown during the visit. We are also grateful to nine people living at the home (a roughly representative sample of those living at Howard Lodge), three relatives and four staff for completing questionnaires, which were returned to us by post. There has been one change of management within the actual home since December 2005, when Heena Patel was registered with other partners; a new manager came into post in Sep 07, however due to personal reasons resigned after four months - with Heena Patel taking the management role back again. The other partners have also now subsequently withdrawn, leaving Heena Patel as manager / sole proprietor. The manager / proprietor completed an annual quality assurance assessment (AQAA) document for us that was completed in August 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The document was excellently filled in, giving a very good insight into how the home was running and what the proprietor aspires to for the future. What the service does well: “They’re very kind to you here” was one of the first things heard during the inspection visit; and “I am very happy here” was repeated more than once verbally and in the questionnaires received back from people who live at the home. Relatives reported: “We are very impressed by the kindness and caring attitude shown by staff to residents. We can see that the residents’ welfare is important to them.” - and “Heena Patel is very efficient, but also kind and approachable.” Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 6 The home is a warm and homely environment, which strikes one as an extended family home, rather than a substantial care service for up to 21 people. The traditional furnishings and décor lend a ‘quaint’ air to the premises, whilst generally ensuring the safety of the people who live there through being both clean and well managed. The home ‘scores’ at least at a solid and consistent level of ‘standard met’ in each section that has been inspected; the general overarching approach by the home in all aspects of its operation are becoming or are very satisfactory. Where concerns or issues were pointed out, the manager / proprietor immediately sought a solution to the issue, and was impressive in her initiative and lateral thinking. She is clearly an intelligent and forward thinking person who is ideally suited to such a developmental role in a care home. The home should now aim to consolidate its improvements, record keeping and audits - the quality of the service clearly has further to go - and it is moving in the right direction. What has improved since the last inspection? What they could do better: Two issues only arise as requirements from this report; both relating to safety and staircases. It was discovered that one fire staircase was not as clear as it should be (the Fire authorities refer to such areas preferably being ‘sterile’); some items of equipment and furniture had encroached onto this area - which could cause a blockage in an emergency, and - anyway - encourages ‘bad practice’ when such a ‘convenient’ location is found. The second concern was for the door at the top of the basement (/lower ground floor) staircase to the ground floor - which was not locked when the inspector arrived, nor later on that morning. This door is central to the ground floor area. Such a steep staircase could be the cause of a significant accident if a person wandered that way. This door must be kept locked at all times. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 7 A few final recommendations relate to best practice aspects within the home. 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. Howard Lodge DS0000066326.V369689.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 Howard Lodge DS0000066326.V369689.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): 2, 3, 5 & 6. 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 are appropriate arrangements and pre-admission assessments for obtaining information about the needs of a person before they move into the home - which allows for these specific needs to be fully addressed and met. This user-focused service involves people at the home with their relatives / friends in fully participating in the process of the planning for their care and monitoring their changing needs, thus ensuring that the wellbeing of service users is promoted and protected. The home does not provide intermediate care. EVIDENCE: The home has a pre-admission questionnaire that ensures that a good idea of what service level is required is already known prior to admission. These assessments are carried out in the person’s home or in a hospital setting. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 10 Relatives / next-of-kin are also consulted to build up as big a picture as possible for the developing care plan. The prospective person and their relatives are encouraged to visit and ‘test drive’ the home to see if they feel comfortable there. The manager makes herself available whenever is convenient to both the current and prospective residents, enabling any questions or concerns to be resolved. An admissions checklist is used, as is a keyworker’s checklist to ensure a smooth introduction to the home. A relative newcomer to the home and their relative were very positive about the process; it was acknowledged that the manager had given “every help needed to settle [the newcomer], including providing information about life as a resident and services available.” Clearly even the preliminary care plan was working, as they commented: “[they] have been at Howard Lodge only a short time, but we are reassured to find all her needs are met.” The majority of people living at the home are privately funded; local authorities - currently Croydon and Northampton social services - fund about a third of the placements. All respondents to our survey confirmed that they had received contracts for the service they receive from the home. Every respondent also stated that they received enough information to make a considered opinion and decision about whether to apply to move into the home. The first month of occupancy is seen as a trial after which a written assessment is produced to confirm the stay and to agree fee levels. The manager is hoping to develop a post-admission mini-survey to gain more feedback about how the entire process is received from the resident’s - and relatives’ - perspective. Howard Lodge DS0000066326.V369689.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. 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. Good arrangements exist for ensuring that service users have their health, social and personal care needs well met, with new documentation available to ensure that all staff members are clear about how they should address people’s needs. There are good arrangements for ensuring that medication is handled safely, and a strong emphasis is placed on protecting the dignity, and respecting the privacy of service users. This focus ensures that the well being of service users is protected and promoted. EVIDENCE: The planning of care has developed more recently as a new system of care planning has been introduced alongside the keyworker system. Monthly meetings are held to bring together reflections on a person’s progress and to record changes. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 12 A relative observed: “I have spent quite a lot of time at Howard Lodge and have observed the staff’s kindness towards my [relative] at all times. They know her needs and are happy to learn of anything else I tell them.” More than one relative noted the staff’s kind attitude and caring. All respondents to our questionnaire stated that they received the care and attention they needed ‘always’. There is a choice of a ‘Parker bath’ or a ‘Malibu’ bath facility to make bathing easy for both service user and staff. They also unanimously confirmed that staff listened and acted on what they said, confirming that staff are available when they are needed. All respondents to our questionnaire stated that they received the medical support they needed. All are able to access GP, chiropody and district nursing attention as needed. It is recommended that the chiropody service at the home should be moved from the open conservatory area (as was the case on the day of the inspection visit) either to individual people’s rooms or that privacy screens should be provided. Boots the Chemist - who also provides some of the staff training and regular advice and support visits - provides the medication. A senior carer and the manager deal with ordering and receipt of medication stocks. Almost all medication is provided in blister packs, and the storage and recording of its administration was kept tidy and well ordered. Only authorised staff members administer medication, and the manager undertakes an overviewing audit on a weekly basis. Two people self-medicate themselves and this is carefully recorded on a selfmedication authorisation document. A record of their medication is kept up-todate to ensure that all relevant information is kept at the home. One issue arising from the examination of ‘prn’ (‘when required’) medication was thoroughly addressed within 24 hours of the inspection visit, to the satisfaction of the inspector; within this time the prescribing GP had been consulted, and a clearer procedure was put in place to ensure no room for misunderstanding in this discretionary area of administration. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 13 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 - 15. 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. People’s lifestyles in the home continue to be varied - with an activities programme seeking to express individual’s social, cultural and spiritual backgrounds. A positive welcome is given to relatives, friends and visitors, ensuring active and ongoing engagement with past skills and interests - and an enjoyable lifestyle. Wholesome and enjoyable meals are provided - in a pleasant and warm environment; by responding to choice and preferences, this encourages a balanced diet and the positive benefits from nutritional wellbeing. EVIDENCE: All except one of the respondents to our questionnaire stated that there are activities within the home in which they participated; one proudly stated: ”I have recently started knitting again after many years.” Another mentioned: “I enjoy having may nails done” and another: “I take part in the piano and other activities….” The home offers a wide range of activities - an Activities coordinator attends the home 2-3 times a week and offers a wide range of Reminiscence / bingo / Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 14 poetry/ discussion groups / armchair aerobics / puzzles and manicures. Theme days are also run to celebrate particular festivals or cultures. Visiting theatre shows are also booked for festivals such as Easter and Christmas. A monthly pianist session is widely enjoyed (by the staff as well). One person commented that activities such as the Piano playing should or could be used more; it is already the declared intention of the manager to increase such sessions. A relative commented: “it would be nice if residents could be encouraged to sit outside more and get the fresh air - and perhaps even more local outings.” Religious practices are encouraged through a Christian Service being held regularly at the home - enabled by a group from a local Church - and through Holy Communion being provided by a Roman Catholic priest on a weekly basis. Phone points are available in each bedroom, enabling people living at the home to have a private telephone line installed to provide their own lifeline to the outside in their own privacy. Newspapers, magazines and other periodicals are delivered daily to nine people at the home, and an in-house library stock (including big-print) is rotated two-monthly. Relatives are very welcome at the home; as evidenced by a number calling I and out on the day of the visit. One commented: “Heena has been in touch several times with me by phone regarding my [relative].” All respondents to our questionnaire stated that they liked the food ‘always’ - a vegetarian reported: “I am always satisfied with how they cope with this.” Others stated: “The food is always lovely - especially the chicken curry…” “It’s very good food”… “ I do enjoy the food.” The manager was able to cite a number of examples of respecting individual’s preferences - from providing a specific breakfast cereal to serving meals on a small plate for one person thus respecting the right to choice. Sadly one aspect of note brought to the manager’s attention (and immediately addressed with the staff member) was this staff member not sitting alongside one person when feeding them; they should not stand besides / over them during this activity which needs to be personalised and relaxed. A recent (Feb 2008) London Borough of Croydon Food Safety Inspection visit had resulted in the home being described as operating to a ‘good standard’ and there was no follow up work required by Brian Griffiths - the visiting environmental health officer. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. 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. A well-documented system effectively handles complaints and concerns expressed by people using the service and their relatives. All are encouraged to highlight concerns they may have. People are confident that they might report their concerns, and that they will be noted and acted upon. Arrangements are in place for recognising and handling allegations of instances of abuse, including staff training and appropriate checks for people working in the home. This ensures that people using the service are protected from harm. EVIDENCE: All respondents to our questionnaire stated that they were clear about whom to make comment to if they were unhappy or had a concern or a complaint. The Manager, Heena, was mentioned in a number of responses - indicating the open style of management and accessibility she presents. The Complaints policy is openly available to all, and is on display in the entrance area. Complaints are relatively rare. All staff surveyed commented that they knew how to react if they were aware of a resident or relative having concerns about the home. The home has a custom- built abuse training pack, which is available to all staff - including at induction. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 16 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, 25 & 26. 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 home is maintained, decorated and furnished to a high standard and facilities are clean and kept safe. A wide provision of communal space allows for individual activity and diverse stimulation. This all ensures that people using the service live in a pleasant, homely and comfortable environment. EVIDENCE: The house is a large detached Edwardian property situated in a pleasant suburban area of Purley. The home is within walking distance of local shops, bus routes and a main line railway station. The home consists of seventeen single occupancy bedrooms and two doubles, eleven of which have their own en-suite facilities. All rooms seen were individual and pleasant - and well populated with each resident’s items, in their own specific unique ways. On the ground floor there are two spacious lounges, a conservatory (air conditioned) and wood- panelled dinning room. Sufficient numbers of suitably Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 17 adapted bathroom and toilet facilities, including en-suites, are conveniently located near or within service users bedrooms and the communal areas. The wooden flooring areas could benefit from stripping and re-sealing. The home has a separate kitchen, laundry facilities, and two offices, of which the manager uses one - at the strategic front of the building. The staircase to the lower ground floor (a private flat) must be kept securely locked at all times to ensure the safest environment for all those walking by. The fire alarm system has taken precedence in capital investment more recently - in being prioritorised for modernisation and the panel upgrading providing more ‘zones’ within the home for better identification / isolation of problems. The front door operates with a keypad system connected to the integrated fire alarm system, ensuring that inappropriate exits are not made from the building. This facility is also regularly professionally checked. The passenger lift has also undergone a programme of complete modernisation in late 2007, this increasing its reliability. All respondents to our questionnaire stated that the home was ‘always’ fresh and clean. A relative commented: “They have made the home ‘home-like’, in other words comfortable for the residents - and visitors are welcome all day.” The bringing to the attention of the manager / proprietor the urgent need to ensure that all hot surfaces - such as radiator panels were covered, elicited the response to provide a timescale to rapidly comply with this requirement. The project had already been costed in the home’s capital programme; it was mentioned in the AQAA, and quotes were seen for the work - which was planned for later in the year; this initiative was brought forward, therefore, and the work completed within two weeks of the inspection visit. Externally, the garden and patio area are attractive and generally well maintained - an external contractor keeps the grounds under control, and there is limited space for parking vehicles in the front drive or on the road immediately outside. Garden fencing and a secure framework surrounding the stairs by the fire escape leading to the back garden was confirmed by the manager / proprietor as renewed within a few weeks of the inspection visit. It is recommended that the edge of the steps down from side / rear fire exit are painted so that they are clear to people who are not familiar with them. It is also recommended that regular checks should be undertaken to ensure fire exit routes are free from leaves and accumulating detritus. All health and safety checks - through professional servicing and maintenance visits for all appliances and machinery - were adequately in place (see management section below). The home achieved a 5-star ‘scores on the doors’ award following a Croydon Council environmental health inspection. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 18 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 - 30. 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. Staff members are provided in sufficient numbers to provide a focused and comfortable service to those living at the home, and the procedures for the recruitment of staff are robust and provide safeguards to offer protection and safe handling / treatment to the people living in the home. There is a good staff training and development programme that provides staff members with skills and competencies necessary to meet residents’ needs. EVIDENCE: Staff surveyed felt that staffing numbers were adequate at least to meet the individual care needs of residents; they also felt they had the right support, experience and knowledge to address these various and changing needs. The residents and relatives responding to the CSCI questionnaire also reflected this opinion. Staffing is provided at a level of 4-5 staff on in the morning with a domestic worker also. There are three carers on duty in the afternoon and two staff available at nighttimes. There are 20 care staff employed by the home and four staff members have moved on - for various reasons - in the past year. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 19 The home uses a company which provides care staff - mainly Chinese and Philippine staff - who work for a two-year span undertaking their NVQs in care at level 2 and 3. Staff come to the home ready-checked and with valid work permits and a level of basic language and cultural competence. A concern about the linguistic skills expressed as a recommendation in our previous report is reiterated, however, as some staff surveyed expressed a concern about the new staff’s capacity to fully comprehend both the staff and the residents at the home. The inspector also noted a number of missed ‘nuances’ in communication during his time at the home. The manager is aware of this aspect and is making efforts to ensure that English as a second language training is provided to lessen the possible effects of this ‘dissonance’. Staff members confirmed that they had been thoroughly checked by the home before commencing work. Staff members were clear that their induction provided them with most of the information they needed before they started the job. Mentors are appointed to new starters, with the induction workbook being used to cover all vital areas of training. General training opportunities are expanding as the home has recently purchased a license to run a training sequence from a company which enables in-house training on 23 subject areas / disciplines. The AQAA showed that 12 staff were undertaking their NVQ in Care at level 2 and of the five already qualified, two now have the next level up, one is studying for their level 3 and another is working towards NVQ level 4 - which the manager already has. The manager is planning to enrol on the A1 NVQ assessor’s qualification - which will assist in assessing competencies at the home in the future. Training records are kept on a matrix to identify deficits and skills; this also records the frequency of supervision provided. Staff responded that they were given support and supervision either ‘regularly’ or ‘often’. The open door approach of the manager is clearly helpful in this aspect. 90 of the care staff members have training in safe food handling, and a number are First Aid qualified; 80 are trained in infection control. Staff surveyed confirmed that training is given which is relevant to their role, and that it helps them to address the individual needs of the residents and that they are kept up to date with new ways of working. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 20 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 & 38. 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 good and able management at the home, including a quality assurance system, which, alongside other consultation processes, ensures that the home is run in the best interests of service users. All necessary safeguards for people are taken seriously, with appropriate measures to ensure everyone’s welfare, with staff well supervised, and ensuring that the health and well being of users is maintained and protected. EVIDENCE: Since December 2007, Heena Patel has been the sole proprietor / manager of the home - her two partners having withdrawn from the partnership. We found Ms Patel to be very competent is dealing with both the day-to-day home management and overarching organisational view of the service. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 21 Ms Patel has a clear vision for developing the service, with a sense of the people being clearly at the centre of her focus. She is qualified to NVQ level 4 in management and care and shows a clear concern for quality both in facilities and the care provided. A relative stated: “The manager of Howard Lodge is very efficient, but also kind and approachable. She obviously has a very personal involvement in the running of the home and interaction with the residents, relatives / friends.” Staff also commented that they had a “good manager”. The home also benefits from the support of a company to assist in personnel issues and also the training of staff in various disciplines. Quality Assurance measures adopted by the home include regular Residents’ Meetings, Staff and Keyworker meetings, and the Annual Quality Questionnaire for residents and relatives / friends. The home has an “Investors in People” Award - this will soon be due for renewal. The home does not take responsibility for the financial side of any resident currently at the home, relying on relatives or representatives to undertake such a responsibility. The home has a full system of maintenance and servicing checks for all equipment and facilities within the home. The AQAA provided information, which was duly verified, and one certificate - which was not available from the servicing agent - was duly provided to us by fax within a few days of the inspection, confirming previous work carried out. With regard to risk assessment, a more complex system of recording temperatures of hot water outflow was implemented from the point of the inspection visit, onwards; the recording system will ensure that all hot water outlets are monitored when they are best positioned to show up any problems. Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(4)(b) Requirement The rear fire exit staircase must be kept ‘sterile’. And free of furniture or other items - which may obstruct free passage. Timescale for action 23/08/08 2. OP19 23(4)(b) The door leading to the staircase 23/08/08 to the lower ground floor / basement must be kept locked at all times to avoid the risk of accidents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP10 Good Practice Recommendations That the chiropody service at the home should be moved from the conservatory area either to individual people’s rooms or privacy screens should be provided. That the wooden flooring surfaces at the home need stripping and resealing. 2. OP20 Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 24 3. 4. OP15 OP27 Staff should sit alongside people when feeding not stand over them. The manager arranges for staff to access an appropriate education course when English is their second language so that communication with residents is more fully enhanced. Regular checks should be undertaken to ensure fire exit routes are free from leaves and accumulating detritus. That the edge of the steps down from side / rear fire exit are painted so that they are clear to people who are not familiar with them. 5. 6. OP38 OP38 Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Howard Lodge DS0000066326.V369689.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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