Care Home: Linda Lodge

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What the care home does well The service provides a warm and generally comfortable environment for people living there, enabling them to go about their business in an independent and generally dignified manner. The `younger` people in the age range - of the mental health client group - aged approximately 50+, help `anchor` the population living at the home within the `younger` age bracket / approach, encouraging self-help, activity and communication; it is clear that this attitude at the home does encourage continued activity and participation in the outside community - by a number of those living there. Questionnaires from people using the service show a positive `slant` on the general service provided: they are confident that they will receive the care and support they need - though some (a minority) feel there are not enough staff available at all times. Staff are described as: "Always very helpful" / "very helpful / "Staff very good" / "staff keep me informed at all times" / "staff very good if you have problems". A more balanced view covered the variety of activities and couple of respondents shared the feeling that they "wish there were more (activities)". Food provided at the home was always liked by two-thirds of the respondents and `usually` liked by the other third. Everybody knew how to make a complaint, and all were usually aware who to go to if they were unhappy. Almost every respondent agreed that the home is kept `fresh and clean`. What has improved since the last inspection? Most significantly, we have noted an improvement in the focus on staff training, supervision and support. Following the previous inspection visit in January 2008, and in line with the Commission`s `Inspecting for Better Lives` approach, a Statutory Notice was served on the proprietors in regard to staff induction, supervision, and training. We are now satisfied that the elements hare being more fully addressed by the home, and we believe that the structures established by the home are strong enough to ensure that these managerial focuses will continue to function for the future. Annual Appraisals for staff have also been introduced, this being the trigger for some of the long-term staff member`s supervision being revived. Staff development and training is being better focused on; alongside the home`s own assessment of training achieved / required, the home has also contributed to the local Borough`s Training Needs analysis process. The home`s fire alarm system is now being regularly professionally maintained and Fire drills are being held for staff - though a recommendation emphasises the need to ensure structured drill are held to ensure that everyone is covered by such training.It is encouraging to see the home restore itself to a level and standard where it was a couple of years ago - the more focused management input will no doubt be even more enhanced as the manager completes her Registered Manager`s award - and the developing future looks very positive for Linda Lodge.Linda LodgeDS0000007164.V365813.R01.S.docVersion 5.2Page 8 What the care home could do better: There are no requirements set after this inspection; recommendations are made this time with regard to five areas; the expansion of care planning into the `social engagement` side, the proprietors ensuring they let us know then they are able to install the stair lift; the development of a clearer `overviewing` training matrix; the ongoing focus on Quality Assurance - be that encouraging the Resident`s Committee to revive or making sure questionnaires are circulated and completed; and finally the abovementioned issue about ensuring sufficient fire drills cover everyone. CARE HOMES FOR OLDER PEOPLE Linda Lodge 91 Worcester Road Sutton Surrey SM2 6QZ Lead Inspector David Pennells Key Unannounced Inspection 11:30 3rd July 2008 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 Linda Lodge DS0000007164.V365813.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. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Linda Lodge Address 91 Worcester Road Sutton Surrey SM2 6QZ 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 8642 0343 N/A Ms Tina Freed Mrs Lynda Penfold Mrs Lynda Penfold Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Old age, not falling within any of places other category (0) Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 13 Elderly and 13 either elderly or aged 55 with mental ill health. 24th January 2008 Date of last inspection Brief Description of the Service: Linda Lodge is a large extended family house situated on the west side of Sutton, being roughly equidistant from Cheam Village. The house sits on a corner plot, a short walk to a bus stop that allows access into Sutton town centre within a few minutes. Parking is available on site and is free in the road outside. The surrounding environment is a pleasantly green and a well-treed suburban Surrey residential area. The home offers single bedroom accommodation to twenty-two of the total possible maximum of twenty-six service users. The two potentially doubleoccupancy rooms currently continue to accommodate a single occupant each. The service provides for people who are on the older age category, and for people in the general ‘mental health’ (not dementia / learning disability) category - though continuing to emphasise the ‘older people’ slant of the general population living there. The entrance to the house is a pleasant space - where the manager has her bureau, and occasional chairs provide for those passing through to sit and watch the world coming and going - access to the main staircase, public telephone booth, staff room and kitchen is also through this area. The main communal space is pleasant, and provides a choice of two lounges, one overlooking the back garden patio, the other adjoining the separate dining area. A pleasant patio area with good garden furniture is provided. Bedrooms are provided both on the ground and first floors; a new shower / ‘wet room’ facility has been provided on the first floor, this increasing the variety of bathing services available to people living there. The home still has to address the need for one certain aspect of a basic requirement within the old age category of the home: the provision of a passenger lift / transport to the first floor; this absence limiting the use of these bedrooms upstairs to reasonably agile / mobile service users only. This remains an outstanding issue, which the proprietors are currently addressing the plan probably being to install a stair lift on the secondary staircase provided all permissions can be obtained. Linda Lodge DS0000007164.V365813.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 inspected the home by arriving at 11.30am and staying there until approximately 7.00pm. During this time we met with both the proprietors Tina Freed and Linda Penfold, and also met staff and a high proportion of the people who used the service. Formal interview time was spent with the proprietors / managers, and some substantial time in the afternoon was spent speaking to people who live at Linda Lodge about their experience of the service. Questionnaires were formally handed over to those met by the inspector, in the hope that a high proportion of them would be returned to us in the prepaid envelopes provided. Happily, twelve forms had been returned to the CSCI by the time of the writing of this report - a 60 response rate, which is significantly high. The inspector is grateful to those who took the trouble to complete this document, and express their opinions. Respondents answering the details about themselves showed that responses covered the gender balance well, and also reflected well the different categories of service provided - and also the age range and ethnicity factors. See below and throughout this report for some of the outcomes expressed. We again examined paper work relating to the building, and also checked both staff files and care plans and other records (including medication records) relating to the people who live at Linda Lodge. We are, as ever, grateful to the service users, staff and the co-proprietor of the home for their welcome, cooperation and hospitality. The service provided an annual quality assurance assessment (AQAA) in early June 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. There have been no changes in the ownership, management or service registration details of Linda Lodge within the past twelve months. What the service does well: The service provides a warm and generally comfortable environment for people living there, enabling them to go about their business in an independent and Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 6 generally dignified manner. The ‘younger’ people in the age range - of the mental health client group - aged approximately 50 , help ‘anchor’ the population living at the home within the ‘younger’ age bracket / approach, encouraging self-help, activity and communication; it is clear that this attitude at the home does encourage continued activity and participation in the outside community - by a number of those living there. Questionnaires from people using the service show a positive ‘slant’ on the general service provided: they are confident that they will receive the care and support they need - though some (a minority) feel there are not enough staff available at all times. Staff are described as: “Always very helpful” / “very helpful / “Staff very good” / “staff keep me informed at all times” / “staff very good if you have problems”. A more balanced view covered the variety of activities and couple of respondents shared the feeling that they “wish there were more (activities)”. Food provided at the home was always liked by two-thirds of the respondents and ‘usually’ liked by the other third. Everybody knew how to make a complaint, and all were usually aware who to go to if they were unhappy. Almost every respondent agreed that the home is kept ‘fresh and clean’. What has improved since the last inspection? Most significantly, we have noted an improvement in the focus on staff training, supervision and support. Following the previous inspection visit in January 2008, and in line with the Commission’s ‘Inspecting for Better Lives’ approach, a Statutory Notice was served on the proprietors in regard to staff induction, supervision, and training. We are now satisfied that the elements hare being more fully addressed by the home, and we believe that the structures established by the home are strong enough to ensure that these managerial focuses will continue to function for the future. Annual Appraisals for staff have also been introduced, this being the trigger for some of the long-term staff member’s supervision being revived. Staff development and training is being better focused on; alongside the home’s own assessment of training achieved / required, the home has also contributed to the local Borough’s Training Needs analysis process. The home’s fire alarm system is now being regularly professionally maintained and Fire drills are being held for staff - though a recommendation emphasises the need to ensure structured drill are held to ensure that everyone is covered by such training. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 7 It is encouraging to see the home restore itself to a level and standard where it was a couple of years ago - the more focused management input will no doubt be even more enhanced as the manager completes her Registered Manager’s award - and the developing future looks very positive for Linda Lodge. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 9 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 Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 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. Service users can be sure that - both prior to, and on admission - information is gathered to ensure a suitable service can be provided at the home. The staff competency / training profile now provides that people using the service - whatever their admission category - will be is sufficiently supported, through staff accessing to adequate mental health and ageing process training. Linda Lodge does not provide intermediate care and therefore standard 6 has not been inspected or assessed. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 11 EVIDENCE: Newcomers to the home are fully assessed prior to admission; each has a full comprehensive assessment and initial care plan on file, this leading to an initial review of progress after six week’s residency. One person interviewed said how useful it was to be able to ask questions when the manager visited them at home, prior to their admission. The Linda Lodge information brochure contains a sample copy of the Terms & conditions for the home. Charges additional to the fee are made for: toiletries, hairdressing, newspapers, private chiropody, non-NHS dental work, holidays, transport and clothing. We were pleased to note again the presence of the resource / information files - available in the staff room, which carried a lot of useful, contemporary information about different mental health conditions. Additional to this, now, is a web-based ‘online’ resource provided to staff - through the purchase of a lap top computer for the home - which can enable access to online and CD-Rom training resources. The service also is accessing training resources from the mental health charity ‘Mind’. Our previous concerns about staff training and their resultant competence served in a Statutory Notice after the last inspection visit - have now been satisfactorily complied with. The proprietors are making positive efforts to access more appropriate and easy-to-access information around mental health - an essential knowledge focus to prospective and current service users / relatives / placing officers. The proprietors have also actively sought appropriate training in the ‘host’ borough (LB Sutton), through contributing to their Training Needs analysis process - which will hopefully result in increased training opportunities for the home’s staff. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 12 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. Service users can rely on the home having a plan of identified care needs set out in the home to assist in promoting their wellbeing. Service users can expect their health care needs to be fully met through community resources and the general vigilance of the home’s staff. Service users may rely on the home to properly manage their medication, through appropriate systems / procedures, and to have well managed / supervised policies and procedures, with staff adhering to them. Service users can expect to be treated with dignity and respect at the home; regard for privacy extending to personal sensitivity around the expectation to share a [double] bedroom, where necessary. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 13 EVIDENCE: We checked / ‘case-tracked’ the personal file for a newcomer at the home, which showed that daily records are kept alongside a care plan being established and further developed. Annual ‘reviews’ for each person are conducted for each service user - this generally involving other professionals as appropriate- and their relative / representative if wished. Some people had ‘lost contact’ with their placing officer, this making it difficult to sustain a contact with the funding authority. Personal files continue to be more focused and purposeful than before; the noted improvement focuses on the mental-health status of those who are in the home indicating their specific support need. Accident / incident records were also seen, and risk assessments were present where necessary. A recommendation suggests that the ‘social engagement’ aspect for each individual needs further development. Most people at the home continue to help themselves quite substantially in regard to personal care, daily routines, etc. The majority of those using the service are still seen as having ‘low’ level care needs. Only a very few have any continence problems, with a few requiring help with dressing and personal care tasks. Any person suffering discrete medical problems were appropriately cared for with District Nurses attending them regularly, and the appropriate equipment and treatment being in place to support them. We inspected the storage and administration of medication; the processes employed being appropriate. A recent Pharmacy inspection showed nothing untoward. The majority of staff - including the proprietors - are trained in administering medication; four staff have more recently having attended a ‘Safe handling of medicines’ course at North East Surrey College. Storage was appropriate and the records of medication were well kept, and stocks were well ordered. A new medicines refrigerator has more recently been purchased. Questionnaires previously received from GP practices and previous interviews with the District Nurse who serve the home showed a positive reaction to the service they experienced / observed in the home. “I am very happy with the care my [relative] receives” responded a relative. A hairdresser visits the home once a fortnight. Chiropodists from the NHS also visit a number of times a year; a private chiropodist also visits and ‘plugs the gaps’ of the statutory provision. Domiciliary dentists and opticians visit the home on a regular basis (the latter quite recently), providing services as required – and people can also visit / be taken out into Sutton or Cheam for other external appointments. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 14 People were treated with dignity and respect at the home; all have singleoccupancy bedrooms; the two double rooms being occupied by a single person each. The proprietor continues to make it clear that they would not ‘fill’ these two bedrooms unless it was the occupant’s active / positive wish. Linda Lodge DS0000007164.V365813.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 - 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. Service users can expect to enjoy a programme of activity and leisure pursuits at the home; they are also encouraged to engage with the local community resources available to meet their own religious and cultural needs, where individually expressed / identified. Visitors - especially relatives and friends - can expect a positive welcome to the home, and are encouraged to remain involved with the care and attention given to their loved one, ensuring a ‘shared’ care approach. Service users can expect to be supported and encouraged to exercise their own choice, ensuring the retention of some independence and personal control over their lives. Service users receive a satisfying, wholesome and nutritious diet - provided in suitable variety, with the necessary need for adequate fluids being recognised alongside this good service. EVIDENCE: Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 16 The proprietors have both completed a certificated training course on ‘Provision of activities in the care setting’ - run by Nescot. A number of service users enjoy the ‘stretch and exercise’ activity slot. Activities such as Art / Cooking / themes days for notable celebrations (St Patrick’s & St George’s days) and barbeques are popular; games such as draughts, cards, ‘Frustration’ and dominoes, alongside Bingo and informal quizzes are staged within the relaxed atmosphere of ‘passing the time’. Concerts are sometimes held and invitations for local school events / school visits are sometimes received and taken up. Some respondents to the CSCI questionnaire, however, thought there was a need for more activities: “more stimulation and entertainment” was called for. Newspapers are available at the home through a local agent’s delivery service. The council’s mobile library regularly visits the home, and videos, DVDs and the use of satellite TV has expanded the horizons of some, who thoroughly enjoy sports and programmes of interest communally, or in their own rooms. Those living at the home regularly stretch their legs to get out to the local shops or even just to walk ‘around the block’. Some people at the home are actively ‘out and about’ on a daily basis. A few attend formal activities - such as the African-Caribbean club. Local afternoon trips out to Epsom, the ‘Duck Ponds’ or to local venues are enjoyed, as occasional seaside trips. Despite the ‘older age’ category focus at the home, the general ethos / ‘feel’ of the establishment is one of (slightly) ‘younger elders’ - and this encourages a self-help ethos, which pervades the home to a significant extent. Hopes to establish a residents Committee have, sadly, come to little or nothing as yet. Relatives and friends are positively welcomed to the home at any time of the day, and all reports have spoken of the positive welcome received. Religious activity is ‘low key’ within the home - people can go out to religious activities / Services, or may invite people of religion to their own space; one person does welcome religious visitors to visit them privately. Food is provided in people’s own rooms or in the main dining room, though people are encouraged to ‘come out’ of their rooms especially for the main meal of the day - to share food in a more sociable and engaging atmosphere. The home’s menu is available on the dining tables and in the lounges – and includes a second option, which people may and do opt for. Dietary needs / preferences are provided for. People spoken to have stated that the food is generally in good quantity, and always served hot. People using the service are always positively satisfied with the food that is provided. One staff member has recently trained in ‘Nutrients & health’, and some staff have quite recently retaken / undertaken Food Hygiene training. The service Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 17 was assessed by the local council against Food Hygiene standards in November 2007 - and gained a 3-star rating for the ‘good level of compliance’ assessed. Linda Lodge DS0000007164.V365813.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 & 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. Service users and their supporters can be confident that complaints will be taken notice of, and action taken at the first opportunity by the proprietors. Service users can be assured that they are safeguarded from abuse by the policies, staff knowledge and the conduct of the home in general. EVIDENCE: The home has a clear complaints policy and procedure. The home seeks to resolve issues at the local level before they become a serious problem / issue. Records evidenced that issues have been addressed immediately at the point they arise in the past. There is a suggestions / ‘moaning’ book in the hallway. A good Adult Protection policy and procedure exists within the house. The policy is clear and precise, and contains all the useful aspects such as the emergency contact numbers of the local authority duty teams for referrals to be made, and is held alongside the London Borough of Sutton agreed multiagency procedure. The majority of staff members at the home have been trained in Adult Protection / Vulnerable Adult / ‘Safeguarding’ issues. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 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 establishment is a generally well-maintained, clean and homely environment, enhanced by the change of the service to a ‘no smoking’ ethos. The home lacks a passenger lift or similar facility, this issue being addressed to ensure the home fully meets the ‘older people’ national minimum standard requirements and resulting in a fully accessible and safe environment for the people living there, both now - and into the future. The home is clean and hygienic, providing all such equipment and staff training to ensure that best infection control measures are in practice. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 20 EVIDENCE: As is customary, we again found that the premises to be clean and odour-free. The establishment presents as a homely and comfortable environment for people to enjoy - as if it were their ‘own home’. All bedrooms are individually furnished, warm and welcoming. The front hallway, stairs and landing have been recarpeted, recurtained and refurbished. Several bedrooms have been redecorated and curtains and carpets replaced. A carpet cleaner has been purchased to ensure the continuous maintenance of high standards. The lounge and eastern-aspect bedroom windows have been replaced with double-glazed units. Garden furniture has also been replaced. The first floor bathroom has been turned into a shower / ‘wet-room’ - this providing a second type of bathing facility in the home. It is now planned to renovate the ground floor bathroom - which will have a new hoist to assist people to access the bath if they are infirm. This innovation is welcomed by people living in the home - and is well used. In regard to the issue of there being no assisted mechanism to get to the first floor bedrooms, the proprietors have now consulted with the London Fire & Emergency Planning Authority, and are now seeking a ‘sign off’ from the Area Health Authority before going ahead (if all approved) with installation. All covers to the remaining radiator surfaces that were not low surface temperature units have now been installed. Contracts and documentation concerning regular maintenance / safety checks for systems / equipment in the house were available for counterchecking against the evidence provided in the AQAA - and seen on the day of the visit. All was satisfactory. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 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. Service users can be assured that staffing is provided at the home in line with previously agreed formula for staffing levels. Staff training to NVQ Level 2 in Care or equivalent or above, is now at a level which ensures that sufficient staff members are qualified to guarantee safe and appropriate care practices within the home. Staff members are recruited within the context of safe employment practices, including appropriate Safeguarding and Criminal Record Bureau checks, ensuring the safety and wellbeing of people using the service. Staff training and induction ensure the service provides an adequate and appropriate service to those using the service. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 22 EVIDENCE: A minimum of four care staff are generally available to service users during the day, two coming on early and two arriving a little later - and carrying the shift through to the evening, when two night staff are available throughout the night. Most users of the service commented that staff are usually available when they are needed - though one state that they are “often too busy”. The question about whether “staff listen to and act on what a person says” was 100 unanimous in the ‘yes’ response. “Staff are very good if you have problems” responded one person. The majority of staff have had First Aid training which remains in date, and other staff members have also more recently completed Food Hygiene training, and eight (including the proprietors) took part in a Fire Safety course. Two staff members have completed a course on understanding Parkinson’s Disease. Training planned within the next few months included: Protection of Vulnerable Adults for 8 staff; Oral Health for 9 staff; and the local authority’s Fire Safety course for 9 staff. John Ruskin College has provided certificated training on Medication, on Supervising Staff and on Control of Infection & Contamination. Plans are afoot to introduce staff to the ‘learning pool’ training courses - which are provided on line. The home now has a lap top computer which staff will use to access ‘on line’ training. This will particularly bolster training on mental health issues; ‘Mental Health Awareness’ / ‘The Mental Capacity Act’ being two of these online resources alongside such issues as ‘Safeguarding Adults’. Induction records were examined as part of the checking of compliance with the Statutory Notice served after the last inspection visit. The formats provided cover local knowledge as well as basic introductions to care / policies & procedures and wider familiarisation documents. It is incumbent on the manager / proprietors to now maintain adequate records of induction for all staff members when starting at the home. Staff Supervision was also examined - alongside evidence of appraisals being started; it is clear that staff members are now expecting to be provided with 1:1 supervision time on a regular basis and for this to be recorded. Again this process will work well as long as consistency is provided in it’s implementation. This positive evidence is carried onto Standard 36 - emphasising the managerial importance of such an aspect of staff support. The Commission’s minimum standard of at least 50 staff trained to, minimally, NVQ Level 2 in Care has now been exceeded, with 66 now having such a minimum qualification, with three staff carrying on to upgrade their level 2 qualifications to level 3. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 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. The registered manager / owner is experienced in running care homes, and is undertaking a professional training course for registered managers - to consolidate her learning and leading to enhanced management processes. The home would benefit by insights afforded by the home’s quality assurance audits of service users and other stakeholders being more actively used. People using the service can be assured that the general financial management of the home is sound, and that the management of monies held in safekeeping is secure and appropriately recorded. The proprietors have routines in place to generally protect the health, safety and welfare of both people using the service and staff members, through maintaining the equipment servicing routines and related risk assessments. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 24 EVIDENCE: The manager/co-proprietor - Lynda Penfold works alongside her sister, the second registered provider - Miss Tina Freed, who assists with the management at the home in a ‘deputy manager’ capacity. Mrs Penfold’s husband, Barry, also assists at the home on a regular weekly basis - and is seen as a second, assistant manager. There are no ancillary staff members provided, so all care staff members need to have multiple skills, and the management of the service has to build these elements into the daily routine. The proprietor has now progressed to approximately half way through her RMA Course, having completed the four mandatory units. Miss Freed has completed a training course relating to staff supervision and support, and is moving on to studying for her level 4 qualifications in management and care. The proprietors have now responded to the statutory requirement to provide regular staff supervision, appraisals and induction. Documentation seen endorsed a system being up-and-running. This focus will provide ongoing and focused support for staff including identifying individual training and learning needs, as well as providing personal support and encouraging staff to achieve better outcomes at the home. ‘Quality Assurance’ at the home has been covered by the introduction of questionnaires for service users and stakeholders. It is hoped that the outcome of such surveys will inform the future planning of the service. Initial ‘How was it for you?’ questionnaires are used by the service to check the quality of care for newcomers to the home, but there is little subsequent ongoing monitoring. This should be further developed. People who use the service are resistant to the idea of running a resident’s committee - which is a shame, as a lot can be picked up through such a regularised ‘feedback system’. A significant number of people at the home manage their own financial affairs. Some people resident at the home are under a Power of Attorney order. Others have small sums held by the Home is separate people’s accounts. Some authorities are invoiced for items purchased after the event. General financial records operated by the home consistently appear to be in order when fully audited / inspected. Fire drills have been more carefully recorded, but it was clear that the need for vigilance is still needed to ensure that all staff members - and people using the service - experience the reality of such a [planned, but] ‘surprise’ Drill. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 25 Maintenance documentation relating to the systems and equipment within the home evidenced that all were being dealt with in line with best practice and this results in the service being provided in a safe and well-managed way. Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X 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 X X 2 X X X 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 X 3 X 3 3 X 3 Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The social engagement side of the care planning process should be developed to ensure a full perspective is provided for each individual living at the home. Confirmation of the installation of a lift to the first floor level of the home should be provided to CSCI once the ‘go ahead’ has been received from the necessary authorities. A more discrete overall training matrix for staff should be introduced to ensure a quick reference guide for analysis. Quality assurance measures should continue to be put in place / promoted to ensure a listening responsive service. Fire Drills should be formally staged sufficiently regularly to ensure that no staff member is ‘left out’. 2. OP22 3. 4. 5. OP30 OP33 OP38 Linda Lodge DS0000007164.V365813.R01.S.doc Version 5.2 Page 28 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. 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