Care Home: Ludlow Lodge Care Centre

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What the care home does well One person completing a questionnaire stated: I am privileged to be here in the care of these wonderful people...they are very willing, kind and patient without being patronising.... Another stated personally to us: I would give it three stars. It is a nice place. They look after you well, but let you be yourself. We found that the service provided to those who live at the home on a longer-term basis continues to be well appreciated. All of the people living on the ground floor had decided to stay at the home even though the introduction of the Intermediate Care service had, in some ways, radically changed the way in which the home was run with some of those residents having to relocate and move down to the ground floor units. Those who had sufficient capacity, and to whom we talked, were clearly, we felt, now anxious about the future, and aware that a change will inevitably occur quite soon. It would seem a compassionate approach to start that process of formal dialogue - as people told us it was now only a matter of time (their expression) before they were expecting to be moved on. We found, taking the opportunity to dine with and spend informal time with a group of people using the Intermediate Care service - that they were happy and impressed with the service they were receiving. The ethos of the first floor is to positively encourage rehabilitation - with people leaving Ludlow Lodge and returning home. We found the general feeling within the service to be one of life and activity. There was genuine (and realistic) encouragement, between the people using the service - and them and staff members, to do well with their rehabilitation programmes, and to get well enough to regain skills and return back under their own roofs / into their own beds. Respite care services were used more fully during holiday periods in the year; the period in late April, after Easter, being a low demand time. In conversation with staff, the expressed opinion of the manager, that there was good mutual and collaborative respect between Sutton Council and the PCT staff members, was agreed with and self-evident. The Intermediate Care service is succeeding in providing a service to more people than was originally projected - evidencing the success and effectiveness of the scheme. What has improved since the last inspection? The premises have been maintained to a generally good standard - though one upstairs lounge (previously the smoking lounge) would benefit from further redecoration. The external entrance road and pathway to the building has now been freshly tarmac-ed and provides a good solid, flat surface for access to the building. A new main front door was due to have been installed by the time of the inspection visit, but held up by a manufacturing technical hitch. This will open up and make more pleasant the front door area, which is currently somewhat drab and uninviting. The immediate front entrance lobby area has been converted into an information zone providing documentation and access to the Internet, including the Council website and other useful sites. Plans are afoot to remove the large tree in the quadrangle of the building, which will provide a better and newly landscaped safe area for use by people during goodweather. 2009 plans also involve creating a rehabilitation kitchen on the ground floor to encourage greater independence, and the creation of a mini-gym on the ground floor for additional physiotherapy work. It is also planned to replace mattresses throughout the home, following comments from a number of people using the service. The London Borough of Sutton START Team (providing assessment and intensive initial domiciliary care / re-enablement service) is now based in what was the old day centre part of the Ludlow building. This is clearly going to provide a positive connection between the assessment aspect of the initial home care services with the people currently using the Intermediate Care service, who are expecting to be discharged home into their care. Two rooms have been set up within the home to demonstrate the Telecare service, which people can access for their own homes; this allows many misconceptions to be dispelled - and people can actively try out the system. One requirement only was set at the last inspection - requiring that the registered provider regularly produced reports of the visits that are actually made under Regulation 26 to check the conduct of the home, and that these reports were communicated to the Commission. This has now been undertaken to the our satisfaction; we have seen evidence that the service is being regularly appraised and monitored, and that senior management are actively involved in ensuring the maintenance of a good service. The one recommendation from the last inspection asked that the quality of decoration and furnishings / furniture be reassessed on the ground floor, and this was completed. The general standard of the accommodation being used on the ground floor assessed is good quality. What the care home could do better: A few people using the service and two of the professionals working at the service felt that a greater focus on activities could be beneficial to help pass the time - though this has to be carefully arranged in co-operation with the therapeutic services that are provided throughout the working day each day by the (for instance) occupational therapists and physiotherapists. The upstairs (ex-smoking) lounge should be redecorated. It is strongly recommended that the process of consultation with those who are longerterm occupants of the home should commence - to progress the ongoing agreed reprovision project of the Council. Such a process is now necessary, as the numbers of people using the service has reduced to a critically low number. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ludlow Lodge Care Centre Ludlow Lodge Alcester Road Wallington Surrey SM6 8BB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Pennells     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 32 Information about the care home Name of care home: Address: Ludlow Lodge Care Centre Alcester Road Ludlow Lodge Wallington Surrey SM6 8BB 02086697260 02087731215 rita.collier@sutton.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Borough of Sutton care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 Intermediate Care Beds can accommodate service users who are 50 years of age and over. (no more than 2 persons) The maximum number of service users who can be accommodated is 40 The registered person may provide personal care (excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category:- Old age not falling within any other category (Category OP) (no more than 40 persons) Date of last inspection Brief description of the care home Ludlow Lodge is a substantial care home property owned and run by the London Borough of Sutton, and providing predominantly a short-term Intermediate Care (IC) service (for 15) in conjunction with (and co-funded by) Sutton & Merton PCT. Funding for the IC beds is covered for the first six weeks - after this, a charging policy applies. There is also a Respite Care service (for 7 - means-tested and charged for), and also longer-term care and accommodation to a small, but diminishing number, of older physically frail people. Care Homes for Older People Page 4 of 32 Brief description of the care home Demand for the Intermediate Care service is high, the focus of this service being clearly at the re-enablement / preventative stage, seeking to avoid crises leading to hospital admissions. The demand for the respite aspect of the Ludlow service is seen to be a more seasonal factor, with use at some points during the year being low, whilst during peak / bank holiday and summer periods, usage is up to capacity. The home is located off a main road linking Croydon and Sutton to Wallington - the town centre being close by - providing good transport links and local community resources. The home has its own accessible transport, which is used for both transporting people to their homes and also to enable outings and activities as part of the home programme. The home is laid out on 2 floors, the upper floor being accessible by passenger lift. All bedrooms are single occupancy. The home is split into smaller living units, providing a distinct group living model of care, each having a member of staff allocated, per shift, to support service users - with additional floating staff. Each unit has its own lounge, dining area and bathing and toilet facilities; there is also a small kitchen, where breakfasts and snack meals are freshly prepared. The home has a central kitchen where the main meals are prepared and distributed to the units. Care Homes for Older People Page 5 of 32 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: three star excellent 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: We visited the service over a daylong visit on 17th April 2009, arriving mid-morning and staying until late afternoon. During this time the opportunity was taken to meet formally with the registered manager, to speak to staff, to visit those who were resident in the two distinct services provided within the building, and the chance was taken to discuss how these people found the experience of living there. We also spoke with Linda Adams - who manages the Intermediate Care Team for Sutton & Merton Primary Care Trust. There was also an opportunity to review documentation, both centrally and on the units, to view the premises, and to review general safety standards within the home. The registered manager had provided us with pre-inspection information - the Care Homes for Older People Page 6 of 32 Commission Annual Quality Assurance Assessment questionnaire - this providing current information about the service, and independent surveys were also subsequently received back from people who were using the service (15), from staff (6), and from health care professionals (3) who provide input at the intermediate care service. This report is has also reviewed any other information received about the service since the last inspection visit and report. Current longer-term service users at Ludlow Lodge have been supported to handle the changes experienced with the intermediate care service establishing itself - since 2007 - on the first floor, whilst the diminishing longer-term community remains situated on the ground floor. The number of people resident on the ground floor has now reached six - a critical number in so much as the sense of community is now reduced - with just one or two people being situated on each unit area; this being their choice to remain in their familiar personal territory. This spread of people is difficult to manage from the point-of-view of efficient and effective staffing input, and also creates inevitable problems of isolation / loneliness for the individuals concerned. What the care home does well: What has improved since the last inspection? The premises have been maintained to a generally good standard - though one upstairs lounge (previously the smoking lounge) would benefit from further redecoration. The external entrance road and pathway to the building has now been freshly tarmac-ed and provides a good solid, flat surface for access to the building. A new main front door was due to have been installed by the time of the inspection visit, but held up by a manufacturing technical hitch. This will open up and make more pleasant the front door area, which is currently somewhat drab and uninviting. The immediate front entrance lobby area has been converted into an information zone providing documentation and access to the Internet, including the Council website and other useful sites. Plans are afoot to remove the large tree in the quadrangle of the building, which will provide a better and newly landscaped safe area for use by people during good Care Homes for Older People Page 8 of 32 weather. 2009 plans also involve creating a rehabilitation kitchen on the ground floor to encourage greater independence, and the creation of a mini-gym on the ground floor for additional physiotherapy work. It is also planned to replace mattresses throughout the home, following comments from a number of people using the service. The London Borough of Sutton START Team (providing assessment and intensive initial domiciliary care / re-enablement service) is now based in what was the old day centre part of the Ludlow building. This is clearly going to provide a positive connection between the assessment aspect of the initial home care services with the people currently using the Intermediate Care service, who are expecting to be discharged home into their care. Two rooms have been set up within the home to demonstrate the Telecare service, which people can access for their own homes; this allows many misconceptions to be dispelled - and people can actively try out the system. One requirement only was set at the last inspection - requiring that the registered provider regularly produced reports of the visits that are actually made under Regulation 26 to check the conduct of the home, and that these reports were communicated to the Commission. This has now been undertaken to the our satisfaction; we have seen evidence that the service is being regularly appraised and monitored, and that senior management are actively involved in ensuring the maintenance of a good service. The one recommendation from the last inspection asked that the quality of decoration and furnishings / furniture be reassessed on the ground floor, and this was completed. The general standard of the accommodation being used on the ground floor assessed is good quality. What they could do better: 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 set out 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 32 Care Homes for Older People Page 10 of 32 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 11 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The process for assessing prospective service users - and subsequent decisions about their future - takes into account the factors that are identified through a detailed exploration and assessment of needs, both written and spoken. Staff members have the collective skills and experience to deliver a service to a good standard for people living at the home. People assessed for Intermediate Care (IC) services are positively helped and encouraged by the multi-skilled team to meet their planned goals and to maximise their independence as quickly as possible, thereby facilitating their speedy return home. Services are based on professional best practice, and the Scheme ethos is one of keeping abreast of current thinking with regard to supporting people to stay at home for as long as is practicable and reasonably possible. Care Homes for Older People Page 12 of 32 Evidence: No new permanent admissions have been made since the arrival of the Intermediate Care service to Ludlow, however some people are still resident on limited term contracts, in the full knowledge of the fact that the future of the home remains under review. We again found that all temporary IC placements at the home had been furnished with full assessment documents - this enabling the home, along with the familiarisation documents, to ensure that a plan of care had been devised for the point of admission. Documentation is a single shared document, which follows the person home - thus ensuring a seamless continuity of care input. The re-enablement professionals also follow through care out into the community - thus following up the specific treatment plans. The Intermediate Care service aims to encourage rehabilitation, as often as is practicable, with the intention of a return to their own home or move on to an alternative placement once they have maximised their independent living skills. This is a well-established service, working in close partnership with the local PCT, facilitating early discharge, and preventing admission or re-admission through rehabilitation input, such as physiotherapy, occupational therapy and a strong rehabilitation ethos / philosophy. The Scheme (Department of Health) target to have 166 people using the service and hence avoiding hospital admissions - was exceeded, with the figure for 2008-09 being 184. There are dedicated facilities in a therapy area and room, and equipment is located throughout the home to promote and encourage service users to sustain their activities of daily living. The stairs within the home are regularly used to practice mobility / stair climbing skills. 2009 plans in action involve creating a rehabilitation kitchen on the ground floor to encourage greater independence / skills base, and the creation of a mini-gym on the ground floor for additional physiotherapy work. Assessment documentation relating to the Intermediate Care service is thorough; Rehabilitation Assessments and Personal Care Plans are in place alongside Manual Handling and associated Risk Assessments. The individual person concerned signs an IC contract. We also found that the scheme daily records were comprehensive and detailed, with all grades of staff contributing their perspectives in a continuous narrative. Weekly Multidisciplinary team meetings are held to review the current people using the IC service. The Visiting Medical Officer, other health care professionals - as well as the Care Homes for Older People Page 13 of 32 Evidence: team leaders / management responsible for the Intermediate Care units and representatives of the START Team attend this session. The local Primary Care Trust deploys the qualified Occupational Therapists and Physiotherapists, and the IC Manager is responsible for the supervision of these health care professionals. Care Homes for Older People Page 14 of 32 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. Individual Care Plans are provided for people using the service from the outset, with a full assessment informing the focus providing a plan of action, enabling the service to meet each persons health and social care needs. Health care needs are adequately and individually met; the home respects the right to choice of GP, keeping contact with many surgeries, this providing a personalised and focused approach to healthcare needs. The storage, administration and recording of medication is general well organised and managed, with staff being well trained and supervised, this ensuring a safe service. Staff members relate respectfully and appropriately to people using the service, sustaining the rights, dignity and privacy of each person. Evidence: People using the service, in their questionnaire responses, stated that they always or Care Homes for Older People Page 15 of 32 Evidence: usually received the care and support they needed, and similarly, that staff were available when they were needed. People reported: They (staff) make you feel at home and comfortable... Another person spoke of the friendly support and encouragement they received. The care staff were singled out for praise - being identified as very supportive, and helpful at all times. The health service professionals attached to the Intermediate Care Service felt that the service responds well to both the social and medical or health care needs of the people there, whilst identifying that greater independence - such as administering their own medication and making their own cups of tea - could still be encouraged more. The latter will hopefully be addressed through the encouragement gained in the planned rehabilitation kitchen. Issues of privacy and dignity were also recognised as being generally addressed well. People receiving the longer-term service had care plans reviewed at least every six months and are created on a person-centred approach. People spoken to confirmed that they enjoyed a good level of service and were respectfully treated as individuals. We found that the IC single care planning system maintained a clear focus, and daily recording within the home was noted to be of generally good quality. A comprehensive assessment of an individuals requirements is created, this enabling staff members to have sufficient information about the individual when they are admitted. Risk and other individual assessments are completed as soon as practicable after an admission. Reviews of risk assessments and care plans are being regularly undertaken and are clearly documented. The records now go home with the individual at the point of discharge - this allowing a seamless record and point of reference for their developing independence in the community. Hairdressing services are planned to be provided in the future again - this need for personal grooming being important to people on the road to recovery. Toiletries, newspapers and other luxuries can be obtained or shopped for, as required. The interaction between staff and service users throughout the visit - on both the longerterm and IC units was observed during the visit; it was warm and familiar, but also respectful. We audited medication administration processes during the inspection visit; this showed they were managed correctly, with just one error identified. The manager was following this up. Records seen were generally concise and accurate. Care Homes for Older People Page 16 of 32 Evidence: Those using the Intermediate Care service are encouraged to maintain independence, through managing their own medication - this was observed through staff handing them their medication containers at the appropriate times. All staff members are trained in handling medication and the senior supervisors monitor receipt, recording, storage, handling and disposal. The Boots pharmacy conducts regular independent reviews / checks of the system. Wall mounted cupboards are provided for people in the IC units - where medication is held securely if a person is happy to self-administer their medication. Care Homes for Older People Page 17 of 32 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. The general lifestyles lived by people provide for meeting their individual needs, ensuring a level of fulfilment and general satisfaction. Contact with the local community, friends and family are positively encouraged, this bringing the home into the community - and vice versa. The Intermediate Care therapeutic environment encourages visits from family and friends and contacts within the local community as appropriate. Encouraging independence and self-reliance, people are expected to exercise their own choice and control, this approach promoting decision-making, maintaining self-esteem - and encouraging the impetus to get back home. The home seeks to ensure that autonomy and choice are afforded throughout the home; people are encouraged to express themselves individually - recognising their specific cultural and spiritual needs. The provision of food at the home is wholesome and nutritious, well presented and in good quantity; choice and a personalised service is provided, and individual preferences are acknowledged - especially through the small Unit living approach of the home. Care Homes for Older People Page 18 of 32 Evidence: All the people using the service, in their questionnaire responses, stated that they always - or usually - liked the food that was served at the home. The food was singled out by a number for qualitative praise: they are good solid meals - one reported, whilst another stated that they thought the meals, the cleanliness and the help was: all first rate. Another commented: The food is very good - cannot be faulted. A caution about portion sizes was stated by one questioned, as they found they were put off if the food portion was too substantial. The service at Ludlow Lodge has an added quality with the short-term Intermediate Care culture running alongside the longer-term care provision. This aspect brings a sense of life to the home that is rarely evident in stand alone care homes. Staff at the home spoke of the importance of providing an environment that was like home-fromhome. The home being relaxed and informal - and family-like - was also important to staff. One person reported that people are often sad to leave the unit at the end of their rehabilitation - but the road to recovery and re-enablement was clearly an important positive factor that staff valued. Activities arranged by the home include some people going out shopping with staff and care [plans identify the wishes of people to attend church services / religious activities if it is their wish. Barbecues, Outings (the home has its own accessible minibus), Shopping trips, and occasional outside entertainments, alongside various local Parish Church activities and Services are made available. Internal home activities include (when requested by people using the service): Bingo or table games, Library, Sing-alongs, Reminiscence Sessions and Video Film Shows and parties. Some people using the longer-term service have no clear representative in the guise of relatives or close friends - and are connected with advocates; this being especially important throughout the period of change and further inevitable intensive consultation. A wide variety of food is provided; the main kitchen catering for all the units for main meals. The menu plan was displayed in the Unit kitchens - rotating over a five-week cycle, and offering a choice of food throughout the week - and also addressing individual dietary needs. Specific food is provided to people to meet their cultural preferences. People are asked what they would like to have, or select the choice from the menu on a previous-day ordering basis. Care Homes for Older People Page 19 of 32 Evidence: The home has been awarded a Heart Beat Award - reflecting the focus of the chef at the home to provide good food that is low in fat, sugar and salt. We found the dining areas in the Units are really quite pleasant to sit in - friendly and homely, especially when the community comes together for their main meals. Breakfasts are served very informally to suit each individual on the Units, using provisions stored locally in the small Unit kitchens and refrigerators. Care Homes for Older People Page 20 of 32 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. People can be confident that their right to complain will be respected and any expressions of concern or complaint will be acted upon and dealt with in an appropriate manner - and that they are protected from abuse. People can also expect to be appropriately consulted with regard to issues which will affect their lifestyle, being given assistance to understand change, where appropriate. Evidence: The home has a formal complaints procedure in place. A small booklet easy-read accessible complaints procedure makes the entire process clear and understandable. Records held at the home showed that complaints had again been dealt with appropriately, with deadlines heeded and all stated action taken by the home if any. Only about 50 of the people in their questionnaire responses stated that they knew how to make a formal complaint - whilst 100 knew who to speak to if they were not happy about the service. The manager confirmed that no restraint or adult protection issues had arisen recently. Advocacy services have been provided by the local Age Concern for service users without relatives / interested parties to help support people through the transformation of the home. The last stage of this process is now expected to begin again, and the use of advocates is being revciewed to ensure that every person in the Care Homes for Older People Page 21 of 32 Evidence: longer-term care units has an external voice to speak up for them. The home has Adult Protection / Safeguarding and Whistle Blowing policies and procedures. All senior staff have Advanced level training in Safeguarding issues, and other staff members have attended the Borough mandatory Safeguarding / Adult Protection and Child Protection training. The recruitment of staff and use of volunteers are covered through thorough referencing, CRB and PoVA checking mechanisms. Care Homes for Older People Page 22 of 32 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. People can rely upon the home being well maintained to a safe and comfortable level, with generally appropriate furnishing and good facilities to meet their individual needs. Consistent ongoing maintenance and servicing checks / inputs by the staff and other professionals ensure a clean and hygienic home, and maintain health & safety. Evidence: 95 of the people using the service, in their questionnaire responses, stated that the home was always fresh and clean. All bedrooms and lounges have now been fitted with the dorgard facility that enables the door to be held open until such times as a fire emergency is alerted by the fire bells. Personal possessions and furniture lend a individual air to bedrooms for the people living in the longer-term service. Lighting in all the corridor areas is good - ensuring clear pathways and safety. The passenger lift has been recently entirely refurbished, the call bell system within the home also being changed to an integrated bleep system - which has to an extent reduced the disturbance from the previously noisy hard-wired system. The home has upgraded security provisions throughout the building; all windows having window restrictors, and doors connected to the call bell system. Care Homes for Older People Page 23 of 32 Evidence: The first floor facility has been generally redecorated and refurbished to provide the Intermediate Care service. There are 40 places in single bedrooms registered at the home; two have ensuite facilities. There are six unit areas, with lounges and a visitors room provided. The home is a pleasant, relatively modern establishment, with plans for the refurbishment of the entrance area bringing a brighter feel to the entrance area. The general decorative state of the building remains in relatively good condition throughout, though a recommendation is made that the (ex-smoking) lounge should be redecorated. An induction loop system is installed in each of the sitting rooms - to enable better hearing for people using hearing aid. The home provides an assisted bathing facility in each of the six units. A ground floor wheelchair-accessible toilet is available on the ground floor for disabled persons at the home. We also found the house to be clean and odour-free throughout during the time of the inspection. The home has access to Occupational Therapy services for people who live at Ludlow on a longer-term basis needing assessment for equipment; the home has mobile hoists for moving and handling purposes. The courtyard and garden areas are well appreciated; plans to remove the large Horse Chestnut tree in the quadrangle will create a pleasant and secure new landscaped area for use. The immediate outlook to the gardens and Parish Church property next door is pleasant. Care Homes for Older People Page 24 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing input at the home is provided in numbers and skills-mix to a level that meets the assessed and needs of people using the service. Staff members are very well trained - both in local and vocational disciplines - and suitably supervised, to ensure that the people using the service are in safe and competent hands at all times. The registered provider supports the home through its recruitment and employment procedures and practices, ensuring that diversity and equality is promoted, and protecting people from potentially abusive staff. Evidence: The staff are good! - stated a response in one questionnaire from a person using the service, whilst other questionnaires made similar comments about the skills of carers to encourage and befriend people using the service. To cover the living units at the home, 25 permanent care staff and 5 seniors are employed. All care staff members have a qualification at least to NVQ level 2. All senior staff members are qualified at least to NVQ level 3, and are expected to commence training at Level 4. Ancillary staff all have minimally Level 1 qualifications. Care Homes for Older People Page 25 of 32 Evidence: The Manager is qualified to NVQ level 4 and has completed a number of units towards her NVQ Level 5 award. Three night staff members are available; awake, each night - one holding the senior position. Only one staff member has left the service in the past twelve months. All permanent care staff who work independently on Units are trained to administer medication and seniors have been trained in reviewing / assessing staff competency in this particular important area. With the coming together of two previous staff teams to provide the one service, the staffing establishment remains well provided for - all staff members have been recruited using the thorough London Borough of Sutton recruitment procedure, ensuring that references and checks - including Criminal Records Bureau declarations have been undertaken before starting on shift. Staff questionnaires confirmed that they all were fully checked and referenced before starting work with the home, and 100 felt their induction covered all the necessary elements when they first started. All agency staff utilised at Ludlow have a profile supplied by the agency including training profiles, CRB clearance, photograph and reference checks. Staff also reported that they received positive support to do their job, that communication channels usually or always worked well, and that there was a sufficient mix of skills and knowledge to address the needs of the people they were caring for. Staff appraisals have been rolled out to all staff, with the manager cascading this process through the senior staff and the remaining staff would receive theirs. Staff supervision in general is managed / overseen by the manager. Staff training input has continued; a wide variety of input - including focusing on person-centred support has been covered. As part of the staff integration strategy, training for all care staff has sought to ensure they share. We saw an excellent staff training strategy including covering Child Protection awareness / Infection Control / Care of Medication / person-centred Support. Diversity Training for staff is mandatory. Training records are kept with current competencies informing future input. The majority of staff hold a current Emergency First Aid qualification - thus ensuring the rota is covered at all times. Care Homes for Older People Page 26 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is suitably qualified and competent to ensure that the over-arching service is provided in a professional and person-centred manner, and that the service provided is run in the best interests of those using the service through clear leadership and good management support. Service users can be confident that there is appropriate accounting / financial procedures and management will safeguard their financial interests. The registered provider, through a process of updating policies and procedures, ensures that best practice is known and adopted, whilst also positively promoting the health & safety of people using the service and their staff, through regular servicing, maintenance and checks of facilities. Evidence: Other professional staff providing a service to the Intermediate Care service confirmed Care Homes for Older People Page 27 of 32 Evidence: that they felt the service was managed well, and that the staff and management had the correct skills base to support the identified health and social care needs. There is a clearly a positive relationship between the home manager and the PCT Intermediate care manager; this interaction is vital. The manager, Rita Collier oversees the service at Ludlow Lodge. She holds a Diploma in Management Studies, has completed her Level 4 NVQ in Care and is now studying at NVQ Level 5. Ms Collier has also recently completed her Training as Trainer in Infection Control measures. It is clear that her knowledge, experience - and evident enthusiasm and commitment - is an asset to the service. Rita Collier managed Bawtree House prior to moving with the service to Ludlow, and has many years of direct care-related experience. We found the home has an effective management structure, with senior care staff managing the units and allocated groups of care and ancillary staff. Areas - such as care planning, medication, staff training and activities & outings - are designated areas held in additional responsibility by each senior carer. An excellent Service Development Plan - with cross-references to the National Minimum Standards and Care Homes Regulations - is used to identify all the various elements of staff training and input would affect the outcomes for users of the service. Sutton Council - as the registered provider - under Regulation 26, ensures that a monthly, unannounced visit is made to the home by an appointed representative to inspect the conduct of the home - and they make a report of this visit for the information of the registered provider, and also the Commission. The home manager confirmed that the service also has to complete a monthly self-assessment form on behalf of the home for the organisation - and that this forms the basis of discussions about the conduct of the home. The financial interests of people using the service long-term are safeguarded by the home; the accounting of monies at the home held in safekeeping and local administration processes have been previously carefully examined and found concise and well maintained. Individual receipts are signed to receive monies paid as personal allowance; transactions are undertaken in the home within a context of privacy and appropriate recording management. Such finances are regularly declared by statement to the person involved. Audits are also regularly undertaken by the Finance Department of Sutton Council. The provision of single occupancy rooms throughout the home equally provides for the respect for, and protection of, the security and privacy of every person. A lockable Care Homes for Older People Page 28 of 32 Evidence: facility in bedrooms is provided for each person resident at the home. Due to the short-term transitional approach used by the intermediate Care service, it is extremely unusual for the home to take responsibility for any money or possessions in this sector. The person - or a relative - normally deals with these aspects. Each has a lockable facility in their room and bedroom doors are also lockable. The local authority has procedures in place should this provision of safekeeping be necessary, however the ethos of self-help / independence predominates in all areas. We found all in-house and external maintenance and servicing activities for the premises were up-to-date and evidenced by thorough, well kept and ordered records in the premises manual. All such measures ensure the safety of people using the service. Care Homes for Older People Page 29 of 32 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 30 of 32 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 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 1 12 A review should be conducted to consider the opinion of people who felt that a greater focus on activities could be beneficial to help pass the time. It is strongly recommended that the process of consultation with those who are longer-term occupants of the home should commence - to progress the ongoing agreed reprovision project of the Council. Such a process is now necessary, as the numbers of people using the service has reduced to a critically low number. Advocacy services should be used where appropriate. The upstairs (ex-smoking) lounge should be redecorated. 2 17 3 19 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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