Care Home: Plumstead Lodge

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What the care home does well Information about the service was displayed in the reception area where residents, relatives and visitors could see and read it. Staff carried out an assessment to establish what support people would need if they decided to live in the home. The GP visits the home regularly. Staff obtained advice and support from other health and social care professionals, if necessary. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. The range and choice of activities provided in the home was good and there were regular outings to local places of interest. Visiting times were flexible. There were areas where residents could meet their friends and family in private.Relatives were satisfied with the care and support their family members received in the home. Complaints were logged and investigated promptly. Residents knew who they could speak to if they were unhappy. Staff said they would report allegations to the manager or senior staff. The home has a stable team of staff. This provides good continuity of care for residents. Most of the care staff had a care qualification. The company provides a varied and relevant programme of training for staff. Regular checks were carried out to monitor the homes performance and to obtain feedback about the service. Good records were kept about people`s money and valuables. The manager was respected and trusted by staff. Staff told us that senior staff were supportive and helpful. What has improved since the last inspection? A major refurbishment programme was undertaken. This had provided better facilities for some of the residents and staff and improved the visual appearance of the home. The home looked homely and welcoming. Medicines were stored at a suitable temperature. Meals were well balanced and most residents said they enjoyed the food provided in the home. What the care home could do better: Although the home provides an information pack, some people said they didn`t receive adequate information about the service before they moved into the home. The records did not always provide adequate information about the support that people received in the home. Medication was well managed overall but hand written entries on medication charts were not always checked and countersigned by a second member of staff. The home must introduce a robust system to check that hand written entries on medication charts are correct.The heating in one part of the building was not effective. One resident had to move to another bedroom because of this. Recruitment practices were good overall but the reason for gaps in applicants employment history were not always explored. Restrictors were fitted to all of the windows but some of the restrictors had come loose or were broken. There were no formal checks in place to ensure that restrictors were in place and fitted properly. Good records were kept about resident`s money and valuables but staff did not check valuable items regularly. CARE HOMES FOR OLDER PEOPLE Plumstead Lodge 82-84 Plumstead Common Road Plumstead London SE18 3RD Lead Inspector Maria Kinson Unannounced Inspection 6th and 7th November 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Plumstead Lodge DS0000006856.V374178.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. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Plumstead Lodge Address 82-84 Plumstead Common Road Plumstead London SE18 3RD 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 8854 8255 020 8854 5068 anna.renner@kcht.org.uk www.kcht.org Kent Community Housing Trust Miss Anna-Maria Renner Care Home 53 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (52) Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 53 Date of last inspection Brief Description of the Service: Plumstead Lodge is a registered care home providing care and accommodation for 53 older people. The registered provider is Kent Community Housing Trust. The home is located on the busy Plumstead Common Road close to local shops and bus routes. The building consists of fifty three single bedrooms, a large dining room, three lounges, a smoking room, an activity room and shared bathing and toilet facilities. Residents can access both floors of the home by using one of the two passenger lifts. There are gardens at the front, rear and side of the property. Parking is available in the roads surrounding the home. The fees charged by the home range from £442.96-£495 per week. The fees do not include personal items such as newspapers, toiletries, chiropody and hairdressing. This information was supplied to the commission on 06/11/08. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last key inspection of this service was undertaken in December 2006. We also undertook a random inspection in November 2007 to investigate a complaint. This inspection was carried out over two days in November 2008. Prior to the inspection we reviewed all of the information that we had received about the service. This includes complaints, concerns, notifications and the annual quality assurance assessment (AQAA) form. The AQAA is a selfassessment form that registered services have to complete once a year. We sent surveys to some of the people that use or visit the home to obtain feedback about the service. We received twelve responses, seven from residents, two from staff, two from relatives and one from a local health care professional. We also spoke to four residents and four members of staff during the inspection. We have included some of the comments that we received about the home in this report. What the service does well: Information about the service was displayed in the reception area where residents, relatives and visitors could see and read it. Staff carried out an assessment to establish what support people would need if they decided to live in the home. The GP visits the home regularly. Staff obtained advice and support from other health and social care professionals, if necessary. Residents were appropriately dressed and looked relaxed. They told us that staff maintained their privacy and were polite and helpful. The range and choice of activities provided in the home was good and there were regular outings to local places of interest. Visiting times were flexible. There were areas where residents could meet their friends and family in private. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 6 Relatives were satisfied with the care and support their family members received in the home. Complaints were logged and investigated promptly. Residents knew who they could speak to if they were unhappy. Staff said they would report allegations to the manager or senior staff. The home has a stable team of staff. This provides good continuity of care for residents. Most of the care staff had a care qualification. The company provides a varied and relevant programme of training for staff. Regular checks were carried out to monitor the homes performance and to obtain feedback about the service. Good records were kept about people’s money and valuables. The manager was respected and trusted by staff. Staff told us that senior staff were supportive and helpful. What has improved since the last inspection? What they could do better: Although the home provides an information pack, some people said they didn’t receive adequate information about the service before they moved into the home. The records did not always provide adequate information about the support that people received in the home. Medication was well managed overall but hand written entries on medication charts were not always checked and countersigned by a second member of staff. The home must introduce a robust system to check that hand written entries on medication charts are correct. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 7 The heating in one part of the building was not effective. One resident had to move to another bedroom because of this. Recruitment practices were good overall but the reason for gaps in applicants employment history were not always explored. Restrictors were fitted to all of the windows but some of the restrictors had come loose or were broken. There were no formal checks in place to ensure that restrictors were in place and fitted properly. Good records were kept about resident’s money and valuables but staff did not check valuable items regularly. 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. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had access to written information about the service and could visit or spend time in the home before making a decision to move in. Staff carried out a care needs assessment before people moved in, or within 48 hours for emergency admissions. EVIDENCE: Residents said they received a contract. A copy of the standard contract was provided in the homes information pack. The contract provides adequate information about what the fees include and the terms and conditions of occupancy. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 10 The manager said prospective residents or their relatives were given an information pack when they visited the home and sometimes during the assessment visit. The information pack includes a copy of the homes ‘Statement of Purpose’, a draft contract and information about the fees and registered company. Three residents said they did not receive adequate information about the home before they moved in. See recommendation 1. A copy of the ‘Statement of Purpose’ was displayed in the reception area and visitors room. The Statement of Purpose includes useful information about the support, facilities and services that the home could provide. Information about the manager’s qualifications should be updated. The company employs a dedicated assessor. The assessor was responsible for assessing prospective resident’s needs and handing this information over to the homes staff. The assessor also arranged for prospective residents and family members to visit the home and was a point of contact for questions. Assessments were carried out very quickly because the assessor had no other commitments. Staff undertook their own assessment if the assessor was not available or if they had concerns about a placement. We looked at the assessment records for two new residents and information that was obtained and recorded about one resident that was admitted to the home as an emergency admission. Assessments were usually completed before people moved into the home. The assessment forms that we looked at provided comprehensive information about people’s health, personal and social care needs, medication details and potential risks. The forms included some information about people’s likes, dislikes and preferences. The home also received information from other professionals such as care managers. One resident was admitted to the home very quickly because they were assessed by social services to be at risk in their own home. Staff did not have an opportunity to assess the resident before they moved into the home. Information was obtained from the resident on the day of admission and social services provided some additional information about the resident’s history and home circumstances. The resident that was admitted to the home as an emergency admission had a mental health disorder and some challenging behaviour. Plumstead Lodge is not registered to care for people with mental health problems and none of the staff had received training about supporting people with mental health needs. This issue was discussed with the registered manager who told us that the residents care manager was looking for an alternative placement for the service user. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflected peoples needs but it was not always clear if the plan was followed. There were systems in place to ensure that medicines were properly managed and to identify concerns. Staff worked in partnership with other professionals to meet resident’s health needs. Residents were addressed by their preferred name and were treated with respect. EVIDENCE: The company had recently introduced some new documentation. Staff had started to transfer information from the old forms on to the new forms but had not completed this task. We looked at the records for two new residents. One set of records was on the new documentation and one was on the old style format. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 12 An individual care plan was developed to show what action staff should take to meet people’s needs. The first care plan was easy to follow and understand and addressed all of the persons needs. Although the plan provided adequate information for staff it was not always clear if the plan was followed. For instance the plan stated the resident required assistance to have a shower and a shave. The daily records provided some evidence that the resident was assisted to have a shave and a wash on some days but there was no indication they were supported to have a shower. Some of the entries in the daily care records were vague and did not provide adequate information about the support that people received. For example one entry stated that the resident did not want to go to the dining room for tea. There was no indication in the records if the resident was offered a meal in their room or had anything to eat that night. See requirement 1. The file included various assessments to identify and address potential risks. The resident was known to be at risk of falls, wandering and had some memory loss. Some strategies were planned to address these issues but there was no indication that staff considered these risks when they allocated the resident a first floor bedroom. See recommendation 2. The second file was for a resident that was admitted as an emergency admission. The assessment stated that the resident had some challenging behaviours and required prompting to wash, dress and use the toilet. There were clear plans about how staff should manage the challenging behaviour and about the action they should take to support the resident to wash and dress appropriately. It was not clear if the plan was always followed. For instance there was no indication in the daily care records that the resident was prompted to use the toilet or supported to wash and dress on some days. See requirement 1. Care plans were reviewed regularly and there was some evidence that information was shared with residents and relatives. We received written feedback from one health care professional that was in regular contact with the home. The person told us that staff were able to meet resident’s health needs and always followed their instructions. Residents were satisfied with the care and support they received in the home and said staff listened and acted on what they said. We looked at the medication supply and records for three residents. All medicines were in stock. Good records were kept about medicines that were supplied to or bought into the home. Records of administration were good but one medicine was omitted for several days without explanation. The manager had already identified this issue and provided evidence that action was being taken to investigate and address the matter. Some of the information that was written by hand on medication charts was not checked and countersigned Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 13 by a second member of staff. See requirement 2. Records of disposal of unwanted medicines were satisfactory. A medication profile had been developed for each resident. This provides useful information for staff and the GP about medicines that residents are taking and have taken in the past. The company had recently made a decision to stop using homely remedy medicines. Staff were concerned that some residents might have to wait until they can obtain a prescription, for a minor health issue such as a headache. We will monitor this issue at future inspections. Communication between staff and residents was mostly good. Staff ensured that people’s privacy was maintained and addressed people by their preferred name. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a varied programme of activities to meet people’s needs. Visiting hours were flexible and residents were able to choose how and where they spent their time. People received a balanced diet and were supported to eat, if necessary. EVIDENCE: In the period since the last inspection the smoking room was converted into a dedicated activities room. The room was redecorated and the furniture was arranged to enable staff to carry out activities with small groups of residents or individuals. The home has two part time activity staff. Residents said there were regular activities and we saw evidence of this during the inspection. Staff supported one resident to play the organ and assisted other residents to play games and paint. Some residents had taken part in various games such as quizzes, skittles and darts and completed art and craft, cookery and flower arranging projects in recent weeks. There were regular trips to local places of interests Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 15 and restaurants in the ‘bright days’ bus. The bus visits the home once a month. One resident said they didn’t take part in activities but did like to go on the outings. Some of the residents that we spoke with told us about some of the singers and entertainers that had visited the home and one person said they particularly enjoyed the gospel singers and music sessions. Staff arranged an annual holiday for some of the residents. Two relatives provided written feedback about the service. They told us that they were usually informed about important issues such as accidents and felt staff were usually able to meet people’s needs. One resident said friends and family could visit at anytime. We asked three people if there were any restrictions about what they did or how they spent their time in the home. Residents told us “we can do what we want”, we can stay up late and watch television if we want to, another resident told us that they liked living at Plumstead Lodge “because they let me do my own thing”. One resident said they liked to spend most of their time in their room and staff respected this. The same resident told us that the only restriction was that they could not go out alone because they had a medical problem. The resident said the situation would not be any different if they lived in their own home. There were regular residents meetings. The minutes from two recent meetings indicated that there was lots of discussion about activities and food and some residents put forward suggestions and requested certain dishes. A number of residents said they wanted the ‘sweet trolley’ back. The ‘sweet trolley’ provides a selection of birthday cards, toiletries and sweets that residents can purchase. The sweet trolley was reintroduced. There was a four weekly rotating menu. The menu includes a cooked breakfast on alternate days and a good selection of fruit, toast and cereals. There were two main meal choices at lunchtime, both of which were served with at least two vegetables. The evening meal consists of a light cooked snack, soup and sandwiches and a choice of two desserts. The menu was varied and well balanced. We observed staff serving the lunch time meal in the main dining room. The meal choices were displayed on a menu board by the serving hatch but some of the residents could not see the board. There was a menu card on each table but the cards did not provide any information about the day’s menu. Most residents were asked what they wanted to eat from the menu or were offered a choice of two plated meals. The meal looked appetising and most of the people that we spoke to said the food provided in the home was usually good. Residents told us that they could request an alternative dish such as cheese on toast or a salad if they wanted and some people said the soup was particularly good. One resident requested some extra potatoes and gravy once they had finished their meal. The activity coordinator facilitated this request. One Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 16 resident required support to eat. The staff member provided discreet assistance and was able to maintain good eye contact with the resident. We asked one resident who was not born in the UK if they had any particular dietary needs and if the home was able to meet those needs. The resident told us that they had lived in the United Kingdom since 1953 and had always eaten traditional English food, even when they were not living in the UK. One resident was offered a traditional Jamaican dish but declined. The resident was given a choice of alternative dishes. Residents told us that they were offered regular hot and cold drinks but some residents said they would like more hot drinks. Two residents that spent a lot of their time in their rooms said they were not always offered an evening drink and would like to be able to make their own drinks. This issue was discussed with the activity coordinator who agreed to see whether this would be possible or if they could be supported by staff to make their own drinks. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 17 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to investigate concerns and to protect people from abuse. EVIDENCE: There was information about the homes complaints procedure in the ‘Statement of Purpose’ which was displayed in the home. The procedure states how long it is likely to take the home to investigate complaints and says who people can contact if they are unhappy with the way their complaint was handled. Residents told us that they knew who to speak to if they were unhappy and how to make a complaint. The home had received eleven complaints in the past twelve months. We looked at six complaints, all of which were received in 2008. The complaints file was well laid out and easy to follow. It contained information about the concerns raised by the complainant, details about the manager’s investigation and findings and a copy of the response to the complainant. Records showed that complaints were investigated and responded to promptly. We saw a number of cards and letters thanking staff for their support. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 18 The home has a ‘Protection of Vulnerable Adults’ procedure which was reviewed and updated in April 2008. The procedure indicates that staff should notify CSCI and social services about allegations of abuse and must take immediate action to protect the individual. Staff told us that they would report allegations and concerns to senior staff or the manager. Most of the care staff had attended a safeguarding training session but the ancillary staff such as the administrator and the maintenance employee had not attended this type of training. The administrator was responsible for managing resident’s moneys so is a good position to identify misuse of resident’s monies and financial abuse. We recommend that all of the people that work in the home attend safeguarding training. Plumstead Lodge DS0000006856.V374178.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, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recent refurbishment programme made the home look brighter and more welcoming. One part of the home was heated by convection heaters. This type of heating did not meet some resident’s needs. EVIDENCE: A major refurbishment programme was undertaken in the period since the last key inspection. Some of the windows and carpets were replaced and some new bedroom and lounge furniture was purchased. The clinical room was redecorated and new cupboards and worktops were fitted. Some of the bedrooms, one lounge, the activities room and the reception area, were redecorated. The laundry room was refurbished this included redecorating the room, replacing the floor covering, fitting hand washing facilities and Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 20 purchasing a new washing machine. A patio was laid in the garden at the rear of the dining area. The new area had raised flower beds and some new seating. Although the refurbishment programme was complete, further work was planned to update some of the other parts of the home. The maintenance person was responsible for undertaking routine repairs and health and safety checks. The home was well maintained overall but some of the window restrictors were not in place or fitted properly. See standard 38. The toilet seat in the toilet opposite the activities lounge was chipped and worn and the flooring in this room was stained. See recommendation 3. Bedrooms were arranged to suit individual needs and some residents had personalised their rooms by using some of their own furniture and displaying personal photographs and pictures. The communal areas were pleasantly decorated and furnished. Although it was winter and the gardens were not in use they were tidy and well maintained. The heating in one part of the building, which staff called the ‘west wing’ was not effective. This part of the building does not have central heating radiators. Staff said they had tried different types of heaters but none of the heaters provided adequate heat. Some of the rooms that we viewed in the ‘west wing’ did not feel warm and one resident said they had to move to another bedroom because they were so cold. It was evident during discussions with staff that this is a long standing issue. The manager told us that an engineer visited the home after the inspection and arranged for additional heaters to be installed until work could be undertaken to resolve the issue. See requirement 3. The home was clean and tidy overall and residents said it was always fresh and clean. The lounge near the dining room looked untidy after people had finished their afternoon tea. There were biscuits crumbs over the floor and some people had spilt some of their tea. Two residents raised concerns about the cleanliness of the toilets. They told us that the toilets were cleaned in the morning but were often dirty by the afternoon. See recommendation 4. The local environmental health department inspected the main kitchen in 2008. The certificate that was displayed in the home indicated that they found the standard of hygiene to be satisfactory in the main kitchen. Plumstead Lodge DS0000006856.V374178.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, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a stable team of staff. Recruitment practices were good overall but gaps in applicant’s employment histories were not always followed up. Staff attend regular training updates and were supported to gain recognised qualifications. EVIDENCE: There were five care staff and a team leader on each of the daytime shifts. The manager and assistant manager area provide support during office hours and an ‘on call’ manager was available for advice at other times. Residents said call bells were answered promptly and staff were usually available to help them. Staff said there were usually enough staff to meet people’s needs and told us that managers “help out on the floor”, if necessary. Because the home has a stable staff team it does not need to use many temporary staff. This provides good continuity of care for residents. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 22 88 of care staff had a National Vocational Qualification in Care (NVQ) at level two or above. This exceeds the standard that was set by the department of health that 50 of the care homes staff team should have this qualification. Staff carried out their work in a professional but friendly manner and responded promptly to requests for assistance. We looked at three recruitment files for people that were appointed in 2008. The files included all of the documents that were required such as an application form, two written references, proof of identification, a recent photograph and criminal record check. There was some evidence that the manager had explored gaps in employment histories during the interview but this was not carried out consistently. See recommendation 5. The company has a dedicated training department. The training department organised a relevant and varied programme of training. Staff could also attend local authority training courses and the manager could arrange local training sessions to meet staff needs, if necessary. An individual record was kept about the training that staff attained. In the period since the last inspection some of the staff had attended safeguarding, moving and handling, first aid, mini bus driver and infection control training sessions. Three staff provided written feedback about the service. They confirmed they received training before they worked in the home and one person said, “I was shown everything that I needed to know about my role”. Staff were satisfied with training arrangements and said the sessions helped them to meet resident’s needs and gave them “a better view on things”. Plumstead Lodge DS0000006856.V374178.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, 32, 33, 35 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The atmosphere in the home was open and supportive. There were systems in place to monitor and improve the quality of care provided in the home. Staff carried out a comprehensive programme of safety checks, but this did not include window restrictors. EVIDENCE: The manager holds a Diploma in Management and had attained an NVQ level 4 in care and the Registered Managers Award (RMA) in the period since the last inspection. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 24 Staff said the manager was approachable and easy to talk to. Staff felt supported and said they were encouraged to work as team. One staff member told us that “management has an open door system” and another person said if you need advice or extra training you just have to ask. The manager communicates effectively with the commission. We were told about significant events and allegations and about any action that was taken in respect of these issues. There were various systems in place for monitoring the quality of care and services provided in the home and for obtaining feedback from residents and relatives. A senior manager visited the home once a month to assess the conduct of the service, complete an audit and check that staff were following company procedures. A different topic was considered during each visit. If concerns were identified during audits the manager had to complete a corrective action plan to show what action she would take to address the matter. The issue was reassessed at the next visit to ensure that it had been properly addressed. Satisfaction surveys were sent to relatives and residents once a year. The results from the recent survey were not available at the time of the inspection but the manager agreed to forward a copy to the inspector. In addition to residents meetings there was also an annual forum for residents and relatives. The meeting provides a forum for residents and relatives to raise concerns and question senior staff from the company and some of the board of trustees. There were systems in place to safeguard resident’s personal money. Individual records were kept about money that was received in the home and the records stated how residents used their money. Receipts were kept for items that were purchased for residents and for services that were provided by other people such as the hairdresser. Money and valuables were stored securely. Money records were checked and audited but valuable items had not been checked for over a year. See recommendation 6. Staff said they had an opportunity to discuss their work and training needs during supervision sessions. The supervision contract provides information about the sessions and records were kept about the issues discussed. We observed staff supporting people to move around the home with walking aids and in wheelchairs. Residents usually received appropriate support but there was one isolated incident where a staff member did not follow the instructions in the residents moving and handling care plan. Staff informed the manager about this issue and action was planned to address the matter. Equipment was serviced regularly to ensure that it was working properly and safe for use. Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 25 The fire safety risk assessment was dated 2007. The fire alarm system, emergency lighting and fire safety equipment was checked and serviced at regular intervals. The maintenance employee had attended fire warden training and was responsible for training the other staff that worked in the home. There were regular fire drills to check that staff were familiar with the fire procedure. The magnetic closure on one of the fire doors on the first floor was broken. The maintenance employee had identified this issue and the part was on order. Some of the window restrictors on both floors of the home were broken. On the ground floor a bedroom window that led out to a public alleyway was fully open and on the first floor the opening on three windows was not restricted. The maintenance person had tried to address this issue but the age and design of some of the window frames made it difficult to find suitable and effective fittings. There were no records of any window restrictor checks. This is a health and safety and security risk. See requirement 4. We examined some of the recent accident report forms. Most of the forms were about falls and trips and did not result in serious injuries. It was not always clear on the form if the staff member witnessed the event or if the information recorded was the resident’s account of what had happened. We requested one form about a recent incident. There was some information in the resident’s records about the incident but the staff member had not completed an incident form. See recommendation 7. Plumstead Lodge DS0000006856.V374178.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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 3 3 X 3 3 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Plumstead Lodge DS0000006856.V374178.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. 1. Standard OP7 Regulation 12 Requirement Records must show that staff had made proper provision for the care, safety and welfare of residents. Hand written entries on medication charts must be checked and countersigned by a second member of staff. Adequate heating must be provided in all parts of the building. The commission must be notified by 01/04/09 about the timescale for fitting central heating in the bedrooms in the ‘west wing’ end of the building. The home must establish a system for checking that window restrictors are in place and are functioning properly. Timescale for action 29/04/09 2. OP9 13 01/04/09 3. OP25 23 01/04/09 4. OP38 13 01/04/09 Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP1 Good Practice Recommendations Staff should implement a system that ensures that all residents, regardless of whether they visit the home or not receive a copy of the homes information pack. Potential risks should be considered prior to offering or allocating a room to new residents. This information should be included in risk assessments. The chipped toilet seat and stained flooring in the toilet near the activities lounge should be replaced. Staff should carry out regular checks during the afternoon to ensure that the lounges and toilets are clean and tidy. Staff files should include a written explanation about gaps in their employment history. Regular checks should be carried out to ensure that resident’s valuables are safe. Staff should receive training about accident form reporting. OP7 OP19 OP26 OP29 OP35 OP38 Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Plumstead Lodge DS0000006856.V374178.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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