Care Home: Seaforth Lodge

What the care home does well The location of the home is good and accessible. The new owner has started doing some improvements to the building such as painting of the walls. The meals are good and meet the cultural needs of the people who use the service. There are committed and experienced staff to provide care by ensuring the privacy, dignity and choice of the residents. The home listens to the residents and relatives, for example, through feedback gathering and quality assurance systems. We commend the home for working with the local health service to ensure that each resident receives medical care. There are good management arrangements to provide support to the staff and to ensure safety and well-being of the service users. What has improved since the last inspection? This is the first inspection since the home was registered in August 2009. What the care home could do better: Even though the new owner has started work to improve the facilities and decorations of the home, the bad smell in the ground floor sitting area needs attention. The people who live in the home and the visitors to the home expect the home to be free from unpleasant smells. The commitment, experience and skills of the staff are good. However, we are concerned that there are not enough staff during breakfast and lunch time. The owner needs to ensure that there are sufficient numbers of staff at all times to make sure that the residents` needs are fully met. There must be a regular audit of the management of medication administration. The staff who administer medication must remember to sign on the medication administration sheet to confirm that medicines are properly administered. Key inspection report Care homes for older people Name: Address: Seaforth Lodge Carlton Road London London N11 3EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 1 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Seaforth Lodge Carlton Road London London N11 3EX Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Bye Shameem Yatally Type of registration: Number of places registered: care home 21 Waterfall House Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: Twenty one The registered person may provide the following categories of service only: Care Home only-Code PC To service suers of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Code OP Code DE (E) Date of last inspection Brief description of the care home Seaforth Lodge is a private care home registered to provide care for 21 older people, some of whom may have dementia. Most of the residents at the home speak Greek as their first language but there are also some residents who speak English as well. Care Homes for Older People Page 4 of 25 Over 65 21 21 Brief description of the care home Six of the bedrooms have en-suite facilities. There is a shaft lift connecting the ground and first floors. There is a paved garden area to the rear of the home. There is a car parking space for visitors at the front of the home. The home aims to provide care and support that is sensitive to the cultural needs of service users and that meets their needs. The home was bought by Mr Haresh Dhunno in August 2009 from previous providers. Mr Dhunno has other local care homes for older people and people with mental health needs. Seaforth Lodge is in a pleasant residential area of New Southgate close to shops, services and transport links. Copies of the inspection report are available on request from the provider or from the Care Quality Commission website. Weekly fees for the home are from £495-£525. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection which means that the home had not been told of our visit beforehand. We arrived at the home at 8:00 Oclock and completed the inspection at 15:00 a.m. A Greek speaking person was present between 10 a.m. and 12 noon to talk to the residents in their own language. We had looked at the registration details of the home and the annual quality assurance assessment (AQAA) before visiting the home. An AQAA is a self assessment which the home had to complete and send to us. It tells us what the home does and how it plans to improve the service. As part of this inspection we had a guided tour of the premises. We also spoke to and observed a number of the people who use the service. We also interviewed two care workers. The manager and the owner of the home were both present during most part of the inspection We examined the homes policies, procedures, staff rota, menu, residents and staff Care Homes for Older People Page 6 of 25 files. We also checked health and safety certificates and records. Toward the end of the inspection we gave verbal feedback to the manager and owner. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? 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 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 8 of 25 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 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents can be confident that their admission to the home is based on the outcome of their assessment and the ability of the home meeting their needs. Evidence: We checked the files of five residents, including the file of a person who has been recently admitted. All these files contained evidence of assessments being completed before admission. We talked to the manager and the owner of the home who confirmed that new residents are admitted only if the home has full information about them and after an assessment is completed for them. A person was able to tell us through an interpreter that it was not their choice to come here and they would like to go back to the care home where they used to live. We discussed this with the manager who said that the residents request is being dealt with by the social workers. The manager said that the person was initially admitted following a referral received by the home and following the completion of an assessment. Care Homes for Older People Page 10 of 25 Evidence: The other service users we spoke to where satisfied with their placement. A visitor we spoke to told us that they are happy with the home. they said that they have been visiting the home for several years and the staff have always been good. Our observations indicated to us that the staff have skills and knowledge to treat the residents with respect and dignity. Care Homes for Older People Page 11 of 25 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. While the residents are reassured with the good progress the home has made in reviewing and updating their risk assessments and care plans, they expect that the care plans and risk assessments are clear and specific in identifying and meeting their needs. The would also benefit from a more person-centred care plan. Medication administration is generally satisfactory but is in need of some improvement to further protect the residents. Evidence: The five residents files we randomly selected and checked showed that risk assessments and care plans have been completed and reviewed. The care plans and risk assessments are comprehensive but sometimes ambiguous in that they do not specify the time and manner by which staff are to meet the needs of the people who use the service. We had a discussion on this with the manager and provider who said they will improve the quality of the risk assessments and care plans. We expect the home to further develop its care planning system by making it more specific and person-centred. We could see that a lot of effort has gone into updating the recording and filing system since the current owner has bought the service in August 2009. Care Homes for Older People Page 12 of 25 Evidence: From observations it was evident that the people who use the service were comfortable except one person about whom we mentioned above that they wanted to move back to their last accommodation. The home keeps daily records for each person with the detail of significant events during the days and nights. The AQAA confirms that the residents are supported to see health professionals as and when needed. Appointment letters and the diary indicated that the residents have regular dental, eye and chiropody care. The manager said that except for the newly admitted person all the residents had a flu jab. From discussions with the manager it was clear that each resident has their own general practitioner. Medication is administered by a named member of staff who has relevant training. While checking the medication and medication administration record sheets (MARS) we found out that on one occasion staff did not sign for one person to confirm that the medicines were administered. The medicines were not in the blister packs indicating to us that they were taken out. We were not sure; however, they were given to the person who uses the service. We asked the manager to look into this and put a system in place to ensure that the residents receive their medication as prescribed by their doctors. Care Homes for Older People Page 13 of 25 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 meals provided at the home are good and meet the cultural and dietary needs of the people who use the service. However, the support available during meal times is less than the expectation of some residents. The activities available at the home can be improved so that the residents are meaningfully engaged and stimulated. Evidence: During most part of our observation many residents were sitting in the lounge either watching a television programme. Conversation with the manager and an assessment of the AQAA confirmed that there are three care staff on duty during the days. The AQAA states that the home provides activities such as drawing, dancing, walking in the garden, exercising to music, dominoes and playing ball. A visiting relative we spoke to told us that they were happy about the home but they did not think the people who use the service were stimulated enough. The manager said that two of the residents have gone to a day centre and another two were in a hospital. The manager also told us that an entertainer comes to the home once a month and he is in the process of finding voluntary entertainers to come to the home regularly to help engage the residents. We checked the menu and found that it reflects the cultural and dietary needs of the Care Homes for Older People Page 14 of 25 Evidence: people. The manager said the residents are consulted about what they eat. All the residents we talked to said the food is good. From observations we noticed that the residents can choose what they want to eat. The cook has worked at the home for many years and is familiar with ethnic meals. We saw jugs of water being provided for all residents. The number of staff available during meal times seemed to us insufficient because there were more residents who needed help than there were staff available at these times. The chef and the deputy manager explained how people choose the meals. During breakfast and lunch we saw some residents waiting for their turn while staff finish helping the others. We brought this to the attention of the owner of the home in order to ensure that there are adequate numbers of staff to provide support to the people who use the service. We will ask (below under staffing) the manager to review the staffing level during peak hours. From records such as the residents files and the diary and from discussions with the residents was clear that the residents are visited by their relatives and friends. We saw one resident talking to their friend in the corridor. As we mentioned above we met and spoke to a relative who visited a resident. Care Homes for Older People Page 15 of 25 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. The people who use the service are reassured and feel safe because of the availability in the home of satisfactory policies and procedures on complaints and safeguarding. Evidence: The visitor we spoke to confirmed that they can speak to the staff and the manager if they have concerns. They said that the staff always welcome friends and are approachable. The residents told us that they can talk to the staff and manager. The home has policies and procedures on safeguarding and complaints. Information regarding how to make a complaint is displayed at the home. The manager confirmed that the staff have attended training on safeguarding. We interviewed two staff. Both were able to demonstrate their knowledge and experience of dealing with complaints and safeguarding. There have been no recorded complaints since the new owner has taken over the management of the home in August 2009. Care Homes for Older People Page 16 of 25 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. The people who use the service can feel safe and comfortable because of good maintenance arrangements and the availability of facilities and equipment. However, the unpleasant smell in the sitting area needs improvement to make the home more safe and comfortable for the residents to live in. Evidence: Most parts of the home were clean, bright and free from unpleasant smell. However, in the sitting area, on the ground floor, there was a bad smell. The manager said that the home is cleaned regularly. He also mentioned that they will talk with the residents and families about changing the flooring. A number of the residents and the visitor we talked to said the home is good. The home has facilities and equipment for the residents wellbeing. Records and certificates showed that there are systems in place for the regular maintenance of these facilities and equipment. From observation of the premises and discussion with the owner of the home it was clear that a lot has been done since August 2009 to improve the rooms and facilities. For example, the office is rearranged and painted and the front of the building is paved for car parking. The home is located in a quiet residential area off a busy road with easy access to the London buses. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use service benefit from the availability of experienced and knowledgeable staff. The residents can be more reassured if and when staff are available in sufficient number to provide support that meets their needs. Evidence: We examined five staff files. It was evident from the files that pre-employment processes have been undertaken and the necessary documents such as two written references and satisfactory criminal record bureau checks obtained. The staff also have contracts in their files. From the staff files and discussions with two staff we confirmed that they have attended various training programmes including fire safety, first aid, basic food hygiene and dementia. In the AQAA the manager has a plan to train all the staff to provide care that meets the needs of the service users. The owner also said that he will recruit and train more staff from the residents cultural background. The residents and a visitor we talked to said the staff are good. The staff we interviewed were able to describe their knowledge and experience of ensuring the residents dignity, privacy and choice while supporting them with personal care. They also gave us satisfactory explanation of how to manage safeguarding by keeping records and reporting concerns to the appropriate manager. The staff we spoke to confirmed that they have achieved a care qualification (national vocational qualification at level 2). Care Homes for Older People Page 18 of 25 Evidence: The staff rota and the AQAA showed that there are three care staff and a manager on shift during the day. A domestic assistant and a cook are also available during the day shift. The night shift is covered by two waking night staff. We mentioned earlier in this report that the staffing level at peak hours (morning and lunch time) was not enough as some residents had to wait for their meals while the staff finish supporting the other residents. In the AQAA the manager describes his plan to recruit voluntary workers. We feel that the home needs to review the staffing level so that each resident receives good quality care when they need it. This will also help reduce or eliminate the chance of staff making medication administration errors. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that the home is run in their best interest by committed and experienced management team. Evidence: The manager has worked at the home for over five years. He said he has finished his registered managers award and is currently doing a national vocational qualification (NVQ) level 4. The manager is supported by a deputy manager who has been recently employed. The owner, Mr Dhunno, also visits and supports the manager daily. A visitor we spoke to said they are happy with the way the home is run and that they have been consulted about the transfer of the ownership from the previous to the current owners. The manager said a quality assurance questionnaire is prepared in English and Greek to be given out to the residents, visitors, and professionals. The home has also established a system for gathering feedback from visitors. One visitor, who gave a written feedback, wrote: I am so pleased that my [relative] is in this residential Care Homes for Older People Page 20 of 25 Evidence: home. [They are] looked after very well by all staff. The home has health and safety policy and records showed that the facilities and equipment are checked and serviced regularly. For example, certificates confirmed that the hoists in the bathrooms were last serviced on 08/05/2009 and the boilers were checked on 03/03/2009. The London fire officers visited the home on 17/03/2009. Their judgement was that the home was satisfactory in respect of fire safety. The passenger lift was serviced while this inspection was being undertaken. The certificate for portable electrical appliances was dated 22/06/2009. Records and discussion with the manager confirmed that emergency lights, fire alarms and points are checked regularly. From a discussion with the manager we understand that the home does not manage the residents finances. However, the home receives personal allowances from relatives of some residents and helps them buy toiletries. A visitor we spoke to said they buy toiletries for a resident. Care Homes for Older People Page 21 of 25 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 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must ensure that staff who administer medication sign on the medication administration sheets confirm administration of medication. This ensures health and safety of the people who use the service. 15/12/2009 2 26 16 All parts of the home must be free from offensive smells. This is to ensure the health and safety and comfort of the people who use the service. 24/12/2009 3 27 18 The staffing level must be 15/02/2010 reviewed to ensure that enough staff are available at key times such as meal times and mornings to meet residents needs. This will ensure that the Care Homes for Older People Page 23 of 25 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 people who use the service are appropriately cared for, for example, without having to wait too long for staff while they finish helping others. 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 7 Risk assessments and care plans should be clear and specific so that staff know what, when and how to do things to meet the needs of the residents. The manager should audit medication regularly to prevent errors happening and to ensure that the residents receive the right medication as prescribed by their health practitioners. There should be suitable and appropriate activities so that the residents are stimulated and engaged. All residents who need assistance with their meals should get it without having to wait for the staff to finish other tasks. 2 8 3 4 12 15 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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