Care Home: St Luke`s Lodge

What the care home does well St Luke`s Lodge is a relatively small care home where there is a homely atmosphere. A relative wrote on their comment card, "the staff provide for the needs of my X very well." The home monitors the quality of care by regularly consulting the residents and their relatives or representatives. Written comments included, "good services all round" and "staff do their job very well and are so pleasant and courteous." Other feedback said, "It`s always a pleasure coming to visit St Luke`s." We received complimentary views on surveys returned to us. Seven residents were supported to fill out their questionnaires. For what the home does well, responses said, "they look after us very well"; "I like people here. I can`t find fault with them." and "all staff good." When asked do you receive the care and support you need and are staff available when you need them? all seven people responded `always`. The manager and staff are approachable, have a caring attitude and respect the views of the people living in the home. They are asked how they want their care and support to be provided. Admissions to the home are well managed and arranged in a planned way so that people`s needs are fully assessed, whilst ensuring that the home is suitable for them. Care planning is well organised to ensure that residents` specific needs associated with memory loss are addressed and met. When a person`s needs change, the home is good at making sure the appropriate action is taken. This includes consultation with other relevant professionals and making any necessary adjustments to people`s care and support plans. Areas of the environment have been adapted in a way that meets the specific needs of people who have dementia. There are lots of visual aids around the home such as photographs to help people identify different rooms. The owners and their son, the general manager have a positive approach to developing the service, are aware of the shortfalls and show a willingness to work with us to maintain and improve standards. There is a commitment to staff training so that staff have the skills and expertise to support people`s collective and individual needs. What has improved since the last inspection? The manager and staff have worked hard to make the required improvements following our last inspection in July 2008. They have made good efforts to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations being made. Care plans now cover all aspects of people`s health, personal and social care needs in ways that give ownership to each individual. People now benefit from regularly reviewed risk assessments to ensure that best actions to minimise any risks are in place and followed. Each person now has a specific risk plan concerning fall prevention and ownership of keys. More visual aids are available for helping people who experience memory loss. Photo identifcation on bedroom doors and illustrated food menus are two examples. There have been ongoing home improvements within the premises. The call buttons in the lift have been replaced for easier identification, some of the bedrooms repainted and repair work completed in one of the ensuite bedrooms. Extra hand rails have been fitted following an assessment by an Occupational Therapist and there is a planned programme of maintenance and redecoration to improve the environment. Staff have undertaken further training to keep their knowledge and skills refreshed. Rota shift patterns havebeen adjusted so that they do not work excessive hours. The home`s overall standard of record keeping has improved so that people`s rights and best interests are better safeguarded. We have been kept informed of any reportable events that affect the welfare of people who use the service. The policies and procedures have been updated for clarity and relevance. A specific policy for locking the front door has been written to ensure that residents rights are considered whilst maintaining their safety. Health and safety risks within the home have been recorded in more detail to ensure that the premises remians safe for people living and working there. Following this key inspection, we have assessed that the home has improved upon standards in the required areas and judged the home to provide good outcomes for the people who use this service. What the care home could do better: Whilst we have assessed that the home has made good progress, there are some areas that still need development in relation to staffing and environmental standards. Appropriate locks must be fitted to all bedroom doors so that people`s right to privacy is not compromised whilst ensuring their safety. Similarly, a lock on one of the toilet doors needs replacing. Suitable window restrictors need fitting in one of the shared bedrooms to ensure residents` safety. In the lounge call bells must be available so people can summon assistance when necessary. To minimise the risk of cross infection, staff must be provided with disposable aprons in the bathroom areas. The manager`s working hours, roles of the staff and designated person in charge each day must be identified on duty rosters for clarity and legal purposes. Recruitment practices still need to be more thorough, to ensure that people are kept safe from possible harm or poor practice. Full employment histories must be explored for all employees and the staff job application form amended to reflect such information. Some improvements are needed in relation to the management of medication to ensure safer practice. All stock medication must be checked regularly. Any as required medication needs to be reviewed more promptly when changes occur. Finally, each person needs an up to date contract so that they have accurate information about all costs and facilties they can expect to receive. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Luke`s Lodge 7 Southborough Road Surbiton Surrey KT6 6JN     The quality rating for this care home is:   two star good 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: Claire Taylor     Date: 0 9 0 7 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 33 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 33 Information about the care home Name of care home: Address: St Luke`s Lodge 7 Southborough Road Surbiton Surrey KT6 6JN 02083992085 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): anna.raja.sll@gmail.com Mrs Annapoorani Rajanayagam,Mr Christie Kamalanathan Rajanayagam care home 17 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 17 dementia Additional conditions: 0 The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) (of the following age range: 65 years and over) Date of last inspection Brief description of the care home St Lukes Lodge provides care to seventeen older people, some or all of whom may have dementia. The home is a detached property situated in a quiet residential area of Surbiton. There is good access to shops, public transport and other local resources. The home is owned and managed by Mr and Mrs Rajanayagam. Bedrooms are provided over three floors, all of which can be accessed by passenger lift. There is a large well-kept garden to the rear of the property. Parking spaces are available. Twenty-four hour care is provided. As well as care staff, the home employs a cook and activities coordinator. A copy of the homes Service User Guide and Statement of Purpose can be obtained on request from Care Homes for Older People Page 4 of 33 Brief description of the care home the home. Fees for the home ranged from £437.62 to £560.00 and were correct at the time of this inspection. There are additional charges for social trips, taxi hire, hairdressing, newspapers, chiropody and some toiletries. Care Homes for Older People Page 5 of 33 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: We as it appears throughout this inspection report refers to the Care Quality Commission. The people who live at the home prefer to be known as residents, so that is the term that has been used in this report. This was an unannounced inspection, which took place over two days. We spent time meeting with some of the residents to discuss what it is like to live at St Lukes Lodge. Some individuals do not have the capacity to fully share their views regarding their care. In order to make judgements about the care that individuals receive, we observed care practices; interactions with staff and tracked records of care. Discussions were held with some of the staff on duty, the home manager and their son who is employed as general manager for the service. Various records were looked at in relation to care planning, staffing and the way the home is run. We also looked around the building and checked to see that the Care Homes for Older People Page 6 of 33 environment was safe. During the inspection we observed the daily life of the home and how staff assist people living there. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that must be completed once a year. It is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments. Some details from the AQAA are included in this report. Following the homes last key inspection in July 2008, we asked the provider to complete an improvement plan which is used to tell us how the home will meet the required improvements. We received a detailed response within the correct timescale and checked that the plan had been actioned as part of this inspection. Seven residents, four staff and one relative returned questionnaires. We would like to thank the residents and staff for their time, assistance and hospitality. What the care home does well: What has improved since the last inspection? The manager and staff have worked hard to make the required improvements following our last inspection in July 2008. They have made good efforts to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations being made. Care plans now cover all aspects of peoples health, personal and social care needs in ways that give ownership to each individual. People now benefit from regularly reviewed risk assessments to ensure that best actions to minimise any risks are in place and followed. Each person now has a specific risk plan concerning fall prevention and ownership of keys. More visual aids are available for helping people who experience memory loss. Photo identifcation on bedroom doors and illustrated food menus are two examples. There have been ongoing home improvements within the premises. The call buttons in the lift have been replaced for easier identification, some of the bedrooms repainted and repair work completed in one of the ensuite bedrooms. Extra hand rails have been fitted following an assessment by an Occupational Therapist and there is a planned programme of maintenance and redecoration to improve the environment. Staff have undertaken further training to keep their knowledge and skills refreshed. Rota shift patterns have Care Homes for Older People Page 8 of 33 been adjusted so that they do not work excessive hours. The homes overall standard of record keeping has improved so that peoples rights and best interests are better safeguarded. We have been kept informed of any reportable events that affect the welfare of people who use the service. The policies and procedures have been updated for clarity and relevance. A specific policy for locking the front door has been written to ensure that residents rights are considered whilst maintaining their safety. Health and safety risks within the home have been recorded in more detail to ensure that the premises remians safe for people living and working there. Following this key inspection, we have assessed that the home has improved upon standards in the required areas and judged the home to provide good outcomes for the people who use this service. 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 33 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 10 of 33 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. Peoples needs are fully assessed prior to admission to ensure that the home can meet their needs and that staff are aware of how to support them. Up to date contracts are needed so that people have accurate information about the facilities and services they can expect to receive and any costs involved. Evidence: Three residents files were sampled and all contained assessments, which were personcentred, including a detailed life history of the person, their likes, dislikes and preferences, hobbies, interests and involvement with family and friends. Key areas and events in a persons life such as their childhood, adulthood and retirement are also fully explored through the assessment process. There were details about where a person was independent in meeting their needs and good information about healthcare needs such as skin care, nutrition and mobility. For people who fund their own care however, the home should ensure that their needs assessments are reviewed annually Care Homes for Older People Page 11 of 33 Evidence: or sooner if something changes. We saw that one persons mobility had deteriorated but their needs assessment had not been updated to reflect the changes. Positively however, the care plan did reflect the persons support needs. We also looked at care records for one person who had recently moved to the home. This showed that the home completed an assessment of their needs with involvement of the person and their family before they made a decision to use the service. Personal care needs arising from culture and diversity were identified through a questionnaire provided by the home. This included details about a persons preferred religion or beliefs and identity. The manager told us that people are given a statement of the terms and conditions and a contract at the time of admission and also send a copy to their respective relative or family member. We checked some of the contracts for people who fund their care privately and generally,they gave people clear information about the obligations of the provider and the persons responsibilities when staying in St Lukes. Full details about any extra costs needs to be included however and all contracts must be reviewed each year so that people have accurate information about the fees and services they can expect to receive. This will help them and/ or their representatives to have a better understanding of the care that is promised and likewise the homes duty of care to them. Where care is funded by social services, contracts are also agreed between the local authority, the home and the resident. We saw that these were up to date on respective files. Intermediate care is not offered at the home; therefore this standard was not assessed. Care Homes for Older People Page 12 of 33 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. Improvements have meant that care plans are more person centred and staff know how to support peoples needs in ways that the residents prefer.Plans are regularly reviewed to ensure each residents current needs are being addressed. Medication practices are generally well managed although some improvements will ensure better safety and consistent treatment for each person. People who live in the home are treated with respect. Some improvements to the physical environment are needed so that peoples right to privacy is upheld. Evidence: A requirement has been met for care plans to include more information about peoplesneeds and goals. The home has worked hard to develop the care plans and used more person centred approaches. The care plan style also considers the specific needs of people who have dementia. We checked four peoples care records which each gave a good overview of their holistic needs and clearer direction about the most appropriate ways to give the required care and support.The plans were written in a way that gave ownership to each person and included clear objectives. An example Care Homes for Older People Page 13 of 33 Evidence: said, I am able to walk with a frame and would like to maintain the mobility that I have. One of the planned improvements on the AQAA said, Person centred care plans can be further developed with further additions of more photos and pictures. At our last inspection we required the home to ensure that risk plans were reviewed at least six monthly and that risk assessments were carried out for each person concerning the prevention of falls. Based on the evidence we saw for this key inspection, the home has made significant improvements to its risk management process meaning that people are more fully protected from the risk of harm. We saw up to date moving and handling assessments which directed staff on the correct ways to support people. All risk plans had been reviewed every six months. The care plans clearly outlined the support a person may need for health check-ups and health screening. All residents are registered with a general practitioner and are supported to access a full range of NHS services. The input of other healthcare professionals was clearly recorded in peoples care plans. In response to our previous recommendation, healthcare records and any outcomes were being logged in a specific section of the care plan. This gave an overall summary of a persons specific healthcare needs and medical history to quickly track any events if concerns arose about a persons health. There are good systems in place for monitoring each residents physical well being. Examples concerned one residents loss of appetite and anothers changed mobility needs. Care plans had been reviewed accordingly to ensure that staff took further action to meet their support needs. This included a nutritional monitoring chart and revised moving and handling care plan for each respective person. Records also told us that staff seek advice promptly if they have concerns about an individuals health. We saw that one person had experienced increased pain in their hip and that the home arranged for the person to attend an orthopaedic clinic. In response to our previous recommendation, each person had a detailed profile which gave staff up to date information about the type of medication, the reasons for its use and any allergies or side effects that they must be aware of. Where as required medication had been prescribed, people had guidelines to inform staff on what action to take before this type of medication can be given. The relevant GP had also signed to approve these guidelines. Charts for one person showed that they had been administered an as required medication every night for two weeks. Given that the medication was prescribed on an as required basis, the home must ensure that the medication is reviewed by the persons GP. Aside from this issue, records told us that the homes registered GP undertakes regular medication reviews every three months. All medicines stored in the home on behalf of residents were locked in a metal portable trolley. This is secured to a wall in the hallway when not in use. Medication records were accurate for the receipt, disposal and return of medication. A monitored dosage system is used with most medication being delivered in blister packs by the dispensing pharmacist. We checked some of the medication administration charts which were signed and accounted for. We saw that medication was stored correctly with records Care Homes for Older People Page 14 of 33 Evidence: kept for its receipt and disposal. One area for improvement is that the manager needs to make a weekly recorded check on medication stock. This is to further ensure safe practice and minimise the risk of error. As further good practice, we think that the home should also undertake regular checks on all other medication to maintain an audit trail. In addition regular visits should be undertaken by the supplying pharmacist to offer advice and make similar audit checks. We saw that the manager had consulted with the pharmacist to arrange an audit. She was due to complete a written self assessment of the homes medication practices in preparation. Records showed that two staff had undertaken recent medication training. All staff had received in house medication training with the manager. The manager advised that she has applied for a refresher training course through Boots pharmacy. In discussions with individual residents it was very clear that staff treat people kindly and respect their privacy. Comments included, the staff are very nice; helpful and they are kind to me. We found one area for improvement however concerning the locks on the bedroom doors. Many were not locked and had a locking device that had been disabled with a piece of wire. This means that some people would be unable to lock their bedroom door for privacy or choice. In addition, there was no override facility for staff to enter the room in the event of an emergency. Although some indivduals may lack the capacity or choose not to own a bedroom key, suitable locks must be provided that promote privacy for people and safeguard their welfare. We also viewed the vacant shared bedroom on the first floor. The screening curtain was held in place by an unsightly copper pipe and we suggest that this is replaced with a more suitable curtain pole. Peoples wishes in respect of what will happen in the event of their death had been obtained and recorded. Families and representatives were also involved. Care Homes for Older People Page 15 of 33 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. People are provided with a range of activities to enhance their lives and meet their needs and interests. People are supported to keep in touch with their families and friends and maintain relationships that are important to them. Meals are nutritional and take into account peoples individual preferences and choices. Evidence: We saw that assessments and care plans included all the information necessary to ensure each residents preferences with respect to lifestyle, social, cultural, religious and recreational needs were known. Plans included lots of detail about a persons interests and how best to support them. There were sections in the care plans to tell staff what people like or dislike as well as their favourite pastimes and proudest memories.We spoke to one resident who enjoyed talking about their previous job with an airline company. This corresponded with the persons care plan and life history. The home employs an activities co-ordinator who works 3 days a week.Staff also organise activities for residents and these are mostly offered during the mornings. Daily activities were written up on a notice board in the main lounge. Some residents were doing jigsaw puzzles during our visits, others spent time chatting together and some indivduals looked at magazines. People we spoke to said that there were things to do Care Homes for Older People Page 16 of 33 Evidence: in the home. During the inspection residents were observed to move around the home choosing which room to be in and what level of company they wanted to enjoy. For a few people living at the home, being able to exercising their choice was difficult due to their level of dementia. However staff were seen to use their knowledge of a person to help them make choices and encourage occupational activities. The AQAA included details about improvements made over the last 12 months such as Introduced a reminiscence box and an in house shopping trolley. We have started a cinema night in the home. An activities book is used to keep a record of the events and activities that residents take part in. We saw a variety of activities provided that also corresponded with peoples individual needs and preferences. Residents can join in with meetings every month to discuss activities and menus. Records confirmed that people are asked what they want to do and that the home supports their choices. As good practice however, we suggest that the previous meeting minutes are reviewed each month to show how any actions agreed have been acted upon. The home also has an information file about the activities on offer which is supplemented with photos. Residents and relevant family members are encouraged to fill in life history sheets so that they can be used for reminiscence therapy. A hairdresser visits the home regularly and a musician had visited within the last six months. The general manager also showed us some picture menus of snacks and meals available to the residents. Such visual aids are a useful tool to assist people with memory loss to make choices. The lunchtime meal was relaxed and staff supported those residents who needed assistance in an unhurried fashion and with sensitivity. We saw that people can take their meals in the conservatory dining area or in the lounge and that residents individual preferences are respected. One person did not like the barbecued chicken and was offered an alternative meal. Records told us that dietary needs are monitored and a record of the food provided kept. Any specific dietary needs were clearly recorded in the care plans and residents weights are monitored monthly. People we spoke to said they liked the food at St Lukes. A resident ticked always on their survey when asked do you like the meals in the home? For how the home could improve, one relative commented on their survey,I think the nutrition content of the food on offer could be improved. A few more fresh veg would be great. One of the planned improvements on the AQAA said, Explore more options for residents to do cooking as an activity. Care Homes for Older People Page 17 of 33 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 have confidence that their concerns would be taken seriously and acted upon. Improvements have ensured that people are more fully protected and staff have a better understanding of recognising and preventing abuse. Evidence: The home keeps a record of any comments or complaints made about the service in a book. We saw that two informal complaints had been raised by residents since our last inspection. These were dealt with promptly and resolved to each persons satisfaction. Two residents who completed surveys said that they knew how to make a complaint. One relative also confirmed that they knew how to raise concerns. Staff ticked on their surveys that they knew what to do if a person or relative raised concerns about the care or services they receive. In response to our last inspection, some staff have updated their training on abuse awareness and safeguarding as organised by the Royal borough of Kingston. The manager plans for the remaining staff to attend the local authority course once places become available. Records showed that all staff also receive in house training on abuse awareness and safeguarding. The local authority safeguarding policy and procedure from the Royal borough of Kingston was available and the general manager had updated the homes own policy on protection. As previously required the, procedure for dealing with aggression had also been reviewed in January this year. Prior to new employees commencing duties at the home a check is made against the Protection of Vulnerable Adults (POVA) list to ensure that people Care Homes for Older People Page 18 of 33 Evidence: are suitable and therefore assist in safeguarding people using the service. We saw records to reflect this on two staff files although the provider is reminded that staff should not start work until the employer has received a completed CRB disclosure. This has been discussed further under staffing standards. We have received no complaints or safeguarding alerts about this service in the last 12 months. Care Homes for Older People Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements had been made to the environment but further work is required to ensure the home is well maintained for the safety and comfort of the residents. People have the right specialist equipment that encourages and promotes their independence. Evidence: Since our last inspection, there have been ongoing home improvements within the premises and previous requirements actioned. The call buttons in the lift have been replaced, some of the bedrooms repainted and repair work completed in one of the ensuite bedrooms. Other improvements highlighted on the AQAA included, New curtains and bed covers have been purchased for room 9. A TV wall mount has been installed in room 1. Have painted the walls on the ground floor entrance. Have implemented a deep clean on the kitchen extractor fan (removal of the fan and thorough maintenance) As required at our last inspection, an Occupational Therapist had assessed the premises for suitability and made some recommendations which were actioned such as the fitting of extra hand rails around parts of the home. Further areas of the home are in need of some refurbishment and the owners have an ongoing programme of maintenance and renewal. For how the home has improved over the last 12 months, the AQAA said,Created a personalised name plate system in response to several users experiencing confusion in finding their bedroom. Bathroom, toilet and all bedroom doors had pictures or photo identification to assist persons with a memory Care Homes for Older People Page 20 of 33 Evidence: loss. During our first visit, the weather was very warm and the owners and staff had ensured peoples comfort by providing portable fans in the lounge and conservatory dining area. We saw that residents had water or juice readily available to them. The communal areas were furnished comfortably, well lit and pleasantly decorated. There is a large rear garden and a new gazebo had just been purchased. Some residents said they like to sit out in the garden if the weather is good. As noted at our last two inspections, the armchairs in the lounge were still arranged in rows against the walls and could be set out in a more homely fashion. Again, the owners might consider replacing some of the chairs with sofas so that people can sit together more closely if they so choose. The majority of bedrooms were comfortable and personalised to reflect the individuality of the person and accommodate their needs. Repairs had been carried out in one bedroom where a new shower screen, wall tiles and shelf had been fitted. In one of the vacant shared rooms,the owners must ensure that a more appropriate window restrictor is fitted. The double window had a chain type bolt fastening which did not provide adequate restriction. Both windows could be fully opened out onto a lower flat roof and could therefore put residents at risk. It is acknowledged that the room was not in use at the time of our visit but there was also no lock on the door meaning that a resident may be able to gain access. We also saw that one person had a bed with a metal headboard which looked rather clinical. The manager agreed that it should be replaced with a more suitable one. The previous requirements concerning risk assessments for the provision of keys and the locked door policy have been met. The general manager had written a policy that included the keypad entry system on the front door. It covered access arrangements and safety in the event of an accident or fire. There are adequate toilets and bathrooms for people to use, with some bedrooms having ensuite facilities. Overall, the bathrooms and toilets checked were clean and fit for purpose although some work is needed in one of the gorund floor toilets. The hand rail had come loose from the wall and the door lock had no override device. Both these issues must be addressed to ensure peoples safety. The home was clean and tidy with suitable hand washing facilities available to both residents and staff. People ticked on their comment cards that the home was always fresh and clean. There were good hygiene practices in place and appropriate arrangements for the safe storage and disposal of clinical waste. Staff spoken to had a good understanding of infection control and used colour coded tunics when serving the lunchtime meal. Protective clothing was not available to staff in the bathrooms however and disposable aprons must be provided to minimise the risk of cross contamination. We further suggest that the colour coded food chopping boards are replaced as they were heavily marked and scored. At our last inspection, we required the home to improve its call bell system. A planned improvement on the AQAA said,New call bells to be installed in the lounge (or consideration for completely new install of a wireless call bell system) quote already received - is to be actioned in the next three months. We discussed this with Care Homes for Older People Page 21 of 33 Evidence: management who advised that they were still in the process of obtaining quotes. We observed that call bells were accessible to people in their bedrooms and tested the call bell system. Staff responded promptly to the alarm and the system was in good working order. Our previous requirement has therefore been partly met as the Care Homes for Older People Page 22 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team who receive regular training to ensure that they have the necessary skills to meet their needs. The recruitment practices still need to be more thorough, to ensure that people are kept safe from possible harm or poor practice. Evidence: Rotas showed that staffing levels allowed for three carers in the morning, two to three in the afternoon and two waking night staff. Domestic staff consist of one cook and a part time cleaner.The staff on duty had a good rapport with residents, which promoted a relaxed atmosphere in the home. Residents were observed showing signs of recognition towards staff and being relaxed and comforted by their presence. At our last inspection we required the home to improve its staff rotas and shift patterns for staff. Rotas were clearer and showed that staff were not working excessive hours although they still did not provide an accurate record of who worked. Neither the manager nor the activities officer were included. In addition, the roles of the staff and designated person in charge each day must be identified on duty rosters. This must be addressed for clarity and legal purposes. The general manager advised that there has been a high staff turnover since our last inspection due to several staff members leaving. This resulted in the home losing most of its NVQ trained staff and a much needed recruitment drive. During our first visit, we looked at three staff files to check Care Homes for Older People Page 23 of 33 Evidence: how they were recruited. At our last inspection some of the required records were not available and positively the manager had obtained health declaration checks from each of the staff. Some files still lacked the required information however. Two staff had started work before their CRB clearance had been verified. Although the manager had obtained a completed POVA first check and staff were not working unsupervised, this is not good practice and must only be used in exceptional circumstances. We were advised that the home had experienced high staff shortages and an urgent need to recruit staff. There was only one reference for one staff and for all three staff, there were gaps in their employment histories with no written explanation. Full recruitment checks must be carried out on all employees to ensure that people are fully protected and any gaps in employment must be explored and recorded. We therefore asked the home to put this right within a week as we have raised other concerns over recruitment processes at previous inspections. On our follow up visit, we saw that the general manager had obtained the required information, updated the staff files and revised the policy on recruitment. The application form did not require sufficient information to ensure the safety of the residents. A full employment history and the reasons for leaving posts, which involved the care of children or vulnerable adults, and an explanation of gaps in employment needs to be included. Recruitment practices therefore need improving to ensure that staff are vetted correctly and people are safeguarded. We may take enforcement action in the future if there is a continued failure to comply. A recently inducted staff member had followed the Skills for Care Common Induction Standards to ensure they were well prepared for the caring role. In addition, they had completed lots of in house training under the supervision of the manager, Mrs Raja. Topics include dementia awareness, safeguarding and key areas of health and safety.The home uses DVD training packs and staff are then given written questions to check their learning and understanding. We suggest that such records are retained on each staff members file as further evidence of acquired training. Some of the training is accessed externally, through either the local authority or independent companys. Records confirmed that four staff have completed an NVQ 2 qualification, with one staff due to complete the level 3 qualification. Staff who completed comment cards were positive about the training;appropriate training is given for the care workers to work as a team effectively. For what the home does well, another staff wrote,by giving us training. Three staff who works at the home replied to our questionnaire and responded that they each had appropriate recruitment checks carried out prior to starting work. They ticked that they were given training relevant to their role, two responded that there were always enough staff to meet the individual needs of the people using the service and the third said usually. One relative wrote,I visit once a week and have the chance to observe the staff and how they relate to the other residents,some with demanding conditions.They treat people with kindness and respect. Planned improvements on the AQAA said,Get service users to feed into the recruitment process - service users are to be a part of the interviewing process and Care Homes for Older People Page 24 of 33 Evidence: their feedback will bear impact on the recruitment outcome. Look into getting new training material on Dementia care from the Alzheimers Society. Care Homes for Older People Page 25 of 33 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. People who use the service benefit from a well managed home. There are good arrangements for monitoring the quality of care and people are often consulted about the services provided and have influence over the way the home is run. Record keeping has improved to ensure that peoples rights and best interests are safeguarded. Improved safe working practices ensure that the home aims to promote and protect the health and welfare of people living and working there. Evidence: The owners have been running the home for many years but there is no named registered manager for the service. Mrs Raja, one of the registered providers, takes responsibility for the main day to day running of the home and recently completed the required Registered Managers Award qualification in May of this year. She is supported by her son, Marcus Raja, who has a role of general manager in the home and manages many of the administration duties. Over the last year, record keeping has progressed well and he has made a significant contribution to meet our Care Homes for Older People Page 26 of 33 Evidence: requirements and improve outcomes for the people who use the service. To ensure clear lines of accountability however, the service should have an appointed manager and the providers should make an application to register with the Commission. Mrs Raja has attended training to keep her knowledge and skills up to date. Courses have included local authority training on the Deprivation of Liberty safeguards (DoLS) and Mental Capacity Act as well as a supervision course. Records showed that staff receive regular supervision with the owner as well as an annual appraisal of their work. All staff who completed questionnaires said that they regularly meet with their manager. In February 2009, satisfaction questionnaires were offered to the residents and their families. We read some of the completed surveys which were all complimentary about the services provided. Comments included, good services all round and staff do their job very well and are so pleasant and courteous. Other feedback said, Its always a pleasure coming to visit St Lukes. From the findings, the home wrote a yearly annual development plan that also identifies the aims and outcomes for the following year. We have again suggested that the home extends its quality assurance practice further by consulting with the staff and other professionals who have an interest in the service. Their views should also form part of the development plan. The home does not hold money for people who live at the home. The home invoices their families or the relevant social services department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any financial transactions.The returned AQAA was informative and well supported by appropriate evidence from this inspection. Full records are maintained of all accidents and incidents at the home. As required at our last inspection, the owners have kept us informed of any reportable events that affect the welfare of people who use the service. As good practice we think that information about reporting events under Regulation 37 could be kept in a folder so that it is readily available to staff. The home has systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In response to our last inspection, a risk assessment of the premises had been completed. In addition, there was up to date policy guidance for staff to follow regarding a range of health and safety activities. We saw that all policies and procedures had been reviewed at the beginning of the year. The completed AQAA stated that all relevant safety checks were up-to-date. We confirmed this when we checked the servicing and maintenance records including gas and electrical safety.Records showed that fire equipment had been regularly tested to make sure it was safe to use. Most staff had completed training on fire safety, moving and handling, infection control, food hygiene and first aid. There were arrangements for remaining staff to update such training as and when needed. Care Homes for Older People Page 27 of 33 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 28 of 33 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 2 5A Each person needs an up to 30/09/2009 date and completed contract that includes the full terms and conditions for staying in the home. So that people have accurate information about all costs and the facilities and services they can expect to receive. 2 9 13 The manager must ensure 30/09/2009 that any as required medication is reviewed promptly when changes occur. This is to ensure that people receive the correct treatment regime that meets their needs and welfare. All stock medication must be 30/09/2009 checked on a regular basis. 3 9 13 Care Homes for Older People Page 29 of 33 To maintain an audit trail that further ensures safe practice and reduces the risk of error. 4 10 12 Suitable locks must be provided on all bedroom doors that can also be overridden in the event of an emergency. To promote privacy for people and safeguard their welfare. 5 21 12 The lock on the toilet door on the ground floor needs repair or replacement. So that peoples right to privacy is not compromised whilst also ensuring their safety. 6 22 12 Call bells must be available to people in the lounge and dining area. So that they can summon assistance as necessary 7 24 12 Appropriate locks must be fitted to all bedroom doors. So that peoples right to privacy is not compromised whilst also ensuring their safety. 8 25 13 The window restrictors in bedroom 11 need replacing. So that residents are not put at risk of falling. 30/09/2009 30/12/2009 30/12/2009 30/09/2009 31/12/2009 Care Homes for Older People Page 30 of 33 9 26 13 Staff must be provided with 30/09/2009 a supply of disposable aprons for supporting people with personal care. To minimise the risk of cross infection 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 3 All needs assessments, specifically those for people who fund their own care should be reviewed at least annually or sooner if changes occur. This is so that staff have up to date information about a persons current needs. Regular visits should be undertaken by the supplying pharmacist to offer advice and carry out audit checks on medication. This will further ensure safe practice. The unsightly copper pipe holding the dividing curtain screen is replaced with a more suitable curtain pole in bedroom number 11. That the home reviews the previous meeting minutes each month to show how any actions agreed have been acted upon.This is to form an audit trail of decision-making and show how these are being followed up for people who use the service. The colour coded food chopping boards would benefit from replacement as they were heavily scored. To create a more homely feel in the lounge, the owners might consider replacing some of the chairs with sofas so that people can sit together more closely if they so choose. (Repeated from last inspection July 2008) A mirror on the back wall of the passenger lift would assist residents and staff to know who was waiting to enter. (Repeated from last inspection July 2008) It would be better if there was a registered manager for the home to ensure clearer lines of accountability. Quality assurance surveys should be offered to the staff and other professionals who have an interest in the service. Thier views should form part of the overall development of 2 9 3 10 4 12 5 6 19 20 7 22 8 9 31 33 Care Homes for Older People Page 31 of 33 the home. (repeated from last inspection in July 2008) 10 38 Information about reporting events under Regulation 37 could be kept in a folder so that it is readily available to staff. Care Homes for Older People Page 32 of 33 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. 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