Care Home: The Lodge Walton

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What the care home does well People who use the service said that staff spoken to them in a friendly fashion, with respect, and they welcomed visitors to the service without restrictions. Staff were observed to treat all people as individuals with dignity and respect. One person using the service commented "the care staff are very good". The large garden provides areas for people to sit outside. Rooms visited were personalised with photo`s and ornaments. A robust pre and post assessment package is in place to ensure that the changing needs of people who use the service are being met. The AQAA tells us that "we always carry out pre admission assessment for any prospective new resident. Written documentation is sent confirming suitability of the home being able to meet the clients needs and requirements. Our assessment information is comprehensive and forms the basis of the residents care plan". Care plans are completed and up to date and the format used is person centre focused. The AQAA tells us that "physical, psychological, emotional, social and spiritual needs are addressed. Each resident has a comprehensive care plan detailing their needs, requirements, likes, dislikes, choices and preferences and how to meet them. Included where required and necessary related to each individual are relevant risk assessments stating activities considered to carry potential risks e.g. Falls, moving and handling, fire the list is not exhaustive". Pre employment checks are in place for all staff which safeguards the people using the service. One relative commented "great respect shown for the dignity of the residents. Excellent management". The AQAA tells us that "we follow equal opportunities in our recruitment policy and ensure all prospective staff are vetted, two references obtained, POVA first/CRB full employment history is obtained where any gaps have occurred is clarified and documented . A recruitment check list to enable documentation of dates information is sent and received giving clear clarification". What has improved since the last inspection? The AQAA tells us that the service has made a number of improvements over the past twelve months. This includes a focus on staff development and training to increase their skill base and knowledge which will improve on the delivery and quality of the service to the people they care for. Improvements have been made to the communication and contact with the people who use the service family and or representatives. The service has attempted to increase their vital involvement with the people who have Dementia and have commenced life histories. The AQAA tells us that a umber of the bedrooms have been refurbished including the completion of the radiator covers ensuring people are safe. Risk assessments have been developed for a number of areas and reviews are completed on a regular basis. The service continues to maintain effective recording processes and procedures and has made further improvements to the recording of minor concerns. Where an individual may wish to administer their own medication, the service has completed a Mental Capacity Assessment to determine the current ability of the individual. This is then applied to a care plan as required. The AQAA also tells us that improvements have been made to supervisions which are now being completed on a regular basis. What the care home could do better: The service must ensure that all medications with an "as and when required" statement have additional administration guidelines in place, in order for staff to follow to ensure they are being administered as prescribed and recommended by the GP. Temperatures must be recorded where medication is stored. A balance should be carried forward of medication in order to ensure an audit system is in place. All hand written entires should be double signed and a date of opening should be added to all bottles and box`s upon opening. Suitable activity provision must be provided for the people using the service. The lounge carpet must be replaced as this is a potential tripping hazard. Other areas of continued development and redecoration are required throughout the service and includes the replacement of the corridors carpets and other communal spaces being extended to provide adequate communal facilities for the pople using the service. Bathrooms must also be available in adequate numbers to meet the needs of the pople using the service. Key inspection report Care homes for older people Name: Address: The Lodge Walton 82 Kirby Road Walton On Naze Essex CO14 8RJ     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: Louise Bushell     Date: 1 0 1 2 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 34 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 34 Information about the care home Name of care home: Address: The Lodge Walton 82 Kirby Road Walton On Naze Essex CO14 8RJ 01255850809 F/P01255850809 ros_walton@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Rajeev Chopra,Mrs Renuka Rani Chopra,Mr Ramesh Chandra Chopra care home 20 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 20 persons) The total number of service users accommodated must not exceed 20 persons Three persons, under the age of 65 years, who require care by reason of a physical disability, whose names were made known to the Commission in May 2003 Date of last inspection Brief description of the care home The Lodge is a detached two-storey property, situated in a quiet residential area on the outskirts of Walton-on-the-Naze. There is a car park to the front of the property and well-maintained attractive gardens to the rear. The property is on a local bus route, and has easy access to the town. The home provides care and accommodation for up Care Homes for Older People Page 4 of 34 Over 65 20 20 0 0 0 2 1 8 1 2 2 0 0 8 Brief description of the care home to 20 older people. Accommodation is provided on two floors; access to the first floor is by means of a passenger lift and stairs. Communal areas include a main lounge and a pleasant dining room with small lounge area. The home charges between £390.37 and £425.00 per week for a single room with additional charges for hairdressing services and for personal items such as newspapers, toiletries and sweets. This information was provided to us in December 2009. Care Homes for Older People Page 5 of 34 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: The focus of the inspections undertaken by the Care Quality Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place in December 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 34 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors where applicable. The visit took place between 9:30am and 15:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and the manager. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? The AQAA tells us that the service has made a number of improvements over the past twelve months. This includes a focus on staff development and training to increase their skill base and knowledge which will improve on the delivery and quality of the service to the people they care for. Improvements have been made to the communication and contact with the people who use the service family and or representatives. The service has attempted to increase their vital involvement with the people who have Dementia and have commenced life histories. The AQAA tells us that a umber of the bedrooms have been refurbished including the completion of the radiator covers ensuring people are safe. Risk assessments have been developed for a number of areas and reviews are completed on a regular basis. The service continues to maintain effective recording processes and procedures and has made further improvements to the recording of minor concerns. Where an individual may wish to administer their own medication, the service has completed a Mental Capacity Assessment to determine the current ability of the individual. This is Care Homes for Older People Page 8 of 34 then applied to a care plan as required. The AQAA also tells us that improvements have been made to supervisions which are now being completed on a regular basis. 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 9 of 34 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 34 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. People who use the service can expect that their assessed needs can be identified and met. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All people who use the service are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the individual. One person using the service stated, the care staff are lovely and kind. A relative commented I am very happy with the way they Care Homes for Older People Page 11 of 34 Evidence: look after my X in the Lodge. The AQAA tells us that we continue to have a good up to date Statement of Purpose, and Service Users Guide. All residents have contracts containing the required details, including the terms and conditions of occupancy. We always carry out pre -admission assessment for any prospective new resident. Written documentation is sent confirming suitability of the home being able to meet the clients needs and requirements. Our assessment information is comprehensive and forms the basis of the residents care plan. Admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment format was detailed and appropriate to the policy and procedure in place. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. The assessment also explores the cultural needs of the individual and details such preferences as gender of care workers, clothing, whether the person likes blankets or duvets etc. The assessment process details vital links to further risk assessments, care plans and additional management plans that will be required, based on the completion of the assessment. The assessment is detailed in order for a holistic view of the person to be formed. Evidence was directly observed of the involvement of family members in the assessment process and where appropriate these documents had been signed either by the person using the service or the family member and or representative. One relative surveyed commented the service is very good. All staff are very kind and caring. In addition to this a further relative stated over all I am pleased with the Lodge. The manager and care staff have been very supportive and caring. I know my X is safe and well looked after. I am pleased because it is such a small residential home and I fell there is the opportunity for a more personal approach. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. A total of twenty one comment cards were received from people who use the service, their relatives, staff and health and social acre professionals. All comments cards received from the people using the service determined that they always or usually have enough information to make informed choices about the service. One person using the service stated I feel safe and cared for at the Lodge. Privately funded people who use the service are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role Care Homes for Older People Page 12 of 34 Evidence: and responsibility of the provider, and the rights and obligations of the individual. People who are funded receive a social service contract. The Annual Quality Assurance tells us that we have increased the involvement of relatives of service users with dementia in helping us to gather more detailed information about life histories to help us care for and understand people better. This was seen on the day of the inspection and case tracking showed that a number of people had life histories completed held on their files. Care Homes for Older People Page 13 of 34 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. People who use the service can expect that their immediate medical, health and social care needs will be met, however improvements in the management of medication will ensure that people receive a better service. Evidence: A total of three care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health; mental health and nutritional requirements are clearly recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes guidelines, risk assessments for the management of falls, bed rails, manual handling and self medication. One person file showed that the service had completed a mental capacity assessment to support in evidencing a persons currently ability to manage and self administer their medication. Care Homes for Older People Page 14 of 34 Evidence: It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. One staff member was directly observed sitting with a umber of individuals chatting to them ,reading magazines with them and holding their hands. The service listens and responds to individual choices and decisions about who delivers their personal care. Evidence of this was seen on one of the care plans case tracked where a person had their preferences recored in relation to the gender of the care worker supporting them. People are supported and helped to be independent and can take responsibility for their personal care needs. The AQAA tells us that each resident has a comprehensive care plan detailing their needs, requirements, likes, dislikes, choices and preferences and how to meet them. Included where required and necessary related to each individual are relevant risk assessments stating activities considered to carry potential risks e.g. falls, moving and handling, fire the list is not exhaustive. Staff, monitor residents constantly to maintain their physical and mental well being. Nutritional status is recorded and monitored where there is a change in residents eating and drinking habits regular daily monitoring of fluid and food charts are implemented to assist in minimising potential risks of dehydration and malnutrition occurring. Residents weight is recorded monthly to ascertain stability in weight is maintained. Individuals have access to healthcare and remedial services. The health care needs of individuals unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the General Practitioners. A number of comments were received directly from people that use the service, their relatives and friends. A relative commented that, the staff are all friendly and address the residents respectfully and are patient and considerate. A number of comments have been received that have determined that the care is provided to meet the needs of the people who use the service. A health and social care professional stated the manager is usually well informed about patients health needs and able to give accurate accounts of concerns which is valuable to a clinician. Staff are equally competent and friendly. A person using the service commented it provides good standard of care and the carers think about the residents personal feelings and their individual needs and preferences. Care Homes for Older People Page 15 of 34 Evidence: The service has a reviewed medication policy in place. A total of three peoples medication was case tracked to monitor complaince and management of the medication process and procedures. It was evident that the service had good information available regarding the individual needs of the person being administered the medication. Information regarding medication being administered was also available for staff. The AQAA tells us that we have a full policy covering all aspects of medication practices and procedures which conforms to Royal Pharmaceutical Society Guidelines. Monitored dosage system is in place. All staff are well trained in the ordering, obtaining and administering residents medication conforming to all protocols required. The medication trolley was located in the larger dinning room area and was bolted to a wall. Temperatures of the were not being recorded to ensure that the medication was being stored as per the guidelines by the manufactures. The senior staff member stated that a nurse practitioner attends the unit on a weekly basis and records are maintained in the persons individual notes. Evidence of this was directly observed on the individual files. Bottles and boxs were directly observed to not have a date of opening added to them and the medication administration record had a number of hand written entries made which were not double signed. One one occasion the current stock balance of the medication could not be established as a balance had not been carried forward of the medication. Observations also found that photos were not in place for all people. Some people are prescribed medication which is to be administered on an as and when required basis. Some of the medications viewed did not have additional administration guidelines in place to inform staff of the circumstances where administrating should take place. This was brought to the attention of the manager who agreed to implement new guidelines following the inspection. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. It was evident through information obtained directly from the staff that they had completed and passed an appropriate medication course. Care Homes for Older People Page 16 of 34 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 adequate 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 are encouraged to join in with the variety of activities when made available. Evidence: The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. During the inspection staff were indirectly and directly observed offering people equal dignity and respect in a manner of ways. One relative commented great respect shown for the dignity of the residents. All of the staff are very caring to the residents at all times. In addition to this a person using the service stated always caring. People who use the service are sometimes able to enjoy a stimulating lifestyle with a number of options to choose from. The service has sought the views of the individuals and considered their varied interests. It was directly observed during the inspection process that staff who were carrying out care duties were positively engaging with individuals. Three people were observed helping to wipe the dinning room tables and re lay them. These individuals were also observed folding napkins for the lunch time meal. Care Homes for Older People Page 17 of 34 Evidence: The service does not employ an activity organiser. The manager stated that she had attempted to recruit to the role but has been unable to fill the post. Discussions took place regarding how this could be better achieved and improvements could be made to the provision of structured activities available. During the inspection staff were directly observed spending as much time as they could with the people using the service. Staff were directly and indirectly observed chatting with people, holding their hands and reading to a number of people who were visually impaired. People were seen to access the entire building safely and freely with out restriction of movement. During the inspection in the main lounge people were reading, chatting and listening to old time music. A number of people were singing along and dancing periodically throughout the day. The AQAA tells us that Staff spend time on a one to one basis with residents talking reminiscence, manicuring fingernails and involving them in activities such as light domestic tasks such as folding items of laundry, laying the tables folding napkins. Group activities are offered which involve word games and varying others that the residents may wish to choose. We feel that an activity programme is a guide and should not be adhered to, the residents daily choices and preferences are taken into consideration as to whether they wish to take part in any form of activity. One staff member commented we try to do our best to do activities but there simply is not enough time. The service has strong focus on involving people in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. The AQAA tells us that improvements have been made over the last twelve months and states, relatives meetings has improved in terms of attendance and with increased effort on person centred care planning for our service users. Records are maintained where individuals have engaged and or participated in any activity. In addition to this night time activity records are also maintained as a number of people may wake early or retire to be later. An activity stimulation pack has been devised by a staff member working at the service. This offers people using the service with memory based activities, pictures, discussion ideas and recognition tasks. It was directly observed that the pack had last been recorded as being used in October 2009. One person using the service commented its very good here, food is excellent. They Care Homes for Older People Page 18 of 34 Evidence: come and ask us the day before about what we would like for the next day. We sometimes throw a ball to each other but not much else really, just the television is on. We read magazines and chat t the staff though. In addition to this a number of comments were received from relatives. They stated perhaps a little more entertainment would be nice, and more activities for the residents. The AQAA tells us that we ask residents daily what they would like to do, the current residents enjoy music, singing to old songs. Others like to go out for walks with members of staff. The home holds two or more open days a year where families, friends and external agencies are invited to visit the home. We where possible encourage residents to continue to follow their hobbies and pastimes which they enjoy and get pleasure from. A vicar visits every third Wednesday in the month offering communion. We have a Reverend who holds a half hourly church service every Monday within the home. We have an open visiting policy enabling families to visit for as long as they wish, those who have travelled a long way are always offered to stay and have lunch or an evening tea with their relative. One person using the service stated in relation to what the service could do better, bit more entertainment. Meals are well balanced and nutritional and cater for varying cultural and dietary needs of individuals. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably. One person using the service commented Love the food, whilst a further person stated the meals are good. The AQAA has identified that improvements are required and states we intend to continue to develop and build on the activities available, in accordance to the changes, wishes and preferences of each individual resident. During the inspection the manager stated that they are planning to develop a sensory garden to meet the changing needs of the individuals using the service. Through discussions with the manager it was established that the service is not using memory boxs currently, however is planning to introduce these. Care Homes for Older People Page 19 of 34 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 who use the service can expect that complaints or concerns will be listened to acted upon. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided; feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. One person who uses the service stated If i was ever unhappy about something I would speak to a carer. The manager of the service has identified in the Annual Quality Assurance Assessment that our complaints procedure is included in our Service Users Guide which enables all residents / relatives to have copies. We also have a copy on display in the front entrance hall with the homes Minor Concerns procedure enabling visitors to the home to be aware of the procedures to follow where they may have concerns or a complaint. We continue to have a positive attitude to complaints and feel it is an opportunity to improve our service. Complaint and minor concerns log file is in place for information to be documented in these areas. Staff are aware of the complaints/minor concerns procedures with it being included in the induction programme for all new staff. Care Homes for Older People Page 20 of 34 Evidence: The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a number of areas within the service. There is a detailed record of all complaints and compliments made and received. There has been complaint made which has been investigated and responded to within the time scales as required. All of the complaints had been dealt with within the timescales. Compliments were also present. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of the Whistle-blowing policy and when the use of this may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Care Homes for Older People Page 21 of 34 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. The physical design and layout of the service enables the people who use the service to move freely without restriction. However improvements to communal space and facilities would improve the quality of the service for the people using the service. Evidence: The service provides a physical lay out that is appropriate to the specific needs of the people who live there. The environment provides aids and equipment to meet individual needs. The service is a pleasant, safe place to live, the bedrooms and communal room provide a personal and homely feel. The layout of the building enables people to move freely with several different seating areas throughout to encourage socialising or enabling the person to have privacy. The Annual Quality Assurance Assessment completed by the service demonstrates that the the building is suitable for the varying needs and requirements of elderly people including individuals who have dementia. The home has communal space with a high standard of decor and furnishings e.g. chairs are suitable for individuals with restricted mobility. Adequate bathrooms and toilet facilities including 13 en-suites. The home has wide corridors and doorways with suitable adaptations fitted e.g. grab rails and ramps etc. All required and necessary equipment is provided and maintained. The people who use the service appear to like the service. One person using the Care Homes for Older People Page 22 of 34 Evidence: service stated I Love my room. The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if their needs change. The AQAA identified that they intend to improve through the provision of a rolling programme of furniture replacement. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. This is spacious and allows people to move freely. The environment promotes the privacy, dignity and autonomy of individuals. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The space in the main front lounge is small, however the manager was discussing the plans in place to extend with a conservatory area. One person using the area commented that they would like a bit more room in the lounge. In addition to this a further person commented the public areas, especially the lounge is a bit cramped and not big enough to accommodate visitors if all the residents are in it. There is a garden to relax in. The garden has been adapted with time and consideration spent making separate seating areas and areas of interest for all the people who use the service. The AQAA tells us that there are large grounds accessible to the residents. To assist minimise risks residents are escorted by staff while out in the grounds. The grounds are being kept in good order by the gardener/maintenance man. In addition to this the manager confirmed that they are planning to complete a sensory garden in the next twelve months. The home has a robust infection control policy. The service is clean, well lit and smells fresh. One person using the service commented my room is very nice I like it here. During the inspection a number of areas were directly observed as requiring re decoration and or renewal, this included the corridor carpets, lounge carpet, (due to it being a trip hazard) and the redecoration of the communal corridor areas. The service was able to identify the need for these improvements and this has been evidenced within the services AQAA. The AQAA states that the service is planning to have a conservatory built onto the lounge. Double room converted to two single rooms enabling privacy and dignity. Five room extension to ground floor. Refurbishment of car park area enabling more parking for visitors and staff. Modernisation of entrance porch. Ground floor corridors to be refurbished. Bedrooms to be refurbished as required with en-suites tiled assisting with infection control. Bathrooms to be fully tiled assisting with infection control and low maintenance. Sensory/reminiscence garden. Care Homes for Older People Page 23 of 34 Evidence: During the inspection it was observed that one of the main bathrooms was not in use. The manager confirmed that this was not used as there was no hoisting facilities for that bathroom. The manager confirmed that there is currently only one bathroom in use for the current thirteen people using the service. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Care Homes for Older People Page 24 of 34 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. Staff are suitably trained and skilled and are in sufficient numbers to support the people who use the service, in line with their care plan, ensuring that the needs and changing needs are being met by a consistently competent team. Evidence: Feedback from the people who use the service shows that they have confidence in the staff who care for them. Staff rotas were seen and displayed adequate numbers of staff on duty to meet the needs of the people using the service. Currently the service is supporting and caring for thirteen people. The staffing rota shows that there are three staff on duty during the day and two waking night staff. The manager is in addition to these numbers and supports as required. Currently these staff numbers appear adequate to meet the care and support needs of the people using the service, however consideration must be taken when the occupancy levels increase. This was brought to the attention of the manager on the day of the inspection. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. One person using the service stated the care staff are very good. One staff member confirmed Care Homes for Older People Page 25 of 34 Evidence: that they had recently received training in Manual Handling, Health and Safety, Dignity, Dementia, Fire Safety and Food Hygiene. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of three staff files were audited and were seen to contain all the required documentation. Three individual staff commented on the strong team culture of the service and felt that following recent recruitment, there are enough staff on duty to meet the needs of the people who use the service. Staff confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans to cover for vacancies and sickness and the use of agency staff was limited. One staff member stated the staff team is good, we get on very well and work well as a team. Once recruited staff receive an induction and training. The programme is then signed at the end of each stage. The AQAA also tells us that all new staff are provided with GSCC code of practice, the homes induction booklet and abuse pack and adapted units of skills for care induction is implemented to ensure they complete within the time scales of their start date. Where foreign staff are employed and have difficulty with written English the home offers support and guidance and extends the time scales to suit the individuals needs. All new staff undertake moving and handling prior to or as soon as an available date allows. The service also has a training and development plan in place for 2009 - 2010. This showed that a number of courses are being provided and included, Fire Safety, Dementia Awareness, Moving and Handling, Infection Control and Safeguarding. Staff confirmed that the senior team provide supervision. Records showed that this was occurring. Staff reported that they felt supported in their roles and that they were able to discuss issues with a member of the senior team if required. A comment received from a relative states that; I know my X is cared for at the Lodge and this gives me peace of mind. The AQAA tells us that the service is aiming to make further improvements over the next twelve months and states maintain continuity and consistency within all areas for the residents within our care and promote this in particular for people with dementia. To further extend the skills knowledge of staff by providing dementia training designed specifically for The Lodge. Care Homes for Older People Page 26 of 34 Evidence: During the inspection positive manual handling practices were indirectly observed where by a person was being hoisted from a chair to their wheelchair. Throughout the process the care workers were talking to the person and making them feel at ease. Care Homes for Older People Page 27 of 34 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 expect that the service is run by a competent qualified manager ensuring best outcomes for all. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager and the senior team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and as part of the feedback questionnaires received determines that the management are effective and approachable. One relative commented Overall I am very pleased with the Lodge. the manager and the care staff have been very supportive and caring. I know my X is safe and well looked after. The care planning format encourages and enables staff and the people who use the service to focus on person centred thinking, with the people who use the service Care Homes for Older People Page 28 of 34 Evidence: becoming increasingly more involved. The format reviews the persons entire needs. The Registered Manager and senior team lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. This is reflective in the managers leadership style, her ability to work with the team and ensure that the service is run in the best possible interests of the individual. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the service, through close monitoring, supervision and training. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. This includes the management of finances within the service. Staff meetings take place regularly and minutes of the meetings are available on each unit, this increasing effective communication throughout the teams. The AQAA tells us that The homes manager has obtained NVQ level 4 RMA and care. She is very experienced and confident in elderly care having worked in the industry for more than 10 years. Relevant training courses attended to enhance her knowledge and skills. The manager has a clear job description and lines of responsibility in the home are understood by all. She provides strong leadership, enabling staff to contribute ideas and suggestions etc. The home has an annual business plan which is worked through throughout the year. We ensure and maintain adequate business insurance cover is in place at all times. The service works to a clear health and safety policy. Safeguarding is given high priority and provides a range of policies and guidance to underpin good practice. Through discussions with the management team and it was determined that priority is given to ensure that all staff are in receipt of training, including in house refresher courses and a full complete induction programme. Individual training needs analysis are being developed and will be used, once complete to review the annual performance of staff in their appraisal. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 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 Temperatures of the storage 29/01/2010 of medication must be recorded. To ensure that medication is being stored in line with the manufactures guidance and instructions. 2 9 13 As and when required medication must be suitable guidelines for safe administration. To ensure that people who receive the medication have been administered it correctly in line with guidance provided by the general practitioner. 05/02/2010 3 12 16 The provision of activities must be reviewed. To ensure that people using the service are offered a varied range of stimulation and activities meeting individual needs. 26/02/2010 Care Homes for Older People Page 31 of 34 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 4 19 13 The lounge carpet must be replaced. To ensure that people using the service are kept safe from potential tripping hazards. 09/02/2010 5 20 23 The service must ensure that there is adequate used communal space for the people using the service to use. To ensure that people using the service have usable communal space suitable to meet the needs of the service. 31/03/2010 6 21 23 The service must ensure that usable bathrooms facilities are available in numbers adequate to meet the needs of people using the service. To ensure that the facilities are available in adequate numbers to meet individual needs. 31/03/2010 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 9 All hand written entries must be double signed. Care Homes for Older People Page 32 of 34 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 2 3 4 5 9 9 9 12 A record should be maintained of all medication received into the building. Balances of medication should be carried forward from month to month. All bottles and boxs should have a date of opening added when opened. Memory boxs should be considered throughout the service. Care Homes for Older People Page 33 of 34 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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