Care Home: Thetford Lodge

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What the care home does well "I`m happy that I`ve got such a nice place to live", "very good", "I`m looked after very well" and "it`s lovely" were comments from people who live there. Individuals we spoke to said that the staff were polite and respectful to them. Feedback included "very nice", "very polite" and "they`re quite nice". Care plans kept for each person are well written and now contain some good `person centred` information. Medication is managed well by the service for the people who live there. The environment has a pleasant homely feel throughout. What has improved since the last inspection? What the care home could do better: "The place needs livening up" was a comment from one person. Helping people to have purpose and to be engaged and occupied should be a central part of the homes culture. Care staff need to be creative in finding ways to involve people in the daily life of the home. The menus need to be reviewed with the people who live there. New menus should be provided in picture formats and displayed where people can see and use them. The stair lift needs to be repaired or replaced as soon as possible. CARE HOMES FOR OLDER PEOPLE Thetford Lodge 16 Thetford Road New Malden Surrey KT3 5DT Lead Inspector Jon Fry Unannounced Inspection 10:15 16 September 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thetford Lodge Address 16 Thetford Road New Malden Surrey KT3 5DT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8942 6049 020 8336 5831 CHD (Care Homes) Ltd Post Vacant Care Home 17 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (13) of places Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 13) 2. Dementia - Code DE (maximum number of places:4) The maximum number of service users who can be accommodated is: 17 19th July 2007 Date of last inspection Brief Description of the Service: Thetford Lodge is located in a quiet residential street in New Malden, close to the High Street and local transport facilities. The home has fifteen single bedrooms and one double bedroom with accommodation provided on two floors. The first floor is accessible by stairs and a chair lift. There is a small garden to the side of the home and parking is available. Information about the service is available in the Statement of Purpose and Service User Guide. Fees range from £372 to £600 per week dependant on the room and type of funding. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. One inspector spent approximately six hours in the home. We spoke to eleven people who live at the home, one relative or friend of an individual, the acting manager and three staff members. We looked at records and documents kept at the service including two people’s care plans. The manager completed an Annual Quality Assurance Assessment (AQAA), which gave us good information about the home and the people who live and work there. What the service does well: What has improved since the last inspection? As stated previously, care plans have been improved to give better information about the person – their social interests and background. We found that the service has better quality assurance procedures. People who use the service and their relatives or friends have been asked for their views and the results summarised. The manager was clear about which areas needed more work to improve the service provided. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory information is available about the home and the service it provides. Assessments are carried out to make sure that the service can meet people’s needs before they move in. EVIDENCE: An information pack is available about the home. This contains the Statement of Purpose, User Guide and the complaints procedure. We looked at the User Guide and saw that this provides satisfactory information about the service provided but it could be made much more user friendly. Adding photographs of key people, the facilities and places in the local area may help people to use the guide. Other formats such as large print and audiotape should also be considered. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 9 Individuals are encouraged to visit the service before they move in. One person we spoke to said they had visited and “fell in love with the room”. An assessment is carried out to make sure that people’s needs can be met. This covers areas such as personal hygiene, social interaction and physical support. As a signpost to good practice, we have recommended that the home look at how Equality and Diversity is addressed at the assessment stage. The prompts published by CSCI for care homes may help with this as well as recent bulletins about providing services for black and ethnic minority people. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are individualised and clearly address people’s support needs. Arrangements for the storage and administration of medication are good. EVIDENCE: “I’m looked after very well”, “it’s lovely – I’m looked after” and “there’s not much I’m not happy about” were comments from the people we spoke to. We looked at two care plans and saw that some very good information about people’s needs is recorded. The plans are written in the first person and look at the things that the person can still do and what they need support with. We saw some nice detail in parts of the care plans such saying the soap and perfume people use and the particular interests they had. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 11 We discussed with the manager areas where the care plans could be made even better. Staff should continue to look at making the information even more person centred and detailed. This could include looking at what a good day would be for the person and recording their dreams / wishes for the future. It is recommended that the home look at developing life storybooks with the people living there and these could then be shared with others in the home. This may also help staff to relate to people as individuals and encourage more interaction. Staff may also wish to develop their own life storybooks as part of this process. Sexuality may be an area where there could be more discussion about peoples needs and the care planning required. The plans we looked at talked about people looking ‘smart’ that did not seem to be in line with the overall stated goal for the individual to be enabled ‘to express my sexuality’. We saw that care plans are reviewed monthly and daily notes are kept about each person. These gave some good information but tended to say the same thing day after day. Care staff should look at the notes to make sure they are recording good quality information and that they are useful in evaluating the care plan each month. Notes that say the same thing each day could also be showing that there is a problem with the quality of life for that person – do they have purpose in their daily life? People who use the service have access to local GP services. Arrangements are in place for regular dental, optical and chiropody checks to be available. The people we spoke to said that they could see the doctor when they needed to. We looked at medication and saw that this area is managed well by staff. Administration records are kept up to date and items stored properly and securely. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Levels of activity and occupation could be improved for the people using the service. Individuals are generally satisfied with the food provided to them but mealtimes could be made more of a social occasion. EVIDENCE: “I don’t like just sitting”, “nothing like enough going on”, “it can be boring” and “the place needs livening up” were comments from people who use the service. Two people said that they were happy with the activities provided and spent their time reading. Care staff we spoke to said that they provided activities in the afternoon but this was sometimes difficult due to the increasing needs of people using the service. We saw staff playing skittles and singing with individuals while we were there. The manager spoke about trying to involve people more in the daily life of the home and that she felt that this was an area that could be Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 13 improved upon. Three people attend local Day Centres regularly and staff were trying to access this service for another person at the time of our visit. We have recommended that the service look at employing an activity coordinator. The AQAA for the home stated that the employment of a part-time person was planned along with improving the activity programme and providing more outings. Care staff also need to be actively involved in social and emotional care and make sure they are person centred rather than task based. Helping people to have purpose and to be engaged and occupied needs to be a central part of the homes culture with all staff fully signed up to this. Staff could also involve people in daily tasks such as food preparation, gardening, laundry and shopping. As discussed later in this report, the lounge needs to have more items that can be used to engage people and provide occupation. People who live there said “not bad”, “some days good, some days not so good”, “very good”, “patchy” and “I couldn’t wish for better food”. The meals being served did not match the four-week menu in place and the people we spoke to could not tell us what they are having for lunch on the day we visited. The menu was displayed on a whiteboard in the dining room but many people did not see this until just before the meal was served. The service needs to look at the menu with the people living there and come up with a new one that reflects people’s current preferences. Ideas such as international menus, recipes from the past or recipes from individuals or their families / friends could also be used. The home should also consider how they give people choice each day in what they eat. People we spoke to said they were ‘sometimes’ asked what they preferred for mealtimes but this did not happen everyday. We have recommended that the menu be displayed in pictures to make sure that everyone knows what is being served. It may be better to locate this information somewhere where people will see it more easily. There may also be opportunities to make mealtimes for those eating in the dining room a more social occasion. Ideas to consider include protected mealtimes, people serving themselves at the table from serving bowls and for staff to eat their meals alongside the people living there. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: People we spoke to said “I’d see the manager if I was unhappy” and “no complaints”. The manager told us that they had received no complaints since the last inspection and this was mainly due to good communication with people and their relatives or representatives. This allows for any issues to be dealt with immediately and informally. A complaints procedure is included within the information pack about the home. We recommend that the procedure be made available in other formats. It would be good to have pictures of the manager or other senior staff so people can see who to go to if they are unhappy. Care staff at the home receive training that teaches them how to recognise and report abuse as part of their induction. We saw that further mandatory training is provided by the organisation on an ongoing basis. There is an organisational procedure for staff to follow in the event of any allegations being made and the Local Authority Safeguarding procedure is also available. We Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 15 saw that these procedures had been discussed at one of the regular meetings held with the people who live there. This is good practice and should be continued. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. People using the 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 live in a safe, homely and well-maintained environment. EVIDENCE: Thetford Lodge is an attractive property in a pleasant residential area and in keeping with neighbouring houses. The home is laid out over two floors. The ground floor has a lounge and separate dining area which are well furnished and spacious. There is a small rear garden area with seating and a gazebo. People spoken to said they were happy with their rooms. We saw three bedrooms during our visit and these were personalised and homely. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 17 The environment has a nice homely feel throughout and we saw that people live in a clean and well maintained home. One issue that was discussed during the inspection was the chair lift and its possible repair or replacement. We were told that this equipment is not working well and sometimes stopped when in use. The daily notes for one person said that they were unable to come down to the communal areas because of this problem. We have asked the service to sort this problem out as soon as possible. We have recommended that staff look at ways to make the environment more stimulating and interactive. Rummage boxes, books and interactive objects could provide stimulation and help staff to engage with people. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are generally happy with the care they receive and feel they are treated politely and respectfully. Staff recruitment practices and training are of a good standard. EVIDENCE: Feedback from the people who live there about the staff was positive. Comments included “the staff are very nice”, “nice – it’s a horrible job”, “always polite”, “they’re quite nice” and “friendly and chatty”. Staff were polite and respectful when interacting with people but we saw a number of ‘missed opportunities’ where staff could have spent more time with people. The senior staff need to keep role modelling person centred care rather than task based care and make sure that staff see this as a very important part of the care being provided. As stated previously in this report, engagement and occupation should be constant throughout the day. We looked at the records kept for three members of staff. Recruitment checks are completed and these include a Criminal Records Bureau (CRB) check. Staff have mandatory training in a number of areas such as manual handling, Health Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 19 & Safety and Safeguarding Adults. We saw that the organisational programme of training also included the Common Induction standards for new staff, dementia care and implementing activities. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the 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 live in a home that is well run. Regular Health and Safety checks are carried out to help keep people safe. EVIDENCE: An acting manager has been in post but was due to leave in September 2008. An existing senior member of staff is then to become acting manager of the home. We have made a Requirement that a permanent manager be appointed for the service and an application to register be submitted to the CSCI. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 21 Feedback from care staff was positive about the way the home was managed with comments including “she is available to speak to”, “really nice” and “good”. We found that the service has good quality assurance procedures. People who use the service and their relatives or friends had been asked for their views in surveys and the results summarised. The feedback from relatives or friends had showed that activities were an area for improvement. The AQAA supplied to us reflected this. We saw that monthly meetings were held with people who live at the home and discussions included food, the environment and activities. Health and Safety is well managed. Regular checks take place for areas such as hot water temperatures, fire, gas and electrical safety. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP22 Regulation 23 (2) (n) Requirement In order to maximise people’s independence and help them access all areas of the home, the stair lift must be fully repaired or replaced. A permanent manager must be appointed and an application to register with the CSCI submitted. This will make sure that the home benefits from having stable leadership from a suitable person. Timescale for action 01/11/08 2. OP31 8 (1) (a) 01/01/09 Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The user guide should be made available in accessible formats such as large print or audiotape. Photographs of key staff, the home and local places could help people use the guide. The home should look at how Equality & Diversity is addressed at the assessment stage. The related guidance from CSCI could be used to help with this. The home should continue to look at how care plans could be made more person centred. Sexuality in care planning should be discussed within the staff team. Life story books could be developed with the people who live there. Care staff could also make their own story books to share with individuals. Daily notes should be reviewed to make sure they capture useful information and can be used to help evaluate the support being provided. The organisation should consider employing an activities co-ordinator. Care staff should look at the daily routines and make sure that the support provided is person based and not task based. Providing engagement, occupation and purpose needs to be seen as a very important part of their job role. The home should look at how the people living there can be more involved in the life of the home. This could be with tasks such as cooking, gardening, laundry and other household jobs. The menus need to be reviewed with the people who live there. New menus should be provided in picture formats and displayed where people can see and use them. The menus should provide a choice for individuals at each Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 25 2. 3. OP3 OP7 4. 5. 6. OP7 OP7 OP12 7. OP12 8. OP15 9. OP15 10. 11. OP16 OP19 mealtime. The home should look at how mealtimes could be made a more social occasion. Ideas such as protected mealtimes, use of serving bowls and staff sitting eating with the people who live there should be considered. The complaints procedure should be made available in alternative formats to help people use them when they need to. Care staff should look at ways of making the environment more stimulating and interactive. Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Thetford Lodge DS0000065234.V368005.R02.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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