Care Home: Victoria Lodge

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What the care home does well Since the last key inspection in 2007 the manager has resigned and taken up a position elsewhere. However, we were pleased to note that the owners have already advertised for a new manager and that they are spending a considerable amount of time at Victoria Lodge in the interim. One of the owners is a registered manager at their other care home We saw that all staff treated residents with kindness and respect, and knew a great deal about the individual needs of each person. Residents appeared well dressed and groomed and those spoken to said that they were very pleased with the care that they receive. Relatives told us that they were very pleased with the care of their relative, and that staff were always helpful, attentive and kind and that they always made them feel welcome. One relative told us "Mum has only been here for a few weeks, but already we have noticed an improvement. She is eating well and has put on weight." Another relative told us "my dad was not very well but the owner has been excellent with him." We were told by another relative that "I know that my husband is well looked after and I can leave him knowing that he is in good hands." We were told by residents that they can always see the GP, and are helped to keep hospital appointments. This was supported by relatives and a GP who commented on a survey that he thought the standard of care the residents at Victoria Lodge receive was excellent. Feedback from other health and social care professionals was very postive, with one comment being made that she found the staff very kind and caring. We saw that meals were nicely presented and that residents are given a choice at each meal. One resident told us "I like kippers and always have them for breakfast, and another good thing is that it is not always sandwiches at teatime." We had received a complaint from a concerned staff member that food was rationed, but this was not supported through discussions with residents, staff and from observations and viewing menus/other documentation and the store cupboards. We found that the home`s policies and procedures on safeguarding, including whistleblowing and recruitment, were sound and that staff knew about these. A member of staff told us "I have had training on POVA, and would not hesitate to report any abuse either to the owners or the Commission." We were told by a resident that "I always feel safe here, but if I didn`t I would speak to either the manager or my friend. I have never seen nor heard staff treating people unkindly." Training and supervision of staff was found to be given a high profile within the service, and records showed us that some staff have had training in the implications of the Mental Capacity Act, POVA (protection of vulnerable adults), first aid and health and safety. We also discussed other areas relating to equality and diversity with the owners and staff and found that they had a good working knowledge and understanding of the various and, sometimes complex, areas relating to this. Some residents were able to tell us that they felt that all of their needs were met by the staff. One person told us that she does not like the church services, and that she goes and sits in the small lounge and this has never been an issue. What has improved since the last inspection? We found that several bedrooms and the small lounge had been redecorated and that new lounge chairs and dining room furniture has been purchased since the previous inspection. New carpet has also been laid in the lounges and dining area of the home. A new emergency lighting system has been installed and this now runs off the main electricity supply and not from a battery. Some rooms have been fitted with door guards which means that residents can leave their doors open, as the door guards would be activated by the fire alarm sound in the event of a fire. What the care home could do better: Some work has been undertaken on making the care plans more person centred, but there is still more that could be done in this area. We discussed this at length with the owners and they have assured us that this work will be completed in the next three months. Hand written medication entries should be signed by two people and this was discussed during the inspection. Also the owners should purchase a controlled drugs cabinet in line with new legislation, and also have a controlled drugs register. Although no controlled drugs are currently held at the home, the purchase of the cabinet and register will ensure that in the event of any resident requiring the prescribing of controlled drugs then the home would be able to facilitate this, which would be in the interests of the resident/s. We discussed with the owners the need to have some domestic staff cover at weekends to ensure that toilets/bathrooms and communal areas were clean for the benefit of the people living at the home. This would also ensure that care staff could spend more time with residents. We were told that they would review the current situation with regard to domestic cover at the home. CARE HOMES FOR OLDER PEOPLE Victoria Lodge 26-28 Manor Road Romford Essex RM1 2RA Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 9th May 2008 08:00 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 Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Lodge Address 26-28 Manor Road Romford Essex RM1 2RA 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) 01708 765 757 01708 765 757 hightrees_17@hotmail.com Kirkstone Care Ltd Care Home 17 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (17) of places Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories 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: Old age, not falling within any other category - Code OP (maximum number of places: 17) 2. Dementia - Code DE (maximum number of places: 7) The maximum number of service users who can be accommodated is: 17 3rd July 2007 Date of last inspection Brief Description of the Service: Victoria Lodge offers 24-hour residential care to a total of 17 people over the age of 65 years in the categories of OP, older people not falling within any other category, and DE, dementia care. The maximum number of people with dementia that can be accommodated is 7. The home is a two-house conversion on a corner site in a quiet residential area within the London Borough of Havering. The accommodation is split between 3 floors with two passenger lifts. All rooms are spacious, airy and bright with 15 single rooms and 1 double room. 6 single rooms and 1 double room also have an en suite toilet. All have hand basins, TV points and an emergency call system. There are two lounges, one small and one larger lounge which is integrated with the dining room overlooking the rear garden, with disabled access. There are carparking facilities to the rear of the property for staff and visitors. The home is located close to local services and facilities at Romford Town Centre. The home is easily accessible by public transport or car via the M25, A127 and the A12. The home is operated on the basis of a family and homely home environment. The statement of purpose and a copy of the last inspection report were available in the entrance area of the home. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 5 Fee levels at the time of this inspection were £366 - £480 per week. Additional charges are applicable for hairdressing and chiropody. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson. The inspection took place on the 9th May 2008 between 08.00 hours and 17.10 hours. The two owners of the care home were available throughout the time to aid the inspection process. At the end of the inspection the inspector was able to provide feedback to the two owners. The inspection process included a tour of the home, and we were able to talk to many of the residents, 6 visiting relatives and staff members, including two night care staff, and also case tracked 4 people who use the service, together with viewing staff rotas, training schedules, 4 staff files, activity programmes, maintenance records, accident and complaints records and menus. Telephone calls were also made to interested health and social care professionals to gain their views on the service at Victoria Lodge. Also as part of this inspection we specifically looked at the National Minimum Sandards for protection and safeguarding to assess whether people who use services are protected from abuse. We also looked at recruitment to assess whether people who use the service are supported and protected by the home’s recruitment policy and practice. We asked people who use the service how they wished to be referred to in this report, and those people who were able to respond told the inspector that they wished to be referred to as “residents because that is what we are.” What the service does well: Since the last key inspection in 2007 the manager has resigned and taken up a position elsewhere. However, we were pleased to note that the owners have already advertised for a new manager and that they are spending a considerable amount of time at Victoria Lodge in the interim. One of the owners is a registered manager at their other care home We saw that all staff treated residents with kindness and respect, and knew a great deal about the individual needs of each person. Residents appeared well dressed and groomed and those spoken to said that they were very pleased with the care that they receive. Relatives told us that they were very pleased with the care of their relative, and that staff were always helpful, attentive and kind and that they always made them feel welcome. One relative told us “Mum has only been here for a few weeks, but already we have Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 7 noticed an improvement. She is eating well and has put on weight.” Another relative told us “my dad was not very well but the owner has been excellent with him.” We were told by another relative that “I know that my husband is well looked after and I can leave him knowing that he is in good hands.” We were told by residents that they can always see the GP, and are helped to keep hospital appointments. This was supported by relatives and a GP who commented on a survey that he thought the standard of care the residents at Victoria Lodge receive was excellent. Feedback from other health and social care professionals was very postive, with one comment being made that she found the staff very kind and caring. We saw that meals were nicely presented and that residents are given a choice at each meal. One resident told us “I like kippers and always have them for breakfast, and another good thing is that it is not always sandwiches at teatime.” We had received a complaint from a concerned staff member that food was rationed, but this was not supported through discussions with residents, staff and from observations and viewing menus/other documentation and the store cupboards. We found that the home’s policies and procedures on safeguarding, including whistleblowing and recruitment, were sound and that staff knew about these. A member of staff told us “I have had training on POVA, and would not hesitate to report any abuse either to the owners or the Commission.” We were told by a resident that “I always feel safe here, but if I didn’t I would speak to either the manager or my friend. I have never seen nor heard staff treating people unkindly.” Training and supervision of staff was found to be given a high profile within the service, and records showed us that some staff have had training in the implications of the Mental Capacity Act, POVA (protection of vulnerable adults), first aid and health and safety. We also discussed other areas relating to equality and diversity with the owners and staff and found that they had a good working knowledge and understanding of the various and, sometimes complex, areas relating to this. Some residents were able to tell us that they felt that all of their needs were met by the staff. One person told us that she does not like the church services, and that she goes and sits in the small lounge and this has never been an issue. What has improved since the last inspection? We found that several bedrooms and the small lounge had been redecorated and that new lounge chairs and dining room furniture has been purchased since the previous inspection. New carpet has also been laid in the lounges and dining area of the home. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 8 A new emergency lighting system has been installed and this now runs off the main electricity supply and not from a battery. Some rooms have been fitted with door guards which means that residents can leave their doors open, as the door guards would be activated by the fire alarm sound in the event of a fire. 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. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 9 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 Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 (standard 6 is not applicable to this service) People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective residents and their relatives are given information by the care home, together with an invitation to visit the home at any time to enable them to decide if they want to live at Victoria Lodge. A comprehensive assessment of their needs is undertaken before moving in and all current residents have a contract stating the terms and conditions of residency at Victoria Lodge. This should ensure that people moving into the home know that their needs will be met. EVIDENCE: We were shown the revised statement of purpose and service user guide and were satisfied that these were compliant with the Care Home Regulations. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 11 Wherever possible all prospective residents and their families are encouraged to visit the home prior to admission, and a comprehensive assessment of needs is undertaken by a person employed by the home who is suitably qualified to do this. During the visit we met with a person who was being shown around the home, and we were also told by a visiting relative that she viewed Victoria Lodge before her mother moved in. All residents are given a contract stating the terms and conditions of residency at Victoria Lodge, and copies of these were seen on the file of 4 residents who were being case tracked as part of the inspection process. Intermediate care is not provided at Victoria Lodge, and therefore standard 6 is not applicable. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 12 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, 9,10 and 11 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Although each resident’s health and personal care needs are set out in an individual care plan, these need to be more person centred. However, residents can be sure that their health needs will be met and that they will be treated with respect and their right to privacy is upheld. The medication policies and procedures of the home ensure that all residents are protected. EVIDENCE: We looked at the files for 4 residents and found that although some work had been undertaken on the care plans to make these documents more person centred, there was still more work to be done. However, we were satisfied that staff at the home were very knowledgeable about the individual needs of each of the residents, and this was supported in discussions with residents and some visiting relatives. We discussed with the owners the need for all of the care plans to be more person centred, and they have undertaken to ensure that all care plan documentation is reviewed within 2 months from the date of Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 13 this inspection. As part of the reviewing process the owners will also look at including end of life decisions and care, and that such decisions are in line with the wishes of the individual and/or family. They are aware that sometimes this may need input from the GP, district nurse or other professionals, and are also aware of the implications of the Mental Capacity Act 2005. We were satisfied that residents who have diabetes have comprehensive health care plans, and that blood sugar monitoring was being undertaken in accordance with their care plan, and the instructions of the GP or the district nurse. Staff also demonstrated a good knowledge and understanding of the needs of another resident who has dementia and some mental health problems, and it was evident from observation that this resident had a good relationship with staff on duty. She told us that “I like living here, everybody is so kind and helpful.” Records showed that all residents have access to a GP, dentist, chiropodist and other health/social care professionals and that residents are assisted to keep hospital or other appointments. The owners have purchased a new weighing machine, and this has ensured that all residents are being weighed on a monthly basis, and that weights are being monitored. All new residents are weighed on admission. Where there may be cause for concern referrals are being made to the GP for input from a dietician or nutritionist. Records are kept as to the food intake of all residents. We were told by residents that the staff were very nice, and one resident told us “staff are always on hand to help you if you need it.” A relative told us “I am very happy with the care that mum gets, since she has been here she has put on weight and seems much happier.” Another relative told us “they always let me know if dad is not well, and recently he has been under the weather, but staff and the owners have been excellent with him.” We were able to observe that staff were sensitive to the changing needs of the residents, that they they listened and responded to a person’s individual choices and decisions. Residents are encouraged to retain as much independence as is possible, and this was confirmed in discussions with residents and relatives. Medication administration records (MAR) were inspected and these were all found to be in good, as were the medications. Handwritten entries should have two signatures to verify the entry and this was discussed with the owners during the inspection. The home has a good record of compliance with the receipt, administrration and safekeeping of drugs, and staff involved in the administration of medication have undertaken appropriate training. We did discuss with the owners the benefits of purchasing a controlled drugs cupboard and register in case an existing resident needed to be administered a controlled drug. They have undertaken to purchase such a cupboard and register as they agreed that this would be to the benefit of residents. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 14 We were satisfied that any resident wishing to remain at Victoria Lodge at the end of their life would be enabled to do this with the appropriate support being provided from the GP or other health professionals as necessary. We were able to evidence this during the visit as a resident had returned from hospital having made the choice to spend the remaining days of life at Victoria Lodge. Support was being given by the GP and community nurses including McMillan Nurses. Family and friends were also visiting this person and staff were observed to be very kind and sensitive to their needs. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 15 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 who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents find the lifestyle experienced in the home matches their expectations, and generally satisfies their social, cultural, religious and recreational interests. Residents are encouraged and assisted to maintain contact with family, friends and the local community and are helped to exercise choice and control over their lives. A wholesome appealing balanced diet is provided in congenial surroundings. EVIDENCE: We spoke to several residents about life in the home, and they told us that they were very happy. We saw staff sitting and talking to residents, and one member of staff was playing cards with another resident. One person told us “we sometimes have entertainment, but can play board games, cards and we have a lady who visits and does some exercises and other activities with us.” This was also supported by a programme of activities which was displayed in the home. Annual festivals are celebrated and these include the birthdays of residents. Books with large print are also available Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 16 within the small lounge of the home. We were satisfied that staff were also aware of special communication needs of some of the residents, and this meant that residents can still fully participate in daily living activities. Relatives told us that they can visit the home at any time and are always made to feel welcome with staff offering drinks and biscuits. One relative told us “I can come and have dinner with my husband if I want.” A resident likes to spend nights away from the home with a friend and she is supported in this by staff from the home, and within a risk management framework. We were able to see breakfast and lunch being served and meals were well presented and residents were given choices. Where assistance was needed with eating and drinking, staff were seen doing this in a very sensitive and personal manner. Menus are also provided in a pictorial format for those residents who may have dementia or memory loss, and this enable them to make some informed choices. One resident told us “the food is quite good and I am always given a choice. I always like kippers for breakfast and also what is nice is that it is not always sandwiches for tea.” We were able to speak to the cook who compiles the menu with the residents, and she is also very flexible in what she prepares as often residents change their minds. She told us about one resident who has not been eating very well, and she thought he might like a rice dish as he had spent some time in Japan. She said “I prepared the dish and the resident ate every little bit.” We also saw fresh fruit and vegetables in the home. The Commission had received a telephone call from a concerned person about control of food and lack of choices for residents, but this was not supported from evidence and discussions with residents and staff obtained during the inspection. A resident told us that she felt that she could have a bath whenever she wanted, and also that staff were very good at helping her choose what to wear on a daily basis. At the present time all of the residents are white British, but staff are from various ethnic groups. However, it was evident that staff were aware of the cultural needs of residents and of the religious needs. Most of the residents told us that they were Christian, but one resident told us that “I don’t like church services so I go and sit in the small quiet lounge, and nobody seems to be mind.” Staff told us that sexual preferences of residents would be respected by them, along with any other choices that an individual wanted to make because it was their right. The home also has a pet cat “Mitsi” which seems to give great pleasure to many of the residents. One lady told us “Mitsi is lovely because she lets me stroke her.” Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives can be confident that their complaints will be listened to and taken seriously and acted upon. Residents are protected from abuse through the training of staff and the adherence to policies and procedures within the home. EVIDENCE: We viewed the complaints log and were initially concerned at the way in which complaints had been dealt with by the previous manager who had recently resigned. However, we were able to discuss this at length with the owners and are satisfied that the culture of the home is, and will continue to be, that it welcomes complaints and suggestions about the home, and that these are used positively to improve the service to residents. We were told by relatives that if they needed to complain they felt that the owner would listen to them and act accordingly. A resident told us that “I did complain to the owner and he sorted things out straight away.” Complaints forms were available within the home for both residents and relatives. At this inspection we looked particularly at safeguarding issues and were satisfied that staff were very knowledgeable about the policies and procedures, including whistleblowing, and what they should do if they felt that a resident was being abused. We were told by one member of staff “our job is to make sure people here are looked after, and if I ever saw anybody being Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 18 unkind to a resident I would confront them and then tell the manager. If need be I would ring you, the inspector.” We spoke to some residents who told us that they always felt safe, but if they did not they would tell the owner or their relative. The owners and staff knew about the local authority’s role and that any incident around safeguarding should be reported to the safeguarding co-ordinator and also to the Commission. All staff working at the home have to undertake training in safeguarding adults, and were aware of what restraint is. When talking to staff it was evident that they were aware of the various types of abuse such as physical, financial, emotional, sexual and institutional. Staff were also able to demonstrate an understanding of diverse needs of people due to age, race, religion or sexuality. The service does promote independence and choice as much as possible and respects the rights of people using the service. Risk assessments are completed where necessary with the involvement of the individual and other appropriate people. We were pleased to see that the little tables in the lounges were placed alongside residents and not in front of them so as not to restrain their mobility. Since the previous inspection there have not been any safeguarding incidents at the home which involved staff at the home. A complaint had been received by the Commission and the issues were looked at in the overall inspection of this home, and it was found not to be substantiated. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents live in a safe, well-maintained environment which is clean, pleasant and hygienic. However, although areas of the home do not meet the National Minimum Standards on the environment, the owners make every effort to ensure that the rights and safety of all residents remains a priority, with gradual improvements being made where the structure of the building will allow. EVIDENCE: We undertook a tour of the premises, both internal and external, and are satisfied that the home was clean and generally in a good decorative condition, reasonably well maintained, with no offensive odours. There is now a programme of redecoration, refurbishment and maintenance and the downstairs corridor and some bedrooms have been redecorated. A new carpet has been laid in the large lounge/dining room and there are new lounge Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 20 chairs and dining room furniture in place. We were told by one resident “I like my new chair because it is really comfortable.” 15 of the bedrooms are single, 6 of which have an en suite toilet, and there is 1 double room (currently used as a single room) which also has an en suite toilet. All of the bedrooms viewed were clean, airy and spacious and had been personalised by the occupant. There are two communal bathrooms, one of which is fitted with chair hoist for the ease of residents getting into and out of the bath, and the other is now a shower room. Taps are fitted with temperature control valves which are checked regularly. All bathrooms with toilets, communal toilets and en suite toilets looked at had soap, towels and toilet rolls. We were able to observe good infection control methods being employed by staff. Many of the external doors are alarmed and all fire signs where necessary were in place during the inspection. For the benefit of those residents who have varying degrees of short-term memory loss and/or confusion the rear garden is secure so that residents are not in danger of wandering through the side gates into the road, nor into the car park. The rear garden is well maintained and has been made secure by the use of shrubs and a low fence. Locks on the garden gates can be unlocked by the input of numbers, known to the staff, and following a previous fire inspection it was confirmed that this security does not impact on the fire exits. We were told that since the last inspection a new emergency lighting system has been installed, as has a new central heating/water boiler. Because Victoria Lodge is an older care home, originally registered under the 1984 Registered Homes Act (now repealed and replaced by the Care Standards Act 2000), it is exempt from complying with some of the environmental standards contained in the National Minimum Standards for Care Homes for Older People. These are mainly around room sizes and width of doorways and corridors. However, the owners are making every effort to ensure that standards are met wherever the structure of the building will allow. For the ease of those residents who are unable to negotiate stairs, there are two lifts and a ramped access to the smaller lounge. In discussions with several residents they did not express any concern around using the ramp and this did not pose a problem. We saw residents and relatives using the ramp safely. Necessary aids and adaptations are provided where necessary. The kitchen was clean and well maintained, and food was appropriately stored and labelled. The laundry area was clean and well maintained. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents can be sure that their needs will be met by the skill mix of staff, and that they will be supported and protected by the home’s recruitment policy and practices, and that these will be consistently applied. They can be sure that staff are trained and competent to do their jobs. EVIDENCE: More than 50 of the staff have achieved NVQ level 2 and some have achieved NVQ level 3. Staff told the inspector that they had previously received training in moving/handling, safeguarding adults, fire safety, administration of medication, food hygiene and infection control, and this was confirmed when viewing the training schedule. There is a programme already arranged for future training for some of the staff in the Mental Capacity Act. We were told by residents that they liked the staff, and relatives also told us that the staff were very good and interacted well with the residents. We inspected the files of 4 members of staff and were satisfied that the recruitment procedures were robust. All files showed us that staff completed application forms, underwent an interview process with answers being recorded, had to show evidence of work status, and that 2 references had been taken up and a criminal records bureau disclosure (CRB) obtained. Where a Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 22 member of staff had started work before the receipt of a CRB then a POVA first had been received. Original certificates of qualification had also been seen and photocopies were on file. We were satisfied that staff attended regular meetings and that supervision sessions were regular. This was confirmed in file records and when talking to staff. We were a little concerned at the fact that there is no domestic cover at the weekends. This was discussed with the owners who have agreed to ensure that there is some domestic cover at this time to ensure that toilets and communal areas are kept clean. This will mean that care staff can spend more time with residents at the weekends. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a view to the service. In spite of the absence of a registered manager, residents can be sure that the home is being run in their best interests. Staff are being appropriately supervised and the financial interests of residents are safeguarded. Both staff and residents can be sure that their health, safety and welfare will be promoted and protected. EVIDENCE: We were told that the manager has resigned to take up a post in a larger care home. However, we are satisfied that until a new permanent manager is appointed the home will be managerd by the owners, one of whom is a registered manager at their other establishment in North London. This was confirmed to us by residents and staff who told us that one of the owners is Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 24 always at the home. Advertisements for a new manager have already been placed in local papers and at the job centre. The owners have a clear understanding of the key principles and focus of the service, and are working continuously to improve the home. They provide a strong focus on equality and diversity issues and on promoting the rights of the residents, especially in the areas of dignity, independence and respect. There is a good staff team, and without exception we were told by residents and relatives that the staff were very good and that nothing was too much trouble for them. Staff receive appropriate supervision as evidence from records and talking to staff. We were satisfied, both from discussions with residents, relatives and staff and from documentation that the owners give safeguarding a high priority, and that risk assessments are undertaken which involve residents and, where appropriate, their relatives and other professionals. There is a quality assurance system in place which seeks the views of residents, relatives and visiting health/social care professionals, and information from the quality assurance exercises feed into the improvements of the service. The owners ensure that health and safety requirements and legislation are complied with. Records around the maintenace of the home were viewed and these included fire safety checks, fire alarm testing weekly, a fire risk assessment is in place, electrical and gas certificates are up to date as are those for the lifts. A recent inspection undertaken by the local environmental health officer showed satisfaction with the home. Policies and procedures are regularly reviewed and updated in line with new guidance/legislation. There is a financial and business plan in place and the owners access professional business and financial advice when necessary. Insurance cover is sufficient to cover any loss or legal liabilities. We are confident that the owners will make any necessary improvements to the service, and that they will continue to work co-operatively with the Commission. Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 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 3 X 3 X 3 3 X 3 Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered provider must ensure that each person has a care plan which is person centred. This will ensure that the service to residents improves to an even higher standard because it will give more information to care staff about the individual needs. The registered provider must appoint an individual to manage the care home, and advise the Commission of the name of the person appointed and the date on which the appointment is to take effect. This will ensure that the care home continues to be run and managed effectively on a day to day basis for the benefit of residents and staff. Timescale for action 31/07/08 2 OP31 8 31/08/08 Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 27 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 OP9 Good Practice Recommendations It is recommended that hand written medication entries should be signed by two people to ensure the safe transcription of instructions, thereby safeguarding both staff and residents. It is recommended that the owners purchase a controlled drugs cabinet in line with new legislation, and also have a controlled drugs register. Although no controlled drugs are currently held at the home, the purchase of the cabinet and register will ensure that in the event of any resident requiring the prescribing of controlled drugs then the home would be able to facilitate this, which would be in the interests of the resident/s. It is recommended that the owners employ some domestic staff at weekends to ensure that toilets/bathrooms and communal areas were clean for the benefit of the people living at the home. This would also ensure that care staff could spend more time with residents which would be to their benefit. 2 OP9 3 OP27 Victoria Lodge DS0000069388.V363821.R01.S.doc Version 5.2 Page 28 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. 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