Foxley Lodge Nursing Home v Croydon Health Authority

Decision of Registered Homes Tribunal held at Croydon General Hospital on Wednesday 11th December and Thursday 12th December 1985. Appeal by Lodge Residential Homes Ltd against de-registration of Foxley Lodge Nursing Home of 4 Foxley Lane, Purley, Surrey by Croydon Health Authority. The Tribunal.Mr W Morris JonesChairman Dr S Morton McDougall MB ChB FFCM Miss B Cowell SRN SCM MTD Representation Mr Robert FrancisCounsel instructed by Messrs Le Brasseur & BurySolicitors for the Appellant Mr James BadenochCounsel instructed by Messrs Capstick Hamer & CoSolicitors for the Croydon Health Authority Heads of Appeal

1. Failure to comply with fire regulations within a reasonable time.

2. Failure to agree to and provide adequate staffing levels.

3. Unsuitability of premises to comply with current standards:- a. No lift b. Inadequate sanitary facilities c. Inadequate laundry provision d. Inadequate office e. No clinic room f. No visitors' room g. The kitchen does not meet the standards of the Environmental Health Officer Interpretation "The 1984 Regulations" means the Nursing Homes and Mental Nursing Homes Regulations 1984. SI 1578 of 1984. The Tribunal adopts Regulation 2 of the 1984 Regulations. "the Appellant" means Lodge Residential Homes Ltd "Foxley" means Foxley Lodge Nursing Home of 4 Foxley Lane, Purley, Surrey. Witnesses For the Appellant:- Mr Francis Joseph VooghtMrs Doreen Elizabeth Crawley SRNMr Robert Stewart RGN, RNT For the Health Authority:- Mrs Ena Cook SRN RCN NDNDr Daphne Richards MB ChB DCH DPH MFCM Background Foxley has been in its present ownership, that of the Appellant, since 1977, having previously been used as a nursing home. The property is leasehold from the London Borough of Croydon. A certificate of registration under the Nursing Homes Act 1975 was granted to the Appellant on the 6th January 1983, for 19 elderly residents. Considerations

1. Fire Regulations. In November 1982, as the result of a visit from the London Fire Brigade, the use of the room on the second floor of Foxley was granted provided:- (a) the occupant of the second floor room was fully mobile and (b) the requirements of the Fire Brigade "that an additional fire escape be provided to the second floor to be completed by December 1982." In February 1984, a schedule of recommendations by the London Fire Brigade became available. These recommendations appear to have been accepted by the Appellant although it was admitted in evidence on behalf of the Appellant that there had been delay in carrying out the work. The Health Authority asked, in a letter of January 1985, about the failure by the Appellant to comply with the Fire Officer's requirements ie. the provision of a fire-escape to the second floor, and, inter alia, for a time scale for undertaking the necessary work. In evidence it became clear that the occupant of the second floor room had not been mobile, and had remained there until her death in June 1985. The required fire-escape to the second floor has still not been provided.

2. Staffing Levels Recommendations were made from time to time to the Appellant by the Health Authority, regarding the level of nursing staff at Foxley. In particular the number of qualified nurses to be employed at specified times in relation to untrained staff. Although notice of these recommendations was included in correspondence, the Appellant resisted these on the ground that the directors of the Appellant had been assured by the then Matron, the person in charge, that existing levels were "adequate". However, this was subsequently denied by the same Matron in a letter written by her on the 4th December 1984, and addressed to the Assistant Director of Nursing Services to the Health Authority, when she indicated that the staffing levels recommended "would be a great improvement towards the really efficient running of the Home". We were concerned that the administrative duties necessarily undertaken by the Matron, from time to time, were taken into account in calculating the overall nursing staff levels. Evidence showed that on Saturday and Sunday in each week-end, no domestic assistance was available, and this – together with laundry work – was undertaken by nursing staff and auxiliaries.

3. The Premises We appreciate that the development of the premises is restricted by site constraints, and the requirements of the lease under which the premises are held from the Local Authority. (a) No lift. This would be desirable in view of the average age of the residents, who find it difficult or, in some cases, impossible to negotiate steep and narrow stairs between the ground floor and first floor. We were told in evidence, that some of the residents were satisfied to remain in their own area, but the provision of a lift might enable some residents to lead a fuller life, and associate with others of them. (b) Sanitary facilities. The only sluice for dealing with soiled linen and clothes was in the present laundry room on the ground floor. We accepted the view taken and expressed by witnesses that the sluice should be entirely separate from the laundry room, because of the possibility of cross infection from the soiled and infected linen. On the first floor, the bathroom and lavatory combined was the only room available for dealing with soiled linen and clothing. The present position of the downstairs lavatory, situated off a bedroom on the left of the hallway, was inadequate; furthermore, it was too narrow for convenient use by residents, whether ambulent or in wheelchairs, and the entrance was often cluttered with commodes and with domestic equipment. In evidence, it was recommended that proper facilities for sluicing should be provided on both the ground and the first floors. We also consider that the number of lavatories available for the use of patients and for the staff was inadequate. This often led too much to the reliance on the use of commodes for the residents. (c) Laundries. There was an industrial type washing machine and a separate tumbler-drier in the laundry room on the ground floor. The sluice was situated in a corner of this room. Although most of the laundry was contracted out, foul linen had to be sluiced first and there were inadequate facilities for this. There were no facilities for the staff dealing with foul linen to wash their hands within the area. As indicated above, the whole arrangement whereby laundry facilities were in such close proximity to the sluice was totally unacceptable. (d) Office. This was a very small area with a cramped desk, one chair, a small wall cupboard used for drugs, and a telephone. The Matron tended to take paper work home, partly due to the interruptions requiring her to assist in nursing duties, and partly due to constant queries arising either on the telephone, or from callers to Foxley. Also to the in-adequacy of the office. This office was too small in which to interview relatives of residents, doctors or staff. (e) Clinic Room. We formed the view that it is desirable to have a clinic room with the normal facilities for sterilising surgical instruments, storage of drugs, dressings, etc., It is appreciated that minor dressings can be carried out at the patients' beside, but this might not always be desirable. (f) Visitors' Room. It was suggested in evidence that the association of visitors and residents made for a happier and more sociable atmosphere. The provision of a visitors' room could also be used for discussing confidential matters with doctors, solicitors, relatives etc., particularly in view of the comments made in paragraph (d) above. (g) Kitchen. The counsel for the Health Authority indicated that the Health Authority no longer wished to pursue the criticisms of the kitchen. We visited Foxley on Wednesday 11th December in the middle of the day. Decision We considered all the evidence put before us, and had the advantage of visiting Foxley. It is to be stressed that no criticism is made of the Matron and her staff, who provide the daily care with the skill and kindness which one would expect from the nursing profession. However, considering the difficulties of altering the building to make reasonable changes to conform with the requirements of the Health Authority and thereby to improve standards, and particularly with the inadequacies of the sanitary and laundry provision, we believe that the Health Authority were correct in making the decision which they did on the 18 April last. We consider that there was delay on the part of the Appellant in taking steps to carry out the recommendations of the London Fire Brigade, and we are not satisfied with the nursing staff level, and the lack of domestic staff at weekends. Since the 1st January 1985, the 1984 Act and the 1984 Regulations came into effect, the Health Authority carried out their duties in looking into the standards of all nursing homes in their area and upon insisting on the provision of those which would ensure a reasonable measure of care and personal dignity for the patients and any future patients. We recommend that the appeal of the Appellants be dismissed. Order accordingly. Signed.W M Morris Jones Dr S M McDougall Miss B Cowell December 1985.