Inspection on 12/04/05 for Washington Lodge Nursing Home

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Washington Lodge Nursing Home 16/06/08

Washington Lodge Nursing Home 19/06/07

Washington Lodge Nursing Home 20/07/06

Washington Lodge Nursing Home 18/10/05

Washington Lodge Nursing Home 23/11/04

Washington Lodge Nursing Home 04/06/04

Washington Lodge Nursing Home 29/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Washington Lodge Nursing Home The Avenue Washington Tyne and Wear NE38 7LE Lead Inspector Katie Tucker Unannounced 12 April 2005 10:00pm 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 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. Washington Lodge Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Washington Lodge Nursing Home Address The Avenue Washington Tyne and Wear NE38 7LE 0191 4150304 0191 4150306 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Services Limited Mr Lester Burnett Care Home with Nursing 65 Category(ies) of Dementia - over 65 - 65 registration, with number Physical Disability - 10 of places Learning Disability - 1 Washington Lodge Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23/11/04 Brief Description of the Service: Washington Lodge care home is a purpose built nursing home. It was first registered in September 1996. The home provides both nursing and personal care for people with dementia type illnesses and can also offer a service to people who are physically disabled. The home does not provide intermediate care services. Washington Lodge is a two floor building built of traditional brick and tile. The home is divided into two units and both have communal facilities, bathrooms and bedrooms. All bedrooms are single occupancy and there is a separate kitchen, laundry area and staff room. The home is accessible to people with a physical disability. At the centre of the home there is an enclosed garden, which has a seating and activity area. Washington Lodge is sited in a residential area near to local shops. Other community facilities are a short distance from the home. A bus route provides access to the Galleries shopping centre, Sunderland and Gateshead centres as well as surrounding areas. Washington Lodge Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection was carried out during the night. Two inspectors spent 7 hours at the home and spoke to the 6 service users who were up and the staff. The service user guide, assessments, care plans and risk assessments and medications records were examined. The staff were asked about the service user plans, the protection of vulnerable adults procedure, access to training and changes to working practices, as were the service users. Staff discussed their care practices and the nurse in-charge discussed how improvements were being made at the home. Also the outcome of complaints and Protection of Vulnerable Adults investigations were used in the compilation of this report. Washington Lodge provides a service for people with a dementia-type illness. The majority of people experienced difficulty communicating their views verbally. Therefore staff practice, attitude and approach were observed and judgements were made on the effectiveness of the approaches that were adopted. This type of observation formed a part of the inspection process as well as what people said and was backed up through the examination of records, comments made by service users, staff, relatives and the manager. What the service does well: What has improved since the last inspection? The staffing levels have improved on the downstairs unit. This has led to the service providing a better quality of care for the less able service users. The working practices on nights have changed and new skills are being shared. The level of staff training has markedly improved and staff were very enthusiastic about going on courses and completing awards. The manager has also been ensuring that all of the staff receive mandatory training as it is required. Staff behaviour towards each other has been looked into and appropriate action has been taken to reduce staff conflict. Staff commented that the atmosphere and working relationships at Washington Lodge had improved over Washington Lodge Nursing Home Version 1.10 Page 6 the last few months. They said felt very comfortable raising any concerns with the manager and deputy manager and gave examples. They said they were confident all concerns would be looked into and sorted out. The manager is working to engage staff in changing the culture and direction of care given at Washington Lodge so it becomes tailored to each individual needs. The aim being that staff practices fully value the individuality of people living at the home. Staff confidently discussed people’s life histories, routines and needs. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Washington Lodge Nursing Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Washington Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 6 All the necessary information documents are available but but are not sufficiently detailed to give full information about the home. The assessment tool does not allow staff to evidence that they can meet the needs of the service user or provide all of the information that would be needed to care for individuals. EVIDENCE: Although the service user guide and inspection report have been given to all concerned. Staff were unaware of the service user guide and did not know whether service users or their relatives had received copies of the most recent inspection report. The service user guide is designed to make people aware of the services that are available at Washington Lodge. The inspection reports outline how the home meets the regulations and accompanying national minimum standards. However staff had seen the inspection reports and said that these were discussed during staff meetings. They said that the positive comments were shared as well as areas that needed to be improved. Thus it was evident that the manager was trying to engage the staff in working as a team to develop the service. Washington Lodge Nursing Home Version 1.10 Page 9 Southern Cross Healthcare uses an assessment form, which is based on the Roper Tierney and Logan nursing model. This tool is suitable for those people who are able to communicate fully and have general nursing needs. However it does not provide sufficient information on the care needs of people with dementia or mental health needs. The assessment has a small space to cover issues relating to mental health but the limited space does not allow staff to fully record challenging behaviours, triggers and actions that can be taken to divert or reduce such challenging behaviour. The majority of care practices will be directed at working to support people’s mental health needs and this tool does not show that staff complete any of this type of work. Therefore the tool does not allow staff to demonstrate that they could meet the needs of the people who wish to use Washington Lodge. A manager from another home run by Southern Cross Healthcare has collaborated with a neuro-rehab psychologist and elderly psychologist to design a more appropriate and comprehensive tool. This tool was seen to be very useful and encourages staff to provide a range of information. At the last inspection the Washington Lodge’s manager was advised to introduce this assessment tool, as far as staff were aware this had not occurred. The assessments completed for new service users continued to be completed on the corporate inappropriate tool. However staff said that one of the nurses had been going to the Dementia North learning sets and this group was designing a universal dementia care assessment tool. At the follow up meeting it was confirmed that the new tool is being introduced. However the manager needs to ensure that as assessments are reviewed the old documentation is replaced with this new tool. People have a dementia-type illness and the generation of life histories for these people must be treated as a priority. People with dementia tend to revert to previous routines and patterns of behaviour and having this information allows staff to work more effectively with people and reduce the challenges that may be presented. By understanding how people have lived and their lifestyles, what often seems to be unusual behaviour when seen in the context of what people previously did becomes perfectly reasonable. The service users who were up discussed their relationships with the staff and felt the staff were like family and understood their needs. Staff collectively had a great range of knowledge about triggers for behaviour, people’s preferences, lifestyles, reaction’s towards stress and how to reduce people’s anxiety. The staff spoke in a relaxed and sensitive manner towards service users. Quite a social gathering was seen on the upstairs unit with people chatting well into the early hours of the morning. People were not pressured to go to bed and staff worked to ensure people rested while they followed previous patterns of behaviour. Those people who were up had tended to have worked during the night or been night owls when they were younger. Staff were very aware of this and accepting that people felt more comfortable following these routines. Washington Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 Although the level of recording has improved at times it still fails to demonstrated that the health, social and personal care needs of service users has been met. Staff have a good knowledge of people’s needs and behaviours but at times sedative medication is used as a first line of treatment. Therefore at times staff practices and recording does not fully promote the needs of individuals. EVIDENCE: Record keeping has been a major issue at the Washington Lodge over the last year. Southern Cross Healthcare Ltd and the manager have organised and provided a range of training courses both on how to write reports and the specific tools that are used by Southern Cross. Staff level and detail of recording has improved. However gaps and shortfalls remain particularly around identifying and planning care around people’s social lives and challenging behaviours. Since the last inspection the nursing staff have started to give oversight on the upstairs unit. This has led to them taking over the development of care plans. These have not been updated and changes in need recorded since this change. The care staff confidently discussed the care needs and life histories of service users. They could describe in detail how to manage challenging behaviours and Washington Lodge Nursing Home Version 1.10 Page 11 the triggers for these. However their insight is not being sought and this information is lost. Thus rather than a strategy being put in place to reduce someone’s anxiety or understand that because of medical conditions certain behaviours may arise sedative medication is being prescribed. Often sedative medication will not alter or reduce patterns of challenging behaviour. Also some forms of neuroleptics cause an increase in aggression displayed when used on an older client group. Also risk-taking assessments are not fully developed. These types of plans identify the strengths people have and the common day risk that would be still acceptable for someone to take. People may retain the skills to continue to do the gardening on their own, make hot drinks. Staff record the evidence that demonstrates the level of risk presented by continuing these activities would be outweighed by the service users level of skill and the quality of life it would lead too. The medication procedures and practices on the top floor previously met the requirements of the national minimum standards. On this visit it was found that some service users medication was being stored in a tray on the top of the drugs trolley. Also staff were not following the storage guidance around temperatures. Medication was in the unit that was not recorded as being received and returns were not being completed, as they should be. Also there were gaps in the recording of medication given out. These poor practices could lead to service users not receiving medication or drugs running out and must be addressed. On the ground floor there were a number of areas of poor medication practice. For example emergency prescribed medication had not been entered in the medication records and there was not an auditable record of medication from the prescribing General Practitioner to the dispensing Pharmacist and then to the home. These records must be in place to ensure that all medication stocks are accurate and service users receive the correct medication for their needs. Washington Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 Care practices and recording systems often do not fully demonstrate that service users are encouraged to exercise their right to choose. Shortfalls in access to foods at night meant service users cannot always be guaranteed to have adequate diets. EVIDENCE: Most service users at the home have dementia type illness, which may limit their capacity to make judgements and decisions about themselves or their preferred lifestyle. Staff who were spoken to during the inspection gave concise and detailed information about the personal history and historical preferences of service users. This is particularly important for those service users whose condition causes them to deteriorate further. Good examples of this support were seen and discussed with staff. However these were not recorded in service users’ case files and could easily be lost should staff change. Notices and literature in the homes entrance lobby encourage service users families to visit and gives information about advocacy services. Staff demonstrated that they were knowledgeable of service users’ personal history and family details. However family involvement was not recorded in service user files, nor were incidents where families or advocates had been involved in making decisions on behalf of service users. Washington Lodge Nursing Home Version 1.10 Page 13 In store cupboards there are multiple pairs of slippers and tights, which as confirmed by staff and the nurse in charge are used on a communal basis. This is not an acceptable practice and the manager must ensure that all service users have sufficient personal items of clothing to meet their needs so that sharing of these items does not take place. The kitchen area was clean and appeared to be well organised. However apart from access to breakfast cereal tea, coffee and toast, most of the food stores were locked without access by the nurse in charge or available for inspection. There was therefore no opportunity to verify that wholesome ingredients were used in the preparation of meals. Some people who have dementia type illness have disturbed or reversed sleeping patterns, which means that they are awake during the night. There are currently no measures in place to ensure that these people have access to a full balanced diet, which would support their health and wellbeing. Dining rooms and surrounding corridors were inspected and all found to have an unpleasant odour of stale food. Additionally the first floor ‘servery’ was not clean, nor had routine cleaning been carried out there. There was also unrefrigerated food being stored in this area. The nurse in charge was advised to ensure that a thorough cleaning of all dining rooms and food preparation areas takes place and that food is always stored safely. At a follow-up meeting it was confirmed that the nurse-in-charge on nights now has access to a wider range of foods and the fridge. Also that two care staff are working towards their NVQ Level 3 and as part of this have taken on board the responsibility for designing some regular activities. Also the manager is in the process of determining whether it would be feasible to take a group of service users on a weekend break in England this year. Washington Lodge Nursing Home Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff recognise and are clear about what would be considered staff abusive practices. The manager has demonstrated that his is aware of how to take action to investigate concerns. However, minor gaps remain. Not all staff have yet attended local authority MAPPVA training and awareness training of when challenging behaviours would be considered abusive. Records must clearly identify how to work with people who pose risk. EVIDENCE: Washington Lodge Nursing Home Version 1.10 Page 15 Southern Cross Health Care has agreed to adhere to the Multi Agency Protection Panel for Vulnerable Adults Procedures developed by Sunderland Social Services Department. The manager is aware of the procedures that he needs to follow and has been involved in protection of vulnerable adults investigation. The staff discussed their knowledge of procedures but had not had the local authority training. This training equips staff with a good understanding of how to use the procedures and all staff need to have this knowledge. Southern Cross Healthcare has provided training around abuse so staff do understand what would be considered abusive practices and what the company procedures require them to do. Senior staff discussed their interpretation of abusive practice and easily recognised when alerts would need to be made in relation to staff. But staff will need to be given clarity around the actions they must take when service users pose a risk to each other and how this will be managed. Staff are given information about people who may be aggressive. The staff are aware of the actions that they need to take but risk assessments do not reflect this and neither is information recorded on the measures that should be taken if people’s behaviour deteriorates over not or poses a risk to others. Last year staff have raised issues around practices at the home. Some of the concerns related to staff adopting abusive practices towards service users. Both Southern Cross Healthcare and CSCI have investigated these concerns. Throughout the investigations that took place in March and October 2004 staff have been asked in a confidential setting to raise any concerns they have around practice. The only issues that were raised concerned some care practices that had been thoroughly examined previously and resolved. The findings indicated that staff were not being abusive towards service users. The investigation in October also concluded that there were concerns related to staff attitudes toward each other. Where concerns have been upheld the manager and regional manager have taking appropriate action. Staff discussed how confident they were to raise concerns with the manager and deputy manager. They were extremely clear that appropriate action would be taken to rectify any issues. Staff openly discussed the improvements in the atmosphere at Washington Lodge. Service users were comfortable talking to staff in an informal manager and were very relaxed about what they felt able to discuss. Washington Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24, 25, and 26 The home is not well maintained, has a number of significant faults and urgent repairs are required to ensure that service users can live in a safe and hygienic environment which protects them from unnecessary illness or an accident. EVIDENCE: The home has not been sufficiently repaired or maintained to maintain the comfort and safety of service users. Whilst there is evidence that a small number of service users accommodation has been repainted the majority of the home requires further updating, repair and redecoration in order that service users have a comfortable living environment. There is no evidence that any maintenance or refurbishment plan has had any significant effect on the accommodation used by service users. All bathrooms and toilets in the home have faults. These range in severity from lack of emergency pull cords to several which are completely not useable due to faults with sanitary ware or drainage. In several bathrooms and surrounding corridors the smell of drains is overpowering and the nurse in change was Washington Lodge Nursing Home Version 1.10 Page 17 advised to take urgent action to remedy this. In one bathroom the water temperature was too hot to touch placing service users at risk of accidental scalding. The nurse in charge also confirmed that the homes extraction / ventilation system has been inoperative for several months. Some of the lighting in te home was not sufficiently bright to ensure the comfort and safety of service users. Much of the furniture at the home is worn out and must be replaced particularly the seating. Care should be taken to ensure that when new furniture is purchased the design meets the needs of service users and makes it easier for staff to support them for example dining chairs that have gliding rails. As previously mentioned, cleaning regimes are not sufficiently thorough or frequent to maintain an acceptable standard of cleanliness and hygiene at the home. All dining areas smelled of stale food and some of the food preparation areas were unhygienic placing service users at risk from infection. On inspection the laundry area appeared to be disorganised with large amounts of dirty laundry stored haphazardly whilst awaiting washing. The laundry floor was also flooded with water due to faulty washing machine. Hand washing and drying facilities must be improved to ensure effective hygiene control. An Immediate Action Notice was issued to draw these to the urgent attention of the manager. Since the inspection the manager has contacted CSCI to say that repairs have been completed. As a routine practice the Health and Safety Executive were informed of this issue and may be following this up with Washington Lodge. Since the inspection Southern Cross Healthcare have reviewed all aspects of the building and are planning to refurbish the home, inclusive of the lighting. The manager was made aware of the literature, which is available on making environments friendly for people with dementia. Washington Lodge Nursing Home Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 On the whole Southern Cross Healthcare has ensured that service users needs are met. They have demonstrated that if following assessment the people’s needs are higher than the minimum staffing standards. Staff are being provided with a range of training and it was evident that staff are trying to provide a quality service however until all of the staff have received this training minor gaps in understanding or practice may persist. EVIDENCE: Washington Lodge Nursing Home Version 1.10 Page 19 The manager and deputy manager discussed at the last inspection the high dependency needs people had who lived in Washington Lodge. Thus Southern Cross Healthcare had agreed to increase the staffing levels downstairs. This led to staff being able to consistently meet people’s needs and provide a higher quality of care rather than just barely meeting people’s basic personal care needs. The upstairs unit was developed after April 2002 and the owners have to meet the requirements of the Residential Forum (a staffing guide). The guide follows an assessment of need. None of the individuals on the unit can leave the building on their own and require significant support either physically or emotionally therefore nobody would be assessed as falling within the low dependency category and the majority have medium/high dependency needs. Thus the minimum staffing levels for the unit if it was full would be 876.34 waking hours per week. The manager would then have to deploy these hours, as he felt fit. Since the last inspection nursing care is being provided upstairs and a nurse is in charge during the day. The night nurse oversees care but is based on the downstairs unit during the night with 3 care staff. The dependency levels of people were discussed and during peak periods such as late evening and early morning staff struggle to meet people’s needs. The majority of people downstairs need to staff to assist them to meet any personal care needs. Also a number of people upstairs need the support of two staff to attend to their personal care needs. One person downstairs needs a higher level of supervision and this cannot be maintained during these peak periods. It was felt that providing an additional carer to provide cover on both units over these peak periods would assist staff to maintain the safety of all the residents and attend to people’s needs. When inspectors arrived at Washington Lodge all of the service users were in bed downstairs but several were up chatting with staff upstairs. They said that night staff were very ’kind and helpful’. Staff clearly understood people’s needs and routines. Staff described the people downstairs as being very frail and got very tired by early evening. Cares plan don’t currently record their level of frailty and the indicators that would suggest that they would want to go to bed before 10pm and this is an active choice rather than a custom and practice. Senior care staff have now been employed on both floors but the unit manager’s post on the upstairs floor no longer exists. It is hoped that the knowledge of the service users and systems that worked well will not be lost. Many of these have proved extremely useful for ensuring staff consistently meet the needs of people but evidence so far would suggest that they have not been continued. Washington Lodge Nursing Home Version 1.10 Page 20 Staff discussed the range of training that they had received. One carer said that she was working through the NVQ level 3 in care and was going to do a level 4. Staff also said that they had completed safe handling of medicine course and some staff were starting a distance learning dementia care package. Staff were receiving food hygiene training and this was a requirement of the last inspection. Staff are also being given access to the remaining mandatory training and this will ensure that safe practices continue to be adopted. At the follow-up meeting the manager stated that 90 of care staff now hold a NVQ Award, which is an excellent achievement. Also Southern Cross Health care are promoting training and the home will be provided ‘focus on food training’ by a dietician in the near future. Also a 13 week course on protection of vulnerable adults, challenging behaviour and working with people who have dementia, which the training providers have tailored specifically for Washington lodge is to commence in the next few weeks. Washington Lodge Nursing Home Version 1.10 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The owner and manager of Washington Lodge have not ensured that sufficient specific maintenance, repair, and routine good practice is undertaken to protect the health, safety and welfare of service users and staff at the home. EVIDENCE: The measure taken to protect the health safety and welfare of service users and staff was found to be poor in a number of areas. These include: - Incorrect storage of cooked food left at room temperature in the kitchen and servery areas. - Non operating ventilation system to all bathrooms and toilets. - Poorly maintained bathroom, toilet and shower areas. - Overpowering odours from poorly maintained bathroom drains. - Poor cleaning regimes in food servery and dining areas. Washington Lodge Nursing Home Version 1.10 Page 22 - Not ensuring a safe environment for example by storing of flammable material in the stair well. The manager has contacted CSCI to discuss these issues and has confirmed that they will be dealt with as a priority. Washington Lodge Nursing Home Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 2 15 1 COMPLAINTS AND PROTECTION 1 2 1 x x 2 1 1 STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x 1 Washington Lodge Nursing Home Version 1.10 Page 24 yes Are there any outstanding requirements from the last inspection? 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 3 Regulation 14 (1) Timescale for action An assessment tool, which allows 16.08.05 peoples mental health needs to be fully assessed must be introduced for all service users. The assessment documents must 16.08.05 be regularly updated. Care plans must set out in detail 19.07.05 the actions that staff need to take to meet service users needs. (required at the last 2 inspections - 30.03.05) The staff must compile information on all areas of service users lives where there are limitations or restrictions occuring. Service users or their representatives must agreed these interventions. (required at the last 2 inspections - 12.01.05) The manager must work with staff to develop risk-taking strategies and assessments with the service users (required at the previous inspections 12.01.05) Medication practices must meet guidelines issued by the NMC and Royal Pharmaceutical Society. Version 1.10 Requirement 2. 3. 3 7 14 (2) 15 (2) 4. 9 13 (2) 16.08.05 Washington Lodge Nursing Home Page 25 5. 12 12 (3) 16 (2) (m) 6. 15 16 (2) (j) The service users must be consulted regarding social interests and suitable arragnements made to enable them to go out . (required at the last 2 inspections -22.09.04) Service users must have access to a range of nutritional foods overnight. Fridges must be available to store perishable food in overnight. Kitchen staff must receive training on specialist diet and dietary needs of the elderly. The ventilation system must be in good working order. The home must be free of offensive odours. The first floor shower must be repaired and the room decorated. (required at the last 2 inspections - 1.03.05) Lighting in all service user bedrooms must be reveiwed and meet the recognised lighting lux standard of 150 (required at the last 2 inspections - 1.02.05) All staff must receive training on caring for people with dementia, specific mental health needs and local authority protection of vulnerable adults procedures. Sufficient staff must be employed during the late eveniong and early morning to meet the dependancy levels of service users. a robust system for CRB disclosures must be in place. A qualified first aider must be on duty over the 24 hour period (required at the last 2 inspections - 22.09.05) Version 1.10 19.07.05 19.07.05 7. 19 23 (2) (c) 19.07.05 8. 30 18 (1) (c) 13.09.05 9. 27 18 (1) 19.07.05 10. 11. 29 38 19 (5) (b) 13 (4) 19.07.05 16.08.05 Washington Lodge Nursing Home Page 26 12. 13. 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. 2. Refer to Standard 7 9 Good Practice Recommendations The information that staff on the top floor have gathered about peoples previous lifestyles, triggers for behaviour and diversional tactics should continue to be used. The sheet on medication developed by staff on the top floor should continue to be used. Staff should gather information on the adverse affects of neuroleptics when used for older people and use this to support GP decisions around choice of medication or intervention. If service users are prescribed pain relief but unable to request this. This medication should be rountinely given at least until a baseline has been established. Research on the providing a useable environment for people with dementia should be used during any refurbishment programme. 3. 19 Washington Lodge Nursing Home Version 1.10 Page 27 Commission for Social Care Inspection Baltic House Port of Tyne, Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 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 Washington Lodge Nursing Home Version 1.10 Page 28 - 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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