Inspection on 16/06/08 for Washington Lodge Nursing Home

This inspection was carried out on 16th June 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 12/04/05

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Washington Lodge Nursing Home The Avenue Washington NE38 7LE Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 09:45 16 & 17th June 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Washington Lodge Nursing Home DS0000018213.V367113.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. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Washington Lodge Nursing Home Address The Avenue Washington NE38 7LE 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) 0191 4150304 0191 4150306 washingtonlodge@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Robert Mark Hearn Care Home 65 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (65), Learning disability (1), Physical disability of places (10) Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Learning Disability Category applies to current service user only The DE service user category relates to a current service user only. Date of last inspection 19th June 2007 Brief Description of the Service: Washington Lodge is a purpose built care home that opened in September 1996. The home provides both nursing and personal care for people with dementia care needs. The home does not provide intermediate care services. Washington Lodge is a modern two-storey building. The home is divided into two units (one on each floor) and both have communal facilities, bathrooms and bedrooms. All bedrooms are single occupancy. The main kitchen, laundry area and staff room are at the rear of the ground floor. Access into the home is level and a passenger lift provides access to the first floor. At the centre of the home there is an enclosed garden, which has a seating area. Washington Lodge is set back on a tree-lined road in a pleasant residential area of Washington Village, near to local shops, church and pub. A bus route provides access to the Galleries shopping centre, Sunderland and Gateshead centres as well as surrounding areas. The fee for residential care is £417 per week. The fee for nursing care is £422 (which is topped up by £101 continuing care payments). There is an additional charge for people who are privately funded. Items not covered by the fees include chiropody, hairdressing, toiletries and clothing. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Before the visit: We looked at: • information we have received since the last visit on 11th July 2007 • how the service dealt with any complaints & concerns since the last visit • any changes to how the home is run • the provider’s view of how well they care for people in the annual assessment that we ask for (this is called an AQAA) The Visit: An unannounced visit was made on 16th June 2008. Another visit was made on 17th June 2008 when we told the manager what we found. The people who live here have dementia care needs and most find it very difficult to express their views. Time was spent observing the care that residents receive and talking with visiting relatives. Their views are included in this report. During the visit we: • talked with people who use the service, relatives, staff, and the manager • joined residents for a meal and looked at how staff support the people who live here • looked at information about the people who use the service & how well their needs are met • looked at other records which must be kept • checked that staff had the knowledge, skills & training to meet the needs of the people they care for • looked around parts of the building to make sure it was clean, safe & comfortable • checked what improvements had been made since the last visit What the service does well: Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 6 The home makes sure that peoples’ needs can be met before they move here. The home has good care records so that all staff can help a resident in the right way. Visitors said that staff are “supportive”, “friendly”, “patient” and “respectful”. One relative said, “They have a good way with the people who live here.” Staff help people to go out from time to time. One relative said, “They make good use of the local community, such as the pub and Washington Hall.” The meals are good quality. The cooks try hard to make sure residents get meals that they like. It is good that residents are asked at the table what they would like from the choices on offer. Visitors said that the home always has a “bright, welcoming atmosphere.” The building is well-maintained, warm and comfortable. Staff work hard to keep it clean. There are lots of different sitting areas for resident to use including a sheltered, private garden. Staff are well trained in care so they know how to support people. The manager makes sure that relatives can make suggestions and comments about the home, and listens to what they say. The home is run in the best interests of the people who live here. What has improved since the last inspection? Over the past year there have been many improvements to the home including: Each resident now has their own information book about the home. Care records are clearer, especially about risks to people’s health. The cook and care staff now work together to make sure everybody has better support to keep their weight at a healthy level. People have had more chances to go out for walks out to shops and pubs. People get better support at mealtimes if they need it. People have better information about how to make complaint, and these have been listened to and put right. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 7 All the bathrooms and toilets have been redecorated so they are now bright and inviting. Many bedrooms have been redecorated in light colours, and most have had new light bulbs fitted so it is brighter for people to see. Access into the home has changed so visitors do not have to wait outside. The corridors are filled with pictures, colours and textures so that they are interesting for people to see and it can help them find their way around. There are now training records to show what training staff have had or need. Some staff have had training in dementia care needs, and this is planned for other staff. Relatives have lots of opportunities to comment on and be more involved in the service. Staff have had up-to-date training in health & safety. 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. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 8 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 Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. (NMS 6 does not apply to this service) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People get good information about the home and their needs are fully assessed so they can make an informed decision about whether to move into Washington Lodge. EVIDENCE: Since the last inspection, a Service Users Guide (information booklet) has been placed in all of the bedrooms, so that residents or their relatives have information about the service. Prospective new residents and their relatives are also given this guide. In discussions people felt that they had been give enough information before they made a decision about this home. Some relatives said that they had also Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 10 visited other homes before making their choice. One relative said, “I looked at a few homes, unannounced. This one had the best atmosphere and best response by the manager and staff.” At this time the home does not have the Service Users Guide in other forms, for people who may come to live here with different needs. The manager agreed it would be helpful to have the information ready on cassette or CD for people with visual impairments or reading difficulties. At the time of this visit there were 47 people living here. The needs of prospective residents are assessed before they move in so that the home knows whether those needs could be met here. A sample of new residents’ care records showed that the home gets assessment information from social and health care professionals. The home also carries out its own detailed assessment of new residents and this information assists staff to plan someone’s care. It is good practice that residents and their relatives have been helping to complete a ‘Life History’ booklet, that includes their likes, background, interests, religious and cultural needs, so that the home can try to meet their individual and diverse preferences. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Good staff practices and improved care records ensure that residents have good support with personal and health care needs. EVIDENCE: Care plans are records that are used by all care services to show what sort of help each person needs and how staff will provide that care. There have been more improvements to the care records and these were very informative and detailed about how to support people with their individual needs, such as mobility, nutrition, and skin care. In this way all staff generally have clear information about how to support each person. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 12 One person has behavioural needs that can make them “aggressive” towards staff. The care plan is very detailed about the behaviour but less detailed about how staff should help this person to manage their behaviour. For example, staff are only advised to “distract” the person, so they may not always be providing a consistent response to that person’s needs. It is evident that care plans are evaluated at least monthly, to note any progress or change in need. A very small sample had not been evaluated for several months, because the part-time staff responsible for those records has left. The management staff agreed that supervision sessions could be used to identify any future gaps like this. Health care assessments are detailed and include falls, pressure care, and use of special profiling beds. Health care records show that residents have good access to health care professionals, such as tissue viability services, continence services and Falls Co-ordinator. Discussions with relatives showed that the staff keep them informed of any change in health needs. New moving & assisting plans are being introduced that are very detailed, so it will be very clear about what equipment and moving techniques to use for each person. Nutritional care plans are in place and weekly weights are recorded for people who are at risk of losing weight. It is very good practice that the cook is given her own copy of those weight records. In discussions the cook was able to describe how this improved communication between care and catering staff has helped the people who live here. She said that she can now make sure that any people at risk are provided with finger foods, additional snacks and fortified drinks to improve their intake. Medication is securely stored and managed on behalf of the people who live here. Medication is delivered by a pharmacist to each person in the home in blister packs. Medication is administered by the qualified nurses. Management staff carry out regular audits of medication to ensure it continues to be correctly managed. Nursing staff now wear a red tabard when they are dealing with medication so that other staff do not distract them at those times. During discussions staff talked about residents in a respectful way. Throughout the inspection visits there were many instances of good practice where staff supported residents in a sensitive and encouraging way. For example, discreetly helping people to recognise that their clothes had become marked after lunch and sensitively supporting them to get changed. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 13 Residents can use their own bedrooms for privacy whenever they wish. There are easy-to-use locks on the inside of bedroom doors if residents do not wish to be disturbed. A visiting relative said, “I visit at all different times of the day and staff are always the same - supportive and friendly. Even the younger ones are very respectful and have a good way with the people who live here.” Another relative said, “Staff are amazing - they manage situations very patiently and in such a nice, friendly manner.” Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 14 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents have good opportunities to make choices so that they lead a lifestyle that matches their individual preferences. EVIDENCE: The home employs a part-time activities co-ordinator who works flexible hours to suit the activities planned. Recent activities have included artwork, baking sessions, and a night out at the local pub. There are colourful posters on both units to advertise forthcoming activities. There is also a monthly plan of social events in the monthly newsletter. The colourful, informative newsletter also has photos of residents, relatives and staff enjoying previous events. At the time of this inspection the activities co-ordinator was on holiday. Although care staff did encourage a sing-a-long one afternoon, some relatives Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 15 felt that more could be done to engage residents when the activities staff is not here. One visitor said, “They could do with more activity-staff to actually do things with people.” However there are improved opportunities for people to get out and about. One relative said, “They make good use of the local community, such as the pub and Washington Hall. It’s a lovely village, very green, and it’s good that staff take them out from time to time.” People are supported to follow their own lifestyle where possible. For example, some people prefer to eat their meals in their bedroom and this is supported. One person who needs a daily shower or bath for their skin care had asked that this be done in the evening before they go to bed and this is supported. There were a number of visitors to the home at the time of this inspection. One relative said, “It’s got a very welcoming atmosphere. Bright and friendly, but calming and peaceful too.” Relatives are encouraged to be as involved in the service as they want. For example, one visitor continues to care for their relative by supporting her at mealtimes in the dining room. Other relatives have been invited to help write out life history booklets so that staff know the individual preferences of the people who live here. The quality of meals continues to be good. Residents are offered the choice of two main dishes, as well as a selection of daily alternatives, such as jacket potatoes, omelettes, and sandwiches. Those people who can express a view, are asked for their choices the day before, but this is just to give the cook an idea of quantities. All residents are then offered the choice at the table if they are able to express a view. Those who cannot choose are offered the dish that staff know they would most likely enjoy. In discussion the cook said that she tries out various meals with new residents until she gets to know what they like or dislike. One relative said, “They get very well-fed. Most older people at home would not have two courses at each meal, such as cereal and a cooked breakfast. No wonder they are all so quiet after meals!” The dining rooms are well decorated, and well presented with tablecloths, napkins, glasses, jugs of juice and condiments. The mealtime was unhurried, and residents could take as long as they wanted to independently complete their meal. There is now a second sitting for a small number of people who need individual staff support to eat their meal. This support was carried out at the resident’s own pace. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 16 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Suitable complaints and protection systems are in place and these are dealt with effectively, so that residents’ welfare and rights are safeguarded. EVIDENCE: Since the last inspection all residents (or their relatives) have now been given a copy of the complaint procedure, which is in the Service Users Guide information booklet, in residents’ rooms. The manager has been very pro-active in trying to get relatives’ views about the service. He has an open-door policy for all visitors and holds a weekly ‘surgery’ for relatives. In discussions relatives said that the manager encourages them to express their views at any time they are visiting, and this is also outlined in the home’s monthly newsletter. The Provider has dealt with six complaints about the service over the past year. Some related to missing laundry and cleaning of carpets, others were about care issues. Complaints records are very detailed and show that these were all taken seriously, investigated and resolved. Outcomes of complaints have led to improvements in the service, for example the home has purchased Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 17 a new carpet cleaner and a monitoring system is used to ensure that all rooms are cleaned and regularly checked. One visiting relative said, “Whenever I’ve made any critical comments these have been dealt with straight away by the manager.” The home promotes the council-wide Safeguarding Adults procedures and the manager is very well trained in this area. He is experienced in dealing with safeguarding alerts and referrals, and makes appropriate contact with the safeguarding adults team of the Social Services Department whenever necessary. All staff have had some training in recognising and reporting ‘abuse’. They will also be nominated for future training in the safeguarding adults policy. It is clear that staff are aware of their responsibilities to report poor practices, and staff have done so appropriately. In this way the service aims to protect people from potential abuse both within and outside the home. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 18 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, 21, 24, 25 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The building is well-maintained, warm, bright and clean, so that people live in a comfortable, safe environment. EVIDENCE: Since the last inspection there have been some good improvements to the accommodation. All bathrooms and toilets have been redecorated and are now light, bright and inviting for the people who live here. New wood-effect flooring has been provided to some areas of the ground floor, which has brightened these areas. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 19 There is a continuous programme of redecoration to bedrooms. Most of the ground floor bedrooms have benefited from redecoration over the past year in brighter, neutral colours. Lighting to most areas of the home has improved, although a small number of bedrooms have still not been fitted with brighter light bulbs. Many of the decorative improvements also support the orientation of the people with dementia care needs, so that they can find their way around the building more easily. For example, all the corridors have been decorated in different ways so that they are distinguishable by the people who live here. All provide many items of visual stimulation and interest for residents to look at and touch as they walk around the building, such as pictures, posters, and collages. It is good practice that access into the home has changed so that visitors do not have to wait outside without shelter for the door to be answered. Instead visitors can now enter the small, secure lobby and sign in before waiting to go into the home. Relatives said that the only improvement that could be made to the building would be en-suite facilities. However they commented very positively on the layout of the home which is designed like a hollow square so that residents can walk all the way round the corridors, passing toilets and bathroom on most corners. One relative said, “I like the way residents describe going for a walk around The Square. They can walk around and find places to sit or look out over the garden in the middle.” Overall the standard of cleanliness and odour control is very good. A small number of bedrooms need extra attention due to the individual needs of the people who live there. A head housekeeper supervises a team of domestic and laundry staff who work hard to keep this busy home clean. In discussions the housekeeper described how the whole team can work together to provide a clean, odour-free environment that respects the people who live here. She said, “We can use deep-cleaning practices to reduce odour. But if it’s still there we need care staff to try different personal hygiene practices and for management to look at replacing floor coverings.” It is good practice that almost 90 of all staff have had certificated training in Infection Control. The home provides a laundry service for all the people who live here. Relatives commented that occasionally some clothes have “gone missing” as they may have been returned to the wrong room. Discussions were held with housekeeping staff about the benefits of individual laundry bags that can be washed, dried and taken back to the right room. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 20 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides competent, well-trained staff and in sufficient numbers to ensure that the needs of the people who live here are met. EVIDENCE: The care staff team consists of a manager, a deputy manager, nine qualified nurses (and two bank nurses), seven senior carers, and 20 care assistants. It is good that the care staff team includes eight male staff (and two male bank nurses) as there are several male residents living here, and some may prefer or benefit from male support. At the time of this inspection there were 47 residents living at the home (36 people receiving nursing care and 11 people receiving personal care). There was one qualified nurse and one senior care staff on each floor. There were also three care staff on the ground floor, and two care staff on the first floor. The manager stated that these were the minimum levels that the home provides, and were sufficient to meet the number of people who live here at this time. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 21 There are also satisfactory levels of catering and domestic staff. This is evident from the good standard of catering and housekeeping services that residents receive. The home also benefits from an activities co-ordinator, an administrator, and a maintenance staff. Southern Cross Healthcare is an equal opportunities employer and promotes clear equality and diversity procedures when recruiting new staff. There have been ten changes to the staff team over the past year. All posts have been filled and there are no current vacant posts. A sample of staff personnel records showed that the correct recruitment and selection checks had taken place and this ensures that only suitable staff are employed here. Some staff have worked here for many years and are committed to the service. There is clearly a good relationship between them and visiting relatives. One relative said of staff, “They’re all good. I know them all by name. They make this place feel like a family home and they call it ‘home’ too. If they’ve been away they say they couldn’t wait to get back home.” It is very good practice that nearly all the seniors and care staff have a social care qualification. For example, 20 have achieved NVQ level 2 (and one staff is working towards this) and three have achieved NVQ level 3. It is also good practice that catering and housekeeping staff have also achieved similar relevant qualifications. In this way the home ensures that staff have a professional qualification that demonstrates they are equipped to do their jobs. Since the last inspection there have been good improvements to the training records for staff so that the manager can now plan training around individual staff’s developmental needs. There have also been better opportunities for staff to receive training they require for their roles. For example, seven staff have completed certificated training in dementia care needs, called ‘Yesterday, Today and Tomorrow’. All other care staff are to attend this training. The manager also commented that he is looking into training in managing challenging behaviour for staff. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well-managed, consequently it is run in a way that upholds the best interests of the people who live here. EVIDENCE: Since the last inspection the new manager has now been registered with CSCI. He is a qualified RMN (Registered Mental Nurse) and has around 11 years experience of working in social and health care settings for people with mental health and dementia care needs. He is currently working towards the Registered Managers’ Award, which is a care management certificate. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 23 It is clear that the manager has worked hard to meet the many requirements that were made at the last inspection. Several staff also commented positively on changes that he has introduced. For example, weekly meetings for the ‘heads of department’ so that information can be shared between senior care staff, senior catering staff and the head housekeeping staff. One staff said, “We work best when we work as a team. The weekly heads of departments meetings are a very good opportunity to sort out any issues and bring the different parts of the service together to make it better for the residents.” Southern Cross’ quality assurance processes include a number of audits of the home and at least monthly visits carried out by the Operations Manager. The manager actively seeks the views of residents and their relatives. He has set up weekly tearoom sessions in the bar area for chats with residents and relatives. He has weekly surgeries, monthly support groups for relatives, and a bi-monthly relatives meeting. Although there has been a low turnout to some meetings, he remains committed to involving and including relatives in the service for the people who live here. One relative said, “He is very approachable. He makes himself available and has dealt with any comments we’ve made.” There has been a change to how the home helps people to keep their personal monies. Residents are now offered an account within a high street bank where their individual monies are stored. The home can then debit their account to pay for services such as hairdressing and chiropody. Any interest accrued is provided to each individual account holder. Residents can access money from their account from the administrator for trips to the shops or pub. This new system provides clear, printed statements for residents or their advocates. There have been good improvements to the training opportunities and records of health and safety training for staff. A training manager of Southern Cross now provides in-house fire training for all staff. More than half the staff team, including all catering staff, have also had food hygiene training. It is good practice that three staff, including the manager and deputy manager, have completed a moving & assisting trainers course so that they can provide all staff with training in this area. The majority of staff have now had this updated training, and more is planned. However at this time there is only one staff member who is an appointed first aider. In this way the home does not ensure that there is a first aider on duty at all times. The manager is aware of this shortfall and has requested such training from the training manager. Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 24 The maintenance staff carries out health & safety checks of the premises and equipment. There were no health & safety issues in the premises at the time of this visit. Washington Lodge Nursing Home DS0000018213.V367113.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 3 X X 3 3 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 3 4 X 3 X X 2 Washington Lodge Nursing Home DS0000018213.V367113.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 Care plans relating to behavioural needs must include clear guidelines for staff about how to approach, support and manage behavioural incidents in a planned way. This is to ensure that staff provide support in a consistent and de-escalating manner. Arrangements must be made for sufficient staff to be trained in first aid so that there is a first aider on duty at all times. This is to ensure that residents and staff can receive appropriate first aid treatment whenever this is necessary. Timescale for action 01/08/08 2. OP38 13(4) 01/10/08 Washington Lodge Nursing Home DS0000018213.V367113.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. 2. 3. 4. 5. Refer to Standard OP1 OP7 OP12 OP25 OP26 Good Practice Recommendations It would be useful to have the Service Users Guide on cassette or CD so that it is ready for any new residents who have visual impairments or reading difficulties. Consideration could be given to management staff occasionally sampling some care plans (e.g. as part of a supervision session) to ensure that these are up to date. Consideration could be given to providing additional staff to support activities at those times when the activities coordinator is on annual leave. The remaining bedrooms without 100-watt bulbs should be provided with these so that they are bright enough for the residents. Consideration could be given to the provision of laundry wash bags so that individual people’s clothes can be washed and returned without being mixed up with other people’s clothes. Proposals to provide training in managing challenging behaviour should be put into place. 6. OP30 Washington Lodge Nursing Home DS0000018213.V367113.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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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