Inspection on 19/06/07 for Washington Lodge Nursing Home

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Washington Lodge Nursing Home The Avenue Washington NE38 7LE Lead Inspector Andrea Goodall 19 th Key Unannounced Inspection & 27 June, & 11th July 2007 10:00 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.V340185.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Washington Lodge Nursing Home DS0000018213.V340185.R02.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 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Vacant 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.V340185.R02.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 16th January 2007 Brief Description of the Service: Washington Lodge is a purpose built care home. It was first registered in September 1996. The home provides both nursing and personal care for people with dementia care needs and can accommodate some people who also have a physical disability. 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 sited in a residential area 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 fees charged at the home range from £387 to £531 per week. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over three unannounced visits. Discussions were held with the Acting Manager and several staff about the running of the home and the care of the people who live here. Several records were examined including a sample of residents’ care records, staff records, personal finance records and health & safety records. The people who live here have dementia and mental health care needs and most find it difficult to express their views. Much of the time was spent with residents, observing the care they receive and joining them for a meal. Discussions were held with visiting relatives and friends, and their views are included in this report. There have been no formal complaints about this service since the last inspection in January 2007. What the service does well: The home makes sure that peoples’ needs can be met by the home before they move here. The home sets out their needs in an individual care plan so that all staff can support a resident in the same way. In discussions visitors, relatives and some residents commented on the “friendly” and “helpful” attitude of staff. One visitor described staff as “excellent” and “very caring”. In discussions staff described residents in a respectful way, and are knowledgeable about people’s individual needs. The home has a warm and welcoming atmosphere. Visitors stated that they are “always made to feel welcome”. Some also commented that they are always offered drinks or even a meal if visiting near a mealtime. There was clearly a good relationship between staff and many of the visitors. The meals are very good quality, appetising and wholesome. Catering staff try hard to make sure residents get their individual preferences, and special diets are made as appetising as possible. Residents who were able to express an opinion described the meals as “always very good”. It is good that residents are asked at the table what they would like from the choices on offer. Overall the building is well-maintained, warm, clean and comfortable so residents live in a safe environment. Most areas are well decorated, and there are lots of different sitting areas for resident to use. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 6 There are sufficient staff for the number of people who live here to be supported. Many staff have achieved a care qualification so residents are supported by capable staff. The owner of the home, Southern Cross Healthcare, carries out visits to the home and regular checks to make sure that it is running in the right way. What has improved since the last inspection? What they could do better: Each resident (and/or their relative) should have a copy of the Service Users Guide so that they have information about the service at this home. It would be better if life histories, social care and religious needs were completed on the assessment form so that staff would know how to support people in these areas. Also moving and assisting plans should show staff exactly how to support someone and what equipment they need. The home must keep records of all accidents and falls by residents. Risk assessment records must be detailed, signed and dated. Staff must make sure that residents’ rights to dignity and privacy are respected at all times, for example not talking over a resident’s head when helping them to eat. Residents should be given information about menus and activities in a way that they can understand so that they can make choices. There should always be condiments in the dining room for residents to use, and they should be served cold drinks in appropriate glasses. Every resident (and their relatives) should have information about how to make a complaint if they are not happy with the service. Residents should have access to all parts of their home including the garden, or there should be a clear record to show why they cannot. Bathrooms need to be redecorated, screens provided to showers and broken locks to bathroom doors should be fixed. Some bedrooms on the ground floor should have blinds so that people cannot see into the rooms from the gardens. The dim lighting in bathrooms and bedrooms should be improved. Continence Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 7 equipment should not be on show in bathrooms and toilets, where it can be seen and could get dirty. The recruitment policy could be changed to show that the only time a staff should be employed with only a POVAFirst check is in ‘exceptional circumstances’ and with the agreement of CSCI. Arrangements must be made for care staff to have training in dementia care needs so that they understand the needs of the people who live here. Staff should have regular supervision with their line manager. Staff must have training in health and safety matters, e.g. fire training, at the correct intervals and this should be recorded. 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.V340185.R02.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.V340185.R02.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. (Standard 6 does not apply to this service.) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Current residents do not have a copy of the Service Users Guide so they do not have information about the service. Assessment documents have improved but some parts are not completed so the home does not know how to meet residents’ social care and religious needs. EVIDENCE: Washington Lodge sets out the service it intends to provide in a Statement of Purpose, which is available on request and a copy is in the reception area of the home for visitors. The home also provides a summary of this information in a clear, easy to read Service Users Guide. There is a copy of the guide in the reception area and in vacant rooms for potential new residents. However this information is not Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 10 currently made available to existing residents. In this way current residents do not have information about the service that new residents would have. Before people to move to the home their needs are assessed to ensure that Washington Lodge can meet those needs. The home uses a pre-admission assessment form, social work reports, and rating scales to assess each person’s needs. It is good practice that the home is developing a ‘life history’ for each person. When these are complete staff will have information about individual people’s preferred routines, social activities, family connections, or important events. The assessment also includes a section on spiritual and religious needs. In the sample examined these had not yet been completed by the home. These assessments would help to ensure that people’s diversity needs are met. Washington Lodge Nursing Home DS0000018213.V340185.R02.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident’s needs are set out in care plan so that the home can plan how to meet those needs. However care records for nutrition and falls are unclear, incomplete or uncoordinated so do not fully support these health care needs. Medication is appropriately managed so that residents are supported with their medication needs are met. Some staff practices do not treat residents respectfully so their rights to dignity and privacy are compromised. EVIDENCE: Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 12 There are care plans in place for each resident. These identify goals and needs for each person based on their assessed needs. Of the sample of care plans examined, all were up to date and generally informative. It was clear that the care plans had improved and now show how the home endeavours to support people’s individual needs. For example, one person can become very restless and agitated if she is not active. Her care plan supports this need by involving her in bed-making with staff each morning (if she chooses) so that she has a purposeful task that she enjoys that helps her to keep active. Care files currently contain a great deal of assessment, review and archive material. This can make it difficult to retrieve care plans, and difficult for staff to identify which information is most current and applicable. There are 17 people living here who need lifting equipment to support their mobility. In a sample examined, their care plans showed a general overview of their need for support. However there are currently no moving and assisting handling plans to show specifically what support and equipment they require with each moving task, for example how many staff, which type of hoist/sling for transferring from chair to bed. (During the visit the Acting Manager showed the inspector a ‘safer handling plan’ that is proposed to be introduced for each resident in the near future.) Daily reports indicated that some people had had several ‘found on floor’ entries, but these had not been recorded as a fall so the falls analysis in this home is not accurate. This means that some people’s need for support in this area, and possible trigger times for extra support, is missed. These related mainly to night-time records. It was evident from daily reports that some falls or injuries, particularly those occurring at night, were not then recorded in the accident records. This means that the home’s accident procedures are not being followed. At the time of the first visit two people had bedrails fitted to their beds. One person had a previous history of rolling out of bed in hospital, however there were few reports of this occurring in the home in the accident or falls records. The home ensured that she had mattresses on the floor to minimise any potential injuries. Recently the resident had been found on the floor with a fracture. This may have been the result of a fall but it was not recorded in the falls records. Following a request by the residents’ representative, the home agreed to fit bedrails to her bed. There were two different risk assessments in place about her risk of falling but as neither were dated it was not possible for staff to determine which was current. The risk assessment regarding the bedrails did not set out the evidence to justify the reasons and risks involved in using Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 13 bedrails with someone with dementia care needs; did not include input from other relevant agencies such as Falls Prevention Nurse or OT; was not signed by representatives; and not dated. (At the next visit the Acting Manager stated that both bedrails had been removed and alternative methods of support were being considered.) Southern Cross has recently introduced new nutritional arrangements, (NUTMEG), into its homes to ensure that the correct nutritional content of each meal served to residents. The catering staff are very clear about their responsibility to ensure that the nutritional needs of residents are met. Catering staff are very aware of the individual catering needs of each of the residents, and very knowledgeable about their individual preferences and tastes. Nutritional assessments are carried out on admission and residents weight and nutritional assessment is reviewed at least monthly. However even significant changes in weight do not prompt specific action, and at the time of the first visit there was little communication about changes in nutritional needs between care staff (who assess and weigh residents) and the catering staff (who provide their nutritional intake). For example, weight records showed that a resident had lost significant weight (13lbs) over 6 months. However the nutritional care plan did not direct staff to take any action to address this, and catering staff were unaware of the changes in weight. Since the inspection the Acting Manager has introduced weekly meetings for the ‘heads of department’ so that such information can be shared between senior care staff and senior catering staff. However the care staff still have no guidance about identifying nutritional changes, what action they should take, and recording this within a progressing care plan. 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 via a monitored dosage system (that is, blister packs). Medication is administered by the Registered Mental Nurses. Management staff carry out regular audits of medication to ensure it continues to be correctly managed. Some prescribed, medicated creams are kept in residents’ own bedrooms for easy access by staff when supporting them with this. Some residents’ creams were found to be in the wrong bedrooms and this could present a risk of cross infection. In discussions visitors, relatives and some residents commented on the “friendly” and “helpful” attitude of staff. One visitor described staff as “excellent” and “very caring”. In discussions staff described residents in a respectful way, and are knowledgeable about people’s individual needs. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 14 However some staff practices do not promote residents’ dignity. For example, during a lunchtime meal two staff were physically supporting some residents to eat. However staff did not engage with the people they were helping, and carried on an extremely inappropriate conversation over the residents’ heads. This is very poor practice, as staff treated those residents as if they were objects. Also, one staff wiped a resident’s face with a wet-wipe after lunch. However the person was capable of cleaning their own face, if they needed to, with some verbal guidance. This poor practice is known as ‘infantalisation’, which means treating people as though they were a child. During discussions in a bedroom with a resident and their relatives, a member of staff walked into the resident’s bedroom without knocking and awaiting permission so compromised the resident’s privacy. These matters were brought to the attention of the acting manager at the time of the first visit. At the second visit the acting manager indicated that individual discussions had taken place with the relevant members of staff about their conduct. This is to be followed up at staff supervision sessions, to ensure that all staff respect and uphold the dignity of residents. Washington Lodge Nursing Home DS0000018213.V340185.R02.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are improving recreational activities so some residents now have some social activity or interest in their day. Residents are able to maintain good contact with relatives. Information is not always presented in a meaningful way for residents so they cannot make informed choices. The quality of catering is very good so residents enjoy appetising meals. EVIDENCE: The home employs an activities co-ordinator who works flexible hours to suit the activities planned. Discussions with this staff member indicated a positive and enthusiastic approach to future developments in the range of activities that the staff team can provide to the people who live here. Recent activities include artwork, bowls, cookery sessions, and coffee mornings at local community settings. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 16 The activities co-ordinator recognises the need for greater opportunities for residents to go out, and described how this could be improved by access to transport such as a shared minibus and use of local buses. It is good practice that social activities have been identified as a significant area of care for some residents within their care plan. This suggests that care staff recognise the importance of activity and stimulation for people with dementia care needs. However, in the sample examined, records of social care activities were mainly recorded in daily records not in the care plan, even where a specific care plan goal existed for this area. In discussions, the activities co-ordinator is also considering how and where she can record activities engaged in by residents without duplicating records. At the front entrance to the home there is a board of colourful posters advertising the forthcoming month’s activities, but residents do not have access to this area of the home so are not informed about these activities. Residents can see the white board in a corridor on each floor where staff write on that day’s morning and afternoon activity. However there are no pictures or photographs to support residents’ understanding of this written information. There are photographic menus in the reception area but residents cannot access these (and these are now out of date with the current menu). The home has a warm and welcoming atmosphere and there were several relatives and visitors to the home over this inspection. Visitors stated that they are “always made to feel welcome”. Some also commented that they are always offered drinks or even a meal if visiting near a mealtime. There was clearly a good relationship between staff and many of the visitors. Meals are transported to the dining rooms (one on each floor) by hotlock trolley so that the food remains hot whist being served by care staff. It is very good practice that residents are offered the choice of at least two main meals when seated at the table for that mealtime. However residents are asked verbally for their choice rather than being shown the two different dishes, which might support them to make a more informed choice. The quality of meals is very good. Residents who were able to express an opinion described the meals as “always very good”. The meal sampled was hot, tasty, and good quality. Residents were offered seconds if they wished, and all residents clearly enjoyed the meal. The dining rooms offer a pleasant setting for residents to enjoy their meals. However there were no condiments (such as salt, pepper or sauces) available in the dining room. Residents were served juice in a teacup, which is inappropriate and unnecessarily confusing for people with dementia care needs. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 17 There were no opportunities for residents to serve themselves any part of their own meal. At the end of the meal one resident began to capably clear the place mats from the table. However, rather than encourage this purposeful activity, staff removed the placemats from her and led her out of the dining room to sit in the lounge. This disempowered the person from using her remaining abilities and skills. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents do not have a copy of the home’s complaints procedure. This hinders them from using the process to settle complaints about the service. Most staff have had training in abuse and so should know how to deal with suspected abuse in order to protect the people who live here. EVIDENCE: Information about how to make a complaint is available at the front entrance to the home and in the Service Users Guide. As very few residents have access to a Service Users Guide they do not have any information about how to make a complaint. The complaints procedure is not currently available in other accessible formats at this home, for example on cassette or DVD for people with reading or visual impairments. There have been 3 complaints by relatives over the past year. The record of how these were dealt with is in good order, and includes action taken and outcomes. It was indicated that the home only records written complaints and how these are managed, so there are currently no records of verbal complaints. It is unlikely that residents would be able to formally write any complaints, so this is discriminatory. However the Southern Cross policy states that verbal complaints should also be recorded and dealt with in the same way. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 19 About three-quarters of the staff team have had some training in adult protection or abuse, although only 7 staff have had training in the local council procedures, MAPPVA (Multi- Agency Panel for the Protection of Abuse). The new manager has had training in MAPPVA and is to attend further training in Safeguarding Adults (which is a national protocol that will replace MAPPVA). This is an area for future development for the staff team. There has been one safeguarding adult alert since the last inspection, which involved the actions of one resident towards another resident. The home followed the correct MAPPVA procedures by involving other health and social care agencies in ensuring that neither adult had been harmed, and in minimising the risks of a similar situation occurring again. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 20 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the building is well-maintained, warm, clean and comfortable so residents live in a safe environment. There have been improvements to corridors so that residents can find their way around more easily. However, residents are restricted in their movement between floors (for their safety) so do not have independent access to all communal areas including the garden. Bathrooms are not well-decorated and poorly lit so are not an adequate place for residents to bathe. EVIDENCE: Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 21 Overall the building is in a good state of repair and well maintained. The home benefits from having a full time maintenance staff to attend to minor repairs and redecoration. At the start of this inspection the planted areas around the side of the home had become very overgrown which was affecting the view from bedrooms on the ground floor. However by the second visit this had been addressed, and the gardens at the entrance and internal courtyard garden are well kept. The building is relatively modern. Its hollow square design means that, within each of the two units (one on each floor) residents can walk around a complete square of the building. The home has a very good range of lounges and sitting areas around both floors to break up the long corridors and offer residents places of interest and comfort to take breaks if they are walking around the unit. However it is clear that the home imposes limitations on residents’ movement around the two floors of the home. For example, residents are not ‘allowed’ to independently use the lift. This means that people living on the first floor cannot access the courtyard garden on the ground floor independently. Visiting relatives and staff could not recall an occasion when residents were supported to use the garden. The apparent restriction of residents on the first floor could be viewed as restraint. Also there are locks on the doors between the reception area and the ground floor unit. This means that residents cannot access the reception area unaccompanied (even though there are also further locks on external doors). This could be viewed as restraint. There are no individual risk assessments to justify or demonstrate why residents are locked into either the first floor or ground floor units. There is no evidence to show why residents might be at risk if they were free to access all communal areas of their home. Bathrooms, shower rooms and toilets are rather worn and in need of redecoration. Bathrooms and shower rooms are dimly lit and uninviting. These rooms do not currently provide a homely or appropriate environment to ensure bathing is a relaxed, pleasant experience for the people who live there. A toilet and a shower room did not having working locks which compromises the dignity and privacy of the people who live here. Two shower rooms had no shower screens to protect the privacy of people using this room. (At the end of these inspection visits, work had begun to redecorate bathrooms and toilets.) There are staff instruction notices in most bathrooms, which add to the clinical feel of these rooms and detract from a homely environment for residents. (It is unlikely that staff read the notices, and the information about bath temperatures ought to be well-known to staff through in-house instruction.) Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 22 There have been a number of improvements in signposting for residents to support their orientation around the home. The contrasting paintwork to corridors, handrails and doors is designed to help people recognise different areas and room doors, particularly toilets and bathrooms. There are different coloured doors for bedrooms, with number and nameplates, and there are plans to have relevant framed pictures next to bedroom doors to further support residents to find their own room. Most living areas of the home have a good standard of decoration and furnishings. Lounges are comfortable, warm, bright and cheerful. Of the sample of bedrooms examined, most were also comfortable, warm and well furnished. However several bedrooms are decorated in dark colours and have low wattage light bulbs so are dimly lit. The low lighting in bedrooms could present tripping hazards for the people who live here. Many bedrooms on the ground floor look over the courtyard garden. However there are no blinds at bedroom windows so that anyone using the garden can see directly into residents’ private accommodation. This means that residents’ dignity and privacy may be compromised. There were continence pads and protective gloves on public display in bathrooms and toilets. This does not promote the dignity of residents and also compromises control of infection. Overall odour control is good in most of the home and all areas of the home that were examined were clean. Dedicated laundry staff provides laundry services. The laundry area is well–equipped and satisfactory for the size of the home. Relatives and visitors described the laundry service as “good”. Relatives were unsure whether occasional missing clothes were the result of gaps in the laundry system or due to residents “moving things around”. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 23 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff so the number of people who live here can be supported. Many staff have achieved a care qualification so residents are supported by capable staff. However few staff have had training in dementia care needs so may not be meeting people’s specific care needs. Training records are inadequate so do not demonstrate that staff have appropriate training. EVIDENCE: At the time of this inspection there were 47 residents living at the home (34 people receiving nursing care and 13 people receiving personal care). There was one RMN (qualified mental health nurse) and one senior care staff on each floor. There were also 4 care staff on the ground floor, and 2 care staff on the first floor. The staffing levels at this time were sufficient to meet the number of people who live here. It was evident that there are good relations between staff and residents, and residents seemed relaxed and comfortable when they had the opportunity to chat to staff. Some residents described staff as “very nice”. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 24 However all care staff carry out 12-hour duties, either from 8am to 8pm, or vice versa. This is a very long period, especially for day staff, to support people whose dementia care needs may mean that they are continuously repetitive or unsettled. In discussions the manager indicated that the length of shifts are being reconsidered. The home employs sufficient domestic, laundry and catering staff. The home also has an administrator who manages administrative and financial matters. A good proportion of care staff (around 20 out of 28 staff) have achieved NVQ level 2, which is a care qualification. It is also good practice that catering and housekeeping staff have also achieved similar relevant qualifications. Recruitment and selection processes ensure that equal opportunities practices are followed and that only suitable people are employed at the home. The process includes applications, interview, references and CRB (criminal records bureau) checks. However the Southern Cross recruitment policy indicates that staff can be employed with a POVAFirst check, subject to the person being supervised, whilst awaiting the return of a full CRB check. This procedure omits to say that POVAFirst checks are only acceptable in ‘exceptional circumstances’ and with the involvement of CSCI. However this matter is clearly outlined in the Southern Cross ‘Protection of Vulnerable Adults’ procedures. It was evident from a sample of personnel files that there are several gaps in the information about staffs’ prior training. Training records held in both paper form and on computer are not up to date, and so do not demonstrate that staff have had even mandatory training. Although the home specifically provides care for older people with dementia care needs, very few staff have had certificated training in this area of care. In this way the home does not demonstrate that its staff are equipped to support people with dementia care needs. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 25 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is newly in post so has not yet had the opportunity to demonstrate his competence but is supported by the Provider. The home has suitable arrangements for residents’ finances so that their monies are safely stored. Staff have not had sufficient supervision sessions so have not been well supported or managed in their roles. Training records do not demonstrate that staff have had sufficient training so health & safety is not promoted. EVIDENCE: Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 26 Just prior to this inspection the previously registered manager had left the home to take up employment elsewhere. At the time of the first visit of this inspection an acting manager had been in post for a few weeks. By the end of the inspection visits, the acting manager had been interviewed as part of a competitive process and had been appointed as the manager (subject to satisfactory registration with the CSCI). The new manager is a qualified RMN (Registered Mental Nurse) and has around 10 years experience of working in social and health care settings for people with mental health and dementia care needs. He is supported and supervised in the management of the home by an Operations Manager of Southern Cross Healthcare. The staffing structure of the home includes a deputy manager and 8 RMNs who are responsible for supervising the care of residents. In this way there are clear lines of accountability within the organisation and the home. Southern Cross’ quality assurance processes include a number of audits of the home and at least monthly visits carried out by the Operations Manager. An annual questionnaire is used to gain relatives and residents’ views of the service, and a summary of these is published in the Service Users Guide. There are currently no regular methods of gaining residents’ views (for example, Residents’ Meetings). However the activities co-ordinator is planning to engage residents in discussions so that their suggestions can influence the activities programme. If requested, the home will support residents to keep their personal monies in a safe. Currently individual resident’s monies are securely stored in individual, named wallets. There are clear computerised statements, which are managed by the home’s administrator, of any deposits or withdrawals. A sample of monies and records showed that these were up-to-date and in good order. Staff supervision records show that few staff have had any individual supervision sessions with their line supervisor this year. In this way it is unlikely that the home can achieve the national minimum standard (and the organisation’s own protocol) of at least 6 sessions over a year. Southern Cross provides staff with mandatory training in all areas of health and safety. However the current training records at Washington Lodge are not up-to-date, and have many gaps and omissions. In this way it cannot be demonstrated that staff have had training in these areas at the required intervals. For example, the home’s records show that only a handful of the staff team have had in-house fire training this year. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 27 The manager, deputy manager and a senior staff are designated trainers in moving and assisting. There are future plans to provide all staff with updated training in this area to take account of new regulations. At the first visit communal hoists and spare wheelchairs were being stored in one resident’s bedroom. This is inappropriate, as it is her personal room, and presented a tripping hazard for anyone who may have entered that room. (By the second visit these items had been removed.) All bathrooms, shower room and some bedrooms are dimly lit and this could present a tripping hazard for the people who live here. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 28 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 1 3 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5(2) Requirement Each resident (or their representative) must have a copy of the Service Users’ Guide. This is to ensure that they each have information about the service at Washington Lodge, including the home’s complaints procedure. The moving & assisting plans must clearly outline the specific techniques and equipment to be used to support people with mobility needs. (Previous timescale of 24/04/07 not met.) A record must be kept of any accident affecting a resident. Timescale for action 01/10/07 2. OP8 13(5) 01/10/07 3. 4. 5. OP8 OP8 OP8 17, Schedule 3, 3(j) 17, Schedule 3, 3(o) 13(4) and 17, Schedule 3, 3(q) 01/08/07 A record must be kept of all falls, 01/08/07 and treatment provided, to a resident. Risk assessments must clearly 01/08/09 outline the measures taken to minimise risks, including the details of any involvement by other agencies. Risk assessments must be signed and dated for on-going review. (Previous timescale of DS0000018213.V340185.R02.S.doc Version 5.2 Page 30 Washington Lodge Nursing Home 6. OP10 12(4)(a) 7. OP21 23(2)(d) and 12(4)(a) 8. OP24 12(4)(a) and 23(2)(e) 9. OP25 23(2)(p) 10. OP26 12(4)(a) and 13(3) 11. OP30 18(1)(a) &(c)(i) 12. OP36 18(2) 29/12/06 not met.) Staff must ensure that their practices promote and uphold the dignity of residents at all times, including meal times. All bathrooms, shower rooms and toilets used by residents must be in good decorative order and state of repair; shower screens must be provided; and locks to toilet and bathrooms doors must be in working order. This is to protect the privacy of the people who live here. Window blinds (or similar alternatives) must be provided to the bedrooms that are overlooked by the internal courtyard. This is to protect the privacy of people accommodated in these bedrooms. The lighting to bathrooms, showers and all bedrooms used by residents must achieve a minimum of 150 lux (e.g. the equivalent to a 100 watt light bulb). This is to ensure that these rooms are bright enough for the people who live here. Continence equipment and protective equipment must not be left out on display in bathrooms and toilets. This is to ensure the dignity of residents, and also to protect equipment from possible crosscontamination. Arrangements must be made for care staff to receive suitable training in dementia care needs. This is to equip them to understand the support needs of the people who live here. Each staff member must have appropriate supervision with their line supervisor at required intervals. This is to ensure that their practices and training DS0000018213.V340185.R02.S.doc 01/08/07 01/10/07 01/12/07 01/10/07 01/09/07 01/12/07 01/12/07 Washington Lodge Nursing Home Version 5.2 Page 31 13. OP38 13 (4) (b) needs are formally managed. Staff must receive health and safety training at correct intervals including in-house fire safety, and that such training is recorded. This is to ensure all staff are familiar with current health and safety practices. 01/11/07 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 OP3 OP7 Good Practice Recommendations All parts of the assessment documents should be completed, including spiritual and religious needs, or a record made where the information is unknown. Consideration could be given to making information more easily retrievable for staff from care files, for example by using an index and dividers, and archiving any information that is discontinued. Where care staff identify changes in weight or changes in the nutritional intake of a resident this information should be shared with the catering staff. The home should ensure that all night-time staff and bank staff are fully aware of the correct accident and falls reporting procedures. Staff should support residents to keep their prescribed creams safely within their own bedrooms. This may include reviewing where they are stored within the bedroom. The home should pursue regular use of the Southernwood minibus for planned local trips for small groups of residents. Consideration could be given to where records of activities are recorded, especially if a specific care plan goal exists for this area of care. Information about activities and menus should be made available to residents, and in accessible formats, to support them to make informed choices. Staff should encourage and enable resident to use the strengths and capabilities that they retain, including DS0000018213.V340185.R02.S.doc Version 5.2 Page 32 3. 4. 5. OP8 OP8 OP9 6. 7. 8. 9. OP12 OP12 OP14 OP14 Washington Lodge Nursing Home 10. 11. 12. 13. OP15 OP21 OP27 OP29 14. OP30 around mealtimes, for example serving parts of the meals or drink themselves and clearing tables if capabilities allow. Condiments should be available in dining rooms for residents to help themselves, and juice should be provided in glasses or tumblers. Consideration should be given to removing staff instruction notices from bathrooms and shower rooms as these detract from a homely environment. Consideration should be to be given to the length of care staff shifts to ensure that staff perform at their optimum level. At the next review of its recruitment & selection policies, the Provider could also include reference to the ‘exceptional circumstances’ when a POVAFirst check could be used to initially appoint new staff. Records of individual staff training and development should be up-to-date so that any training needs can be identified and met, to support them to carry out the roles they perform. Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South Shields Area Office 4th Floor 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. Extracts may not be used or reproduced without the express permission of CSCI Washington Lodge Nursing Home DS0000018213.V340185.R02.S.doc Version 5.2 Page 34 - 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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