Inspection on 20/07/06 for Washington Lodge Nursing Home

This inspection was carried out on 20th July 2006.

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

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

Other inspections for this house

Washington Lodge Nursing Home 16/06/08

Washington Lodge Nursing Home 19/06/07

Washington Lodge Nursing Home 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 Mrs Katie Tucker Key Unannounced Inspection 1:00 20 and 21st July 2006 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.V302920.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.V302920.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 www.schealthcare.co.uk Southern Cross Healthcare Services Limited Mr Lester Burnett Care Home 65 Category(ies) of Dementia - over 65 years of age (65), Learning registration, with number disability (1), Physical disability (10) of places Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Learning Disability Category applies to current service user only Date of last inspection 18th October 2005 Brief Description of the Service: Washington Lodge care home is a purpose built nursing home. It was first registered in September 1996. The home provides both nursing and personal care for people with dementia type illnesses and can also offer a service to people who are physically disabled. The home does not provide intermediate care services. The fees charged at the home range from £449 to £512 per week. Washington Lodge is a two floor building built of traditional brick and tile. The home is divided into two units and both have communal facilities, bathrooms and bedrooms. All bedrooms are single occupancy and there is a separate kitchen, laundry area and staff room. Access into the home is level and a shaft lift is provided to take people on the first floor. At the centre of the home there is an enclosed garden, which has a seating and activity area. Washington Lodge is sited in a residential area near to local shops. Other community facilities are a short distance from the home. A bus route provides access to the Galleries shopping centre, Sunderland and Gateshead centres as well as surrounding areas. Washington Lodge Nursing Home DS0000018213.V302920.R01.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 2 days. One inspector spent 10 hours at the home speaking to people using the service, staff and visiting relatives. Prior to the visits the inspector also spoke to health professionals that visit Washington Lodge. Several residents were identified. The care they received was tracked through discussions with all concerned and by looking at the service user plans. Also information supplied by the home, comment cards, previous complaints and adult protection matters were used to make decisions about the quality of service. Washington Lodge provides nursing care for people with a dementia-type illness and care for people with mental health needs. Some of the people have difficulty communicating their views verbally. Therefore staff practice, attitude and approach were watched and judgements made on how well staff worked with people. During this inspection all of the key standards were checked. What the service does well: The manager and deputy manager have a good understanding of current good practice in the care of people with dementia care needs. Over the last two years the manager has worked hard to change the previous poor care practices. A large number of staff now work with people in ways that respect and value the resident. Relatives and residents said that the staff were ‘friendly and helpful’. Relatives were impressed by how patient staff were with the residents and how they ‘never got feed up of reminding people and helping people to do things’. Lots of the staff had good relationships with staff and humour was used when working with people. Everybody enjoyed the friendly banter and residents were comfortable laughing with and at the staff. The cook has a very good understanding of the dietary needs of the residents. She is extremely devoted to the residents and is very keen to make sure they have an excellent diet. Residents are being involved in completing artwork for the home and recently made some textured boards that will be on display in the corridors. One of the lounges has been converted to resemble a bar and this has created very social gatherings. Staff and resident really got a great deal out of sitting in this setting. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Changes to assessments are being made but the current information held at the home is insufficient to clearly show the mental health needs of residents. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Case tracking showed that Washington Lodge uses a pre-admission assessment form, social work reports, Cape, Braden and other similar rating scales are used to assess people’s needs. The tools evidence primarily people’s physical health needs does not provide enough information about the current mental health care needs of the people. Thus information was gathered via a tick box system, to show people could have difficulties controlling their impulses or with anger management, yet space was unavailable for further information to be recorded. Also when working with people who have dementia care needs emphasis has to be placed on the skills people retain and what are their strengths. Southern Cross Health care stated that these forms are to be replaced. Life histories sheets are starting to be completed, which is excellent practice in dementia care settings but more information needs to be gathered about previous routine. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The service user plans do not reflect the care or show the good practices seen at Washington Lodge. Therefore staff cannot demonstrate how they care for people. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The lack of appropriate assessment document and use of generic rating scales means staff do not complete care plans around people’s greatest needs. The case tracking showed that when writing care plans, staff do try to include the full amount of information needed to show how to meet someone’s needs. But at times the language used is very complex and uninformative such as ‘develop a rapport’. Also staff are not writing plans around how to work with people who have challenging behaviours, meet spiritual needs or maintain skills. Plus staff are not using information about people’s strengths or previous routines to inform the plans. In practice staff were meeting resident’s needs and were very aware of the best way to work with people but this was not recorded. Therefore their good practice was not evidenced. Although risk assessments are being generically used, assessments for showing that the risks people take have been judged to be acceptable need to Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 10 be more widely used. Also risk management strategies must be applied more widely. These types of plans show the strengths people have and the common day risks they can continue to safely take. Case tracking showed staff impose limitations on some residents because of their dementia or mental health needs such as needing to be accompanied when outside the home and not being able to independently use the lift. These practices must only be undertaken when evidence is available to show that people would be at great risk if they undertook the task. Otherwise people should be free to access all communal areas of the home or go out when they want. When limitations are imposed for a particular individual this needs to be recorded. When residents have to follow Washington Lodge’s house rules can be recorded in a standard contract. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Staff practices did not always promote the needs of residents. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service.. EVIDENCE: Over the two visits limited activities were undertaken. On the whole residents sat in the lounges watching television. However an activity programme is in place and evidence showed people had been involved in artwork, trips out and gardening. Recently one of the communal areas has been fitted with a bar and this created a very social environment. Residents were able to say who they found to be very good and kind. There was a lot of warmth and humour used by residents and staff. The majority of staff worked with people in ways that were respectful. Relatives said ‘the staff are always kind and helpful’. The cook is very knowledgeable about the maintaining a healthy diet for older people. She is very keen to complete further catering qualifications. The mealtime experience on the upstairs unit was not very well co-ordinated. Serving practice meant for some people the food was cold when they got it. Staff are able to have the left over food and spent more time deciding what meal they were having than seeing what residents’ would like. Because staff had picked their meals this meant residents weren’t able to have more food if they wanted. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The manager and staff are aware of the appropriate action to take when someone raises concerns or makes allegations of abuse and able to safeguard residents. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The complaints procedure is made available to residents and relatives through the service user guide. Residents said that the staff and manager listened to them. The relatives felt that any concern they had would be dealt with and on the whole action would be taken to make sure the problem did not reoccur. Washington Lodge has an appropriate protection of vulnerable adults policy and follow Sunderland Social Services Department guidance. Since the last inspection no protection of vulnerable meetings have been held. A number of staff have received training in the Multi Agency Panel for the Protection of Vulnerable Adults (MAPPVA) procedures and also of the homes whistle blowing policy. Staff were aware of the various forms of elder abuse and how these could be prevented. Such training and awareness amongst staff is aimed at reducing the likelihood of abuse to service users. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The recent refurbishment of the home helps staff to support people with dementia care needs. Currently the home has some problems with odour. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Southern Cross Healthcare has started to fully refurbishing the home and is ensuring it meets research-accepted guidelines for dementia care. The redecoration is creating a very warm and useful environment for people with a dementia. The manager and deputy manager have discussed these changes with residents and relatives last year. Relatives liked the new decorative scheme but were disappointed that it had taken so long to start. The bathrooms continue to have problems with smell returning from the waste pipes. The managing director was made aware of this issue and said he would make sure it was sorted out. One of the lounges continues to have odour problems although carpeting and furniture have been changed. Washington Lodge was generally clean and tidy. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Some shortfalls in staff recruitments causes problems in employing staff in a timely manner. Currently the home has some problems with odour. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Currently staffing levels are satisfactory. As more people who receive nursing care however, there is a need to ensure staffing levels both of qualified staff and care staff meet the needs of residents. The manager is aware that he needs to be mindful of guidance and increase core staffing levels as more people with nursing needs more to the home. Staff are being given access to a range of training including physical intervention training. Recently staff started to receive dementia care training but as yet staff have not put this into their everyday practice. The manager undertook to make sure staff became very familiar about the expectations around person-centred care. 73 of the staff have NVQ qualifications. The Southern Cross recruitment process means the manager is not able to see the company copy of CRB disclosures and therefore cannot be confident that the employee’s is accurate. Current systems for obtaining CRB’s is taking 6 10 weeks, which seem a considerably long time when compared to returns for other services. Often potential employees are finding they are offered posts elsewhere because their clearance is through. Application forms need amending to meet Disability Discrimination Act 1993 requirements. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Changes to some of the systems may adversely affect residents. Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Staff said the new deputy manager was making some positive changes. Some of the residents commented that the nursing staff did not always organise staff very well or make sure people did the jobs they were supposed too. The manager undertook to look at the general running of the home. Southern Cross is proposing to change the personal allowance system so that all monies will be held in a central account. Pooling of residents money is unacceptable as people will not get interest they are entitled too or be confident that their money is used to subsidize others. The current system has been working well and only small amounts of money are kept. Larger amounts are returned to the appointee or power of attorney. Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 16 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 X X 2 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 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 17 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 OP3 Regulation 14 (2) Requirement The new assessment must be introduced and must capture information, which is relevant for someone with a dementia or mental health need. Social information must be context specific and highlight previous routines and cultural practices. Care plans must set out in detail the actions that staff need to take to meet service users needs. (Required at previous inspections - 30.03.05) The staff must compile information on all areas of service users lives where there are limitations or restrictions occurring. Service users or their representatives must agree these interventions. (Required at previous inspections 12.01.05) The manager must work with staff to develop risk-taking strategies and assessments with the service users (required at Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 18 Timescale for action 29/12/06 2. OP7 15 (2) 12 (2) Sch 3 (3) (q) 29/12/06 the previous inspections 12.01.05) 3. OP15 13 (6) 18 (1) (c) Staff must use person-centred and dementia care research supported practice in their every day care. A robust system for interviewing staff who have CRB disclosures must be in place. (Required at previous inspections – timescale 24/01/06) Residents personal allowance must not be kept in a pooled account 06/10/06 4. OP29 19 (5) (b) 24/11/06 5. OP35 20 (1) (a) 06/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations Staff should be assisted to develop the activities and interactions offered on the units when the activities coordinator is not on duty. Application forms should be compliant with Disability Discrimination Act 1993 requirements. 2 OP29 Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 19 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Washington Lodge Nursing Home DS0000018213.V302920.R01.S.doc Version 5.2 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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