Inspection on 08/03/06 for Minster Lodge Residential Care Home

This inspection was carried out on 8th March 2006.

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

Minster Lodge Residential Care... 22/05/07

Minster Lodge Residential Care... 15/11/06

Minster Lodge Residential Care... 25/04/06

Minster Lodge Residential Care... 22/06/05

Minster Lodge Residential Care... 21/09/04

Minster Lodge Residential Care... 20/05/04

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

CARE HOMES FOR OLDER PEOPLE Minster Lodge Residential Care Home Minster Lodge 6 Westminster Road Earlsdon Coventry CV1 3GA Lead Inspector Sandra Wade Unannounced Inspection 8th March 2006 08:40 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 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 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. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Minster Lodge Residential Care Home Address Minster Lodge 6 Westminster Road Earlsdon Coventry CV1 3GA 02476 552585 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) R M Health Ltd Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Work is to be undertaken, by 31 March 2004, to convert the bathroom, which is currently used as a sluice room, to an assisted shower/bath facility. A sluice facility, which is independent of bathing facilities, must be provided by 31 January 2004. 22nd June 2005 Date of last inspection Brief Description of the Service: Minster Lodge is situated close to Coventry City Centre and can be reached easily using public transport. The home is situated over two floors and can care for 27 older people who are frail. There is one shared room and the remaining rooms are single occupancy, two of the bedrooms have en-suite toilet facilities. Communal toilets and bathrooms are available close to the lounge and dining areas and also near to those bedrooms without an ensuite facility. There is a back garden, which is secure with paved areas and this can be accessed from the dining room. The home does not have its own parking facilities and parking is prohibited on the road. There is a Pay & Display car park close to the home. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection to Minster Lodge for this inspection year and took place between 8.40am and 4.15pm. This inspection focused on progress made in regards to the requirements made at the last inspection as well as the review of standards not assessed at the last inspection. On arrival to the home two residents were asleep in the lounge and some residents were seated in the dining area. Smoking is permitted within this home and throughout the day various residents chose to smoke in the dining room outside of mealtimes. The inspection process included discussions with residents, staff and the manager as well as a brief tour of the home and a review of policies and procedures. A period of the inspection was spent seated in the lounge area to observe residents. What the service does well: What has improved since the last inspection? Some staff have received training in Challenging Behaviour and Mental Health Awareness to help them manage some of the complex needs of the residents more effectively. Games and books are now available in the lounge so residents can easily access these. Risk assessments have been completed for those residents who choose to leave the home. The plain glass bathroom window has been covered with a frosted coating to ensure the privacy and dignity of the residents can be maintained. Radiators have been covered to prevent residents from burning themselves on the hot surfaces. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 6 Formal staff supervision and appraisals have commenced so that the manager can monitor staff performance and identify any staff training required. Improvements have been made to the sluice area to allow for commode pots to be washed and dried in line with effective infection control procedures. 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. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 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 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 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 Residents are assessed prior to and on admission but changes are required to the assessment process to ensure all care needs are identified and can be met. EVIDENCE: Records confirmed that assessments of residents take place but it was noted the assessment process does not include a review of all needs as detailed in the care standards. This includes foot care and personal safety and risk. Historically this home have accepted a range of residents with complex needs and backgrounds which has resulted in residents currently within the home having a range of needs including mental health and dementia. It was evident through observation, discussion and the review of records that there is further work required to fully meet the needs of these residents. It was established one resident did have aggressive outbursts and staff were therefore sometimes reluctant to approach this resident. There was minimal staff interaction with this resident during the period of time they were seated in the lounge. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 9 One resident was noted to be very anxious and stated that they felt ill all the time through anxiety. The inspector observed during the time spent in the lounge that staff did not interact with this resident or offer any emotional support. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 The residents’ health, personal and social care needs are not sufficiently organised within individual care plans to ensure there is no oversight when providing care. Further work is required in regard to meeting all care needs of residents. Some actions are required in regard to medication management to ensure residents are protected by the homes procedures. EVIDENCE: Care plans are in place for residents but these are not set out in a way which gives clear guidance to staff on how to meet each individual need. The manager advised that she has been working through the care plans to bring them up-to-date and ensure they accurately reflect the care needs of the residents. The manager had taken action to establish mental and psychological needs of the residents and had documented this in care plan files viewed. Staff actions had been identified on how to meet these needs although information available had not been set out in a care plan format and was not attached to the care Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 11 plan so that staff knew to read this and take the necessary action. The manager had also developed a tool for monitoring residents mental and physical health but this was still to be fully implemented. It was evident that care plans viewed for one resident had been evaluated to identify any changes in care needs. A risk assessment had been completed for one resident in regard to them going out independently but this had not been dated so it was clear this was a current document. It was not evident that all risks had been fully evaluated, for example the risk assessment did not include ensuring that the resident had the name and address of the home on their person in case of emergencies. This resident was observed to have bandages on their legs. A body map was held on this residents file stating “leg condition very bad” but there was no information stating what the actual problem was. This was dated January 2006. A pressure sore risk assessment indicated that there were sores on both legs. The medical history stated that this person had a history of ulcerated legs. No care plan was in place for these conditions. It was evident that this person was receiving support from the district nurses who came on the day of inspection to apply dressings to the legs. Discussion with the district nurses confirmed a medical condition not specified in the care plan. A falls risk assessment in place stated continuously from 7.5.05 to 7.1.06 “no change”. It was clear from reading information held on the care plan file including the body charts that this residents legs had been deteriorating in condition and therefore their physical health had changed. This resident was noted to be wearing dirty clothes and it did not appear their personal hygiene had been attended to. It was established through discussions during the inspection that this was not a one off occurrence suggesting personal hygiene is not being appropriately monitored and addressed as appropriate by staff. A second care plan file was reviewed. Specific care plans detailing this residents needs and staff actions required to meet these needs were not on file as the manager said these were in the process of being updated. Risk assessments had been completed for falls and nutrition and a body chart was on file confirming pressure sores on heels. The nutritional risk assessment stated that this residents food intake should be monitored due to previous malnutrition. Records were not clear in confirming the precise food and fluid intake. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 12 During the inspection this person was noted to be given a toasted egg sandwich. The toast was wet and floppy and the resident was observed to make a comment about this to a member of staff who offered to change it. No weight charts were available on this persons file to confirm their weight was being monitored so that staff could identify any weight loss which could result in poor health. It was noted that daily records stated this resident had “eaten well”. This resident said that staff were “very very kind” but they were feeling very low at the moment and they didn’t know why. Following recommendations made at the last inspection, the manager had arranged for staff to complete training in challenging behaviour to assist them when managing residents with mental health problems. It was clear however from observations during the inspection that further training is required linked to the needs of this client group to ensure staff can provide effective care. During the inspection two residents were noted to spend most of the day asleep in the lounge on a chair. One of these residents was wrapped in a blanket. A member of staff confirmed that this resident had a chest infection and both residents did not look well. When a member of staff approached one of these residents they were reluctant to be moved. This resident was confirmed to have dementia. Two other residents were noted to be seated in the lounge in their coats for long periods with no staff or resident interaction and chose to sit out of view of the television. When one of these residents was spoken to and asked if they were alright they replied that they were and both said they were warm enough. It was confirmed that one of these residents can be verbally aggressive. Another resident spoken to said that they were satisfied with the care they were receiving but stated they could not have an ‘proper’ conversation with some of the other residents. This person said that this was their only concern regarding the home. The manager advised that since the last inspection she has arranged for talking books and some large print books to be available in the home to assist those residents with sensory and physical disabilities. During the tour of the home some of the rooms were found to contain creams with no prescribing labels and in one room cream was found which did not belong to the resident occupying the room. Creams with no labels included Aqueous cream and Magnesium Sulphate paste. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 13 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 Social, cultural and recreational interests and needs are not completely met by the home which means the residents’ life style experience may be reduced. EVIDENCE: During the inspection no social activities were seen to take place. Some of the residents are able to independently go out but many of the residents are not able to make outside visits without staff assistance. There has been minimal outside visits for those needing staff support and the manager confirmed this is mainly due to transport difficulties. Some of the residents did go to a pantomime at Christmas and some of the residents are taken to the bank. On the day of inspection a member of staff put an old musical film on the television which some of the residents enjoyed singing along to. No other social activities were observed during the inspection. A box of board games is now available in the home but an activity schedule was not seen and it was not evident that staff had spoken to each resident to establish their views on activities that could be provided in the home. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Systems are in place in regard to the management of complaints but some of the information on the complaints procedure is out of date which could impact on the complaint being managed effectively. EVIDENCE: The complaints procedure on display included a reference to the National Care Standards Commission which has been replaced by the Commission for Social Care Inspection and out of date information regarding inspector contacts. Since the last inspection the home have received one complaint regarding bins being left outside the home. Records relating to the complaint were not clear in regard to whether the issues raised were upheld. Copies of the letter to the complainant were not on file. The manager agreed to forward this information to the inspector and this has subsequently been received. It was clear from the letter forwarded to the complainant from the home that actions had been taken to address the points raised in the complaint and the this had been responded to appropriately. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 15 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): 19,20, 21, 25, 26 The residents do not live in a well maintained, comfortable and homely indoor and outdoor environment which reduces their quality of life as well as their safety. The home is not being maintained in a clean and hygienic condition to ensure quality of life for the residents. EVIDENCE: The review of the environmental standards focused on issues raised at the last inspection and a full inspection of the environment was therefore not carried out during this inspection. Since the last inspection the dining room carpet has been removed and replaced by a hard floor non-slip surface. Whilst this has reduced the problems in regard to keeping the floor clean, it has made the dining area look less homely. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 16 A risk assessment of the garden with an action plan was forwarded to the Commission in regard to the concerns raised at the last inspection on the paths, slabs, overflowing bins and untidiness. Not all actions as identified have been addressed, the manager acknowledged that there are still some works to be done and advised plans were in process to address these. During a brief tour of the home it was noted that face cloths and towels were not available in all of the rooms. These had been collected by staff for washing and staff confirmed they are not normally replaced until the afternoon. It was established from viewing the laundry that there are minimal supplies of these items in the home preventing staff from replacing these immediately when the dirty ones are removed. The manager stated that broken furniture in bedrooms had been replaced. This will be fully evaluated at the next inspection to the home. The lighting in the main lounge was found to be sufficient on the day of inspection but it was noted that in various other areas of the home it was not. Energy saving bulbs are being used in the home which take time to reach their full light potential which could impact on the safety of the residents including potential fall risks. Bedrooms and a shower room were noted to have dim lighting. The manager said this was currently being addressed in the shower room. The manager also confirmed that the plain glass window in the bathroom had now been covered with a frosted coating to maintain privacy and dignity for the residents. Radiators observed during the inspection had covers to prevent any burn risks to residents. The manager said that all radiators had now been fitted with covers. An unpleasant odour was noted in the lounge and it was also noted that the carpet is marked and stained in areas. One of the bedrooms also had an unpleasant odour as well as a stained chair seat. A cushion on one of the chairs was stained and dirty and a pillow that was to be used to support a residents legs contained yellow stains. One of the seat cushions on a chair rocked when sitting on it and this was removed by a member of staff during the inspection to prevent any fall risks to residents. Many of the cushions on the chairs in the dining room were stained and dirty and some of the chairs were of a small wooden type with spindle type legs which are not sufficiently sturdy to support some residents safely. The nets at the windows in the lounge were noted to be snagged, dirty and yellowing. Skirting boards around the home were noted to be paint chipped. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 17 During the inspection it was noted that residents are continually smoking in the dining area in between meals. Ventilation in this area is not fully effective in eradicating the odour of smoke and the manager stated that this was in the process of being reviewed with the owner. The kitchen area was briefly viewed and a wet cloth was seen on the floor around the dishwasher. A member of staff confirmed that the dishwasher had been leaking and was awaiting repair. The kitchen cupboard above the microwave was dirty and the edging strip was chipped and stained. The paper towels were noted to be above the cutlery tray which would result in drips from staff hands falling into the tray which is not hygienic. The laundry and sluice area was viewed. The two washing machines were in use and there are usually two driers in use but on the day of inspection only one drier was operational. Staff stated that both of the driers had broken down at the same time and they had managed to replace one of them but were awaiting delivery of a second one. Since the last inspection the manager has been auditing the sluice area to ensure effective hygiene procedures are being followed. There is now hot water to the sluice area and racks have been fitted to the wall for the storage of commode pots for effective drying. The waste bins in the garden area of the home were noted to be overflowing and there were various black bags on the floor near to the bins. The manager said that the bins were due to be emptied on the day of inspection. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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, 30 Further work is required to enable the home to demonstrate there are sufficient staff available to meet the needs of the residents as well as provide effective services within the home. EVIDENCE: On the day of inspection there were 19 residents in the home. A resident spoken to said that staffing in the home was “alright” and staff did respond when they used the call bell. Another resident said that staff were “very very kind”. One resident said that their call bell “is not always answered” and at night the staff “don’t even check what is going on”. Another resident said that “staff sometimes don’t come” when they used the call bell and said that staff are “alright”. The manager confirmed that they aim to have three carers on duty during the day and two waking night staff in addition to herself who works in a supernumerary capacity. The home meets with the Department of Health recommended staffing guidelines providing the carers are dedicated to caring duties only. On viewing duty rotas it was established that the three carers on duty during the day are not just doing caring duties but also help with laundry and kitchen duties. The duty rotas were not clear in confirming which staff are doing laundry and kitchen duties. A laundry person is available for three days per week and carers do this on the other days. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 19 The manager advised that catering staff finish their duties at 1pm which means carers are involved in prepare and serving tea. The hours of one of the cooks are not being clearly indicated on the duty rota so that the precise hours being provided can be confirmed. On the four week rota seen, one member of staff is rostered to work an early shift followed by a night shift which is not considered good practice due to the long hours and the impact this could have them remaining effective. The hours being worked by the manager are not being recorded on the duty rota consistently to demonstrate the supernumerary hours being worked. The manager confirmed that she had worked over and above her supernumerary hours on occasions when staff were not available to cover sickness or absences. Other than this the manager said that she was managing to cover the shifts sufficiently. Two new staff who had commenced at the home had not completed an induction in accordance with the National Training Organisation standards. Advice was given in regard to this matter. The manager agreed to devise an at-a-glance training schedule to confirm other training completed by staff. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 20 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, 32, 33, 36, 37, 38 The home is run and managed by a person who is able to discharge her responsibilities but who has not yet completed the registration process with the Commission. Further work is required to demonstrate that the residents benefit from the ethos, leadership and management approach of the home and to show that the home is being run in their best interests to promote quality of life. Further work is required to ensure all staff are being appropriately supervised. Some actions are required in regard to record keeping to demonstrate residents rights and best interests are being supported. Health and safety matters have not been fully addressed to ensure the safety and welfare of the residents and staff. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 21 EVIDENCE: The present manager has been in post since March 2005 but she has not been registered to-date with the Commission. The manager was advised that her application must be completed and forwarded to the Commission promptly to enable the registration process to commence. It was not evident that there has been any action taken since the last inspection in regard to pursuing resident and family consultation on how the home is managed. The manager is aware that records must be maintained to confirm this. The manager advised that a series of quality audit surveys are being used to measure the quality of service and care provided. Blank copies of these were seen but completed copies and outcomes of these were not available to confirm who they had been sent to and actions taken as a result of these. Regular meetings with residents and families do not take place to discuss any ongoing issues relating to the home. It was evident in discussions with residents that there are elements of their care and the service being provided that they are satisfied with but there are others than they are less satisfied with. One resident spoken to said that the food was very good and they ate it all the time, they stated they could have breakfast in their room if they wished and they enjoyed having their hair done. This resident enjoyed visits from their family but acknowledged their limited mobility meant there were restrictions on what they could and could not do in the home. Another resident said that the food was alright but they had to force themselves to eat so they could keep their health. This resident said that they sometimes played bingo but they found this difficult because they could not see very well. One resident acknowledged the difficulty in communicating with some of the residents and stated they tended to stay in one area of the home with people they could talk to. Since the last inspection, the manager has commenced formal supervision sessions with staff and records are being maintained of meetings and appraisals held. The manager confirmed that there are still some staff who need to be seen. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 22 The inspection process confirmed that there is still further work required in regard to record keeping within the home. Details of those records requiring attention are detailed in each section as appropriate within this report. Since the last inspection the manager has instigated fire safety checks. Records were seen of checks made on door guards and emergency lighting. During the inspection it was noted that one of the door guards was continuously bleeping as the batteries needed to be changed. Staff confirmed that this happens regularly which could disturb residents when sleeping. Action was taken during the inspection to purchase some batteries to attend to the door guard. Actions have also been taken since the last inspection to monitor hot water temperatures to ensure these are not too hot to present a scald risk to residents. Some of the records showed that valves had been adjusted but did not show the water temperature. The manager agreed to address this matter. Water outlets in areas vacant for more than seven days are being flushed and records maintained. It was noted during the inspection that door wedges are being used in some areas of the home which do not meet with fire precautions. The manager advised that statutory training is being addressed on an ongoing basis. Most staff had completed moving and handling training and the manager stated there were three staff who still needed to complete this. Food hygiene and infection control and fire training is still to be completed by some staff. Electrical portable appliance testing was carried out on 21 December 2005 and records confirmed all items had passed. A concern was raised with the inspector that wheelchairs are not being maintained. A wheelchair viewed in the lounge did not contain footplates and it was established that a resident who tends to drag their feet on the floor when using a wheelchair did not have a risk assessment in place to ensure they could be transported safely. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 1 3 2 X X X 2 1 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 2 2 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 24 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 OP4 OP8 Regulation 12 18 Requirement The manager must ensure that the staff have received suitable training in specialist areas to enable staff to meet the needs of the residents effectively. The manager is to confirm a training plan for staff. (Issue only part met from June 05 inspection) Care plans must show how a residents needs in respect of their health and welfare are to be met. To ensure this can be done effectively the following must be addressed. Records held on care plan files must be dated. Care plans must be maintained for residents with pressure damaged/ulcerated skin. Falls risk assessments must be completed accurately in terms of identifying changes. Residents personal hygiene must be maintained effectively. Staff Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 25 Timescale for action 30/04/06 2 OP7OP37 12 15 30/04/06 are to monitor those residents who manage their own personal hygiene to ensure this is being carried out effectively. The manager is to review the nutritional assessment for the home to ensure this includes the detailed recording of food and fluid intake to establish an accurate picture of nutritional intake and regular weighing of residents as appropriate. The manager is to confirm that the review of care plans has been completed. Each care plan document must demonstrate a residents care needs and staff actions required to meet these needs. Records are to confirm care carried out as well as changes in a residents physical and mental health. (Issue outstanding from June 05 inspection) Prescribed creams in use within the home must contain named labels and only be used for the person they have been prescribed for. The registered person shall having regard to the size of the care home and the number and needs of residents consult residents about their social interests and make arrangements to enable them to engage in local, social and community activities. A programme of activities is to be arranged following resident consultation which considers the needs and capacities of the residents as appropriate. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 26 3 OP9 13 30/04/06 4 OP12 16,12 31/05/06 A copy of an activity schedule is to be forwarded to the Commission. (Outstanding issue from June 05 inspection) The manager must ensure that those residents without relatives/friends are able to maintain contact with the local community such as arranging outings to maintain their quality of life. (Outstanding issue from June 05 inspection) 6 OP16OP37 22 The complaints procedure is to be reviewed to contain the correct name of the Commission and contact details. The home must be kept in a good state of repair both internally and externally. The manager is to advise a date for all actions as identified on the Risk Assessment for the garden area to be addressed to ensure the safety of the residents. All chairs available to residents are to be checked to ensure they are sturdy and safe for resident use and are clean. The manager is to confirm actions to address the worn and dirty nets at the lounge windows. 8 OP21 23 (1) (2) The manager must ensure there are sufficient washing and drying facilities for residents. The manager is to review the availability of face cloths and handtowels. 30/04/06 31/05/06 5 OP13 16 30/05/06 7 OP19 13,23 30/06/06 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 27 The manager is to address lighting in bathrooms and confirm a date to address the stained flooring as identified in the shower room. (Issue from June 05 inspection). 9 OP21 23(2) 13 The manager is to confirm that arrangements have been made for the bath hoist in room 34 to be serviced to ensure this is safe for residents to use. The manager is to confirm actions to address suitable ventilation in the dining area. 30/04/06 10 OP25 23 30/04/06 11 OP25 13(4) 23(2)(p) Lighting in the home must be 30/04/06 suitable for the residents. The manager is to undertake an audit of all resident areas to ensure lighting is sufficiently bright to maintain their safety. A copy of this audit is to be forwarded to the Commission. (Issue outstanding from June 05 inspection) 12 OP26 16 Satisfactory standards of hygiene must be maintained in the home. The manager is to check all chairs, pillows and equipment used by residents to ensure these are clean. Systems are to be introduced to ensure these are regularly checked and cleaned as appropriate. The unpleasant odours identified in the lounge and one bedroom are to be eradicated. The marked and stained carpet in the lounge is to be cleaned or a date for replacement 30/04/06 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 28 confirmed. The kitchen cupboard is to be cleaned and any chipped edging strips replaced. The location of the cutlery tray or paper towel holder is to be reviewed to ensure hygiene can be maintained. 13 OP27OP37 17,18 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered provider and manager must ensure that there are sufficient staff on duty to carry out all the necessary tasks such as cleaning, laundering and caring for the residents. Duty rotas must demonstrate that staff are available to undertake the laundry each day. Duty rotas are to indicate any care staff undertaking kitchen duties in the afternoon. (Above issues outstanding from June 05 inspection). The manager is to forward a copy of the homes policy in regard to unplanned sickness and absence of staff which demonstrates how staff cover will be maintained. Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 29 31/05/06 The shift times of the manager need to be indicated on the rota to demonstrate supernumerary hours worked. A review of staff working an early shift followed by a night shift is to be undertaken. (Staff must be able to remain effective throughout their shifts). 14 OP30 18 Staff must be suitably trained to carry out their role effectively. The manager is to review the staff induction programme using the National Training Organisation standards as guidance. 15 OP31 7,9,10 The manager is to pursue registration with the Commission with Immediate effect. The manager must ensure that the residents, their families and the staff are involved and consulted in changes that are occuring in the home. Records must be maintained. 26/03/06 31/05/06 16 OP32 12,24 30/06/06 17 OP33 24 The registered provider and 30/06/06 manager must be able to demonstrate that a complete quality assurance and monitoring system is in place and that results from audits and surveys inform changes in practice and provision. (Outstanding from June 05 inspection). All staff must be appropriately supervised. The manager is to confirm that all staff have now received formal supervision. 31/05/06 18 OP36 18 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 30 (Issue only part met from June 05 inspection). 19 OP38 12,13,23 The manager is to audit call bell responses to ensure residents are being attended to by staff in a timely manner. The manager must ensure that door guard batteries are changed promptly when they run out to ensure fire precautions can be maintained. The manager is to ensure that water temperatures are actually recorded on each water check carried out to confirm these are operating within safe levels. The manager is to review the practice of using door wedges as these do not meet with fire precautions. An up-to-date training schedule is to be forwarded which confirms statutory training has been completed for all staff. The manager is to establish which residents use wheelchairs and ensure the wheelchair avaiable for them is is both suitable and contains footplates. Any resident transported without footplates must have a suitable risk assessment in place demonstrating how they are to be transported safely. 30/04/06 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 31 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 OP9 OP12 Good Practice Recommendations It is recommended that the home implement a suitable homely remedies policy and procedure. It is advised that the home develop a suitable recording system for resident participation in social activities to show which residents have participated or refused activities as appropriate. The manager is requested to confirm a date for the dishwasher to be repaired so that this is not leaking onto the kitchen floor. It is recommended that an assessment of the suitability of the managers office in line with Health and Safety at Work is carried out and if required a more suitable space is found. The manager is requested to confirm a date for the second drier to be available in the laundry. The manager is requested to confirm arrangements in place for cleaning and servicing wheelchairs to ensure they are safe to use for residents. The manager is advised to review the refuse collection for the home to ensure bins provided are sufficient for the volume of waste created by the home. A schedule of supervision dates for staff should be devised to demonstrate that each member of staff will receive this six times per year. It is advised that a sufficient supply of batteries are kept in the home to ensure door guard batteries can be changed promptly when they run out. 3 OP19 4 OP19 5 6 OP26 OP26OP38 7 OP26 8 OP36 9 OP38 Minster Lodge Residential Care Home DS0000050158.V285917.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Coventry Area Office 5th Floor Coventry Point Market Way Coventry West Midlands CV1 1EB 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. 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