Inspection on 11/10/06 for Aspen Lodge Care Home

This inspection was carried out on 11th October 2006.

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

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

Other inspections for this house

Aspen Lodge Care Home 07/05/09

Aspen Lodge Care Home 26/11/08

Aspen Lodge Care Home 13/09/07

Aspen Lodge Care Home 21/02/07

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Weston Lodge 222 Weston Lane Weston Southampton Hampshire SO19 9HL Lead Inspector Janet Ktomi Unannounced Inspection 11th October 2006 10:00 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 Weston Lodge DS0000066715.V307787.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. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weston Lodge Address 222 Weston Lane Weston Southampton Hampshire SO19 9HL 023 80 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) Aspen Care Ltd Mrs Sandra Bedwell Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number disorder, excluding learning disability or of places dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Old age, not falling within any other category (13), Physical disability (2), Physical disability over 65 years of age (2) Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users in the categories DE, MD and PD must be at least 55 years of age. A maximum of two service users in the categories PD and PD(E) are to be accommodated at any one time. New service Date of last inspection Brief Description of the Service: Weston lodge is a registered home providing care and support for up to thirteen older people. The home is situated in Weston, close to a park and local shops. Public transport bus stops are located nearby. The property is an extended older detached house with car parking to the front and a patio and large garden to the rear. Although registered for people with a physical disability the home does not have level or ramped access to the front or rear of the property. The home provides private accommodation in thirteen single bedrooms (one en-suite), some on the ground floor and others on the first floor accessible via a shaft lift. Bathrooms and WCs are located around the home. The home was purchased in March 2006 by Aspen Care Ltd, responsible individual being Mr C S Meepegama and is managed by registered manager Mrs Sandra Bedwell. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 11th October 2006. This was the first inspection of a new service registered in March 2006 and all core and a number of additional standards were assessed. The inspector would like to thank the people who live at the home and the staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately eight and a half hours commencing at 10.00 a.m. and being completed at 6.30 p.m. The inspector was able to spend time with the registered manager and care staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and service users. Prior to the visit a preinspection questionnaire was sent to the home. External professional questionnaires were sent to people identified in the pre-inspection questionnaire as having regular contact with the home. Comment cards were returned from one GP and two visiting nursing professionals. Service user and relative comment cards were sent to the home. Two service user and four relative responses were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to all the service users and a visitor. What the service does well: The home is small, providing a service for a maximum of thirteen people. Therefore staff know service users well and aim to meet needs in an individual way. The home has a consistent staff team many of whom have worked at the home for a number of years. Service users stated that staff are kind and helpful. The home provides a varied and individual menu. Service users stated they liked the food provided at the home. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although the inspector found positive aspects of the service the following requirements are made following this inspection. The statement of purpose and service users’ guide must be reviewed and only factually accurate information included in these documents. The home should consider how this information may be provided in alternative formats suitable for people for whom normal size print English is inappropriate. All service users must be provided with a contract. Service users cannot be assured that their needs will be fully met at the home as their needs may not be identified pre-admission, they do not all have a care plan and staff have not been appropriately recruited, inducted or undertaken mandatory or specialist training. All service users must be fully assessed prior to moving into the home and the manager must ensure that their needs can be met by the facilities provided and staff training. Prospective service users and their relatives have an opportunity to visit the home to assess the suitability of the facilities, however only suitable private accommodation should be offered. The home must ensure that service users’ health care needs are fully met by identifying health needs during the pre-admission assessment, care plans must state how these needs will be met and records must be maintained of contact with health professionals. Care staff must receive adequate training to meet service users’ general and specific health care needs. All information as specified in Schedule 3 of the Care Homes Regulations 2001must be held in the care home. The home cannot demonstrate that service users are protected from abuse. Staff must not commence working in the home until all the required preemployment checks have been carried out. Staff and the manager must receive adult protection and managing challenging behaviour training. Since purchasing the home the proprietor has commenced a programme of redecoration and refurbishment. This work is continuing. Additional requirements are made in connection with the environment where it is unsafe for service users and staff. External grounds that are suitable, and safe, for use by service users must be provided. Broken furniture must be removed. The uneven patio surface must Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 7 be resolved and the pipe extending through the patio must be made safe. Access to the garden for people must be made safe and access for people in wheelchairs provided. The service users’ guide must make it clear to potential service users that they will only be allowed to smoke in designated areas. Used continence pads must be removed from bathrooms immediately. Bathrooms must not smell offensive. The home must ensure that all equipment is serviced and maintained. The hoist and bath hoist must be serviced and the bath hoist chair replaced. The provider must explore options such that lounge and dining room doors may be fitted with automatic closure devises so that they may be held open most of the time and close in the event of a fire. The home must ensure that bedroom radiators may be individually controlled to ensure service users have a comfortable temperature in their bedrooms. Service users must only be admitted to bedrooms that meet their individual needs. The practice of placing soiled items for washing on the floor of the laundry room must stop. The laundry floor must be impermeable and along with wall finishes must be readily washable. Care staff must have infection control training. The home must review staffing levels and ensure that at all times adequate numbers of care and support staff are provided. The home must ensure that it obtains information about the common induction standards and that these are implemented in the home. The home must undertake a training needs audit and provide a copy of its training plan, including dates and training provider information to the commission. Training must cover all mandatory training and additional specific training relevant to ensure that service users needs are being met. The home must ensure adequate recruitment procedures are carried out to ensure that only suitable people are employed at the home. The manager does not have an NVQ level 4 in care or a Registered Manager’s Award. The proprietor is new to the care business having not previously owned a care home. It is the inspector’s opinion that the manager and proprietor do not between them have the necessary skills and knowledge to adequately manage the service and move it forward. The proprietor must consider how management consultancy can be provided for the home whilst the manager and proprietor gain the necessary qualifications and knowledge. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 8 The home must decide how quality monitoring can be achieved in the home and ensure that the results of quality assurance audits are included in the homes annual development plan. The standard of record keeping in the home must be improved. Throughout this report the inspector has identified significant concerns in respect of the health and safety of service users and staff and the inspector does not consider that the home provides a safe place for service users or staff. 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. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 9 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 Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4 and 5. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The statement of purpose and service users’ guide require reviewing to ensure that accurate information is provided. All service users must be provided with a contract/statement of terms and conditions of occupancy. New service users have not been fully assessed prior to moving into the home. Service users cannot be assured that their needs will be fully met at the home as their needs may not be identified prior to moving into the home and staff have not been appropriately recruited, inducted or undertaken mandatory or specialist training. Prospective service users and their relatives have an opportunity to visit the home to assess the suitability of the facilities, however only suitable private accommodation should be offered. The home does not provide Intermediate care therefore standard 6 is not applicable to this service. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has a statement of purpose and service users’ guide, copies of which were provided to the inspector. The manager stated that copies have been provided to all service users. Although written in March 2006 when the new owners purchased the home the document refers to the National Care Standards Commission, and should state Commission for Social Care Inspection. The registered provider for the home is Aspen Care Ltd with responsible Individual Mr C Meepegama, the address for Aspen Care Ltd is in Middlesex although in the statement of purpose Aspen Care Ltd is not listed. Other important factual inaccuracies were noted in the statement of purpose which must be reviewed and only contain factually accurate information. Factual inaccuracies were also noted in the service users’ guide which must also be reviewed and only contain factually accurate information. The service users’ guide contains a sample contract. The information within this would all appear appropriate, although it should be amended to reflect that the home is registered with the Commission for Social Care Inspection and not the local Social Services/Health authority. The home has admitted two new people to the home since March 2006 when Aspen Care Ltd purchased the home. There was no evidence that either of these people had been provided with a contract. Comment cards were received from two service users (not the same two as had been admitted since March 06) and these also stated that they had not received a contract. The manager could not provide the inspector with any evidence that any of the people living at the home had been provided with a contract by the new provider. All service users must be provided with a contract stating the terms and conditions of their residency. The home has admitted two new people since March 2006 when Aspen Care Ltd purchased the home. The records for these people were viewed. One service user was admitted for respite care, there was no evidence of a preadmission assessment having been undertaken for this person. There was also no evidence that the home had received information from the service user’s care manager in the form of a summary of the care management assessment and a copy of the care plan produced for care management purposes. The records for the second person admitted were also incomplete. There was no information about previous medical history on the pre-admission assessment form that had only partly been completed. No risk assessments had been undertaken although the manager and care staff identified that the service user was unable to walk and required a wheelchair. The inspector viewed the room occupied by this service user. There is one step into this room that Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 12 makes it unsuitable for a person who is dependant on a wheelchair. No care plans or risk assessments had been completed for either of the people admitted since the home was purchased by Aspen Care Ltd. During the inspector’s visit there were discussions concerning a potential new service user. The manager had not yet undertaken an assessment on the service user, although it appeared from discussions that a place had been offered to this person by the provider to the service users care manager. New service users must only be admitted on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. As previously mentioned a service user who was unable to walk and uses a wheelchair at all times had been admitted to a room that has one step immediately inside the door to the room. This represents a risk to the service user and to staff. The manager was aware of the problem but had not acted to resolve the issue. The home also does not have wheelchair access (ramp or level access) either at the front door or to the garden. The home is registered for up to two people who have a physical disability and must consider how the needs of people in these categories can be met by providing ramped or level access to the home and garden. There was no evidence that staff have received any training since the new owners purchased the home. Service users have various needs including dementia and mental health needs, the potential new service user having a learning disability and problems associated with old age. Comment cards received from external professionals stated that staff did not demonstrate a clear understanding of the care needs of service users. The home therefore is unable to demonstrate that it can meet the needs of people admitted to the home. The home must ensure it is able to meet the needs of people admitted to the home. The service users’ guide contains information about the home’s admission process and states that service users are able to visit the home prior to moving into the home. Care staff confirmed that the relative of one of the people admitted into the home since March 06 had visited the home. The service user had been unable to visit as she was in hospital. The relative had been shown a number of rooms and selected the one now occupied by the service user. Whilst this is noted as good practice the room selected is unsuitable for the service user who is a wheelchair user. The home must be clear during service users’ or relatives’ visits as to what facilities the home has to offer depending on the service user’s needs. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. All service users do not have a care plan, stating how their health, social and personal care needs will be met. Risk assessments have not been undertaken for all service users. The home does not maintain full records of health professional visits. Medication administration records were not fully completed. Care staff have not received induction, mandatory or specific training to enable them to appropriately meet service users health or personal care needs. Service users feel they are treated with respect and their rights to privacy are upheld. EVIDENCE: As previously stated the home has admitted two people since the new owners purchased the home. Neither of these people had had a care plan or risk assessments completed and the pre-admission assessments had not been completed to enable a care plan to be written. All service users must have a care plan stating how their health, social and personal care needs should be Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 14 met. All other service users were noted to have care plans that were updated monthly by their key workers. Service users or their relatives had signed to confirm their agreement of care plans. The home has a range of risk assessments that had been completed for existing service users but not the people admitted since March 06. Risk assessments must be completed for all service users. As previously stated care staff have not received training to meet service users general or specific personal care needs. Care staff have not undertaken manual handling or infection control training. There is no evidence that new staff undertake adequate induction training in line with the Skills for Care common induction standards. Service users confirmed to the inspector that the home would arrange for a doctor to visit if they requested this. Two service user comment cards were received prior to the inspectors visit and both stated that they received the medical care they required. A comment card was received from one GP who stated that he was satisfied with the overall care provided at the home. Comment cards were also received from two nursing professionals who regularly visit the home. These were less positive and stated that staff did not always demonstrate a clear understanding of the care needs of service users. As previously stated the pre-admission assessments were not fully completed for the two people admitted since March 06 and there was no information available about the past medical history of these people. These people did not have care plans and therefore no information as to how health needs should be met. The manager showed the inspector the system for recording appointments and visits from medical professionals. Recording sheets are held with care plans etc. in the kitchen and should be completed whenever health professionals visit a service user. However these had not been regularly completed. The manager discussed this with a member of care staff who had been working at the home for a number of months and she appeared unaware of the forms. Medical appointments are recorded in daily records however it might prove difficult and time consuming to check through months of daily records to identify previous medical visits and treatment prescribed. There was evidence that service users are supported to attend dental and optician appointments in the form of taxi receipts seen when examining service users’ invoices and personal money records. A chiropodist visits the home and service users are invoiced for this service. Care staff, the manager and the proprietor confirmed that care staff had not received any training since the home was purchased in March 2006. Care staff have not had manual handling, infection control, first aid, food hygiene or health and safety training. Some of the people who live at the home have challenging behaviour associated with their dementia or mental health needs. Staff have not received training to enable them to understand and meet these specialist needs. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 15 The home must ensure that service users’ health care needs are fully met by identifying health needs during the pre-admission assessment, care plans must state how these needs will be met and records must be maintained of contact with health professionals. Care staff must receive adequate training to meet service users’ personal and health care needs. The arrangements for the management of medication within the home were assessed. All medication is administered by care staff. However, from discussions with the manager, only one would appear to have undertaken accredited medications training, the others having been shown what to do by the manager. Medication was seen to be stored appropriately with the home using a blister pack, pre-dispensed system. This is an appropriate system to use, however the inspector was concerned that the manager had to remove tablets from a blister pack when the medical opinion required a reduction in one service user’s medication part way through a month. This could constitute secondary dispensing and might result in tablets being lost from the opened back of the pack. It is recommended that the manager discuss this with the pharmacist to determine how this could be better managed as changes to this particular medication are likely to occur midway through a blister pack. Medication is booked into the home on its arrival. The medication administration records were viewed. The Medication Administration records were seen to contain a number of gaps where there was no indication as to whether a medication had been administered or not. If a medication is not administered then the relevant code letter as detailed on the MAR should be used. Gaps must not be left in Medication Administration Sheets. The inspector was able to speak with all the people who live at the home. They confirmed that care staff are pleasant and friendly. All bedrooms are for single occupancy therefore providing a high level of privacy during personal care tasks. Comment cards from visiting professionals and relatives/visitors confirmed that they are able to see people in private. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Care staff aim to provide activities but this is not always possible due to other demands on their time. Visitors are welcomed at the home with residents having as much control over their lives as possible. Residents told the inspector that the food in the home is generally very good, however all staff preparing food for service users must have a Food Hygiene certificate. EVIDENCE: Comment cards received from two of the ten service users stated that there are activities arranged by the home. Discussions with service users indicated that activities do occur but not everyday. The manager showed the inspector a plan of activities and list of equipment the home is to purchase to provide a greater range of activities for service users. All activities are provided by the care staff who aim to provide something in the morning and afternoon. Care staff stated that this is not always possible as they have to cover cleaning Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 17 duties on four mornings per week when a cleaner is not provided at the home. Discussions with afternoon staff indicated that they do not always have time to undertake activities. Activities are recorded in daily records. The inspector viewed individual daily records and these indicated that on some days activities are provided whilst on others they are not. It is important that care staff have time to spend with service users, talking or reading and this should be seen as part of a service user’s care planning and recorded as an activity. Activities must be seen as an essential part of service users’ daily routines and not as something to be done when and if there is time. The home has a large pleasant rear garden. The access is via patio doors from the lounge. The inspector noted that these doors have to be stepped over and wheelchair access could prove difficult. The inspector walked around the patio and noted that the surface is uneven with a trip hazard of a pipe emerging about three inches from the surface in the centre of the patio. Broken furniture was noted on the patio area which would present a real danger to service users if they tried to sit on it. Broken furniture must be removed from the patio and the patio made safe for service users to enjoy. The home is located opposite a public park, however there was no evidence of service users having used this facility. Service users must have access to the outside should they wish to do so. The inspector was able to talk with one visitor to the home. He confirmed that he was a regular visitor to the home and that although he was visiting his wife in the lounge he could see her in her bedroom in private if they wished to do so. Comment cards were received from four relatives who all confirmed they could visit their relative in private if they wished. Comment cards received from service users confirmed that staff listen and act on what they say. One stating ‘if I want to listen to music they put my discs on and give me a cigarette when I want it’. During the inspector’s visit to the home afternoon staff were observed asking all service users what they wanted for tea, the inspector saw the completed list which contained almost as many choices as there were service users. It would appear that they could have whatever they wanted, most had chosen sandwiches with a variety of fillings whist a few had requested a hot option which the inspector saw being prepared. Service users confirmed that they could sit where they wanted in the lounge or spend time in their rooms. Service users confirmed to the inspector that they are given choices and that these are respected and acted upon by staff. Service users informed the inspector that they were happy with the meals provided at the home. On the day of the unannounced visit the main lunchtime meal being roast chicken with potatoes and vegetables. The home employs a cook six days per week. The cook is also responsible for the food shopping and informed the inspector that she is able to spend whatever she likes to provide the meals requested by service users. The home does have a menu plan, Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 18 which was seen by the inspector, however the cook will vary this depending on the wishes of the service users. The cook stated that where possible fresh fruit and vegetables are provided with supplies seen in the home. Throughout the day service users were seen being offered and provided with hot and cold drinks. The home has a good sized dining room with space for all service users to eat. Care staff confirmed that they encourage service users to eat lunch and evening meals in the dining room. On Sundays the home does not have a cook and care staff prepare meals as they do the evening meal every day of the week. Care staff must undertake food hygiene training if they prepare meals for service users. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. Service users or their relatives are able to complain if they are unhappy with the service received at the home. The home cannot demonstrate that service users are protected from abuse. Staff must not commence working in the home until all the required preemployment checks have been carried out. Staff and the manager must receive adult protection and managing challenging behaviour training. EVIDENCE: Comment cards from service users indicated that one was sometimes aware of how to make a complaint and the other stated that he/she would ‘speak to the staff, then the manager who is called Sandra’. Discussions with service users during the inspector’s visit indicated that they had no complaints or concerns and that they would probably say something to a member of care staff. None could recall having being provided with the home’s complaints procedure however this may due to age related memory loss. The complaints procedure is included within the service users’ guide that the manager stated has been provided to all service users. Relatives stated that if they had concerns they would probably say something to a member of staff or the manager if it was serious. Care staff stated that they would try to sort out a complaint if they could and if not would pass it onto the manager for her to resolve. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 20 The inspector discussed the home’s adult protection procedure with care staff and the manager. The manager could not locate a copy of the Hampshire Inter-Agency Adult Protection Procedure although she stated that the home did have a copy. In discussion with care staff they stated that they would inform the manager if they had any concerns that might indicate that a service user was being abused. Care staff have not undertaken any training in the protection of vulnerable adults. The manager did not identify the correct course of action that she should take in the event of a suspicion of adult abuse. It was noted in service users’ daily records that one service had informed the manager that morning that she had been physically assaulted by a member of care staff. The manager had not informed social services of this and intended to discuss it with the service user’s community nurse the following day. The inspector reminded the manager of the necessary action she should undertake. The home’s recruitment procedures are inadequate to ensure that unsuitable people do not work in the home. The inspector viewed the records for the three people recruited since March 2006. The first contained two references that stated ‘to whom it may concern’. There was no evidence in the file that the home had sought these references, but had been provided with them by the applicant. The home must satisfy itself as to the authenticity of the references. Later during the inspection the manager informed the inspector that she had spoken with the carer concerned and would be sending to the people named on her application form for references. There was also no evidence that the home had received written confirmation of a clear POVA list check before people commence working in the home. The manager stated that she telephones the umbrella agency who inform her verbally that a clear POVA has been received but that she has no proof of this. The second applicant had only listed one reference on his application form and had only one reference in his personal file. Again a CRB had been requested but the staff member had commenced work at the home prior to any written confirmation of clear POVA first check being received. The third person to be employed had also only provided one reference and had commenced working at the home the week prior to the inspector’s visit. The manager showed the inspector the completed CRB form with cheque ready to send to the umbrella organisation. The home must not commence people working in the home until all the necessary recruitment checks have been complied with as stated in Schedule 2 of the Care Homes Regulations 2001. The inspector was also informed that the proprietor had arranged for two painters/decorators to stay in the home’s empty bedrooms whilst they were undertaking work at the home. The manager stated that no risk assessments had been completed in respect of the decorating work or that two decorators were living at the home. The manager had no information as to the vetting procedures that had occurred for these workers. These workers had access to all areas of the home and to service users. The manager and proprietor must ensure that risk assessments are completed in respect of all work being carried Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 21 out at the home and consideration given to the checks undertaken on people working in the home in line with the CSCI guidance document Safe and Sound. The manager and care staff informed the inspector that some of the people living at the home have challenging behaviour and may be physically abusive towards staff and each other. One service user’s daily record stated that a service user had physically assaulted a member of night care staff. No staff have received challenging behaviour training to help them respond appropriately when they are presented with challenging behaviour. This places service users at risk of abuse by care staff unable to deal appropriately with abuse from service users’ behaviour. The manager explained the home’s procedures for managing service users’ personal finances. These would generally appear appropriate with the home only becoming involved in service users’ personal finances to a limited extent. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 22 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, 22, 23, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. Since purchasing the home the proprietor has commenced a programme of redecoration and refurbishment. This work is continuing. Additional requirements are made in connection with the environment where it is unsafe for service users and staff. External grounds that are suitable, and safe, for use by service users must be provided. Broken furniture must be removed. The uneven patio surface must be resolved and the pipe extending through the patio must be made safe. Access to the garden for people must be made safe. The service users’ guide must make it clear to potential service users that they will only be allowed to smoke in designated areas. Used continence pads must be removed from bathrooms as soon as possible. Bathrooms must not smell offensive. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 23 The home must ensure that all equipment at the home is serviced and maintained. The hoist and bath hoist must be serviced and the bath hoist chair replaced. The provider must explore options such that lounge and dining room doors may be fitted with automatic closure devises so that they may be held open most of the time and close in the event of a fire. The home must ensure that bedroom radiators may be individually controlled to ensure service users have a comfortable temperature in their bedrooms. Service users must only be admitted to bedrooms that meet their individual needs. The practice of placing soiled items for washing on the floor of the laundry room must stop. The laundry floor must be impermeable and these and wall finishes must be readily washable. Care staff must have infection control training. EVIDENCE: The home is situated in a residential area of Southampton, close to a public park and with bus links to other areas of Southampton. The home is an extended detached house with a large garden to the rear and parking to the front. The new owner has commenced a programme of redecoration and refurbishment. Requirements in respect of this are therefore not made as it is acknowledged that work is continuing. However the proprietor must be mindful of adult protection concerns in connection with contractors and people employed by him to undertake work at the home. The inspector noted that items had been left in a corridor space outside the office and a service users bedroom. These consisted of a bookcase, portable TV, duvet, and cardboard box containing other items. Items awaiting removal must not be left in corridors. These items would also further hamper staff trying to manoeuvre the wheelchair of the service user whose bedroom they were located outside. From discussions with staff it would appear that these items had been in the corridor for a number of days. The home has a good sized dining room with seating available for all service users. The home also has a lounge to the rear of the home that opens onto the patio and gardens via patio doors. The home has a small smoking area that service users must use when they wish to smoke. The service users guide must make it clear to potential service users that they will only be allowed to smoke in designated areas. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 24 The home has a large pleasant rear garden. The access is via patio doors from the lounge. The inspector noted that these doors have to be stepped over and wheelchair access could prove difficult. The inspector walked around the patio and noted that the surface is uneven with a trip hazard of a pipe emerging about three inches from the surface in the centre of the patio. Broken furniture was noted on the patio area which would present a real danger to service users if they tried to sit on it. Broken furniture must be removed from the patio and the patio made safe for service users to enjoy. The home is located opposite a public park, however there was no evidence of service users having used this facility. Service users must have access to the outside should they wish to do so. Lavatories and bathrooms are located around the home close to bedrooms and communal areas. The home has an assisted shower on the first floor and a bath with hoist on the ground floor. The ground floor bathroom has been retiled since the home was purchased by the new owner. The bath hoist must be replaced as the winding handle is broken and care staff informed the inspector that it is very hard to wind the handle when service users are sitting on the bath hoist. The plastic coating on the hoist chair has corroded and now presents sharp edges and a cross infection risk as this cannot be adequately cleaned between use by service users. The inspector is aware that further work on the bathroom is planned to place cupboard doors over the shelving. The bathroom was noted to contain large bins for yellow bag (clinical) waste. Care staff confirmed that they do not remove clinical waste immediately but it remains in the large bag until this is full. Care staff confirmed that this can become offensive smelling as also noted by the inspector during the visit to the service. Used continence pads must be removed from the home as soon as possible and must be removed from bathrooms immediately. Service users must not be expected to use offensive smelling bathrooms. The pre-inspection questionnaire completed by the proprietor did not state when the home’s hoist and bath hoist were last serviced. The manager informed the inspector that the home did not have a service contract for the hoists and she was unaware when they were last serviced. The home must ensure that all equipment is serviced and maintained. The inspector noted that the doors from the lounge and dining room cannot easily be opened by service users as they are heavy. The inspector saw service users struggling to open these doors on a number of occasions during the visit to the home. This effectively restricts service users’ freedom of movement around the home, inhibits independence and provides additional risks to service users. The provider must explore options such that doors may be fitted with automatic closure devices so that they may be held open most of the time and close in the event of a fire. The doors to the lounge and dining room also present risks to staff trying to open them whilst assisting service users or carrying trays of drinks or food. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 25 The proprietor is in the process of redecorating all the bedrooms and informed the inspector that once redecorated all carpets will be replaced with new carpets or equivalent floor coverings appropriate to service users needs. Requirements are therefore not made in respect of a number of the bedroom carpets. Some bedrooms had an offensive odour despite being regularly cleaned by care staff. Requirements are not made in connection with this as it is felt that the situation will be rectified with new floor covering more appropriate to the service user. As previously stated the home has admitted one service user who is wheelchair dependant into a bedroom which has a small step immediately inside the door. This presents a risk to staff and service users. The provider informed the inspector that the service user’s daughter had viewed the room and was happy with the presence of the step. However the service user’s daughter is not responsible for the safety of the service user or staff. Service users must only be admitted to bedrooms that are suitable for their needs. All bedrooms in the home are single, one with en-suite facilities. Bedrooms seen contained the appropriate furniture although one was noted not to have an armchair. The manager informed the inspector that the proprietor has arranged for new curtains to be made that will be fitted once the rooms have been redecorated and recarpeted. As part of the refurbishment programme all radiators in the home have been covered with radiator covers to prevent the risk of service users burning themselves should they fall onto hot surfaces. The inspector noted that some of the covers would allow the radiators in individual rooms to be individually controlled while others did not allow access to individual radiator controls. The home must ensure that bedroom radiators may be individually controlled to ensure service users have a comfortable temperature in their bedrooms. The home employs a cleaner three mornings per week for four hours, a total of twelve hours per week. Care staff informed the inspector that they undertake cleaning activities on other days. Care staff informed the inspector that they are unable to undertake activities or adequately supervise service users when they are undertaking cleaning tasks, especially when they have been instructed to move heavy items of furniture such as wardrobes to clean behind them. The home does not employ a laundry person although the statement of purpose states that it does. Laundry is done by care staff. On a number of occasions throughout the inspector’s visit the door to the laundry was noted to be open and soiled items placed directly on the floor. Care staff were observed placing soiled items into the washing machine and not washing their hands before leaving the laundry and going elsewhere in the home. The floor of the laundry room has a lino style surface however this does not extend to the edges of the room and is therefore not impermeable and wall finishes are not readily cleanable. The manager stated that the proprietor intends to enlarge the laundry room by removing a wall dividing the room in half. The practice of Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 26 placing soiled items for washing on the floor of the laundry room must stop. Care staff walk over this area and then into other parts of the home including the kitchen. The laundry floor must be impermeable and these and wall finishes must be readily washable. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 27 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. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The home must review staffing levels and ensure that at all times adequate numbers of care and support staff are provided. The home must ensure that it obtains information about the common induction standards and that these are implemented in the home. The home must undertake a training needs audit and provide a copy of its training plan, including dates and training provider information to the commission. Training must cover all mandatory training and additional specific training relevant to ensure that service users’ needs are being met. The home must ensure adequate recruitment procedures are carried out to ensure that only suitable people are employed at the home. EVIDENCE: Service users stated that staff were friendly and approachable and that they were generally available when required. Comment cards received from nursing professionals who regularly visit the home indicated that there was not always a senior member of staff available and that staff did not always demonstrate a good awareness of service users needs. Interactions between care staff and service users throughout the inspection were warm and friendly. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 28 Duty rotas were not provided with the pre-inspection questionnaire. These were viewed during the inspection along with the day book (diary) that records who actually worked in the home and anything specific which occurred. The home aims to provide two care staff in the morning, two in the afternoon and one awake and one sleep-in at night. The home also provides a cook six mornings a week and a cleaner three mornings per week and the manager who works weekdays. On a Sunday two care staff are provided who in addition to meeting service users’ needs must also cook the main meal and do all cleaning. The proprietor stated that the manager also works on the Sunday however care staff denied this. The inspector noted that the day book recorded that on one afternoon in September only one carer was in the home for the afternoon shift. Care staff confirmed that this is occasionally the case. The manager was unable to comment on this as she had been on sick leave at the time. The home does not use agency staff and expects its own staff to cover shifts left vacant by holiday or sick leave. Care staff stated that they felt pressured into working additional shifts and this is increasing their stress and risk of themselves becoming ill and having time off work. The statement of purpose includes a diagram showing the staffing arrangements in the home. This lists staff such as catering assistants and laundry assistants. None are actually employed at the home. The statement of purpose must only provide factually accurate information as to the staff provided at the home. The home must review staffing levels and ensure that at all times adequate numbers of care and support staff are provided. None of the care staff or the manager have an NVQ qualification. The new proprietor has arranged for all (except one who has refused) care staff to be registered for either level 2, 3 or 4. A requirement is not made in respect of NVQ’s as the proprietor has taken action to rectify the current unacceptable situation. However the proprietor must aim to ensure that new staff recruited have an NVQ in care as it will be approximately one year at least until care staff complete their NVQs. The home has recruited three people since March 2006 when it was purchased by the new proprietor. The records for these staff were viewed. The home’s recruitment procedures are inadequate to ensure that unsuitable people do not work in the home. The inspector viewed the records for the three people recruited since March 2006. The first contained two references that stated ‘to whom it may concern’. There was no evidence in the file that the home had sought these references, but had been provided with them by the applicant. The home must satisfy itself as to the authenticity of the references. Later during the inspection the manager informed the inspector that she had spoken with the carer concerned and would be sending to the people named on her application form for references. There was also no evidence that the home had received written confirmation of a clear POVA list check before people commence working in the home. The manager stated that she telephones the umbrella agency who inform her verbally that a clear POVA has been received but that she has no proof of this. The second applicant had only listed one Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 29 reference on his application form and had only one reference in his personal file. Again a CRB had been requested but the staff member had commenced work at the home prior to any written confirmation of clear POVA first check being received. The third person to be employed had also only provided one reference and had commenced working at the home the week prior to the inspectors visit. The manager showed the inspector the completed CRB form with cheque ready to send to the umbrella organisation. The home must not commence people working in the home until all the necessary recruitment checks have been complied with as stated in Schedule 2 of the Care Homes Regulations 2001. The manager described the interview process used at the home. The manager states that either she or the proprietor interview applicants, and that the proprietor will re-interview people if the manager feels they are suitable. The manager has not undertaken recruitment and selection training and it would be more appropriate for both the manager and proprietor to interview staff together at the home. The home’s induction process does not meet the Skills for Care common induction standards. The manager was unaware of the common induction standards and completes a basic induction for care staff. The home must ensure that it obtains information about the common induction standards and that these are implemented in the home. Information about training undertaken was not included in the pre-inspection questionnaire. The proprietor completed this section of the questionnaire and listed a range of training planned for the future. During the inspector’s visit the manager was unable to provide information about planned training or dates that training has been booked for. The home has not undertaken a training needs audit and does not have a training plan. Care staff informed the inspector that they have not undertaken any training since the home was purchased in March 2006. The home must undertake a training needs audit and provide a copy of its training plan, including dates and training provider information to the Commission. Training must cover all mandatory training and additional specific training relevant to ensure that service users’ needs are being met. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 30 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, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using the available evidence including a visit to this service. The manager does not have an NVQ level 4 in care or a Registered Manager’s Award. The proprietor is new to the care business having not previously owned a care home. It is the inspector’s opinion that the manager and proprietor do not between them have the necessary skills and knowledge to adequately manage the service and move it forward as the proprietor would wish. The proprietor must consider how management consultancy can be provided for the home whilst the manager and proprietor gain the necessary qualifications and knowledge. The home must decide how quality monitoring can be achieved in the home and ensure that the results of quality assurance audits are included in the homes annual development plan. The standard of record keeping in the home must be improved. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 31 Throughout this report the inspector has identified significant concerns in respect of the health and safety of service users and staff and the inspector does not consider that the home provides a safe place for service users or staff. EVIDENCE: The manager has been registered manager of the home for five years, however she does not have either an NVQ level 4 or Registered Manager’s Award. The manager stated that she is now registered for the NVQ level 4 in Care but has not yet commenced the course. The manager also informed the inspector that she has not undertaken regular specialised or update training. The manager does not have access to a computer and was unaware of a number of issues such as the Skills for Care common induction standards. The proprietor was not present at the time of the inspector’s visit but telephoned the inspector the following week. The proprietor is new to the care business and was unaware of a number of the areas in which requirements have been made. The inspector acknowledges that the proprietor wishes to provide a high standard of service at the home however the inspector believes that some of his instructions to care staff are inappropriate and are preventing care staff from meeting service users’ needs. An example being when care staff were told to move wardrobes to clean behind them. This represents a manual handling risk to care staff and also prevents them from adequately supervising and supporting an unsettled service user group. Service users’ needs were therefore not met during this time. The inspector was shown a letter written by care staff to the proprietor in which they identified areas of concern in the home and the way that they as staff are being treated. The inspector was also made aware that the proprietor has the personal mobile numbers of the care staff and will telephone them out of work hours. Care staff should only be contacted out of work hours if there is a change to their shifts or to request them to cover additional shifts. Care staff must be able to relax off duty to enable them to fulfil their work commitments with energy and enthusiasm. The manager is aware that the above issues are occurring but has been unable to act to improve the situation. The manager stated that the home has service user meetings however these are not recorded and could therefore not be evidenced. The home does not have any formal quality monitoring systems based on seeking the views of service users, relatives and stakeholders in the community. Care plans are reviewed monthly by care staff although it is not clear the extent to which service users are involved in monthly care plan reviews. The proprietor does not undertake Regulation 26 visits and does not provide a report to the manager of his findings. The home must decide how quality monitoring can be Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 32 achieved in the home and ensure that the results of quality assurance audits are included in the homes annual development plan. The home does not become directly involved in the management of service users’ personal finances. The inspector was shown the invoices sent to service users or their representatives, these detail what additional services are being charged such as for chiropody and hairdressing. If additional personal items are required, such as toiletries or clothing the manager stated she will contact the service user’s representative and arrange to either purchase these on behalf of the service user and add to the invoice or for the representative to purchase the items and send to the home. The arrangements would seem appropriate. The inspector noted that one service user had been charged for a new bed, apparently his bed had been damaged by the service user. The service users’ guide and sample contract should state that if service users damage items belonging to the home the service user will be charged a replacement cost. Throughout the inspector’s visit a number of records were seen. Generally the inspector was concerned that records were either not available of incompletely recorded. These have been identified within the relevant sections of the report. Examples of poor record keeping being, no pre-admission assessments, risk assessments or care plans for people admitted to the home since March 2006, medical visits and treatment records not maintained, gaps on MAR sheets, poor recruitment records, no minutes of service user meetings. The inspector was also concerned that most of the care records are held in the home’s kitchen. These are not stored confidentially and are available to anybody. In addition care staff must repeatedly enter the kitchen including during meal preparation, to record care or access records. The home must consult with the local environmental health officer to determine what measures the home must take to prevent cross infection and food contamination by care staff who enter the kitchen without wearing protective clothing. Throughout this report the inspector has identified significant concerns in respect of the health and safety of service users and staff and the inspector does not consider that the home provides a safe place for service users or staff. Staff have not been adequately recruited, inducted or received any training to meet service users’ general or specific needs. Staff must undertake moving and handling, fire safety, first aid, food hygiene, adult protection and infection control training. A qualified first aider must be available at all times. Equipment used by service users has not been serviced and maintained. The environment, both inside and outside the home presents risks to service users. People undertaking work in the home were living at the home with unsupervised access to service users and their bedrooms. Checks had not been undertaken on these people. Pre-admission assessments, care plans and risk assessments have not been undertaken on all service users. General risk assessments were not available. Service users have a variety of potentially Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 33 challenging behaviours and may not be adequately supervised to prevent incidents. The provider and manager must ensure that the home is a safe place for all service users, visitors and staff. Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 34 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 2 1 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 2 2 1 2 2 2 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 X 1 1 Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? New service 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. 2. 3. 4. Standard OP1 OP27 OP1 OP2 OP3 OP38 5. 6. OP4 OP38 OP7 OP8OP38 14 (1)(d) 15 (1) 12 (1)(a) Regulation 4 5 5 (3) 14 (1) Requirement The statement of purpose must contain only factually accurate information. The service users’guide must contain only factually accurate information. All service users must receive a contract. All service users must have a full pre-admission assessment, including assessment of risks, prior to moving into the home. The home must ensure it is able to meet the needs of people admitted to the home. All service users must have risk assessments and a care plan stating how their health, social and personal care needs should be met. Care staff must have the necessary training to understand and meet service users’ health care needs. Medication administration records must be fully completed. Care staff must receive accredited medications training. A range of activities must be DS0000066715.V307787.R01.S.doc Timescale for action 01/01/07 01/01/07 01/12/06 01/12/06 01/12/06 01/12/06 7. OP8 OP26 18 (1)(b) 01/01/07 8. OP9 OP38 13 (2) 01/12/06 9. OP12 16 (2)(m) 01/12/06 Page 36 Weston Lodge Version 5.2 10. 11. OP15 OP18 OP38 16 (2)(i) 13 (6) 12. OP18 OP29 OP38 OP18OP38 13 (6) 13. 13 (6) 14. OP19 OP38 23 (2)(o) 15. OP19 5 (1)(b) 16. 17. OP21OP26 OP38 OP21 OP26OP38 OP22OP38 23 (2)(c) 13 (3) available to service users. Food must only be prepared by staff who have a food hygiene certificate. The manager and care staff must receive adult protection and managing challenging behaviour training. All the required pre-employment checks must be undertaken prior to people commencing employment at the home. The Hampshire Inter Agency Adult Protection procedure must be used in the event of any adult protection concern. External grounds that are suitable, and safe, for use by service users must be provided. Broken furniture must be removed. The uneven patio surface must be resolved and the pipe extending through the patio must be made safe. Access to the garden for people must be made safe. The service users’ guide must clearly state that smoking is only permitted in the designated smoking area. The bath hoist must be replaced. Used continence pads must be removed from bathrooms as soon as possible. Bathrooms must not smell offensive. The home must ensure that all equipment at the home is serviced and maintained. The hoist must be serviced. The provider must explore options such that lounge and dining room doors may be fitted with automatic closure devices so that they may be held open most of the time and close in the event of a fire. DS0000066715.V307787.R01.S.doc 01/01/07 01/01/07 01/12/06 01/12/06 01/01/07 01/12/06 01/01/07 01/12/06 18. 23 (2)(c) 01/12/06 19. OP22OP38 23 (2)(a) 01/01/07 Weston Lodge Version 5.2 Page 37 20. 21. OP23OP38 OP23 OP25 23 (2)(a) 23 (2)(p) 22. OP26 OP38 13 (3) 23. 24. OP26OP38 OP27OP38 13 (3) 18 (1)(a) 25. OP30 OP38 18 (1)(c)(1) 26. OP30OP38 18 (1)(c) 27. 28. OP31 OP38 OP33 10 (1) 24 26 29. OP37OP38 17 (1)(a) 17 (2) Service users must only be admitted to bedrooms that are suitable for their needs. The home must ensure that bedroom radiators may be individually controlled to ensure service users have a comfortable temperature in their bedrooms. The practice of placing soiled items for washing on the floor of the laundry room must stop. The laundry floor must be impermeable and these and wall finishes must be readily washable. Care staff must have infection control training. The home must review staffing levels and ensure that at all times adequate numbers of care and support staff are provided. The home must ensure that it obtains information about the common induction standards and that these are implemented in the home. The home must undertake a training needs audit and provide a copy of its training plan, including dates and training provider information to the commission. Training must cover all mandatory training and additional specific training relevant to ensure that service users’ needs are being met. The proprietor should consider how management consultancy can be provided for the home. The home must decide how quality monitoring can be achieved in the home and ensure that the results of quality assurance audits are included in the home’s annual development plan. The home must consult with the local environmental health officer DS0000066715.V307787.R01.S.doc 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/12/06 01/01/07 01/12/06 Page 38 Weston Lodge Version 5.2 30. OP38 12 (1)(a) to determine what measures the home must take to prevent cross infection and food contamination by care staff who enter the kitchen without wearing protective clothing. The provider and manager must ensure that the home is a safe place for all service users, visitors and staff. 01/12/06 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 OP1 Good Practice Recommendations The home should consider how the statement of purpose and service users’ guide may be provided in alternative formats suitable for people for whom normal sized print English is inappropriate. It is recommended that the manger discuss with the pharmacist to determine how Warfarin could be better managed as changes to this particular medication are likely to occur midway through a blister pack. 2. OP9 Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Weston Lodge DS0000066715.V307787.R01.S.doc Version 5.2 Page 40 - 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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