Inspection on 13/06/06 for Chadwick Lodge Residential Home

This inspection was carried out on 13th June 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

Chadwick Lodge Residential Home 12/04/07

Chadwick Lodge Residential Home 20/12/05

Chadwick Lodge Residential Home 27/09/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Chadwick Lodge Residential Home Chadwick Lodge 8 Chadwick Road Westcliff-on-sea Essex SS0 8LS Lead Inspector Ms Vicky Dutton Key Unannounced Inspection 13th June 2006 08:00 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 Chadwick Lodge Residential Home DS0000063515.V300081.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. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwick Lodge Residential Home Address Chadwick Lodge 8 Chadwick Road Westcliff-on-sea Essex SS0 8LS 01702 331599 01702 331599 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) More Care (Home Counties) Limited Mr Peter Roger Cordery Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Old age (over 65) not falling within any other category (OP) (15) Dementia - over 65 years of age (DE(E) (15) Age: Over 65 years of age Total number to be accommodated shall not exceed 15. The registered manager shall complete a recognised qualification (NVQ Level 4/Registered Managers Award) within 12 months of registration. 20th December 2005 Date of last inspection Brief Description of the Service: Chadwick Lodge provides personal care and accommodation for fifteen older people. The home is also registered to provide care for residents who have dementia. The building is a three story property with the second floor being private accommodation. Most accommodation is in single bedrooms, some of which have en suite facilities. The home has two shared bedrooms. There is spacious open plan communal accommodation. A separate area is provided for residents who wish to smoke. Chadwick Lodge has a large and pleasant garden which is well maintained. A minibus is available. The home is situated close to local transport links. Day care places are also offered at Chadwick Lodge. Separate accommodation is provided in the homes grounds for day care. The facility does not currently fall within the remit of the inspection process. Previous inspection reports were not readily available for visitors to the care home. The registered person said that these are available on request and held in the homes office. The homes Statement of Purpose and Service Users Guide, (Dated March 2005) were available in the homes entrance hall. The current scale of charges as quoted by the registered provider at the site visit are £347.00 as a contract price and £350.00 as a private rate. Additional charges to residents include chiropody newspapers and toiletries. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The inspection was undertaken over an eight and a half hour period. At this inspection all the key standards, and the homes progress against their previous agenda for action were assessed. A tour of the premises took place and care, staff, medication and other records were selected at random and inspected. A number of residents, and staff were spoken with. A notice was displayed in the home advising that an inspection was taking place with an open invitation to speak with an inspector. Questionnaires to seek peoples’ views about the quality of the service were sent out to relatives, social workers and general practitioners. Surveys were made available to residents at the home and copies left for any other visitor’s to the home. During the inspection questionnaires were also given to two community nurses. The views expressed in conversations and surveys have been reflected throughout the report. Prior to the inspection the home had been sent a pre-inspection questionnaire together with a request for other additional information. This was returned to CSCI as requested. What the service does well: What has improved since the last inspection? Since the previous inspection further staff training has taken place. This has helped staff to increase their knowledge and have a greater understanding of residents needs. Further redecoration has taken place to improve the environment for residents. A process is now in place for managing and recording any concerns or complaints that are made to the home. New equipment has been purchased to assist staff and improve facilities for residents. This includes new games and materials for activities and a new medication trolley. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 6 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. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to prospective users of the service. Service users have their needs assessed, but this needs to be carried out to a consistent standard. Residents are not currently given a statement of terms and conditions to explain to them the fees charged and service offered. Staff at the home do not all have sufficient specialist knowledge in some areas to ensure that they can fully meet residents needs. EVIDENCE: The home has a Statement of Purpose and Service Users Guide available. The registered person said that these have been reviewed but not re-dated or reprinted. It was stated that the Service Users Guide is made available to prospective residents. In the longer term it is hoped to develop a ‘welcome pack’ to provide more user friendly information. One recently admitted resident could not recall having seen a copy of the Service Users Guide. When the files of two recently admitted residents were viewed one had a local authority standard rate contract in place. Neither had a statement of terms Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 9 and conditions from the home on file to let tem know about fees and the services provided for that fee. The registered provider said that these had not been issued yet as the format and content was being reviewed. It was anticipated that all residents at the home will receive a new statement of terms and conditions to reflect the change of ownership of the home. The home has now been under the present ownership for a year, so this work is overdue. There had been two recent admissions to the home. One had been on an emergency basis so no pre-admission assessment had taken place. Only hospital discharge information was available. No assessment had taken place on admission. The registered person was advised that this should have happened in order that staff were aware of what the residents initial care needs were. Documentation showed, and another new resident confirmed, that they had been visited prior to admission and a basic needs assessment completed. The home have developed a proforma to assist this process. The registered provider said that the home do not currently confirm the assessment with potential residents, or confirm that the home is able to meet their needs. The home is registered to provide care for residents with dementia. The registered provider estimates that approximately 50 of the staff group have received in house training in dementia. Two residents at the home have a significant sensory loss. There was no evidence that staff have undertaken training in this area. Two new residents spoken with felt that the home was meeting their needs and were largely happy with the service being offered. Morning handover was observed by the inspector. This showed that the staff on duty had a good knowledge of residents. The home was praised by a social worker who said that the home had provided ‘excellent support’ to their service user on admission and during a difficult time. Chadwick Lodge does not provide intermediate care. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 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, 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care documentation viewed was inadequate, showed shortfalls and inconsistencies, and needs urgent reviewed to provide an adequate basis for care to be delivered. Residents receive good healthcare, but recording and monitoring needs to be improved. Some aspects of medication management needs urgent review to keep residents safe. EVIDENCE: Each resident at the home has a care file in place. These contain a range of different information/assessment sheets. These were sometimes completed to a reasonable level and sometimes not. Information from these many different sheets was not then reflected in the actual day care plan or night care plan. For example there was no mention on one care plan, or guidance for staff in assisting a resident who was ‘registered partially sighted and profoundly deaf.’ Other care needs were similarly not mentioned in the care plan. The care plan of an established resident with a high level of care needs was very jumbled, contained inadequate and conflicting information. Again there was no mention on the care plan of significant care needs such as dementia. Many other Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 11 examples were seen of worrying shortfalls in care planning at the home. These examples were pointed out to the registered provider. Poor care planning has been an issue at the home for some time. The registered provider was aware that this was a priority to address, but limited action has been taken. At the inspection the inspector was shown the new proposed format for care planning. This has not started to be implemented yet. Care files are kept separately from resident’s daily records. This practice will not encourage staff to fully use or understand care plans. It is understood that the new format will address this issue. Records showed that staff respond to changes in residents health care needs, and that appropriate referrals are made. Regular chiropody and optical care is offered. A resident confirmed that staff responded to their health needs, and that there was never any hesitation in calling a GP or other assistance that is required. It was noted that professional visits are now better recorded, but again any specific health needs/district nurse instructions are not reflected in care plans. Residents are regularly weighed but the accuracy of this needs to be monitored. In one instance the record showed that, over a short period of time, a resident had put on 19 kilogram’s. This was clearly an error, but it had not been picked up or addressed. As at the previous inspection the registered provider was advised that nutrition records need to provide a greater level of detail so that they show how much residents are eating. Pressure relieving cushions were noted to be available but there was no indication that the need for these is formally o individually assessed. The new care plan format contains a ‘Warterlow’ assessment format that will assess resident’s vulnerability to develop pressure sores. Risk assessment at the home is generally weak. A generic risk assessment format is in place. One resident was prone to falling out of bed and bed rails were in place. The registered provider was able to give anecdotal evidence of a multidisciplinary approach having been taken for this, but no evidence was available. No risk assessment was in place for the use of bed rails, and they were not even mentioned on the residents night care plan. This despite the fact that the registered manager and another senior member of staff have recently completed a training course covering the use of bed rails. Since the previous inspection the home has purchased a new medication trolley. This provides grater security and assists staff in delivering medication safely to resident’s rooms. Staff confirmed that they had recently undertaken training given by the providing pharmacist. At the moment no competency assessments are undertaken by the registered provider. At this inspection a number of shortfalls were noted in medication processes and recording. On a tour of the building it was noted, in a number of rooms, that creams has been decanted into small plastic pots and labelled with the residents name only. It was not clear if the cream had come from a prescribed source or a homely remedy source. In one case the pot had one name on the body of the pot and another name on the lid. This practice of decanting is totally unacceptable, Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 12 could place residents at risk, and has infection control implications. Where handwritten entries had been made onto the medication administration records (MAR) these had not been signed. In two instances the medication recorded had also not been booked in. Boxed/bottled medication is not always dated when opened/started. Protocols were not in place for medication prescribed ‘as and when required’ (PRN). Although not a fault of the home, some of the MAR sheets had been printed badly which meant that it was difficult to read the relevant details. This has the potential to lead to medication errors being made. To protect residents the home should have addressed this issue with the pharmacy, and requested alternative sheets. During the inspection staff were noted to uphold residents privacy and dignity when carrying out personal care tasks. One shared room was noted not to have a dividing curtain in place. Since the previous inspection the practice of using communal toiletries has stopped. It seems that now toiletries are being brought in bulk and individually labelled for residents and placed in their rooms. While this is progress it means that all residents have the same toiletries and there are no individual preferences reflected. The registered provider said that he had asked residents about this and that they had all been happy/liked the same product which he provided. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 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, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Development is needed to provide residents with a good level of stimulation and occupation that is suitable to meet their assessed needs. Visitors are always made welcome. Food provided by the home currently meets residents needs and expectations. EVIDENCE: Residents preferences in terms of activities and daily routines such as rising and retiring times are recorded to some degree in care records through the use of a set format questionnaire. On the care files viewed these were not always fully completed, and again any information or preferences gathered were not carried forward onto the care plan. Activities are undertaken on an ad hoc basis. During the inspection staff did spend time interacting with residents, and residents in the communal area of the home were well supervised at all times. An entertainer visits the home on a regular basis. The registered provider said that they have been trying different things, and that residents had been going out. The home has purchased equipment such as large snakes and ladders and scrabble. Feedback from two visitors/relatives felt that residents had insufficient stimulation and activity. Activities were recorded to some extent in Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 14 the care files, but again this seemed to be a bit hit and miss. The home is registered to provide care for residents with dementia. Some resident’s at the home also have significant sensory losses. The home still needs to work on evidencing that resident’s social and occupational needs are assessed in a meaningful way in order that stimulation and occupation is tailored to their needs. The home also needs to ensure that homes routines accord with resident’s choices and preferences. One relative said that some residents have been ready for bed when they have been visiting in the home during the afternoon. The registered provider gave examples, that showed how residents are offered the opportunity to express their spiritual needs. One resident said that he was regularly visited by a minister. Visiting at the home is open and there are no restrictions. The registered provider said that no residents manage their own finances. Three residents have no next of kin, and their finances are managed by the Local Authority. The registered provider is aware of advocacy services and has tried to obtain an advocate for these residents. This has so far been without success due to a local shortage of advocates. Residents are able to bring in personal possessions with them. The home is currently operating a four week menu plan. Feedback on one survey said that they felt that the menus could be improved. The registered provider said that menus are being reviewed in consultation with residents. The home employs a dedicated chef and lunch on the day of inspection looked appetising and plentiful. One resident does not eat meat. The registered provider gave examples of different protein sources tried to ensure that this resident has a balanced diet. Residents spoken with said that the food provided by the home was good, and that they were offered choice. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 15 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are recorded and managed. Staff at the home must be clear about their identified response to any allegations of abuse, and ensure that this complies with identified best practice, and keeps residents safe. EVIDENCE: The home now has a system in place for recording and managing complaints. One complaint had been recorded and dealt with. Most staff at the home have completed training run by the Local Authority on adult protection. In house training has also been undertaken. The provider and a senior member of staff spoken with felt that the message received from Local Authority training is that the home should investigate any concerns before referring the matter to social services. This is not safe practice and needs to be clarified by the registered provider to ensure that residents are kept safe and any incidents are managed appropriately. The home had copies of ‘alert’ forms available, and were aware of a new central contact number for referring concerns to. In house training has been undertaken in managing challenging behaviour. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 16 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, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The communal areas of the home are reasonably appointed. Resident’s private accommodation however does not provide them with a well decorated and furnished environment. The premises are not yet maintained in a safe and hygienic manner to ensure that residents are kept safe. EVIDENCE: The home is situated in a pleasant residential area. The new owner of the home is gradually undertaking a refurbishment of the premises. This will include redecoration of rooms and the purchase of new furnishings to improve the environment for residents. Progress has not so far significantly improved the environment for residents. Since the previous inspection two bedrooms have been redecorated and refurnished. The home has pleasant grounds for residents to enjoy. One resident said that they loved spending time in the garden. The registered provider has made improvements to the home in line Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 17 with the recommendations of the local fire department to provide a better level of safety for residents. The homes communal areas are open plan and include a conservatory, lounge and dining areas. A separate small lounge is available for smokers. The home has two bathrooms with one assisted bath. Five bedrooms at the home have an en suite facility. Many of these areas are in a poor condition and are planned to be refurbished. Due to the loss of one toilet only one communal toilet is available on the ground floor. The flooring in the staff toilet and some en suite areas is not sufficient to provide adequate infection control. The home is registered to provide dementia care therefore signage needs to be improved to assist residents in orientating themselves. More moving and handling equipment has now been provided to assist staff in carrying out moving and handling tasks. All the bedrooms at the home meet the National Minimum Standard in terms of floor space. Although works are underway, most of the home’s bedrooms are shabby and require redecoration and new furnishings to bring them up to an acceptable standard, in order that residents have a pleasant environment to live in. In particular a shared room on the ground floor was in a very poor condition. The ceiling had been damaged and showed signs of damp, some areas of woodwork were unpainted, curtains were hanging off the rail, furnishings were mismatched and the room was cluttered. Two recently admitted residents to the home were happy with the accommodation provided, although one required the new furniture, which had broken, to be replaced and curtains to meet their needs to be fitted. Where rooms have been redecorated and refurnished lockable storage and other elements of the National Minimum Standards have not been provided. The registered provider said that this is planned. Water temperatures tested at random were not satisfactory in that they did not reach a hot enough temperature. Water in areas tested was only tepid to warm. A record of bath temperatures showed values such as 36.9 degrees Celsius were recorded. One resident spoken with complained about the water not being hot enough. The registered provider said that all water was thermostatically controlled, and should be hot enough, but that a new type of boiler was about to be fitted that would improve the situation. There are still some uncovered radiators in the home. In particular the radiator in the upstairs bathroom was felt to be very hot. At the previous inspection in December 2005 the registered provider said that covers were on order and were due to be fitted very soon. On this occasion the inspector was shown documentation that showed that an order for covers had been placed sometime ago. The registered provider said that he hoped fitting would take place within the next five days. Many of the corridor lights at the home are sensor controlled. On the first floor these were not operating well leaving the Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 18 corridor dark for some time before activating. This could present a hazard for residents in this area. The registered provider said that this system was due to be serviced on the following week, but was advised to check the sensors in the meantime to keep residents safe. Adequate laundry facilities are provided at the home. Residents are protected by a laundry disinfection system that provides a high level of elimination of known infections. Dispersible sacks are used for foul linen. The laundry area was very cluttered with water bottles meaning that staff could not easily access the sink or wash their hands without accessing the adjacent staff toilet. Some areas of poor odour were noted around the home. Infection control training at the home is not adequate. A housekeeper at the home did not have knowledge of MRSA and was unclear of how often protective clothing should be changed. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 19 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, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment, induction and training of staff have improved but are still not robust enough. Further development is needed to ensure that staff have adequate training and orientation to be able to safely care for residents. EVIDENCE: The home maintains staffing levels at three care staff, one of whom is a senior in charge, to be on duty at all times during the day. The registered provider is aware that this may need to increase depending on the needs of the residents being accommodated. At night the home has one awake night staff, and one person sleeping in. A night staff spoken with felt that this was sufficient to meet the current needs of residents. The home has a stable core group of staff, but has experienced some turnover. Some agency staff are used to cover shortfalls in the homes rota. The registered provider said that he tries to get consistency in this area, and have the same staff. Staff rotas showed that some staff are still working long hours. This could be detrimental to residents. The home employs a cook, and domestic cover is provided for a few hours each week. Residents spoken will spoke well of the staff team at Chadwick Lodge. There was also positive feedback from visiting professionals and relatives. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 20 At the time of the inspection visit one senior member of staff had an NVQ at level three in care. A further member of the senior team had NVQ at level two and was undertaking level three. The registered provider said that he hoped that a further four staff would soon be commencing NVQ level two and one level three. To protect residents detailed checks such as employment history, obtaining references, checking identity, obtaining a POVA First/Criminal Records Bureau check (CRB) and ensuring people are physically and mentally fit for the work must be undertaken on any new staff recruited. The files of three recently recruited staff were sampled. From previous inspections a significant improvement was noted in recruitment practices. The registered provider tries to obtain three references for each applicant. However some shortfalls remain. One application was very poorly completed, and did not give a satisfactory employment history. References on file did not match those given on the application form. Where such anomalies exist, a record should be kept of any exploration carried out/explanations given and so on. Files did not consistently contain copies of job descriptions or contracts. Agency staff are used from only one agency. This agency have given a guarantee that any staff provided have been properly recruited and have had all appropriate checks carried out. For best practice the required information should also be checked by the home information. To ensure that new staff are aware of how to care for residents, and maintain procedures and standards of care, they should be given a thorough induction into the home. Some induction was evidenced, in the form of first day induction checklist. The registered parson has purchased a package that provides an induction, foundation and training record. This has not yet been implemented. This then, as identified at the previous inspection, is an area that the registered person needs to develop. Agency staff that work in the home should also receive a basic induction and orientation into the home. This is not currently evidenced. Training at the home is ongoing, with many subjects being covered ‘in house’, using bought in training packages. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 21 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, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the current registered provider at the home is well liked, they have been slow to address some important issues that were inherited from the previous provider. Staff receive support and supervision in their roles. Quality assurance systems have yet to be developed. EVIDENCE: The registered provider/manager took over Chadwick Lodge a year ago. Staff, residents, relatives and visiting professionals spoke well of his manner, friendliness and approach. One longstanding resident felt that the home was ‘much better now’. However significant and ongoing shortfalls have been identified at the home. Progress towards meeting these shortfalls has been very slow, and some have yet to be rectified. The registered manager has yet to complete recognised qualifications relevant to the role. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 22 The registered person said that staff meetings are currently held about every six weeks, and that although levels of communication at the home had improved, there was still work to do. Resident meetings are not held. Due to the level of mental frailty at the home, for many residents at the home this would not provide a useful forum for seeking their views. However other residents would be able to contribute their views about the home, so ways to facilitate this should be explored. Quality assurance systems have yet to be developed at the home. The registered manager said that he had prepared a format for seeking stakeholder’s views. The registered manager was concerned about how he would seek the views of frail residents who have no family to assist them in expressing their views. Although the home have tried to access this, local advocacy services are not currently readily available in the area. The registered manager confirmed that the home do not hold any monies for residents at the home, but that all finances are dealt with through families or The Court of Protection, who manage the affairs of three residents at the home. Staff spoken with, including night staff, confirmed that they do receive regular supervision from the registered manger. As at the previous inspection, records of this were not available for the inspector to view. Aspects of health and safety were sampled at this inspection. Staff records viewed showed that apart from one new member of staff, staff are up to date in moving and handling training. A senior member of staff is shortly to undertake an assessors/training the trainers course in moving and handling. This will enable practice to be monitored more effectively. The home have a new book for recording fire equipment tests/drills etc. Regular checks take place to ensure that residents live in a safe environment. Risk assessments need development in respect of COSHH and safe working practices. The home maintains a satisfactory accident record. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 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 3 2 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 3 1 1 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 2 x 2 Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 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 OP3 Regulation 14 Requirement Accommodation should not be provided for service users until their needs have been fully assessed by a person competent to do so. The service user or their supporter to be given confirmation in writing that the home can meet their assessed needs. Although progress has been made, this requirement is not yet fully met. Previous requirement dates of 01/12/05 and 14/01/06 not met. 2. OP4 18 Staff must receive training 01/08/06 appropriate to the care they are to provide. This refers to the need for staff to receive training in dementia care and other areas appropriate to meet the needs of residents. Previous requirement dates of 01/01/06 and 10/03/06 not met. 3. OP7 15 Service users plans must address how all their health, welfare and social needs will be DS0000063515.V300081.R01.S.doc Timescale for action 01/08/06 01/08/06 Chadwick Lodge Residential Home Version 5.2 Page 25 met. As far as possible they must be compiled in consultation with the residents and/or their supporters. Previous requirement dates of 01/12/05 and 01/02/06 not met. 4. OP8 12, 13 Proper provision must be made for the health and welfare of residents. This refers to the need for adequate risk assessments to be in place for appropriate areas of individual care needs such as bed rails. Previous requirement dates of 14/12/05 and 14/01/06 not met. 5. OP8 12 Service users care plans or records must fully show how their healthcare needs are met and document the involvement of relevant professionals such as district nurses in a consistent manner. Previous requirement dates of 14/12/05 and 14/01/06 not yet met. 6. OP8 17 Sch 4 The registered person must ensure that a proper nutrition record is maintained by the home. Previous requirement dates of 14/12/05 and 14/01/06 not met. 7. OP9 13 The registered person must ensure the safe recording, handling, administration and disposal of medicines in the care home. This refers to the issues raised in the body of the report. The registered person must make proper provision for the DS0000063515.V300081.R01.S.doc 01/08/06 01/08/06 01/08/06 01/08/06 8. OP12 12, 16 01/08/06 Page 26 Chadwick Lodge Residential Home Version 5.2 health and welfare of service users. This refers to the need consult with service users and provide meaningful occupation and activity for all service users including those who suffer from dementia or other conditions. Previous requirement date of 14/01/06 not met. 9. OP21 23 The registered person must provide sufficient and suitable toilets and washing facilities. This refers to the issues noted within the body of the report. 01/09/06 10. OP22 23 The registered person must 01/09/06 ensure that the premises are suitable for meeting the aims and objectives of the home. This refers for the need for adequate orientation/directional signage to be provided. The registered person must 01/10/06 ensure that the premises are suitable for meeting the aims and objectives of the home. This refers for the need for adequate private accommodation to be provided for residents, that offers facilities in line with standard 24 of the National Minimum Standards. The provider must make proper 14/07/06 provision for the health and welfare of service users and ensure that all parts of the home are free from hazards to their safety. This refers to the need for action to be taken to manage the temperatures of radiators in the home within a risk assessment framework. Previous requirement date of 01/12/05 and 14/01/06 not met. 11. OP24 16, 23 12. OP25 12, 13. Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 27 13. OP25 23 The registered person must 01/08/06 ensure that the premises are suitable for meeting the aims and objectives of the home. This refers for the need for an adequate supply of hot water to be provided to meet the needs and expectations of residents. Suitable arrangements must made to ensure adequate levels of infection control in the home. This refers to issues identified in the report. The registered person must maintain robust recruitment procedures to protect residents. This refers to the issues raised in the body of the report. The registered person must ensure that staff are given training appropriate to the work they are to perform. This refers to the need for a robust induction process to be in place for all staff (including agency staff to have a basic induction into the home) Previous requirements of 14/10/05 and 01/02/06 not met. 01/08/06 14. OP26 13 15. OP29 19 14/07/06 16. OP30 18 01/08/06 17. OP33 24 The registered person must develop a system for reviewing at intervals and improving the quality of care provided. This refers to the need for quality assurance systems to be developed at the home. Staff at the home must be appropriately supervised. This requirement could not be fully assessed at this inspection 01/10/06 18. OP36 18 01/08/06 Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 28 as records were not available. It is therefore carried forward. Previous requirement date of 01/02/06 not met 19. OP38 12 The registered person must develop adequate risk assessment in relation to managing COSHH products and promoting safe working practices. 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP2 OP7 OP10 Good Practice Recommendations All residents should be given a statement of terms and conditions at the point of moving into the home. The practice of storing daily records separately from residents care plans should be reviewed. Toiletries and personal requisites provided by the home should be in line with individual choices and preferences. Dividing curtains should be provided in all shared rooms. The homes complaints procedure should be on display for residents and other interested parties. Staff induction processes should be in line with Skills for Care standards. The registered person should undertake a relevant qualification in care/management as soon as possible. The registered person should continue to develop stategies for involving residents and other stakeholders in expressing their views and being able to affect the way that the service is delivered. Care staff should receive formal supervision at least six DS0000063515.V300081.R01.S.doc Version 5.2 Page 29 4. 5. 6. 7. OP16 OP30 OP31 OP32 8. OP36 Chadwick Lodge Residential Home times a year. 9. OP27 Staffing levels must be kept under review to make sure that they are sufficient to meet the holistic needs of resident’s. 50 of care staff should be trained to NVQ level 2 or above. Staff induction should conform to Skills for Care Standards. 10. 11. OP28 OP30 Chadwick Lodge Residential Home DS0000063515.V300081.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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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