Inspection on 18/05/05 for Deer Lodge

This inspection was carried out on 18th May 2005.

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

Other inspections for this house

Deer Lodge 02/10/07

Deer Lodge 01/06/06

Deer Lodge 09/11/05

Deer Lodge 10/01/05

Deer Lodge 29/06/04

Deer Lodge 05/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Deer Lodge 22 Sandy Lane Teddington Middlesex TW11 0DR Lead Inspector Sharon Newman Unannounced 18 May 2005 08:15 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 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. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Deer Lodge Address 22 Sandy Lane Teddington Middlesex TW11 0DR 020 8943 3013 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Starcourt Construction Ltd Noel Williams Care home only (PC) 14 Category(ies) of Old age, not falling within any other category registration, with number (OP) of places Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th & 17th January 2005 Brief Description of the Service: Deer Lodge is registered to provide residential care to fourteen older people. The Home is a three storey building situated on a main road running along the boundary of Bushy Park close to local amenities in both Kingston and Teddington. Accommodation is provided on the ground and first floors. A large, well-kept garden is situated to the rear of the property, providing a patio area with seating, lawns and a variety of mature trees and shrubs. As the home is situated opposite Bushy Park, a small number of bedrooms have fine views across the nearby parkland. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspection Team: Sharon Newman Sandy Patrick Regulation Inspector Regulation Inspector This unannounced inspection took place over one day on the 18th May 2005. The Inspection Team consisted of two Regulation Inspectors. Records examined at this inspection included care planning documentation, health and safety information and staff files. A tour was also taken of the premises. A Pharmacy Inspector will conduct a separate inspection of medication issues and submit a separate report. On arrival at the home a number of service users were having breakfast. The atmosphere was relaxed and service users were supported to make choices about what they wished to eat. Teapots and condiments were available for service users to help themselves. The Registered Manager was present throughout the inspection. Inspection Team met with service users, their visitors and staff on duty. The The inspection team were concerned that many requirements remain outstanding from the previous inspection visit in January 2005. The team were also concerned about a number of issues that arose at this inspection visit. Many areas of poor practice were identified at this inspection visit and these are covered in the main body of the report. These areas must be improved upon as they present a risk to the service users. There were thirty-seven Requirements made at this inspection visit and five Good Practice Recommendations. What the service does well: The home has a beautifully maintained garden. The activities officer demonstrated a good rapport with the service users and is enthusiastic about her role. However, this staff member will need support and additional training to ensure they learn more about activity provision and dementia. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: There were many areas of poor practice discovered on this inspection visit, some of these areas are highlighted below and they must be rectified. Service users contracts need to be obtained and attention needs to be paid to the care planning system, as this documentation did not sufficiently highlight service users needs. Regular updating of this documentation should also take place. Risk assessments for issues such as adjustable bed rails and falls were not available, they must be put in place and regularly updated. There are a high number of accidents at this home most of which are falls. A professional assessment of the premises by an occupational therapist needs to be obtained. Medication administration observed on the day of inspection was very concerning and could present a risk to the service users. Medication training will need to be in place for staff. The medication cabinet should be kept locked securely. Activity resources need to be improved to ensure all service users have a choice of activities to participate in. Training must be arranged regarding activities and dementia. Service user meetings are not being held so there is no formal forum for them to express their views. Service users are denied some choices. There was a lack of meal choice at lunchtime. Also staff were observed to turn on a modern music channel on the radio without asking service users what they would like to listen to. On the day of inspection the inspection team observed that there was minimum interaction and communication by some staff with service users. One service user was overheard to say ‘the staff don’t talk much in this place’. The oven was found to be broken at this inspection visit and it must be repaired. The storage of electrical equipment and boxes of mugs in service Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 7 users toilet areas must stop, this presents a risk to the service users and is unsightly. Staff supervision needs to take place on a one to one basis at least six times a year to ensure staff have the support and direction to carry out their jobs safely and efficiently. Staff meetings are not being held regularly these must be resumed. There is limited evidence of staff training - particularly in the areas of dementia and abuse. In addition staff training in areas including first aid, manual handling and food hygiene needs to be regularly updated. Staff rotas were not accurate at the time of inspection; they must reflect which staff are on duty. The use of correction fluid on this documentation is not good practice. Staff files must be up-to-date and contain all the information required in Schedule 2. This includes two references, criminal record checks, up-to-date photographs, an application form, identification and relevant qualifications. All policies and procedures must be in place in the home and must be regularly reviewed and updated. A quality assurance system still needs to be fully implemented to ensure the views of service users, relatives and other interested parties are sought. Attention must be paid to health and safety in the home to prevent risk to the service users. The Fire Risk Assessment must be reviewed. The last recorded test of fire safety equipment was 18.03.05 - this must be carried out. There were no recorded fire drills and no checks have been carried out on first aid boxes. Fridge and freezer temperatures were found not to have been checked daily, these must be checked and fully recorded. The Registered Provider must ensure that the water in the home is stored at 60 degrees centigrade, distributed at 50 degrees centigrade and only thermostatically lowered to 43 degrees centigrade at the actual outlet to ensure the safety of the service users. Also, the kitchen water temperature is 43 degrees centigrade. This temperature is not high enough for washing kitchen equipment, crockery and utensils. The Registered Provider must ensure that all radiators in the home are guarded, this requirement remains outstanding from the previous inspection visit. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 8 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. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5 There is limited information on individual needs and some of the information is out of date. Staff files seen indicated that some staff are not given appropriate induction, training, supervision or support to ensure they are meeting the needs of service users. Service users are at risk of harm or abuse. EVIDENCE: A Statement of Purpose is in place at the home and has been updated by the manager, however it needs to state the sizes of all the bedrooms at the home. The Service Users Guide is not presented in a user-friendly format for the service users it is designed for. Consideration needs to be given to adapting this document to a large print and pictorial format. In the documentation examined only one service user contract was seen. No others were observed to be in place. No contracts were seen in the files examined for service users known to have moved in to the home over the last six months. One new service user who had no service user plan and no risk assessment had only a very basic assessment which did not sufficiently identify needs. The Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 11 only other information in the file was a transfer letter from hospital. Information contained in this letter had not been translated into practice at Deer Lodge. During the inspection a potential service user and two of their representatives visited the home with a view to applying for a place. A member of staff was allocated to show them around the home. The member of staff was seen to answer questions appropriately and one of the service users companions went with this staff member to the office to discuss the process for admission. However, the potential service user was left in the lounge and was not told by the staff member what was happening. No other staff member spoke with the service user who remained sitting in the lounge for approximately fifteen minutes. Staff members were present in the lounge and were not occupied with other service users. This lack of regard for the feelings and needs of the potential service user during such an important time is very concerning. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 7, 8, 10, 11 Care planning documentation does not adequately identify needs and does not give sufficient guidance for staff on how to meet individual needs. Service users have not been consulted about the development and review of their plans. Unsafe practices regarding the administration of medication could put service users at risk of harm. The high number of falls and accidents in this home is very concerning. There is not enough evidence to suggest that service users health care needs are being met. EVIDENCE: The care planning documentation examined at this inspection was found to be inadequate and it requires updating, some of the documentation was not dated at all. Monthly evaluations could not be found in the service users files. The Manager stated these were kept elsewhere. There was no evidence of consultation with either service users or their relatives to indicate involvement of the service users or relatives in the care. Two service users did not have care plans or risk assessments available for inspection. Use of subjective phrases such as ‘poorly’ were found to be contained within the documentation. Much information contained within the service users files was found to be unclear, confusing or contradictory. One Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 13 entry stated that a service user was ‘prone to constipation’ but there was no evidence of a care plan about this issue. One service user’s file highlights continence needs but there is no mention of a professional assessment being carried out or a plan to meet the service users needs. A further care plan entry reports that a service user experiences ‘feelings of nausea’ but there is no information as to why and no mention of follow up care for this matter. Instructions were seen in one file regarding the moving and handling of a resident but it did not specify whether professional advice had been sought. A further file has an entry that states a service user is continent but that they require a bed sheet for incontinence. One service users plan identified that the individual had five falls from bed since admission. The hospital transfer sheet identified the service user as having a high risk of falling particularly late at night and early morning and identified the need for adjustable bed rails. There was no risk assessment in place regarding this issue. One service user was identified to the inspection team as having a pressure sore however, although it was noted that the District Nursing notes were kept at the home there was no care plan in place regarding this issue. Another service user’s care plan had no guidance for meeting their needs and no specific care plan for any identified needs. The care plan was undated and the daily notes were very basic. The inspection team discovered there had been a high number of accidents in the home. In February 2005 there were nine falls recorded. In March 2005 twenty accidents were recorded of which eighteen were falls. The inspection team noted a high number of falls in the lounge including three cases of service users slipping off chairs during the day. In April 2005 nineteen accidents were recorded, seventeen of which were falls. There was no risk assessment or care plan in place for one of the service users who was documented as having three falls in this month. One service user who had four falls documented in this month had no follow up in the daily notes and no evidence of action taken or health professional involvement. Two of the accident reports did not even specify what had happened. One accident report states that a service user fell at the top of the stairs but no risk assessment was seen to be in place. One service user was seen to have a significant number of falls recorded in the daily notes. Also, within this documentation a staff member has written that another service user accused them of pushing this individual on one occasion. The record in the daily notes did not correspond with the accident reports. There was no risk assessment in place and the care plan had not been reviewed. The Manager has started to do monthly evaluation of accidents. However, this log would benefit from more detail as it only records the type of accident and Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 14 the service users initials. It should also include date, time of day, location and action taken. At one point during the inspection, it was seen that the medication cabinet had been left unlocked and with the door wide open. No staff were present and staff had to be informed by the Inspector that it needed closing. The Inspection Team observed the Manager administering medication after the midday meal. The Manager left the tablets in a small pot with each service user and walked away before observing them taking their medication. One service user filled the small pot with water partly dissolving these tablets and they then drank from this pot. One of the tablets got stuck in the pot. The Manager was alerted to this by another service user. He then gave the service user a replacement tablet for the one which had been partly dissolved and stuck in the pot. He once again walked away from the service user before they had taken their medication. In another instance he left the medication in front of another service user saying only ‘paracetamol’ then walked away. There was no evidence of information in the documentation examined regarding the Dying and Death wishes of the service users. This information must be recorded in the service users files. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 This home is denying service users their right to make some choices about the food they eat and the activities they participate in. The Inspectors were informed of and witnessed practices that did not show due respect to the dignity and respect of service users. Service users are not consulted about the running of the home. There is a lack of food choice at mealtimes this could impact upon service user’s health. EVIDENCE: The home employs an Activities Officer twenty hours a week and she spoke with the inspection team. She was enthusiastic about her role and reported that she would like the opportunity to learn more about activity provision and dementia. The activities advertised on the notice board included trips to local resource centres for two of the days of the week. One such trip took place on the day of the inspection. Two service users were taken to the centre. No alternative activity was organised or offered to any other service user. Service users spend the majority of the day sitting in the communal lounge either talking in small groups, reading the newspaper or dosing. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 16 The Activities Officer was heard to ask service users if they wished to listen to music and gave them a choice of CD. However, when this finished the staff put the radio on a modern music station. Service users were not consulted about this at any point. The Inspection Team did not see service users being offered choices throughout the day, except at breakfast time. There are no service user meetings. The home’s ‘Resident Meeting Procedure’ states that service user meetings will take place during the third week of every month. Service users are not consulted about the menu and were not given choices during their lunchtime meal. Throughout the day only a very small number of interactions between service users and staff were seen. Prior to going out to the day centre the Activities Officer spent time chatting with different service users and they clearly enjoyed this experience. However, none of the other staff did this and the only interactions observed were of a practical nature. One service user told the Inspectors that, ‘the staff don’t talk much in this place’. One staff member was seen cutting service users fingernails. The staff member used a large pair of scissors and a metal nail file. These utensils are unsuitable for this task. The inspector’s were situated close to the staff member and noted they did not interact with a service user whilst cutting their nails and did not tell them what they were about to do when they sat down. At one point, one service user who was having their nails cut expressed pain. The Inspector noted that although the staff member changed what they were doing they did not apologise or ask the service user if they were alright. This practice is unacceptable. At one point during the inspection two service users were overheard commenting that they were cold. One service user then told the other one that they were going to close a small fanlight window behind them. They attempted to stand on an armchair to do this. One of the Inspectors intervened and closed the window so that the service user did not have to stand on a chair to do this. A staff member who was present in the room did not react in any way. There was no risk assessment in place regarding this issue. The Manager reported that the oven had been broken for approximately three weeks and that only the hob could be used. He reported that some meals, such as roast dinners had been cooked at his own house and brought to the home. The Manager reported that other meals were ‘pan fried’. On arrival at the inspection the Manager informed the Inspection Team that the chef had called in sick. The cooking was undertaken by the Manager. The staffing rotas indicated that the Manager and care staff undertook the role of cook on a regular basis. There was no evidence of food hygiene training or Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 17 anything to record their competence as a cook within the file for one staff member who was allocated chef on a number of occasions on the rota. The Inspection Team saw service users being offered choices at breakfast. Teapots and condiments were available for service users to serve themselves. On arrival at the inspection the notice board used to display the menu was not completed for the day of the inspection or the rest of the week. During the morning staff wrote the lunchtime dish on the menu. This was changed to another dish about one hour later. None of the service users were informed of either choice and staff did not draw their attention to the board. No alternative choice was displayed. The menu for the rest of the week and the evening meal choices for the day of the inspection were not displayed at any time. Service users going to the table for lunch reported they were unaware of what they were to be given. One service user was brought sandwiches instead of the main meal. They were given a choice of sandwich filling but not offered any choice of hot meal. Food was brought to the table already plated and service users were not offered any choices about the content of their meals. The majority of service users expressed dissatisfaction when their meal was brought to them because the carrots they had been served were black. One service user stated ‘not very appetising are they?’ Another service user said ‘I don’t like these – what are they?’ The Manager came into the dining room to state that the carrots had been caramelised in lemon juice. The majority of service users reported that they did not want them because they were burnt. On observation the carrots looked extremely burnt and unappetising. No alternatives were offered to service users and the Manager and staff did not display empathy when service users expressed their concerns. Service users continued to complain about the food throughout the meal, these comments were largely ignored by staff. The dessert was brought to the table already served with cream and service users were not offered a choice. The salt and pepper were only brought to the table at the request of a service user. The staff on duty asked the majority of service users about their enjoyment of the midday meal as they took away the plates. All the service users asked reported that they had not enjoyed their meal. Staff did not respond to this. A jug of water and squash were available with glasses for service users to help themselves throughout the morning. This is good practice. However, the jugs were in the lounge on arrival at the inspection at 8.15am. Drinks were not refreshed and staff used the same jugs to pour drinks for service users during the afternoon. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 This service does not adequately protect service users from harm or abuse. Appropriate checks have not been made on staff and they have not received adequate information or training on recognising and reporting abuse. Complaints are not fully recorded so it is unclear whether appropriate action has been taken to prevent bad practice. EVIDENCE: The complaints file was found to be incomplete and did not contain sufficient details of the complaints or the conclusion reached. There has been a Protection of Vulnerable Adults complaint at the home and one further complaint concerning the care in the home since the last inspection. An organisational abuse policy is in place at the home and the home has adopted the London Borough of Richmond Protection of Vulnerable Adults Policy and Procedure. A whistle blowing policy was seen to be available in the home. The inspection team did not see any evidence of abuse training for the staff. A staff member spoken to did not know what the whistleblowing policy was or the procedures to be followed. There was no evidence of discussions regarding these areas at staff meetings and supervision sessions. Staff activities seen at the time of inspection could constitute neglect or abuse. As stated previously the inspection team witnessed a lack of interactions by staff with service users. Staff were also observed changing the radio station on to a modern music channel without asking the service users what their Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 19 preference would be. As stated previously a member of staff was seen cutting service users fingernails with a large pair of scissors and not interacting with the service users whilst carrying out this procedure. Also, the high number of falls within this home is very concerning as is the finding that the home has not informed the CSCI of these accidents. Management activities at this home could put service users at risk. Insufficient checks were seen in some of the staff files examined Eg: only one reference in place, not following up negative references and staff beginning work at the home before their Criminal Record Checks had been completed. Limited staff training in the areas of abuse and lack of one to one supervision in this area was also found. Individual risk assessments were not available regarding falls or bed rail equipment. These must be put in place. A recent complaint was made to the home and the manager was advised that he should contact the local authority to implement their Protection Of Vulnerable Adults Procedure. The complaint was not investigated in accordance with this procedure and limited evidence regarding the complaint and the subsequent investigation was available. On the day of inspection, two staff files which were requested by the Inspectors were unavailable. The Manager reported the owner had removed these files. One file provided evidence relating to a complaint investigation. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25 and 26 The environment presents as unsafe due to the high number of falls at the home. The inappropriate storage of electrical equipment and boxes could present a hazard to the service users and is unsightly. The large garden is very attractive and well maintained. EVIDENCE: The home is a detached residence on a main road overlooking Bushy Park it provides accommodation for up to fourteen service users over two floors. It has an attractive and well maintained garden. The maintenance worker clearly takes pride in the garden and spoke about this with the Inspectors. Some service users were seen to use the garden throughout the day. There is limited communal lounge/dining room available inspection report there is no their bedrooms if they wish to Deer Lodge space available at the home. There is a to the service users. As stated in the previous alternative quiet room, service users must use see visitors privately. Version 1.30 Page 21 G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc The arms on the majority of easy chairs in the lounge were observed to be greasy and dirty and some chairs were worn in places. These must be cleaned or replaced as they could present a hazard to the safety of the service users. There has been no assessment of the environment by an Occupational Therapist. The amount of falls and accidents at the home is very concerning. The environment and the needs of the service users must be appropriately assessed in order to effectively reduce the risk of these accidents. In addition the home has recently been granted a variation to offer a service to five service users who have dementia. The Registered Person must ensure that the arrangement of the environment and lighting meet the needs of these people. The carpet throughout the ground floor communal areas and corridors is highly patterned and could be confusing for people with limited sight or mobility to walk on. One service user who was walking in the lounge was over heard commenting about not being able to see clearly where they were going. The advice of appropriate professionals must be sought in relation to this. The en suite WC in one bedroom has been used to store electrical equipment and boxes and was not accessible. The toilet seat was also observed to be broken. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 22 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. Recruitment and selection procedures do not guarantee the safety and well being of service users. Records required in staff files by Regulation are not in place. Staff are not directed, supported or supervised adequately and this lack of support has led to poor practice where service users’ needs are not met. EVIDENCE: Staffing rotas were not accurate and did not reflect the staff on duty, also there were many alterations and use of correction fluid on the rota which made it difficult to assess which staff were actually on duty. Abbreviations were used on this documentation this was confusing as there was no key provided to ensure anyone reading it could identify what was meant. The Manager informed the inspection team that the Registered Person wanted to reduce the staff numbers on duty for the early and late shifts. There is no cleaner at the home and care staff were seen to be ironing and doing the laundry instead of spending time with the service users. A relative spoken to around the time of inspection expressed concerns that there ‘didn’t seem to be enough staff’. The Manager also stated to the inspection team that they were concerned about the staffing levels at the home. A statement signed by one staff member indicated agreement to opt out of the European Working Time Directive. This was not in place in any other staff files seen. The hours of work for one staff member over a twenty day period were examined. These indicated that the staff member worked six days in a row, including four twelve hour shifts. This was followed by a two day break and then another six days work, including four twelve hour shifts. The staff Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 23 member then worked five twelve hour shifts after a one day break. For six of the thirteen long days worked the person had been delegated the responsibility for leading the shift where they would be the most senior person on duty. They were also allocated chef on two of these days. There was no evidence in their staff file or supervision record that they had been supported to understand the roles and responsibilities of being the delegated senior member or chef. The staff member is contracted to work as a carer thirty-five hours a week. The requirement from the last inspection regarding the qualifications of the Chef is still outstanding – she must undertake qualifications relevant to her role. Also, when she is off duty other care staff cook the meals and therefore need to undertake the necessary qualifications and the food hygiene certificate. There was limited evidence of staff training. The induction records were poor and the work book for induction was seen to be completed by the supervisor and not the supervisee. Four staff files were seen and training was seen to be limited. Training is required for staff in the areas of manual handling, first aid, food hygiene, dementia and falls prevention. The Manager stated further training had taken place but evidence was not found to support this. On the day of inspection there was no staff file in place for the Manager and at least one other member of staff. These records must be maintained at the home and be available for inspection. The Manager could not tell the Inspectors exactly how many files were not at the home or which ones had been removed. The Inspection Team examined four staff files and these were incomplete. Criminal record checks were found not to have been requested by the home prior to employment of staff. There have not been appropriate checks in respect of discrepancies in information provided by staff during recruitment and selection. Insufficient reference checks have been made on staff and not all written references have been received prior to the employment of staff. No action has been taken where references record concerns about the staff member. Recruitment and selection procedures do not sufficiently identify staff. The criminal record check for one staff member had been made two months after the staff member commenced work. The criminal record checks for two staff members had been made by previous employers. These checks are not transferable and the Registered Person must make their own checks prior to employment of all staff. In both cases the employer identified on the criminal record check was not recorded in the employment history on their application Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 24 form. The Manager stated that he was not aware of this and therefore no checks in order to establish why this had happened had been made. There was only one written reference in all four staff files seen. The references for two members of staff were negative and highlighted concerns about their work. There was no evidence that any further action was taken by the home to consider the suitability of these staff members. On one of the negative references the Manager had stuck a post it note stating that he was not concerned about the work of this member of staff. The reference had been received one month after the member of staff had started work. A reference seen for a third member of staff recorded dates of employment at a previous employer but little else. There were no photographs of staff in any of the files seen. The photocopies of official documents in one file were unclear. The supervision notes in one staff file refers to a staff member’s work permit expiring. There was no photocopy of the work permit nor any reference to this anywhere within the staff file or at subsequent supervision meetings. Staff meetings are not taking place regularly. The ‘Staff Meeting Procedure’ states that staff meetings will be held during the first week of every month and that extended handovers will be held every other week. The home’s ‘Supervision Procedure’ states that staff will receive regular supervision and annual appraisals. There was no evidence of staff appraisals in any records seen. The Manager reported that staff did receive supervision every two months. On the day of inspection staff files did not contain evidence of this. The Manager reported that supervision records were held elsewhere, however the Inspectors did not have the opportunity to examine these on this occasion. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 & 38 This service is not managed in a way that ensures the health and well-being of service users. Staff are not appropriately trained and supported to carry out their duties. Practices observed at the home during the inspection visit present a risk to the health and safety of the service users. The systems for service user consultation are poor with little evidence that service user views are sought or acted upon. Appropriate checks and assessments of risk have not been made on the environment. EVIDENCE: There are a high number of Requirements made at this inspection visit; many of these remain outstanding from the last inspection. A number of Requirements relate directly to the support and supervision of staff. In order for the home to begin working towards meeting the National Minimum Standards the Registered Person must employ a suitably qualified person to Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 26 manage the home. Once recruited this person must apply to be registered with the Commission for Social Care Inspection. The Registered Person must ensure that the home is appropriately managed and staff are supported until a new Manager is appointed. The service is required to notify the Commission for Social Care Inspection of any event that affects the well-being of service users, this includes any accidents or incidents. During April, there were nineteen recorded accidents at the home. Only four notifications were made to the CSCI. During March, records at the home indicated that there had been twenty accidents, the CSCI was only informed of three of these. The Manager reported that he does not have supervision meetings. He stated that he had not been issued with a job description or a contract of employment. Many of the records need archiving, the Manager could not locate items he was asked for at this inspection visit. The inspection team were given files which did not contain up to date information. The Manager said many of the records were on the computer or stored in his in-tray. The Manager stated that the Registered Provider had removed some records. There are a range of local policies and procedures available. However these were not dated and there was no evidence of review. All policies and procedures must be dated and be subject to regular review. There was no evidence of a formal quality assurance programme taking place at this home. The home must demonstrate that it is seeking the views of the service users, their relatives and stakeholders. The Manager said he is not involved in budget setting or monitoring and is allocated a weekly petty cash for general purchases. He reported that he had had disagreements with the Owner about expenditure. The certificate of insurance which was on display had expired in January 2005. The Registered Person must evidence that appropriate insurance is in place and must display the certificate in a prominent place. Evidence of electrical appliance testing was seen and was due for retesting shortly after the inspection. Evidence of gas and water safety were also found to be in place. The Fire Risk assessment was developed in August 2003 and there was no evidence of recorded review. This must be reviewed. Records for testing fire safety equipment indicated that weekly checks of emergency lighting and fire doors was weekly. However the last recorded test of these was 18.03.05. Alarm points are tested weekly and this was recorded. There were no recorded fire drills and no checks have been carried out on first aid Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 27 boxes. There was evidence that fridge and freezer temperatures were not always being checked daily, these must be checked and fully recorded. The Manager stated that the hot water system is set so that all water is distributed at 43. The home has had a satisfactory legionellas test recently. However, the water in the home should be stored at 60 degrees centigrade, distributed at 50 degrees centigrade and only thermostatically lowered to 43 degrees centigrade at the actual outlet. The kitchen water temperature is 43 degrees centigrade and there is no dishwasher. Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 2 COMPLAINTS AND PROTECTION 2 2 3 1 3 2 2 3 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 1 2 2 1 x x 2 2 1 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 (1) Schedule 1 5 (1) (b) Requirement The Registered Person must ensure that the Statement of Purpose contains all the information in Schedule 1 of the Care Home Regulations 2001. The Registered Persons must ensure that every service user is issued with terms and conditions of residence which must include details of the rooms to be occupied. The Registered Persons must ensure that full assessments are in place for all service users. These must be undertaken by people trained to undertake this task. 1) The Registered Person must ensure that: 1. service user plans include information on social, health and personal care and all identified needs. (Previous timescale of 31/01/05 not met). 2. Service users must be given the opportunity to participate in the development and review of their service user plan. Plans must be signed by the service Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 30 Timescale for action 1st October 2005 2. OP2 1st October 2005 3. OP3 14 (1) 1st August 2005 4. OP7 12 (1) (2) & (3) 15 (1) (2) (a) (b) (c) &(d) 16(2)(m) & (n) 1st August 2005 user (or if necessary their representative) as an indication of their agreement. (Previous timescale of 31/01/05 not met). 5. OP8 12 (1) 13 (4) The Registered Person must ensure that individual assessments are put in place with regard to the risk of falls. These must be kept under review and revised as necessary. (Previous timescale of 28/02/05 not met). The Registered Person must ensure that: 1. Staff adhere to procedures for the correct administration of medication. 2. The medication cabinet is kept locked securely. The Registered Persons must ensure that the service users wishes regarding dying and death are recorded. The Registered Person must ensure that accurate records of activity participation and enjoyment are maintained. (Previous timescale of 31/01/05 not met). The Registered Person must ensure that there is a menu available for service users drawn up with their consultation and service users are offered a varied choice of nutritious and wholesome food. The Registered Person must ensure that the broken oven is repaired. The Registered Person must ensure that a full record of complaints is maintained at the home with actions / timescales / outcomes fully recorded. (Previous timescale of 31/01/05 1st July 2005 6. OP9 13 (2) 1st June 2005 7. OP11 12 (1) (2) (3) (4) 16(2)(m) & (n) 1st July 2005 1st July 2005 8. OP12 9. OP15 12 (2) (3) 15 (1) 16 (2) 1st July 2005 10. 11. OP15 OP16 16 (2) 12 22 (3) (4) (8) 1st June 2005 1st July 2005 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 31 not met). 12. OP18 13(4) & (6), 15 The Registered Person must ensure that assessments of risk are sufficiently detailed and identify action to be taken to minimise risks. Risk Assessments must be kept under regular review. (Previous timescale of 28/02/05 not met). The Registered Person must ensure that: 1. All staff are trained in recognising and reporting abuse. (Previous timescale of 31/01/05 not met). 2. Staff initiate and participate in sustained interactions with service users that demonstrate respect and understanding. (Previous timescale of 31/01/05 not met). 3. All staff respond appropriately to service users who voice concerns. (Previous timescale of 31/01/05 not met). The Registered Person must ensure that the Manager is aware of the procedures for making criminal record and POVA checks on staff. Satisfactory checks must be received prior to the commencement of employment. The Registered Persons must ensure that: 1. The broken toilet seat in the ground floor W.C is fixed. 2. The dirty and greasy chairs in the lounge are thoroughly cleaned or replaced. The Registered Person must 1st July 2005 13. OP18 13(4) & (6), 18(1)(c) 1st July 2005 14. OP18 13(4) & (6), 19(1)(a) 1st July 2005 15. OP19 13 (4) (a) (c) 23 (2) 1st August 2005 16. OP22 13 (4) (a) 1st July Page 32 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 (c) 16 (1) 4 (3) 23 (2) (n) 17. OP25 13(4) & (6), 23(2)(l) 18 (1) (a) 12 (1) (a) 12 (5) (a) 17 (2) Schedule 2 18 (1) (a) 12 (1) (a) 18. OP27 19. OP27 20. OP27 21. OP28 13(4) & (6), 18(1)(c)(i ), 19(1)(a) ensure that an assessment is made of the premises and facilities by a suitably qualified person, including a qualified occupational therapist, with a specialist knowledge of the service users catered for. This is with particular reference to the high number of falls and accidents at the home. The Registered Person must ensure that storage of equipment, furniture and other items does not present a risk to service users. The Registered Persons must ensure that adequate numbers of appropriately trained and competent staff are on duty at all times. The Registered Person must ensure that the rota shows which staff are on duty during the day and night and in what capacity. The Registered Persons must ensure that the ratio of care staff to service users is calculated using recognised guidence from the Department of Health. This is with particular reference to the needs of this particular group of service users, regarding their dementia requirements and the high incidents of falls in the home. fall The Registered Person must ensure that 1. Any person preparing food is qualified in food hygiene. (Previous timescale of 31/03/05 not met). 2. The cook is offered training relevant to their role. The Registered Person must ensure that staff records are complete and that there is 2005 1st June 2005 1st June 2005 1st June 2005 1st July 2005 1st July 2005 22. OP29 19 (1) (a) Schedule 2 1st July 2005 Page 33 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 23. OP30 18 (1) (c) 19 (1) (a) 24. OP31 9 (1) 12 (1) (a) (b) sufficient evidence of the recruitment process, including two written references. (Previous timescale of 31/03/05 not met). The Registered Person must ensure that all staff receive training relevant to their role. This must include food hygiene, first aid, abuse, dementia care, health and safety and manual handling. The Registered persons must 1. Submit an application for a Registered Manager to the CSCI. 2. The Registered Person must ensure that the home is appropriately managed and staff are supported until a new Manager is appointed. 1st August 2005 1st September 2001 25. OP32 26. OP33 27. OP33 28. OP34 12 (1) (2) The Registered Person must (3) (4) ensure that the processes of (5) (a) (b) managing and running the home are open and transparent. This is with particular reference to documentation being unavailalbe at the time of inspection. Also, the alteration of documents with correction fluid such as staff rotas. 24 (1), The Registered Person must (2) & (3) ensure that a formal quality assurance system be put in place at the home. The views of service users, their representatives and other stakeholders must be obtained as part of this process. 12 (1) (2) The Registered Person must (3) 24 (1) ensure that regular service users meetings are held and fully recorded. 25 (2) (e) The Registered Persons must ensure there is a valid up-todate certificate of insurance in place at the home. This is with G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc 1st July 2005 1st October 2005 1st August 2005 1st June 2005 Deer Lodge Version 1.30 Page 34 29. OP36 18 (2) 30. OP37 17 (1) 31. OP38 17 (1) (a) 37 32. OP38 13 (4) 33. 34. 35. OP38 OP38 OP38 12 13 23 12 13 23 12 13 (1) (4) (4) (1) (4) (4) (1) (4) (a) (c) (a) (c) (a) 36. OP38 12 (1) (a) 13 (4) reference to the expired employers liability insurance on display at the home. The Registered Persons must ensure that all care staff receive supervision at least six times annually with full records kept. (pro-rata for part-time staff). The Registered Person must ensure that all policies and Procedures are in place in the home and are regularly updated. Accidents and incidents concerning staff and service users must be fully recorded in the accident log and in the relevant service users care plan. Notifications (Regulation 37 of the Care Standards Act 2000) must be sent to the CSCI. (Previous timescale of 31/01/05 not met). The Registered Person must ensure that First Aid boxes are checked on a monthly basis with full records kept. (Previous timescale of 31/01/05 not met). The Registered Person must ensure that the fire risk assessment is reviewed. The Registered Person must ensure that regular fire drills are carried out and fully recorded. The Registered Person must ensure that the water system in place at the home meets health and safety requirements. It should store water at 60 degrees centigrade, distribute it at 50 degrees centigrade and then it should be thermostatically lowered to 43 degrees centigrade at the outlets. (Previous timescale of 28/02/05 not met). The Registered Person must ensure that the tap water in the kitchen is of sufficient 1st July 2005 1st September 2005 1st June 2005 1st June 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 Page 35 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 37. OP38 12 (1) (a) temperature to prevent infection and that it meets Health and Safety Requirements. The Registered Persons must ensure that fridge and freezer temperatures are recorded daily. 1st June 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP8 Good Practice Recommendations Consideration should be given to presenting the Service User Guide in a more user friendly format using large print and pictures. It is recommended that the acting manager and staff familiarise themselves with local NHS services and resources available for their service user group. This will further enable them to meet the healthcare needs of the service users. It is recommended that a cupboard complying to the Misuse of Drugs Regulations 1973 be available for the storage of controlled drugs. A job description should be in place for the home manager position The Registered Provider should consider the employment of a suitable qualified person to offer professional support and supervision to the acting manager. 3. 4. 5. OP9 OP31 OP31 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 36 Commission for Social Care Inspection Ground Floor 41-43 Hartfield Road Wimbledon London SW19 3RG 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 Deer Lodge G54-G04 S17363 Deer Lodge V221925 180505 Stage 4.doc Version 1.30 Page 37 - 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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