Inspection on 01/07/07 for Deerswood Lodge

This inspection was carried out on 1st July 2007.

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

Deerswood Lodge 19/08/08

Deerswood Lodge 26/02/08

Deerswood Lodge 22/02/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Deerswood Lodge Ifield Ifield Green Crawley West Sussex RH11 0HG Lead Inspector Mrs A Peace Unannounced Inspection 1st August 2007 09:00 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 Deerswood Lodge DS0000068513.V342842.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. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Deerswood Lodge Address Ifield Ifield Green Crawley West Sussex RH11 0HG 01293 561704 01293 561635 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) Shaw Healthcare Ltd Post Vacant Care Home 90 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (50) of places Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of people to be accommodated will be 90 from the age of 60 years. 22nd February 2007 Date of last inspection Brief Description of the Service: Deerswood Lodge is a purpose built care home situated in Ifield in Crawley which was opened by Shaw Healthcare Ltd in 2006. The home was built to replace three other homes in the area owned by West Sussex County Council but managed by Shaw Health Care Ltd. The home is registered to provide personal care, support and accommodation for frail older people and older people with Dementia. Resident’s accommodation is provided in nine units on the ground floor and the first floor, each unit has ten bedrooms, all bedrooms have en-suite facilities. Each unit has its own dedicated lounge/diner and all rooms on the first floor can be accessed by a passenger lift. The home has been designed with indoor streets running the length of the building linking units so that residents can get around easily. Additional communal areas are provided. The registered providers are Shaw Healthcare Ltd and the responsible individual on behalf of the company is Mr Jeremy Nixey. West Sussex County Council currently contracts all of the 90 beds in the home. The fees range from £420.00-£520.00 per week. The home is without a registered manager at present but a manager is in place and has applied to the Commission to be registered. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Ann Peace, Mr E McLeod Regulatory Inspectors and Mrs J Datoo Pharmacy Inspector carried out this unannounced key inspection on the 1st August 2007. This inspection is the second inspection in 2007. It is a key inspection and will determine the frequency of inspections hereafter. Prior to the visit to the home the inspector reviewed the last inspection report and information gathered about the home since the last visit. The Annual Quality Assurance Assessment was returned to The Commission for Social Care Inspection (CSCI) by the manager in time for it to inform the inspection. We met residents in the communal areas in the different units and in their bedrooms and we sat in the various lounges with residents watching daily routines, how residents spend their time and how staff supported their individual needs. In the majority of cases staff were noted to be attentive, caring and respectful and did try to engage residents in various activities. Since the last inspection and following concerns expressed by West Sussex Social Services and the local Primary Care Trust, nurses from the local Primary Care Trust have reviewed the health needs of all of the residents living at the home, following this they made a number of recommendations. A case tracking exercise for a number of these residents was undertaken during this visit to look at how the assessed needs of this group of residents were being met and if the recommendations had been followed up. A number of these recommendations still have to be acted on appropriately by the home. Residents living at the home, staff working at the home and relatives were spoken with to gain their views of the service, comments were mainly positive. Eleven satisfaction surveys were returned from residents who had completed them with the help of staff, three from relatives and the comments of five General practitioners were received. Two resident’s said on their satisfaction surveys that; “they liked living at the home”. One relative said, “her mother was well looked after”. The GP’s comments did highlight that there are still some areas of concern, these were looked into during the inspection and are recorded in the main report. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 6 Recruitment records, training and induction records and records relating to the health and safety of residents and staff were seen. In the majority of cases these were in order however despite a requirement being made following the last inspection that all staff working in the home have the required safety checks to ensure their fitness to work with vulnerable people, checks on agency staff are still not being carried out. Following the seventeen requirements made from the previous inspection, the providers were required to send a plan to the Commission to show how they were going to improve the home to meet legal requirements and meet the needs of residents. The proposed actions stated in the improvement plan were monitored during this visit. We could confirm that thirteen of the requirements have been met, as the improvement plan indicated, however two were only partially met and another two not met. In addition, following this inspection two new requirements and two recommendations have been made. What the service does well: What has improved since the last inspection? There has been intensive managerial support provided at the home from the regional office to meet the requirements made, improve quality of care for residents and to monitor and record progress. The atmosphere in the home has settled down following the recent changes and staff say it is a happier place to work. Assessments for residents have been carried out, care plans have been re written and risk assessments compiled to identify residents at risk. An extensive programme of staff training has been implemented and training records have been improved. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 7 The recruitment records for contracted staff have been compiled to meet legislation and health and safety issues are monitored on a monthly basis and records kept. The increased staffing levels on the dementia units has improved quality of care for residents and working conditions for staff. Automatic closures which will automatically close doors in the event of a fire have been fitted to all bedroom doors. Heated trolleys have been purchased so that meals stay hot until they are served. Some signage has been put up on the dementia units to aid residents. The team leaders offices have been re signed from nurse’s offices to avoid misunderstanding and the team leaders uniforms have been changed from navy blue to pale blue. What they could do better: No agency staff should work at the home until the manager is sure that they have received the appropriate training, that they are safe to work with vulnerable people and there is a recorded proof of this. Despite the intensive training and monitoring, medication errors are still occurring, complete and accurate records are not being kept of medicines administered, so the home cannot be sure that service users are receiving medicines as prescribed. There is a lack of up to date qualified first aiders in the home. If suitably qualified staff were available then the calls to the emergency services and GP’s may be reduced. There is still a lack of team cohesion resulting on staff not being accountable or taking responsibility, there are problems with communication both verbally and in care records. Two sets of care records are kept and in some cases there is inconsistency between the two, which is detrimental to residents. Since the last visit care staff have had short episodes of training in dementia but do not have the in depth knowledge needed to be proactive in the care of residents with dementia, more in depth training should be provided. Staff have to complete food and drink charts for all residents on the dementia units regardless of risk, but there was inconsistency in the quality of records so some are meaningless. Also there is still an absence of picture menus or any prompts on the dementia unit and there is no finger food on the main menus for residents with dementia, we were told that the home was waiting for advice from professionals. Although the improvement plan completed by the providers indicated that this had already happened. Care staff spoken to do not seem to realise how this could help people with dementia to make a choice. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 8 A recommendation was made following the last inspection that the care for the residents suffering from dementia could be improved by environmental considerations in relation to visual clues, colour and appropriate signage, it was recommended that professional advice be sought. We were told on this visit that advice had only recently been sought and that in addition a visit from a representative of the Alzheimer’s society had been arranged. There should be a robust staff supervision process in place to ensure staff have the support and training they require. 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. The summary of this inspection report can be made available in other formats on request. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6.Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide is available for prospective residents and service agreements are in place for the residents accommodated. Resident’s assessments, risk assessments and care plans are in place and have been updated. However in some cases they contradict what is recorded in the daily records which affects the continuity of care for residents. Care staff need more in depth training to look after residents suffering from Dementia. The home does not provide intermediate care. EVIDENCE: Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 11 A Statement of Purpose and Service User Guide is available for the home, a relative of a prospective new resident told us that he had been given a copy with a copy of the last inspection report. He said the manager had explained that an improvement plan had been put in place to address the concerns raised. No new residents have been admitted since the last visit, however all residents in the home have been re assessed, have had risk assessments carried out and these records are available. Care plans have been re written to reflect what is in the assessment and have been updated. Care records on the units are locked away and we questioned why keys are not available to staff to enable them to look at resident’s records, following this, keys were given out. On a daily basis staff use a high-risk prompt sheet which identifies residents needs and then staff record any changes and complete various charts. Staff told us that they only look at the main care records if they show a new member of staff where they are. They said the team leaders have the responsibility for updating them. When tracked a number of the daily care records did not reflect what was recorded in the main care records and in some cases were detrimental to the continuity of care given to residents. The need for so much paperwork was discussed with a representative of the company who said that it was corporate policy to have all the documents. In the records seen, all residents have service agreements which have been signed. Since the last visit care staff have had short episodes of training in dementia but do not have the in depth knowledge needed to be proactive in the care of residents with dementia. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The majority of resident’s health, personal and social care needs are being met by a caring staff team but some of the daily care records are not consistent with the care plans and assessments which is effecting the continuity of care for residents. Residents are not always offered privacy when seeing other health professionals. The home is not keeping complete and accurate records of medicines administered, to ensure that service users receive medicines as prescribed. A requirement in relation to unsafe medication practices was made at the last inspection EVIDENCE: Assessments, risk assessments and care plans have been updated, however there is a lot of documentation for staff to go through to get to the essence of Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 13 the care the residents need and care staff do not use the main records where all of the information is stored. Until the day of the visit these records were locked away on the units and staff said they did not have ready access to the keys. Keys were given out during the visit. Care staff do use daily records which have a précis of the resident’s high-risk areas and then they complete charts to indicate how the residents are that day and what care has been given. Since the last visit health care reviews have been carried out for all residents by nurses from the local Primary Care Trust and a number of recommendations to improve care for the residents made. Recommendations had been made for two residents to have their weight recorded at set intervals but this had not been carried out. Another resident whose blood pressure was high was supposed to be having regular blood pressure readings taken, with the instruction that a doctor was to be called if it was still high. Staff could not tell us what action had been taken because they had not recognised that it was their responsibility to follow this up. Where blood sugars readings are monitored for residents with diabetes the results are kept with the medication sheets in a locked cupboard so staff in the units do not have any idea if the residents condition is stable or not which could be detrimental to the residents. This was discussed with the manager who said he would review the situation. The main care records of another resident said they had an infected wound which was being dressed by the district nurses, the daily care records said that the wound had healed and was clean and dry. When asked, a member of the care staff told us that the wound had come back although no one had recorded this in the daily records but they did not know where the wound was. Another member of the staff told us that the wound had never healed. These inconsistencies may be arising because of the two sets of care records that need completing by different staff. Staff did not seem to realise they should be monitoring the residents health in a pro-active way and take some responsibility and be accountable for their ongoing health care needs. In the daily care plans of one resident it said weigh daily but there was no indication on the main records of why and there were no records of weight, care staff spoken with had seen the weigh daily request but had not asked anyone or taken any action. Other recommendations had been made about pressure relieving mattresses for residents and although there was list in the office of who had been referred, staff working in the units could not tell us who had been referred, who had already received one and who was still waiting. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 14 This indicated that communication needs to improve and staff need to work together as a team. There is evidence that blanket nutritional assessments have been undertaken for all residents but again in some cases the records in the main care files are not related to the daily charts the care staff complete. Staff have to complete food and drink charts for all residents on the dementia units regardless of risk but there was inconsistency in the quality of records and some were meaningless. The manager was advised to monitor this to ensure that those at risk were recognised and there was a person centred approach so that it did not turn into a paper exercise. Since the last visit some signage for toilets and bathrooms have been put up in the Dementia Units and we were told that the home was in the process of obtaining professional advice on how to make these units more suitable for sufferers of dementia to maximise resident’s potential. The majority of staff were seen to be caring, respectful and attentive to the residents during the visit. Where concerns were noted they were discussed with the manager. Since the last inspection staff have had some training in the theory of dementia but it is essential that staff have an accurate understanding of how the dementing process affects the individual residents so they can meet their diverse needs. Those staff spoken to were keen to learn more. Personal and health care is still reactive rather than proactive, as staff still have to multitask especially in the morning. A requirement was made following the last visit that two members of care staff should be always on each dementia unit. Staff told us that this had improved things for residents and staff and on some occasions ancillary staff are helping out with some duties. During this visit staff were observed to follow safe infection control procedures and to wear protective clothing when caring for residents or serving food. There are call bells throughout the home; in all of the bedrooms they have cords on them. Risk assessments have now been carried out for residents suffering from dementia to evidence that they would be safe with cords when alone. Eleven satisfaction surveys from residents were received, 10 had been completed by care staff on behalf of residents. They were in the main positive and reflected that care staff do listen to residents and that the care and support is good. Residents said that staff are usually available when they need them and they did know who to complain to. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 15 Some comments were “I am very happy here”. “I am very pleased with the care I get”. Three relatives completed surveys and again were in the main positive about the home although there was a comment about the high use of agency staff and another that the home could do better in respect of meals and activities. One relative said, “staff genuinely care and I can relax knowing they are doing all they can”. Another relative was not so positive and said “they did not think all of the staff understand dementia and there should be more stimulation”. When her relative was losing weight staff were supposed to keep charts up to date, but this wasn’t being done, inspection of care records also identified this. The comments from five general practitioners were received and said that although there had been some improvements and staff were very willing and caring they were very overstretched. They did say staff did seem to know the residents better now. One comment was that staff were asking for advice and when that advice is given the messages are not passed between staff so GPs and district nurses are called in again. They say there is poor communication in the home and acute care needs are met in a haphazard fashion due to lack of insight and poor communication. This has also been identified from the recorded high amount of calls to the emergency services. They say that situations arise which should have been dealt with earlier and were either missed or overlooked until they become a crisis. GP’s also say that clinicians are often asked to review residents in the communal areas and staff have to be prompted to take residents to their own rooms. Staff did tell us that this sometimes did happen due to the demands on their time. They also said that there have been issues related to lack of training resulting in medication errors. The pharmacy inspector also identified this during the visit. Since the last inspection nine medication errors have been reported involving fifteen residents. There is a lack of up to date qualified first aiders in the home. If suitably qualified staff were available then the calls to the emergency services and GP’s may be reduced. From observing the staff with the residents we concluded that if someone were dying the staff would care and comfort them and their relatives. The provision of additional medicine trolleys has enabled improvements in the organisation of medicine storage and administration records. Staff have had Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 16 further medication training and assessment. Four-weekly supplies of medicine had been coordinated and receipts were recorded. Discrepancies in administration records of four medicines were found, so that residents were at risk of not receiving these medicines according to the prescriber’s current directions. For medicines prescribed to be taken when required (PRN) staff either used codes, to explain when a dose was not given, or left the record blank. The manager said that a new PRN policy was being introduced. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 17 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. 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. There is activities provision on units which residents are enjoying. This would be improved by more staff having the skills and aptitude to undertake the kind of activities resident’s value. Residents are being assisted to maintain contact with their family and friends. In the majority of cases residents are being helped to exercise choice and control over their own lives, although as yet this has not become a consistent part of routines in the home which all staff adhere to. In the majority of cases residents are receiving a wholesome appealing balanced diet in pleasing surroundings, but this could still be improved for residents in the dementia units. EVIDENCE: Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 18 The manager has told us in the home’s annual CSCI quality self-audit that the activities programme in the home has been developed to include entertainers, arts and crafts, reminiscence, religious services, mini bus trips, and walks. However the recent Primary Care Trust audit of the home took the view that 50 of the people accommodated were suffering from social isolation. We found that generally there was a good atmosphere on units we visited. For example, two residents who were chatting to each other also spontaneously sang a song together. On some of the units visits staff were engaging well with residents. Activities were being provided by care staff on the day of the visit, such as cake decoration on one unit, some gentle balloon punching exercise on another unit. These activities were being enjoyed by staff as well as residents. Residents were also being supported to continue individual interests such as knitting. Also, staff interviewed said that some residents went picking for blackberries this week, and had greatly enjoyed eating what they had picked. There was however one unit where staff was initiating no activity on the day of our visit, as a result of which social and activities provision could perhaps be inconsistent at times. Relatives interviewed said they felt welcomed when they visited, and were kept informed about health and care issues. On the units visited staff were ensuring that residents were able to exercise choice in what they had for breakfast, for example. Staff said that some residents could only really make a choice of meal if the choices were placed before them, and this they were happy to do. One resident interviewed said she would like to go for more walks, and when we said that the activities programme included walks around the garden she said she wasn’t aware of this but also that her memory was poor and she couldn’t be sure if she’d been on those walks or not. Meal times on most units visited were noted to be relaxed, and there seemed to be a sociable atmosphere. Most staff were aware of what assistance individuals needed with cutting food and receiving encouragement. Most residents seemed to be enjoying the meals and to be enjoying the social part of lunch times. On one of the units for residents suffering from dementia, during lunch one resident was asleep at the table and remained asleep for the duration of the meal. Another resident did not like the meal provided. It was only when an inspector suggested the other choice of meal be offered that this was done. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 19 This resident did not like the alternative offered so did not have a main meal but did have a pudding, staff seemed to think that this was acceptable and made no effort to get any other food for this resident. There was fruit and snacks around on all of the units and residents on the dementia units were seen to be offered finger snacks such as crisps, biscuits and fruit by the staff. There was no finger food on the main menus for residents with dementia; we were told that the home was waiting for advice from professionals. Although the improvement plan completed by the home indicated that this had already happened. There is still an absence of picture menus or any prompts on the dementia unit and care staff spoken to do not seem to realise how this could help people to make their minds up. One resident’s records said they were asleep in bed so had not eaten any breakfast and one carer confirmed this, however another carer working on the same unit said that this resident had gone to another unit for their breakfast so they had eaten. When looking later we found that the records had not been changed so no one had taken responsibility for accurately recording what was happening. At present there is no senior chef although the home has advertised, kitchen staff told us that menu choices lists are completed by staff with residents on each unit then passed to kitchen staff. The lists seen indicated specialist needs such as diabetic diets. The main choices on the day of the visit were one meat dish and one vegetarian dish. One resident had requested tomato soup instead, so this was provided. The cook said that one person with cultural dietary needs was having specialist meals provided. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaint procedure is available and complaints are recorded with action taken. Resident’s legal rights are protected. In the main residents are protected from abuse but there is a lack of records for agency staff working in the home to ensure that these staff are safe to work with residents. A requirement was made at the last inspection that records to prove staff are safe to work with residents were carried out and a record kept in the home, this is still not happening for all agency staff. EVIDENCE: Complaints are recorded and what action has been taken, in the 10 months since the home opened there have been 26 complaints all of which were substantiated. The manager told us that there are no outstanding complaints. An anonymous complaint was made to the Commission about agency staff, the complaint was upheld. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 21 There has been a relatives meeting recently and minutes acknowledged that some of the issues identified have been sorted out since this manager has been at the home. Regular residents and relatives meetings are held and the manager said that a lot of concerns had been addressed through these meetings. The manager said that all residents who wanted to would have the opportunity to vote and that their change of address had been registered with the local council. An adult protection alert was made in December 2006; the investigation has been ongoing over the last few months. The result was that the allegation of abuse at the home was substantiated. All contracted staff have now had training in safeguarding vulnerable people and were able to tell us what they would do if abuse was suspected. The home is still using agency staff on a regular basis but records are still not available to indicate that all of the agency staff are safe to work with the residents. A requirement was made at the last inspection that records to prove staff are safe to work with residents were carried out and a copy kept in the home. The improvement plan completed by the home and sent to CSCI in answer to the requirements stated that all agency staff would have completed training and that they were required to provide this information before starting a shift. This is not happening therefore this requirement is still outstanding. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26.Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable, clean and well-furnished environment, have access to indoor and outdoor facilities and there are sufficient toilet and washing facilities. Specialised equipment is supplied and resident’s bedrooms are well decorated and furnished. The accommodation for residents suffering from Dementia has not yet been adapted to maximise their potential although advice has been taken and some minor improvements made. EVIDENCE: The home is a purpose built home and resident’s accommodation is on two Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 23 floors, and there is a large car park to the front of the home. There are secure gardens around the home and a patio area with seating. The home has a swipe card facility for entry into the home and the dementia care units for security. There are rooms for team leaders and staff on each floor where some of the records are kept these have been re signed from nurses offices to team leader offices. The team leaders uniforms have also been changed from navy blue to light blue as previously the navy blue uniforms and the nurse office sign were misleading to residents and visitors. We spent time on the majority of the units, the units were clean and fresh and nicely decorated. No bedroom doors were being propped open – door guards were being appropriately used. The standard of décor and furnishings are very high and there are music systems, televisions, pictures and ornaments in each unit. Each unit contains a lounge/dining room with a small kitchen area to the end of each. Kitchens have a microwave for heating up meals and hot milk for drinks and also a kettle. Communal spaces are well furnished with plenty of chairs for residents. Some areas had televisions on but there were areas that residents could go to be quiet. Following concerns identified at the last inspection about the amount of ancillary tasks care staff have to carry out and the dishes not being sanitised we were told that dishwashers would be available for the staff to use. One dishwasher was seen that was waiting to be fitted into one of the units, we were told that this was a trial and if it helped then other units would also be given one. There are accessible assisted toilets near to the lounges, and good bathroom and toilet facilities with specialist baths. handrails, raised toilet seats, hoists and other specialist equipment in place. Toilets and bathrooms on the dementia units now have appropriate signs on them. Bedrooms are very comfortable and attractive and have been personalised with belongings and small pieces of service user’s own furniture. All have en suite facilities. Pipe work and radiators are guarded and the temperature of the water is tested to avoid scalding accidents. An indoor street runs the length of the building linked to wings and facilities, additional communal areas are situated at the end of the ‘street’. All bedrooms on the first floor can be reached by a passenger lift. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 24 The home is a new building and at the last inspection it was pointed out that the environment for the residents suffering from dementia did not differ from the general environment for the frail elderly. A recommendation was made that the care for the residents suffering from dementia could be improved by environmental considerations in relation to visual clues, colour and appropriate signage it was recommended that professional advice be sought. We were told on this visit that advice had already been sought and that in addition a visit from a representative of the Alzheimer’s society had been arranged. Some minor improvements have been made such as picture signs on toilets and bathrooms. The manager said that since the last visit risk assessments for call-bell cords are in place in the units for people with dementia. The laundry facilities were adequate for the residents accommodated although there is an ongoing problem with one of the machines; the company is dealing this with. New kitchen equipment purchased includes a cooker, fridge, and hot plates. Since the last visit all bedroom doors have had fixtures fitted which means that residents can have their door open if they wish but that it would automatically close in the event of a fire. There is a separate day-care facility, which caters for people living in the community. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The majority of resident’s needs of people are met by the numbers and skill mix of staff. The home continues to promote care staff undertaking qualification training. Systems for the recruitment of agency staff are not adequate to ensure that people being cared for will be properly supported and protected. In the majority of cases staff are trained and competent to do their jobs but lack consistency in their approach to promoting the health and welfare of residents. EVIDENCE: The manager has told us in the homes annual quality self audit for CSCI that staffing levels have increased to two staff on each unit for people with dementia. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 26 Staff rotas sampled indicated that these levels of staffing were in operation, and staff interviewed agreed that there had been an increase in staffing levels and a decrease in the number of agency shifts required. The manager told us that he believes the home are taking on more staff with a higher level of skills, one example being that more of the staff recruited to work in the dementia care units have experience and expertise in this area. On the day of the inspection visit we found that staff numbers on the dementia care unit were sufficient to meet peoples’ care and social needs. In the majority of cases staff appeared to have time to focus their full attention on people they were supporting, and to initiate activities and develop a rapport with people. That said, all of the units visited had vacancies, and it may be that when the number of people living in the home increases again the provider will need to review staffing levels again. The manager has told us that of 50 care staff employed, 27 have the national vocational qualification (NVQ) in care at least at level 2, and 3 staff are presently working towards this. The manager also advised that all team leaders have NVQ at level 3, and that care staff are being encouraged and supported to undertake NVQ at level 2. The manager has told us that all staff that have worked in the home for the last 12 months have had satisfactory pre-employment checks although the lack of checks for some agency staff was noted. We sampled five sets of recruitment records for staff and found that a robust system for checks on prospective contacted staff are in place. The Commission has received one anonymous complaint relating to an agency member staff regularly working in the home who had not had any safety checks or appropriate training. This was discussed with the manager during the inspection. No evidence was available that checks had been made to ensure this person was safe to work with the residents or that they had received any appropriate training, therefore this complaint is upheld. We found there were omissions in the checks recorded for agency staff working in the home. We discussed the records held for agency staff, in particular the training records with the manager. We gave the example of one member of agency staff who we believed had worked many shifts over a period of time in the home, but whose training record did not indicate that he had undertaken any statutory training. The manager said that up to date records were being chased up with agencies, but that one agency in particular had failed to provide these. The manager Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 27 agreed that it was not acceptable for any staff to be employed in duties such as hoisting or manual handling where the home had not had it confirmed that the person had up to date training in these skills. Or if their fitness to work with vulnerable people had not been confirmed. The improvement plan submitted by the providers said that all agency staff are required to provide full training details and CRB information prior to starting shifts, they would be orientated into the home and advised of procedures by senior staff. This has clearly not happened. Training records sampled indicated that a significant amount of staff training, including training in working with challenging behaviour and control of infection has been provided. More training should be provided for staff working on the dementia units. All kitchen staff are advised to have up to date food hygiene training. One team leader interviewed said that as a result of all the staff training provided since January 2007 most staff were up to date with their statutory training. Training resources recently obtained by the home include training aids in a DVD format, and the manager advised that it is planned to make greater use of these. Despite all of the training provided since the last inspection staff are still making errors with medication and do not seem to have the confidence to make simple day to day decisions when residents become ill. Staff are not taking responsibility or being accountable and when asked about issues or concerns that had been noted related to residents constantly told us that they either were not on duty when something happened or they had not been told. We were told that many of the staff do have basic first aid training but that no one has a full first aid certificate. If this training was made available to a number of key staff then this may result in fewer calls to the GP’s and the emergency services and more confident staff. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is ensuring improvements are being made to the quality of care provided. Monitoring systems which include the views of people living in the home are being used to monitor performance and make improvements. The quality of service for people living in the home would be improved by all staff receiving one to one supervision which is recorded. The environmental health and safety of service users and staff is promoted and protected but the medication practices and recruitment practices for agency staff are not robust and do not protect residents. These issues were also noted at the last inspection and requirements made these have not been met despite assurances from the provider. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager has told us that a stable management team which provides clear guidance for staff is in place. There is not a registered manager in place for the service; the manager has recently applied to South East Regional Registration Team to be registered with the Commission as manager for Deerswood Lodge. Staff said they are well supported by the manager and that the home has improved since he has been there. Since the last inspection extra management resources have been put into the home to ensure safe systems and good records are in place, and although there have been some improvements this has not solved many of the problems. There is still a lack of team cohesion resulting in staff not being accountable or taking responsibility, there are problems with communication both verbally and in care records and medication errors are still occurring. Staff interviewed also said that the atmosphere in the home has improved, become calmer and relaxed. Staff told us that relatives have said, “things seem to be more cheerful”. Staff believe they are coming into work with a more positive attitude. Senior staff meetings and staff meetings each take place monthly, and staff interviewed said they found these helpful. Feedback we have received from external professionals, such as GPs, indicates that they believe a number of calls to medical and emergency services made by the home have not been appropriate, and question the problem solving skills of the management team. Residents’ questionnaires were sampled which had been collected in March 2007 and June 2007. Responses given on all subjects were very varied. We asked the managers how the outcomes of these surveys are assessed, what action plans result, and how the outcomes are communicated to residents, relatives and others. The manager said that relatives were advised through the recent relatives meeting, though no record of that meeting had yet been made. The manager said that each response was discussed with the individual key worker who would then discuss the outcomes with the individual resident. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 30 The manager said that action which had resulted from this process had included providing a bird table that had been requested and changing some ways of working. A relative of one prospective resident said that the manager had been very open about the home, the problems in the past and how the home was working towards improvements. The home does not manage any money on behalf of the residents but does hold small amounts of personal allowances; records are available to indicate that these are maintained satisfactorily. It was acknowledged by the manager and senior staff interviewed that while more staff supervision has been put in place, staff supervision records are not up to date and not all staff are receiving supervision. The improvement plan submitted by the home to the commission said supervision had been provided so this requirement is still outstanding. One temporary member of staff said that one to one supervision had not been provided for her, but seniors do come on the units with handover sheets to discuss how things are going. The manager has told us that training on health and safety has been undertaken by the majority of staff, and that new staff attend a 4-day induction course. The manager has advised us of the most recent dates on which services and tests of equipment have been carried out. We interviewed the senior member of staff with responsibility for health and safety issues in the home, and sampled audits being carried out to ensure the home is a safe environment. We sampled the manager’s audit of accident records, which indicated that processes are in place to ensure any consistent cause of accidents is being monitored and action taken. We noted that the practice of wedging bedroom doors has stopped, and electronic door guards are being appropriately used. Action taken to ensure staff protect residents from having access to cleaning materials has included making sluices lockable, having catches on the areas under sinks, and training in hazardous substances being provided for staff. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 31 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 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 4 4 2 4 4 4 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 1 1 1 Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement That staff are provided with the specialised training in dementia to ensure that’s resident’s needs are understood and met. Previous date for compliance was 31/03/07 Complete and accurate records must be kept of medicines administered, to ensure that service users receive medicines as prescribed. Previous date for compliance was 31/03/07 No agency staff should work in the home unless proof has been sought that they are safe to work with residents. Previous date for compliance was 31/03/07 Timescale for action 30/09/07 2. OP9 13(2) 30/09/07 3. OP27 18.1 &19(1) a 30/09/07 4. OP30 18.1 (c) All staff including agency staff 30/09/07 should be given training appropriate to the work they have to perform for example first aid. All staff including agency staff DS0000068513.V342842.R01.S.doc 5. OP36 18.2 30/09/07 Page 33 Deerswood Lodge Version 5.2 must be appropriately supervised and records must be kept. Previous date for compliance was 31/03/07. 6. OP37 17 Record keeping in the home must be improved in order to evidence resident’s needs are being met and the health and safety of residents is safeguarded. 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that guidelines are available to staff, for each PRN medicine, which include the presciber’s directions and the needs and choices of the individual service user. 2 OP4 & OP22 Work should continue to ensure residents on the dementia units have access to aids, signage and other prompts that will promote choices and an environment that will fulfil their potential. Deerswood Lodge DS0000068513.V342842.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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