Inspection on 22/02/07 for Deerswood Lodge

This inspection was carried out on 22nd February 2007.

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

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

Other inspections for this house

Deerswood Lodge 19/08/08

Deerswood Lodge 26/02/08

Deerswood Lodge 01/07/07

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 22nd February 2007 08:30 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.V325826.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.V325826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Deerswood Lodge Address Ifield Ifield Green Crawley West Sussex RH11 0HG 02920 364411 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 60 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.V325826.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. New registration 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-£520 per week. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs Ann Peace and Mrs Annie Taggart Regulatory Inspectors carried out this unannounced fieldwork inspection on 222nd February 2007. Mrs Jeanette Datoo Pharmacy Inspector also carried out a pharmacy inspection on Friday 23rd February 2007 and her findings are included in this report. Mrs Peace and Mrs Taggart were in the home 8.5 hours each and Mrs Datoo 7.5 hours. This is the first inspection for the year 2006-2007. It is called a key inspection and will determine the frequency of visits/inspections hereafter. Prior to the inspection, records and information held on file and information were reviewed. The Registered manager’s post at present is vacant. The Acting Manager Mr Karl Heryet was present for both inspections. Mr Heryet had completed a pre inspection questionnaire and sent it back to the Commission in good time for the inspection. The home has recently been opened following the closure of three other homes in the area which were owned by West Sussex County Council but managed by Shaw Health Care. During the inspection the Inspectors toured the building, visited the majority of rooms, and joined the residents in the unit lounges/dining areas. A case tracking exercise was undertaken for a number of residents. The tracking exercise looked at records and tracked the records to the care given for individual needs identified and any equipment supplied. Mrs Datoo also tracked the records of a number of residents to establish how medication was being ordered, supplied and administered. The Inspectors through observation and by speaking to staff and residents formed the opinion that staff are unable to give a good standard of care despite trying hard, due to poor communication between staff, poor staffing levels, care staff having to perform ancillary duties and lack of appropriate training. The Inspectors examined records of accidents, concerns and complaints, the records showed that residents are being put at risk on a regular basis by lack of sufficient staff to supervise them, to minimise the risk of accidents and keep them safe and that sufficient and appropriate food is not always available. The inspectors spoke to the majority of residents in the elderly frail unit; they were all complimentary about the staff but did say that the staff were too busy to spend enough time with them. They said that staff could not care for them the way they used to in their previous homes. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 6 Staff who were spoken said that they were frustrated that they could not care for the residents the way they would like and the way they used to. Some residents in the Dementia units could offer an opinion and told the inspectors that the staff were very nice and caring but were always rushing around. The inspectors were told that it has been a difficult time with three homes and staff groups coming together and the Registered Manager being asked to leave her post shortly after the home opened. The Inspectors did acknowledge that since Mr Heryet has been seconded into the home two months ago a number of things have improved, staff and residents did say this. However in general the health, safety and welfare needs of residents are not being met and staff morale is low. Mr Heryet was told that the home is not meeting the aims promised in their Statement of Purpose. 17 Requirements have been made following the inspections. What the service does well: What has improved since the last inspection? What they could do better: The majority of resident’s assessments, risk assessments and care plans are out of date and do not reflect their changing needs or risks in a new environment, these must be updated. The home must make arrangements to ensure the cultural and linguistic needs of all residents are met. Nutritional screening must be carried out and risk assessments completed for all residents, specialist advice from a dietician should be sought especially for those residents who are losing weight and at risk. An activity program should be available to suit individual resident’s needs. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 7 Nutritious meals must be provided with sufficient quantity and choice for the resident’s accommodated to have the meals they order and meet their cultural needs. Training in the home for the safeguarding of vulnerable adults must be reviewed, as some staff did not know what they should do if they saw a resident being abused. There is a risk of the spread of infection in the home due to poor standards of hygiene being practiced on the units. Staff have to multitask on each unit on a daily basis, providing personal care, serving food and washing crockery and cutlery in the sink. Care staff handling food on the units should follow safer practice to avoid the spread of infection. The staffing levels in the home are not meeting the health, social or safety needs of residents and should be increased and staff should receive appropriate training to be able to meet the specialised needs of residents. Staff who are on the duty rota to work in the home must not be allocated to the Day Unit unless their hours are fully replaced in the home by additional staff. Staff including agency staff must be supervised more closely to monitor standards. The record keeping in the home is of a poor standard and must be improved. Recruitment files should be audited to ensure they are compiled to meet legislation. The use of wedges and other items to hold back bedroom doors open must be discontinued. The Dementia unit should be further adapted to maximise the potential of the residents suffering from this condition. Standards of storage and record keeping plus breaks in supplies of medicines are putting the health and welfare of service users at risk. 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.V325826.R01.S.doc Version 5.2 Page 8 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.V325826.R01.S.doc Version 5.2 Page 9 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 poor. This judgement has been made using available evidence including a visit to this service. Parts of the statement of purpose and service user guide do not reflect the service actually provided in the home. Not all service contracts have been completed for the new home. Resident’s assessments and risk assessments have not been updated since the residents were admitted to Deerswood Lodge from their previous homes. They do not record the changing needs of the residents or identify any risks from their new environment. Some care staff do not have the specialist training needed to look after residents suffering from Dementia leaving the residents and the staff at risk. The home does not provide intermediate care. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 10 EVIDENCE: The Statement of Purpose and Service User Guide do not reflect the service presently being given in the home. Not enough staff are employed to meet all of the residents needs and key worker system to provide continuity of care is not fully operational. There is no evidence that relatives have been involved in planning recent care. Residents social and recreational needs are not being met and activity care plans or records not kept. Residents had not been re assessed since being admitted into the new care home, baseline records are not established, assessments and risk assessments are not being carried out and care plans are not being updated to reflect the changing needs. Residents are being put at risk because staff are working in isolation without an updated plan of care. Staff said that they often have to work on the dementia unit without appropriate training or supervision. Some said they feel they cannot look after residents with these specialist needs. Some but not all service agreements in the care records have been signed. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s health, personal and social care needs are not being met due to the shortage of staff and a lack of appropriate staff training. Care records do not reflect the changing needs of the residents. Standards of storage and record keeping plus breaks in supplies of medicines put the health and welfare of service users at risk. Some residents in the dementia unit were not shown respect from staff. EVIDENCE: Assessments and risk assessments had not been updated putting residents at risk. Care plans do not show the changing needs of the residents and care staff said they never look at them anyway. One member of staff said that care staff gravitate to residents they knew at the old homes and tend to avoid those they do not know well. This has a bearing on equality of care for all. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 12 There is no evidence of nutritional assessments or risk assessments and records showed that some residents are losing weight on a regular basis with no action being taken. Complaints about residents losing weight were also recorded in the complaints log. Records did not show that the needs of residents were being acknowledged by staff and when records were made they were contradictory. For example: One resident did not have a risk assessment for falls despite this being one of the reasons she was admitted to the home and this risk was stated in the West Sussex County Council Care Plan (WSCC). The resident’s dietary risk assessment said staff were to cut meat up thinly but the care plan index said food was to be pureed, the daily records said she enjoyed a sandwich. Continence assessment and plan were not filled in despite WSCC plan saying she needs help to maintain continence. The inspectors saw some residents on the dementia unit go without lunch during the inspection due to residents not liking the food they were given or staff not helping or encouraging them to eat. Food charts were not completed so staff coming on duty would not be aware that some residents had not eaten. This was discussed with the team leader and the acting manager at the time, but no alternative meals were provided. There are no specialist aids on the Dementia floor to maximise resident’s potential, and ethnic and cultural needs are not being respected resulting in some residents being unhappy. One lady who was not English was unhappy about not being able to follow her cultural way of living. Residents whose first language is not English were seen to have difficulty communicating with staff whose first language also is not English. A member of staff told the inspector that it was the residents who had to make the staff know what they wanted and did not think that staff had a responsibility to find out by other means. There are no prompt cards, picture cards or other visual aids to help those residents who cannot communicate. Staff said they have to work in all parts of the home including the dementia units, some said they do not have the training to look after people with dementia and said they feel vulnerable. Inspectors were told that the incidents of aggression on the dementia units have risen, which may be because of the lack of appropriate staff training and staff’s lack of understanding dementia. Personal and health care is reactive rather than proactive, as staff have to multitask especially in the morning, there is only one member of staff for each unit (10 beds) and 2 floating staff on the floor. Care staff have to get residents up washed and dressed, make beds, set tables, serve breakfast help those who need it, and clear and wash up crockery and cutlery on the unit. In between helping residents go to the toilet etc. The inspectors noted that there is a risk of spread of infection due to poor hygiene practices because the staff are rushed and do not wear protective clothing. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 13 One incident where a member of staff without a uniform was seen to carry out personal care, she took a resident to the toilet and then served food without a uniform or apron or gloves. The team leader on the floor was immediately told by the inspectors but due to low staffing numbers could do nothing about it. Staff said they could not look after residents the way they would wish and they way they used to. Residents spoken to said that the staff were kind but did not have enough time for them as they did in the other homes. Nine residents were asked how the call bells were answered and they all said they often have to wait a long time especially in the morning and evening and it was certainly not in 3 minutes as promised in the statement of purpose, staff also said this time for answering bells was unachievable. They said that if a member of staff was in a bedroom or toilet helping a resident and the floating staff were in another unit, bells would not get answered and residents were left unsupervised for long periods at a time. This is a health and safety risk especially in the dementia unit. There was a record of an accident happening in one of the Dementia units when the unit was unsupervised with the result the resident had to be admitted to hospital. There were a number of incidents of falls recorded for another resident although GP was informed, the risk assessment only said, “staff need to monitor service users who like to wander”. The acting manager said they were about to complete a proper risk assessment but on the day of inspection the lady had fallen in the night and been taken to A and E with suspected broken ankle. The acting manager was told that the home needs to be more pro-active with risk assessments. Some residents had bruises noted in their records but there were no explanations of how these occurred and the body charts which should record and where bruises and wounds are on the body and the date first seen had not been completed. There are call bells throughout the home; in all of the bedrooms they have cords on them. Risk assessments had not been carried out for residents suffering from dementia to evidence that they would be safe with cords when alone. One the day of the inspection one member of staff allocated on the rota as care staff downstairs was taken away to work in the day centre and not replaced in the home which took care hours away from residents. Records indicated that residents have not had access to a chiropodist for a period of time, however the acting manager said this had now been sorted out. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 14 A number of the records had entries which were not respectful to residents and one member of staff referred to a resident as “Bolshi” when the inspectors highlighted a concern. The acting manager when told said he was aware that some recordings were not appropriate and this was a training issue with staff. During the inspection it became apparent that the care staff are not working as one team, they still seem to be in the mindset of their other homes and if the quality of care in the home is to meet the standard, more staff, training, better communication and team building must be a priority. The homes medication policy was available to staff. Three certificates of medication training were seen. The acting manager said all team leaders had previous medication training and that a training session by the supplying pharmacist was booked for 13/03/07. Medicines were stored in two lockable rooms, each with internal cupboards, a medicines fridge and trolleys. Records showed that the temperature of one fridge and that of both storage rooms were outside the range recommended for medicine storage. The acting manager said these temperatures would be adjusted. In one trolley there were two loose foil strips of tablets and the tops had been torn off the boxes in the trolley door. A bottle of tablets dispensed on 13/09/06 held more tablets in it than originally dispensed. It was discussed that it was not safe practice to store foil strips outside the dispensed container or to decant from one container to another. During observation of medicine administration a member of staff was interrupted by phone calls. The member of staff prepared medicines with reference to the medication administration record (MAR) and signed after administration. A risk assessment was not completed for the self-administration of an inhaler. A pre-admission assessment showed that a service user was allergic to penicillin but this information was not on the MAR. A staff member said that these omissions would be corrected. For two residents a medicine prescribed to be taken twice a day, had only been given in the morning, as shown by records on the current MAR, with no recorded reason for omission of the later dose, for which the supplies could not be found. For a resident who was aware that she ‘had not had medicines for a couple of days’ the MAR had finished on 18/02/07. Staff said that the medicines had been ordered and would be delivered that day. The acting manager agreed that immediate action would be taken to ensure the supply of these medicines. There were many gaps in recording medicine administration and for one supply the gaps did not correspond to the medicines left in the monitored dose system (MDS). For several MDS there were three days supply left but nine days remaining on the MAR. The acting manager said that arrangements had been put in place to coordinate deliveries and gave assurances that supplies would not be interrupted. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 15 Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some routines of daily living are flexible and residents are encouraged to maintain links with friends and the local community. For some residents their lifestyle in the home does not match their preferences and does not satisfy their cultural or religious needs. The activity program does not meet individual needs and residents are not receiving the choice of wholesome, nutritious food. EVIDENCE: Some of the routines of daily living are flexible, two residents were still in bed at 10 am through choice, and a number of residents were in their rooms. One lady was having breakfast at 10 15 am. Residents confirmed that they can have visitors when they like and that they are encouraged to go out into the community. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 17 A limited activity program was displayed; this was for both floors so was not specifically designed for either the elderly frail or residents suffering from Dementia. Inspectors were told that a new activity co-ordinator has been employed and that it was hoped that activities would be expanded. Residents do go out for trips in the minibus weather permitting and residents spoken to said they did enjoy this. Some residents said that they did not take part in the activities and preferred to go back to their rooms. Some said they were often bored as there was nothing in the activity program that interests them. Individual social care plans had not yet been completed but the Inspectors were told that these were planned. One Resident who was previously a churchgoer has been waiting to see a Vicar since she came into the home 4 months ago. Inspectors were told that this was in the process of being arranged. The home has been designed with “streets” on each floor that run the length of the home, this means that residents can wander out from the units into the street on their floor. On the day of the inspection decorators were working in the home so the residents with dementia were confined to their units for health and safety purposes. The home is a new building but the environment for the residents suffering from dementia does not differ from the general environment. The care for the residents suffering from dementia should be improved by environmental considerations in relation to visual clues, colour and signposts. When talking to residents they said that there were always problems with the food. They ordered what they would like the previous day but often there was not enough of what they had ordered and they had to have an alternative. They said the food was often cold by the time it was served. The Statement of Purpose says food is transported from the kitchens to the units in heated Bane Mari’s but there were none in the home and food was transferred in vacuum boxes on top of trolleys. Inspectors were told these were unstable and food boxes do fall off the trolleys while being transported, this is a risk to staff and service users. When the meal situation was discussed with some staff, inspectors were told that problems occurred because residents often changed their minds on the day, however other staff backed up the residents views and said there was never enough food for there to be a choice. There were also complaints about the food recorded in the homes complaint records. The main meal of the day was lunch, which was braised beef, cabbage, parsnips and mashed pots or curried chicken and rice. The cook had put the beans left over from breakfast into the braised beef and a number of people Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 18 refused to eat it because of this. It was also stated on the menu that there were salads, omelettes and jacket potatoes as alternatives and also several alternatives for sweet but no evidence was seen of any of these having been prepared or served. Residents told inspectors that there was never enough food. One resident with dementia did not like her dinner of braised steak with baked beans mixed in, mashed potatoes and cabbage. The carer on duty removed the plate but did not offer her an alternative when inspectors asked the carer said the lady could have an alternative but did not do anything about it. One carer was serving lunch without speaking to residents; one lady only had mashed potato and gravy and when the carer was asked why she said it was because she was on a soft diet. There were no pureed diets seen. At no time on this unit were residents encouraged to eat or was any help offered. Other residents left their meals and these were just cleared away without a thought that the residents may be hungry. During this time there was only one carer in the unit and she had to take residents to the toilet while serving food and making tea. No protective aprons or gloves were worn. While the carer was out of the unit other residents were left unsupervised. There was no recorded evidence that this carer had received training in food hygiene. The records of one of the residents who did not eat lunch were examined, her record specifically said this resident did not like baked beans however she was served her meal with baked beans. This resident stated she liked salads but when inspectors asked they were told there was no salads left. This resident had also lost weight and there was no action recorded that anyone had identified there was a problem. When the acting manager was told he said that he had only seen the residents eating their sweets. Food charts for these residents were in the dining rooms but these had not been filled in so staff coming on duty would not know these residents had not eaten. One resident likes rice dishes due to her cultural background but the only rice dish she got offered was curry which is not the sort of dish she likes. Another resident was trying to eat a whole half of a parsnip and was offered no help with cutting it up or eating it. The inspector asked for a sample of the food served to residents and was given a tasty meal of braised steak, potatoes cabbage and without baked beans. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 19 When the Inspectors went to the kitchen they were told that residents could have alternatives of an omelette, a baked potato or salad however these alternatives had been in short supply and Inspectors were told that there were none left so the residents who had not eaten a meal were not offered anything else to eat. The kitchen is small for catering for 100 people and staff told Inspectors that some of the equipment was not suitable for a home of this size so there were limits to what could be cooked. The acting manager said another oven was on order. Inspectors asked why the dishes were being washed up in the units by care staff they were told that there was not enough room for the dishes to come back to the kitchen. So the dishes and cutlery were never sanitised. The inspectors had seen a carers on units washing dirty dishes in lukewarm or under cold running water without washing up liquid. The tea towels being used on all units to dry dishes looked dirty. Nutritional assessments were either not in place or were very out of date. People were being given food that their care plans clearly stated they did not like. There was evidence that people were losing weight and there have been several complaints from families about the food. There is also a complaint recorded from an agency cook saying there was not enough food for everyone. For tea, trays of sandwiches were made up for each unit with a de-frosted éclair for each person. There was also an alternative which was supposed to be bubble and squeak but was the potato left over from lunch, mixed with cabbage from lunch with a bit of cheese sprinkled on top, there was only a small amount of this. Deerswood Lodge DS0000068513.V325826.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): Quality in this outcome area is poor. 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. Residents are not safeguarded against abuse because of the lack of staff awareness and lack of appropriate training. EVIDENCE: Complaints are recorded and what action has been taken, in the 4 months since the home opened there have been 18 complaints all of which were substantiated. There are no outstanding complaints. Many of the complaints were about food, lack of staff or lack of care to residents including concerns over weight loss. There has been a relatives meeting recently and minutes acknowledged that some of the issues identified have been sorted out since the acting manager has been at the home. The training matrix given to inspectors showed that training is given to staff for the safeguarding of vulnerable adults. However when three staff were asked what they would do if they saw a resident being abused they all said they would decide if it should be reported and would not automatically report Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 21 to senior staff. One carer has worked at the home since it opened and has not had induction so was not aware of how to safeguard residents from abuse. There have been 4 adult protection alerts since the home opened, one is still outstanding. Deerswood Lodge DS0000068513.V325826.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 poor. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable clean and well-furnished environment and have access to indoor and outdoor facilities and there are sufficient toilet and washing facilities. Specialised equipment is supplied and resident’s bedrooms were well decorated and furnished. The accommodation for residents suffering from Dementia has not been adapted to maximise their potential. Risk assessments are not carried out for the cords on the call bells. Systems are not in place to control the spread of infection and the practice of wedging doors open are putting residents at risk in the event of a fire. EVIDENCE: The home is a new purpose built home. There is a car park to the front of the home. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 23 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 have been instances when residents have managed to get out of the home and have been found wandering, however the acting manager said that this had now been sorted out. There are rooms for team leaders and staff on each floor where the records are kept but these are called and signed as nurse’s offices, as the team leaders wear navy blue uniforms it is misleading to residents and visitors. Staff acknowledged this and inspectors were told that they often get mistaken for nurses. All areas of the home were inspected and were nicely decorated and furnished. All areas were clean.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.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. 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. 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. There were books, magazines and jigsaw puzzles around, but those people who were not able to access them by themselves were not being encouraged or supported by staff to be stimulated. Televisions were on in every “house” and there was also music playing quite loudly on the dementia units even though many of the residents could not make a choice about whether or not they wanted it on. 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. The home is a new building but the environment for the residents Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 24 suffering from dementia does not differ from the general environment for the frail elderly. The care for the residents suffering from dementia could be improved by environmental considerations in relation to visual clues, colour and appropriate signage it is recommended that an occupational therapist advice be sought. There were no risk assessments for call-bell cords in place in the units for people with dementia. The laundry facilities were adequate for the residents accommodated but the kitchen was small and the oven not adequate for cooking for 100 people. The acting manager said another had been ordered. Staff said that the kitchen is too small for the crockery and cutlery from the units to be bought down to be washed and sanitised, the practice seen by inspectors on the units was not hygienic in some units dishes were not being washed properly and none of the tea towels looked clean therefore there is a risk of infection spreading. During the inspection the inspectors saw numerous incidents of poor hygiene practice on the units relating to the serving of food, the washing of dishes, staff not wearing gloves or aprons and taking residents to the toilet while serving food. Any of these incidents would be an infection control hazard and could cause spread of infection. The door to the smoking room (two people were in there smoking) on the first floor was propped open by a large heavy plant pot, this was a fire hazard, staff were told to shut it. Four bedroom doors had also been propped open, two with wedges, one with a box and one with a shoe, the acting manager was reminded of the fire safety implications of this practice. One room had an offensive odour the team leader informed the inspectors that it was the carpet that was smelly and she would ask for it to be cleaned. In some bathrooms there were cleaning fluids and creams left where they could be accessible to vulnerable service users. There is a separate day-care facility, which caters for people living in the community. Deerswood Lodge DS0000068513.V325826.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 numbers and skill mix of staff is not meeting the needs of the residents and staff are not trained to meet specialised needs of the residents. Care staff are not supported by an adequate number of ancillary staff. The recruitment records are not complete so do not show fitness of workers. EVIDENCE: Staff duty rotas were available however they only showed the first names of staff, the acting manager said this had already been changed. The use of agency staff in the home was high 300 hours for the week over Christmas and 500 for the week over New Year. Inspectors were told that said that this had now decreased as they had appointed more staff but they did still use agency. There is only one member of staff allocated on each unit for a possible 10 people and then 2 other floating on the floor. These care staff have to get people up, washed and dressed, make beds, set tables, serve breakfast and help those who need help, take people to the toilet, supervise residents and then wash up and dry up crockery and cutlery. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 26 Through walking around the units and talking to residents and staff it was apparent that the care is hurried, infection control practice is not safe, agency carers were working on the day of the inspection, they did not wear uniforms or identification badges and they were not adequately supervised. Staff said that they were too busy to give the care they would like or care how they used to as they were doing too many things. They said that if they were in with a resident and the floaters were busy the residents were unsupervised for long periods and bells could not be answered. A recorded incident happened on 28/1/07 in one unit, which had no staff on duty, the team leader went in to cover but had to come out for a short time to handover to other staff leaving the unit unattended by staff. A lady fell during this time and was taken injured to hospital. Another unit was also not covered during this time leaving vulnerable residents unsupervised and at risk. Staff said that they are often moved around the units and sometimes went onto the dementia floor even though they had not had appropriate training and felt vulnerable. One carer who was in the day unit was supposed to be working in the home but had been moved as they were short in the day centre inspectors were told that she had not been replaced. While talking to staff it became apparent that staff are not working as a team and that communication is poor. Staff did say that they only liked looking after the residents they knew in the old homes, which could indicate that some residents are getting token care. Generally staff said that the floater system in place was unworkable and very stressful. There are rooms for team leaders and staff on each floor where the records are kept but these are called and signed as nurse’s offices, as the team leaders wear navy blue uniforms this is misleading to residents and visitors. Staff acknowledged this and inspectors were told that they often get mistaken for nurses. The pre inspection questionnaire completed by the acting manager records that 32 of carers have NVQ 2 or above. Inspectors were told that more are being trained. One carer who had been working in the home for 3/4 months had not had any induction and did not know the safeguarding adults procedure. A training matrix was supplied with the pre inspection questionnaire but was confusing, however the acting manager was able to confirm some training from computer records. Staff who were working with the residents with dementia had not had training in dementia, handling aggression or challenging behaviour and they admitted they sometimes felt out of their depth. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 27 A number of staff recruitment and training files were examined. Because the records came from previous home not all of the contained the information required to ensure fitness of staff although all had criminal record bureau checks. Some staff were out of date with essential training and this was discussed with the acting manager at the conclusion of the inspection. The pre inspection questionnaire stated that 20 members of staff have first aid training, however the training file indicated that many of these are out of date. Despite being very busy the majority of staff were seen to be caring and friendly with residents and on one of the dementia units staff had managed to give one of the female residents a manicure. At 2.15 pm the inspector went into one unit and there were 7 residents without supervision one was very distressed the inspector was told that this was because this resident usually likes to wander but they were confined to the unit because of the decorators. Because of this knowledge more staff should have been allocated to the units. The carer who should have been supervising was in the toilet with another resident. The team leader was asked to attend. Deerswood Lodge DS0000068513.V325826.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): 31,32,33,35,36,37,38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Acting manager is trying hard to manage the home under difficult circumstances, however the shortage of staff and the unsafe infection control and health and safety practices in the home are affecting the quality of care and health and safety of residents and staff. Resident’s interests are not safeguarded by poor or non-existing record keeping in the home putting residents at risk. Staff are not appropriately supervised. EVIDENCE: Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 29 The manager’s post is vacant. An acting manager has been bought in from another of the company’s homes. Staff told inspectors that things have improved in the 2 months he has been there, however he said he is still dealing with problems from before his time so has not been able to move forward very far. Staff are not working as a team and said that communication about residents is poor and the records are not up to date so they tend to gravitate towards residents they know from their previous homes therefore there is a risk of double standards operating. Agency staff are not adequately clothed or supervised. The home is being visited on a monthly basis by a representative of the company however the Regulation 26 reports for December 2006 and January 2007 were identical for: feedback from clients and relatives, environment and maintenance, food menu and recording, staff recruitment and sickness so it was difficult to establish what if any corrective action had been taken from December to January. The manager said that the home does not look after any monies of the residents; the relatives or advocates meet their financial needs. A quality assurance system has just started and the acting manager recently held a residents/relatives meeting. He said things that they bought up were previous to his time and that the majority had been satisfactorily addressed. Inspectors were told that staff supervision has started but has not been completely rolled out. As staff are working in isolation this should be a priority. The record keeping in relation to resident’s records is below standard and does not protect them. Some health and safety issues were identified and some staff need to be updated in fire safety training and first aid. The practice of wedging or propping doors open should cease. Food hygiene practices are not safe and safe infection control practice is not carried out. Cleaning substances were in reach of vulnerable residents in some bathrooms and risk assessments are not up to date and no residents had a new one completed for this home. Not all staff have received induction and foundation training. Staff do have pocket alarms but staff said that often these did not work and staff had to call for help. A key worker system is not in operation although inspectors were told about the plans for this and could see that some preparation had been carried out. Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 4 4 2 4 4 4 1 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 1 1 1 Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement All residents should be re assessed to record their changing needs. All residents should have up to date records (risk assessments) of risks to their health and safety. The specialised needs of residents with dementia, ethnic and cultural needs should be understood and met. Residents shall have a written care plan to show their needs and these should be updated to reflect any changes. of action taken by All residents should have up to date nutritional assessments and specialist advice should be taken from a dietician on how to meet individual nutritional needs. Arrangements must be made to ensure an adequate supply of prescribed medicines. Complete and accurate records DS0000068513.V325826.R01.S.doc Timescale for action 31/03/07 2 OP3 13.4 (c) 31/03/07 3 OP4 14 31/03/07 4 OP7 15 31/03/07 5 OP8 12.1(b) 31/03/07 6 7 OP9 OP9 13 (2) 17(1) (a) 05/03/07 05/03/07 Page 32 Deerswood Lodge Version 5.2 8 OP15 16 2 (i) must be kept of medicines received and administered to service users. Residents shall be given suitable 31/03/07 wholesome and nutritious food in adequate quantities. Through training and supervision staff should be aware of how to recognise abuse and the correct procedure to follow. 31/03/07 9 OP18 13.6 10 OP26 13.3 The registered person shall make 31/03/07 suitable arrangements to prevent infection, toxic conditions and spread of infection at the care home. Suitably qualified and competent staff should be working in the home in such numbers as are appropriate to meet the needs of residents and to protect the health and safety of residents. Two members of staff should always be allocated to work on each of the dementia units. Units throughout the home must never be left without competent staff on duty. Staff should be given training appropriate to the work they have to perform. e.g. Dementia training, handling aggression, challenging behaviour, adult protection, food hygiene, infection control. Staff especially agency staff must be appropriately supervised and records must be kept. Record keeping in the home must be improved in order to evidence resident’s needs are being met and the health and DS0000068513.V325826.R01.S.doc 11 OP27 18.1 31/03/07 12 OP30 18.1 (c) 31/03/07 13 OP36 18.2 31/03/07 14 OP37 17 31/03/07 Deerswood Lodge Version 5.2 Page 33 safety of residents is safeguarded. 15 OP29 19 The staff recruitment files should be audited to ensure that they contain information to evidence fitness of staff in order to protect residents. The bedroom doors should not be wedged open because if a fire should start it would not be contained and residents would be at risk. Cleaning items which could harm vulnerable residents should be kept out of reach. 31/03/07 16 OP38 23.4 (c) I 31/03/07 17 OP38 13.4 (a) 31/03/07 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 OP19 Good Practice Recommendations Professional advice should be taken to adapt the Dementia units to ensure residents can maximise their full potential. Deerswood Lodge DS0000068513.V325826.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. Extracts may not be used or reproduced without the express permission of CSCI Deerswood Lodge DS0000068513.V325826.R01.S.doc Version 5.2 Page 35 - 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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