Inspection on 26/02/08 for Deerswood Lodge

This inspection was carried out on 26th February 2008.

CSCI found this care home to be providing an Poor service.

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 01/07/07

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 Ann Peace Unannounced Inspection 26th February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Deerswood Lodge DS0000068513.V358083.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.V358083.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.V358083.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. 1st July 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 new manager is in place and intends to apply to the Commission to be registered. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is o stars. This means the people who use this service experience poor quality outcomes. A visit to the home was carried out on the 26th February 2008 by Mrs Ann Peace Regulatory Inspector and Mr E McLeod Regulatory Inspector and lasted nine hours. The previous visit to the home had been in October 2007 to check on outstanding requirements. We met people in the communal areas of the home and in their bedrooms, we observed residents and staff interactions throughout the day and we spoke to as many residents and visitors as we could to gain an insight into life at the home. We observed that residents were in the main relaxed and content in the home and had good relationships with the regular staff who do try to care for residents in a caring, friendly and professional manner. ‘Have Your Say’ surveys had been sent to people using the service and staff prior to the inspection and the results from the surveys and the comments have been included in this report. Due to the mental frailty of the some of the residents on the dementia unit we were not able to engage in meaningful conversation with many during the visit. Those that could offer an opinion on the elderly frail unit (EFU) were mixed in their responses. The majority said they were happy with the care from permanent staff but were not so complimentary about the care given by agency staff which the home relies heavily on. There were some vacancies in the home at the time of our visit. Some comments from the surveys were: “The home provides care for my mother’s needs”. “The care given from staff is very good and staff are lovely”. Although there were some negative comments: “Some carers do not understand my husbands needs, some days he cannot walk and others he can, his mood changes with the disease”. “Should be more courses for staff in understanding mental illness”. “Not enough one to one contact with staff who are too busy”. Ways to improve is to “Ensure staff who are employed can speak English”. “Employ more permanent staff”. “Would prefer more English staff”. Six requirements were made at the last key inspection in August 2007. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 6 Requirement Notices were issued in September 2007 relating to unsafe medication practices; unsafe recruitment procedures and lack of evidence to show agency staff were competent to work in the care home. The compliance date was 5th October 2007. An improvement plan submitted by Shaw Healthcare Ltd in September 2007 stated that all agency staff must provide details of their fitness, qualifications and training prior to being accepted for duty. We found that this is not being carried out in all cases. On this visit we found that 4 previous requirements are still outstanding and we have made 6 further requirements. The following regulations have been persistently breached: Regulation 14 All services users must have a full assessment of needs including individualised risk assessments to safeguard their health and welfare. Previous date for compliance was 30/09/07 Regulation 17.1(a) 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. Previous dates for compliance were 30/09/07 and 30/12/07 Regulation 19.1 The registered person must operate a thorough recruitment procedure to ensure the fitness of people working in the home. Previous dates for compliance were 31.03.07, 30/09/07 05/10/07. Regulation 19. 5 (b) The registered person must ensure that staff working at the home has the knowledge and skills to care for services users and keep them safe. Previous dates for compliance were 30/09/07 and 05/10/07. It is the intention of the Commission for Social Care Inspection to issue a Statutory Requirement Notice to enforce compliance of the Regulations. and What the service does well: The home is purpose built and is clean, comfortable and well furnished. Resident’s rooms are personalised to make them more homely and the toilets and bathrooms have suitable adaptations. The permanent staff are caring and friendly towards residents and their relatives and friends. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Deerswood Lodge DS0000068513.V358083.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.V358083.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): 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. New residents do have their needs assessed before admission but not all risk assessments and care plans that are needed are in place. Once admitted full assessments are not routinely carried out. The home’s own risk assessments are not always followed up with the action needed to safeguard residents. Care staff have received training to look after residents suffering from Dementia. The home does not provide intermediate care. EVIDENCE: Records of new residents showed that residents are admitted following a full pre assessment by the manager or the deputy manager. Care management summaries compiled by Social Services about the resident are also in the records where appropriate. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 10 However in the case of one resident who had been admitted to the home in mid January 2008 a full assessment had not been carried out. Only 3 parts of the homes’ 17-part assessment documentation had been completed, and one risk assessment for falls but no others. The nutritional assessment had not been completed even though records showed that this resident had lost weight on 2 occasions in February 2008. No baseline observations had been carried out and there had been no care plans formulated despite a promotion of continence assessment saying a care plan had been written. This means that staff do not have the information about the needs of this resident or how to care for them and risk factors for their health and welfare had not been identified putting them at risk of harm. Another new resident who had been admitted following a good pre assessment had scant records to enable staff to care for them. Their own risk assessment documentation showed that this resident was at a very high risk of developing pressure sores but despite this no pressure relieving equipment was in place. When we asked a member of staff why there wasn’t any they said that they would not put in a request for the resident to be assessed by district nurses until the resident had decided whether they were staying in the home as they were on a months trial. This means that for a month this resident is at high risk of developing sore pressure areas and the home are not meeting needs identified by their own risk assessments. Following a requirement made a previous inspections staff now have training in Dementia care, they told us that this had made them more aware of the specialised needs of resident’s with dementia. Intermediate care is not offered at Deerswood Lodge. Deerswood Lodge DS0000068513.V358083.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. The majority of residents but not all have care plans and risk assessments however the staff team are working very hard to try to meet their needs. Not all resident’s health care needs are being met due to lack of staff time and specialist equipment. Staff treat residents with respect and care for them in privacy. The medication procedures in the home are safe. EVIDENCE: We received ‘Have Your Say’ surveys from residents, relatives and staff. In the main residents said they have enough care and support and staff are available and said staff listen to what they say and they get medical support they need. However on the day of the visit residents were not so positive. We received seven surveys from staff and the majority said they have enough training and support to care for residents. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 12 The majority of staff said that only sometimes there is enough staff on duty to care for residents, others said there was usually enough staff. We received nine surveys from relatives and they said they thought the staff had the skills needed and that usually there was enough support to meet differing needs. Some comments were: “The home provides care for my mother’s needs”. “The care given from staff is very good and staff are lovely”. “Most of the permanent staff are excellent”. However there were some negative comments that included: “Some carers do not understand my husbands needs, some days he cannot walk and others he can and his mood changes with disease”. “Should be more courses for staff in understanding mental illness”. “Not enough one to one contact with staff who are too busy”. “Ensure staff who are employed can speak English”. “Employ more permanent staff”. We also obtained by telephone the view of a Care Manager who said that the feedback from relatives during reviews was positive. We did not receive any feedback from health professionals who visit the home in time for this report. When we spoke to people during the visit we had the following responses. One family member we spoke to said they had seen a copy of the care plan for their mother, and one relative said they had not. Another relative we spoke to said that they did not believe her mother was always receiving the help with her personal care that she needed, for example bathing, and that this particularly true when agency staff were assigned to her mother’s care. One resident living in the home said the support with mobilising (hoisting) that he needed was sometimes rushed and done in such a way that caused him pain and discomfort. There was also a complaint recorded in 2007 about this happening to another resident and records indicated that it had been sorted out. We informed the manager that there still seems to be a problem. One resident we spoke to said they liked to be active all the time. She said that while staff did arrange walks with her and for her to assist with making teas and coffees, a lot of the time she was bored and needed more stimulation. The person did have her own plan of activities, but she told us the activities weren’t always things she was interested in. One resident said she was able to get up any time she liked, but as “breakfast doesn’t come up until nine” she wasn’t inclined to get up much earlier. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 13 Another resident said staff had knocked on her door at 6 a.m. that morning though she didn’t have a wish to get up at that time. She said she was however brought a cup of tea of 7 a.m. and she liked that. The care records of nine residents were looked at, five in detail. We noted that the majority had been regularly updated up until December 2007 but since then only one had been updated in January 2008. Of the five seen in detail, one as stated earlier in the report did not have the risk assessments or care plans required for the staff to be able to know the individualised needs of the resident or how they needed to be cared for. When we spoke to this resident she said staff have to ask her what they need to do when they came into care for her. She had asked if she could be helped to mobilise for a short period with a walking aid but said staff are too busy and it is quicker to put her in a wheelchair, staff when spoken to confirmed that they would like to help her mobilise but did not have the time. There were no records to indicate that this resident had been referred for physiotherapy. Another new resident who is a diabetic had scant records. Although the home is promoting person centred care, there had been a generic risk assessment completed which was not person centred, this said the resident could be frustrated and anxious and that staff should watch out for trigger factors. These trigger factors are not mentioned anywhere in the records and there is no care plan for frustration or anxiety. When we spoke to the resident, their relative and the staff they all said that this resident was not anxious and did not get frustrated. When we asked staff on the unit about this resident they said that they only knew she was a diabetic and nothing else about her. They said this is because they are regularly moved between units so were not able to build up any continuity. There have been problems in the past about staff not being competent to make decisions when faced with an emergency and calling the ambulance service. Since the last visit team leaders have attended first aid training and we are told that the calls to the ambulance service has decreased. However in the care records of one diabetic resident there are instructions on the signs and symptoms of a diabetic emergency but no instructions of staff should deal with it. On one unit there is a resident who was quite unsettled and noisy and although staff did go into him on a regular basis while we were in the unit no one gave him his call bell which was attached to the wall, however there were no records to say why he could not have the bell. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 14 This resident had a very high Waterlow score which indicates he is at high risk of developing a pressure sore but he did not have any pressure relieving equipment in place and there was no record of remedial action being planned, also daily records showed that he had not had a bath or a shower since late January even though he had a continence problem. When we discussed this with managers they were not aware of this problem. Staff told us that due to shortage of staff it was quicker to wash residents as usually one member of staff could do it rather that bathe or shower as this usually took two members of staff. Another resident who was also at risk of pressure sores did not have pressurerelieving equipment in place. We were told that they used to have a pressure relieving mattress in place but following an accident it had been removed. This was recorded, but no further action had been taken to either to ask for a re assessment from the district nurses or to access any other equipment. We noted that one resident had a generic risk assessment related to verbal aggression and mood swings. The risk assessment said staff were to be aware of trigger factors, however there are no trigger factors recorded in the care records and there is not a care plan specific to this problem telling staff how to deal with this. This could put staff and other residents at risk. We visited the room of one resident and there was a strong smell of urine in the room and about the resident’s person. Care records did highlight a problem with incontinence however the records recorded that this resident had only been offered one bath in February even though their care plan said offer a bath or shower weekly. January’s records for this resident could not be located so we could not determine how many baths or showers this resident had been offered. This resident’s monthly evaluation had last been carried out in December 2007 and recorded that this resident was self-caring; however further down the same page it said they needed help with personal hygiene so there was a contradiction in the records. On the elderly frail unit we are told that as there was only 4 carers on and one floating for 46 residents so people could not have baths or showers as they wished. The manager told us that as well as these carers, there were also two team leaders on duty however we noted at the busy time of day when residents are getting washed and dressed the team leaders are carrying out drug rounds and have other duties and call bells are going unanswered. During the lunchtime a resident needed help to get out of his room in a wheelchair, we asked an agency member of staff to attend to them to help them. The carer seemed oblivious to the request and continued to watch television we had to ask twice before the resident was given help. We did report this to the manager. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 15 When we looked through the home’s own quality assurance surveys from December 2007 we saw that one resident had expressed concern about “dreading the nights” as some staff did not know what to do, there was no evidence that this had been followed up with the resident or that the problem had been addressed, when we spoke to this resident they did indicate it was when agency staff were on duty which was very frequent. The minutes of the last residents meeting in January 2008 recorded that one resident asked if he could be helped by staff to mobilise for five minutes in the morning and five minutes in the afternoon with a walking aid. The records stated that the key worker would put this request in the care plan and it would be carried out. When we looked at the resident’s records it had not been recorded as stated and the resident said it had never happened. We did note throughout the visit that the majority of staff were very kind and caring towards residents, however in the early part of the day the call bells were ringing a long time before being answered. When we asked why we were told that his was because when staff are in a room attending to one resident they cannot just leave them to answer bells and if the doors are shut staff did say they often couldn’t hear the bells anyway. Requirement notices relating to poor medication practices in the home were issued following the last inspection. A random inspection in October 2007 found the notices had been complied with. Staff have received further training in safe medication procedures and the company have carried out regular quality audits to monitor the situation. These were available for inspection, it was noted that if any action was needed following an audit a record of this is not kept with the audit so does not give a full picture. However the deputy manager told us that the action plans are kept on the units. We monitored part of the medication round on two of the units could confirm that safe procedures are being followed. We were informed that a full medication audit was due to be carried out by an outside pharmacist the day following this visit. Although there are some serious gaps in care records we did note that the majority of staff on duty were very kind, thoughtful and respectful towards residents and do try to do their best for the residents. Where problems were raised about staff it was about agency staff not permanent staff. We followed one senior member of staff around for a short while and she was very patient and sensitive to residents needs and obviously had a good rapport with them and they showed they trusted her. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 16 Deerswood Lodge DS0000068513.V358083.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 poor. This judgement has been made using available evidence including a visit to this service. The home is not ensuring that each resident is having their religious, and disability needs recognised and met. The care home is not always supporting residents to follow personal interests and activities. Residents are able to keep in touch with family, friends and representatives. Residents are not encouraged to be as independent as they can be, lead their chosen lifestyle or have the opportunity to make the most of their abilities. Residents are not always having nutritious and attractive meals at a time and place to suit them and feel they have little or no influence on how the service is run. EVIDENCE: In the survey forms we received, people told us that they wished to be able to go out more often. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 18 An activities programme seen during our visit indicated that there was usually an activity such as quizzes or cards arranged during the afternoon. It was noted that during mornings when residents living in the home may feel more interested in doing activities there was often no activity arranged. Residents we spoke to during our visit gave examples of activities they would be interested in doing, such as singing, feeding birds, art, and rearranging their living area. One resident said he’d done painting at the previous home where he had lived, and would like to try that again. Homes are expected to record the social needs and interests of people living in the home, and set out how those needs will be met. The above examples indicate people’s interests aren’t always being followed up. One resident we spoke to during our visit showed us an individual activities plan which had been arranged with her. However, the individual activities recorded were often those pre-arranged within the home, and one of the activities on her plan was joining in on quizzes, which she said she was not interested in at all. We also found on the morning of our visit the plan advised that she would be accompanied that morning by staff on a walk into the village, but that this activity had not taken place as arranged. This resident said she was not being encouraged to be as independent as she could be, as she’d like to do more. During our visit a member of staff said to us that if more staff time was available this particular resident could become more mobile and independent. This indicates that there are limited opportunities for residents to be independent, they are not helped to follow their own particular interests and little consideration is giving to supporting resident’s individuality or social preferences. We asked two residents living in the home if they liked the sensory equipment which had been set up in the room used for hairdressing. One said the lights were not being switched off when the hairdresser was doing her hair, and this was a distraction. Another one said she would prefer to look at something living like fish in a tank rather than what she referred to as “abstract” things. The daughter of one resident living in the home told us that while her mother liked bingo, due to her memory loss she becomes very insecure and worried outside her usual environment. This means that when bingo is arranged in a different unit in the home to the one she lives in she doesn’t wish to leave her familiar surroundings and therefore misses out on taking part in the bingo. Her daughter told us that if her mother is taken to another unit she becomes unsettled and asks to go back to her own unit. This indicates that managers and staff need to more closely assess how this resident’s social care needs can be met. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 19 We found that during the day we visited and the hours we spent in the morning and in the afternoon on the living areas in the home that staff were generally kind and considerate towards people receiving care. However, it was also noted that we did not see very often staff engaging residents in conversation or spontaneous activities, and this also indicates to us that residents are not being encouraged to maintain their social and independence skills. Comments made in survey forms included that there was “not enough one to one contact with staff who are too busy”. “Employ more permanent staff. “I would like to get out more instead of sitting in this room 24 hours a day not that its horrible but it feels like a prison. If I cant get out I would like to join a club or a library”. On the day of our visit a church minister was leading a church service in the home. The activities plan seen did not refer to any arrangements in place for people with other religious beliefs, such as Catholicism, and one person we talked to said she was a catholic but wasn’t aware of how she might be able to follow her religion while living in the home. One relative we talked to said that she often heard people complaining about the food, and survey forms we received indicated some dissatisfaction with meals provided. On the day of our visit, some people said they were happy with the meals provided and some people said they were unhappy with the meals. Complaints made to us during the visit included a lack of flavour, condiments on the menu such as mint sauce and applesauce not being provided, and food not cooked in the way they would wish, and food sometimes being cold. Three people we talked to said they made complaints to staff or managers about the meals, but that nothing was ever done. Two residents told us that they had recently complained to the manager about the poor food, however there was no record of this in the complaints file. This indicates that residents living at the home feel they have very little or no influence over decisions about how the service is run. We observed a lunch sitting in six of the nine living units in the home. We found that people were being offered a choice of main meals, being a sausage casserole and a potato-based dish which according to which unit you were on was either corned beef hash or three-bean hash. We tasted the one of the meals bought up to the units, it was displayed on the menu as three bean hash but there were very little beans and it was tasteless. The staff on some units were telling residents it was corned beef hash. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 20 The other option was sausage casserole and it looked like sausages boiled in watery gravy it looked very unappetising. Residents said it was tasteless and the hash tasted of potatoes only. One resident who was vegetarian received a cheese salad, and one resident received an omelette. One person said that the day before they had to wait from one o’clock until two o’clock for their lunch to arrive, and said the reason given for this was that staff were on their lunch break. We discussed this example during our visit with a manager. One person said they asked if the menus could be changed, and were told that the company determined the menus. When we spoke to the acting manager, she confirmed that this was the case. We visited the dry stores cupboard and the cook we spoke to confirmed that while items such as mint sauce and apple sauce could be purchased he would only order these if staff asked him to, and that there wasn’t mint sauce or apple sauce held that day in the dry stores cupboard. We found that snacks and drinks were available on each of the units, and that the menu for the day had been written on a white board. We found that people who were requiring help with eating were receiving this, although we noted for some people that by the time they received the help their food had gone cold. This was avoidable, as the food was served in each unit from a heated trolley and the meals could have been left in the trolley until needed. We were also concerned that for one person with diabetic needs there was a delay in their food arriving that could have had medical consequences. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 21 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. However the same complaints are reoccurring so have not been dealt with appropriately. Resident’s legal rights are protected. In the main residents are protected from abuse and permanent staff know the procedure to follow, however agency staff are being employed without confirmation of appropriate training and the recruitment records have gaps in them. EVIDENCE: The complaint procedure is on display in the home with all the relevant information residents or other people visiting the home may need. We looked at the complaints record and could confirm that the majority of times complaints are recorded and action recorded as being taken when necessary. However there were complaints recorded about food, laundry and problems with staff using hoists in late 2007 but we found during this visit that these things were still happening even though an audit had been undertaken. This Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 22 was discussed with the manager at the end of the visit who said she would follow this up. For example the home’s complaints records showed that there had been complaints about the laundry and surveys indicated that there are still problems with resident’s laundry being lost and residents and relatives finding laundry in wardrobes and drawers that don’t belong there. During this visit we saw a relative trying to sort a problem out where they had found two pairs of trousers in their fathers wardrobe that did not belong to him. CSCI have not received any complaints since the last visit. A policy about residents legal rights are on display in the outer foyer, which the majority of residents do not have access to independently, whether this would be better placed on the units must be considered by the manager. We could confirm that staff employed by Shaw Health Care do have regular training in the protection of vulnerable people, however as recorded later in the report managers are not always obtaining proof of training before agency staff begin work in the home, therefore cannot be sure that they have had the appropriate training. One permanent member of staff had been employed without references being taken up. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 23 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 well-maintained, comfortable, clean and well-furnished environment and have access to indoor and outdoor facilities. There are sufficient toilet and washing facilities. Specialised adaptations are available in the toilets and bathrooms and resident’s bedrooms are well decorated and furnished. Some improvements have been made in the accommodation for residents suffering from Dementia to maximise their potential and stimulate them. EVIDENCE: The home is a new purpose built home and there is a car park to the front There are secure gardens around the home and a patio area with seating. The Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 24 home has a swipe fob facility for entry into the home and the dementia unit for security. All areas of the home are nicely decorated and furnished and all areas are 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. Since the last inspection dishwashers have been provided on the units which staff told us has helped them. Communal spaces are well furnished with plenty of chairs for residents. All units had the televisions on during the visit. The hairdresser’s room is also used as a sensory room and has lots of different stimulating equipment in place. We did not see this being used during the visit. 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. Since the last inspection advice has been taken on how to make the environment more stimulating for residents suffering from Dementia and some adaptations have been made. 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 prevent 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. There is a designated smoking room for residents. One room had an offensive odour and this was bought to the attention of the manager. There is a separate day-care facility, which caters for people living in the community. Deerswood Lodge DS0000068513.V358083.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. Residents do not have safe and appropriate support as there are not enough competent staff on duty at all times. Residents are not able to have confidence in the staff at the home because checks have not been done to make sure that they are suitable to care for them. There is a high reliance on agency staff which is affecting the quality and continuity of care. In the majority of cases permanent staff are receiving the relevant training and support from their managers. EVIDENCE: On the day of our visit we found the staffing during the morning shift on the upstairs units Elderly Frail Unit (in which a maximum of 50 people can be accommodated and 46 were accommodated on the day of our visit) to be two team leaders and 5 support workers. We were advised that two of the support staff during the shift were agency workers. The rota indicated that the same units would have two team leaders and 5 care staff, one of whom we were Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 26 advised would be an agency member of staff, for the afternoon shift. The night shift was to be covered by one team leader and 3 support workers. The acting manager advised us that there were three Team Leader vacancies in the home, and that agency nurses were covering these. The acting manager advised us that one new team leader had recently been recruited but had not yet started work at the home. Most of the people living in the home and relatives we spoke to during our visit believed staffing levels were inadequate and that the extensive use of agency staff in the home was creating problems. One relative we spoke to said that while the “regular girls are fine” that good personal care is not consistently being provided. The relative said she had asked managers for extra help for her mother as she was sometimes not receiving washes or the help she needed in the morning, and more support in going to bed. She said that if the regular carer was on holiday things weren’t done, and that “agency staff will try getting away with not giving her a bath”. Due to the high reliance on agency staff residents and their relatives report that the care is rushed, inconsistent and impersonal, as the agency staff do not know them. During our visit we asked a member of staff (later identified as an agency member of staff) why they were not responding to a call for assistance. The member of staff replied because the call bell was ringing in a different unit to the one where she was sitting even though she had been told that a resident needed assistance. Also during our visit we noted that two care staff were sitting talking while bells calling for assistance were ringing. Suggestions for improvements made by people in survey forms we received included “employ more permanent staff”. We asked the manager about the inconsistent levels of care. We were told that the home tried to ensure that the same temporary staff were being regularly employed to help ensure consistency. We noted that they may use the same agency staff but they are not allocated to the same units so residents do not get the continuity. We advised her that people living in the home told us that they don’t get to know agency staff as they change so often. The manager was not able to confirm if a regularly employed member of agency staff always worked in the same unit, or would be employed in one unit during one shift and other units on subsequent shifts. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 27 People living in the home also questioned the skills and training of agency staff, and one person said they “have to tell temporary staff what they should be doing”. At the random inspection visit on 8/10/07 we found that requirement checks and references were being obtained for all staff including temporary staff, and that this statutory notice requirement had been met. We found during this visit, however, that once again records held were not sufficient to ensure the safety of people living in the home. During this key inspection visit we looked at four sets of recruitment records for staff who had begun work in the home in the past six months. We found that for three of the people appropriate checks and references had been obtained before the person had commenced work. For one person we found that while checks had been carried out, no references had been obtained. This indicates that staff are being appointed and starting work without references. This matter has been referred to in the Management section in this report where a requirement in respect of records held has been renewed. At the random inspection visit on 8/10/07 we found that training records were not available for all staff employed (including temporary and bank staff) and that therefore the statutory notice requirement concerning recruitment and training had not been met. At the key inspection visit on 26/2/08 we asked to see recruitment and training records for three named members of temporary (agency) staff working in the home on the day of our visit. The required records for the three people had not been obtained by the home. The deputy manager was later in the day (around 4 p.m.) able to electronically obtain from the employment agency the records for two of the three staff, by which time all three staff would have started their shifts. This indicates that managers in the home did not ensure that temporary staff coming into the home had the appropriate training to undertake tasks such as (for example) hoisting and manual handling, and knowledge and skills in (for example) fire safety, the prevention of the spread of infection, and the safe handling of food. It also indicates that managers had not checked with the agency that adequate references and required checks had been carried out for these staff. Managers are therefore not ensuring that staff employed are safe to work in the home, and that people in the home are being adequately protected. We looked at training records for four members of permanent staff, and found that ongoing training and induction training is being provided although a number were due to have a fire safety training update. Fire safety training had Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 28 been arranged for the day of the visit but was cancelled, although it could not be confirmed that the staff who were out of date on the training matrix were due to attend. We looked at the records for staff having achieved the national vocational qualification (NVQ) in care at level 2 or above, and noted that a number of staff have not commenced this training. While a requirement has not been made concerning this, the provider needs to ensure that staff continue to be put forward for qualification training which will increase their skills in providing care for people in the home. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 29 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 home is not being run in the best interests of the residents, their best interests are not being safeguarded by some of the homes record keeping. The health safety and welfare of the residents is not always promoted and protected and there is a high reliance on temporary staff. EVIDENCE: The home does not have a registered manager at present. A new manager has been appointed and advised us at the visit that she has been managing the service since the 7th January 2008, and that she will be making an application to register. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 30 The manager also told us that she has qualifications in nursing, health studies, and business administration, and that she has appropriate experience in managing care homes including those where skills in working with dementia illnesses have been needed. Also that she is familiar with local safeguarding adults procedures, and attended training concerning this in her previous post. We were told that both she and her deputy manager work 9am to 5 pm Monday to Friday. Team leaders manage the home in the evenings and at weekends. This indicates that when the majority of temporary staff are working in the home there is no senior management available. We looked at records for supervision for three permanent staff and two bank staff (staff employed directly by the home on an occasional basis). We found that sit-down supervision which is being regularly recorded is taking place for staff, including bank staff, and a system is in place for the planning of supervision meetings. At the random inspection on 8/10/07 the statutory notice requirement that 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 was found not to have been met. An example of this was shortfalls in the recruitment and training records of temporary (agency) staff. At this key inspection visit on 26/2/08 it was again found that people living in the home were not being protected by adequate recruitment and training records being obtained for temporary staff working in the home, and we also found that for one permanent member of staff the required references had not been obtained. It was therefore found that the statutory notice requirement in respect of record keeping had again not been complied with. In the majority of cases permanent staff are having ongoing training in health and safety procedures but as stated earlier some staff are out of date with fire safety training. We were told that fire training was planned for the day of the visit but had been cancelled although it was not clear if the staff that were out of date were expected to attend. The company have carried out their own quality assurance audits and these are comprehensive. The audits had highlighted some issues, but as there were no follow up actions recorded we could not determine what action if any had been taken. With the reoccurring complaints and conversations with residents it indicates that they have not been followed up. We were shown the results of a recent financial audit for resident’s monies and the audit showed that resident’s financial interests are safeguarded by the procedures in the home. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 31 Shaw Healthcare have extensive policies and procedures but the high use of temporary staff means that they cannot be aware of these policies and procedures to the detriment of the service. There is little focus on equality and diversity as indicated earlier in the report as residents are not supported to follow their religious wishes and are not supported to promote their independence. We accept that the new manager has only been in place a short time so has not yet been able to put her own plans into place but many of the problems identified during this visit had been found previously and we were told by Shaw Healthcare verbally and in their improvement plan that they had been dealt with. Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 32 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 X X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 3 2 2 Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 33 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 OP7 Regulation 15 Requirement All service users’ health, personal and social care needs must be set out in an individual plan of care. Equipment necessary for the promotion of tissue viability and prevention of treatment of pressures sores must be provided. Service users must be supported and given the opportunities to follow their personal and religious interests and their preferences with activities. Service users must be helped to promote their independence making the most of their abilities. Service users must be offered a wholesome appealing balanced diet. The registered person shall ensure that staffing numbers and skill mix are appropriate to the assessed needs of service users, the size, layout and purpose of the home at all times. Timescale for action 01/05/08 2 OP8 13 01/05/08 3 OP12 16 01/05/08 4 OP12 12 01/05/08 5 6 OP12 OP27 16 18 01/05/08 01/05/08 Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Deerswood Lodge DS0000068513.V358083.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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.V358083.R01.S.doc Version 5.2 Page 36 - 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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