Inspection on 14/07/05 for Earls Lodge Care Home

This inspection was carried out on 14th July 2005.

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

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

Other inspections for this house

Earls Lodge Care Home 13/03/07

Earls Lodge Care Home 03/10/06

Earls Lodge Care Home 13/06/06

Earls Lodge Care Home 28/11/05

Earls Lodge Care Home 21/08/05

Earls Lodge Care Home 24/03/05

Earls Lodge Care Home 15/10/04

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

CARE HOMES FOR OLDER PEOPLE Earls Lodge Queen Elizabeth Road Wakefield West Yorks WF1 4AA Lead Inspector Susan Vardaxi Unannounced 14 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Earls Lodge Address Queen Elizabeth Road Wakefield WF1 4AA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01924 372005 01924 372011 Tamaris Healthcare Ltd Mrs Amanda Cockell Care Home with Nursing 50 50 Category(ies) of Older People registration, with number of places Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 24 March 2005 Brief Description of the Service: Earls lodge Care Home was purpose built to provide personal and nursing care for 50 older people. The home is situated in close proximity to Pinderfields Hospital on Queen Elizabeth Drive, Wakefield. The home is surrounded by gardens that provide a pleasant environment for service users to sit in. It is a two storey building, nursing care is provided on the first floor of the home. There are pleasant lounges and dining areas on both floors of the home. All rooms are single and most have en suite facilities. A team of qualified nurses care assistants and ancillary staff work at the home and the local Doctors and their Primary Health Teams support them. The new registered proprietor is Four Seasons Homes (No 6) Limited (A wholly owned subsidiary of Four Seasons Healthcare). Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection completed by two inspectors on 14th July 2005. The manager was on holiday at the time of the inspection, the nurse on duty and the administrator assisted the inspectors who extend their thanks for the assistance and cooperation of all concerned throughout the inspection. A tour of the building and grounds took place and staff and care records were inspected. Thirty-nine service users and a total of fifteen staff were spoken with. What the service does well: What has improved since the last inspection? The manager has developed the generic care plan format to include the service users specific needs however further development is still required. The standard of cleanliness has improved with no unpleasant odours noted during this visit and the temperature in the home was comfortable as recommended at the last inspection. The Occupational Therapist had completed a moving and handling assessment for a named service user recommended at the last inspection. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3. The service users or their representative are not given accurate information about the service or their rights under the home’s terms and conditions on their admission to the home. EVIDENCE: The statement of purpose and service users guide states that the home is dual registered and the NCSC incorrectly as the regulatory agency to contact in the home’s complaints procedure. The service users guide seen does not include a description of the individual accommodation provided, staff qualifications and experience. There were no samples of service users’ views of the home and a copy of the last inspection report was also not included. A record of pre admission assessments was seen however there was no record of the home confirming to the service user in writing that the home could meet their needs. There were no contracts on two service users’ files seen. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Service users appear satisfied with the care provided however the care plans do not ensure that assessed needs will be met. The method or reviewing accidents does not ensure that appropriate action is taken to prevent some accidents occurring. The medication records kept for service users needing nursing care do not confirm that all medication has been given as prescribed. EVIDENCE: Positive relationships between staff and service users were seen and they were treated with respect and dignity at all times, however the requirement for locks to be fitted to bedrooms doors on the first floor remains outstanding. Two visitors said that they were happy with the care provided and they had never had reason to complain. The records seen showed that the manager had worked towards making the generic care plans personal to the service user. Those seen did not include all the needs and risk assessments for a service user who is blind, in other care plans, pressure area care, anxiety, fluid intake and mobility equipment needed, were not included. Some risk assessments had been completed however not on all files seen. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 10 It was seen that staff had not always written how the care needs had been met in the daily records. The accident records showed that some service users had fallen out of bed on more than one occasion and at the inspection it could not be established on the day what action had been taken regarding completing risk assessments. An accident seen in the records where a service user had been injured and sent to hospital had not been reported to the Commission. The Commission has been informed since the inspection that the manager reviews the accident records weekly and the outcomes are then sent to the area manager. The records showed that GP’s and other supporting health care providers visit when needed. Some weight checks had not been recorded regularly and one service user had not be weighed on their admission to the home, however nutritional assessments had been completed. The medication records seen for service users on the ground floor had been well maintained, however there were some signature omissions on the records for service users living on the first floor. Some bottles of aperients did not have the dates of opening written on the labels. The medication trolleys were tidy and medications were easily identifiable. The medication room was very warm, the temperature was considered to be uncomfortable, there is no window or other ventilation in this room. A bottle of oxygen was seen in the room and not secured to a wall. The staff on duty said that they had contacted the pharmacist who would collect it immediately. It was seen in the records that medication training has been arranged for ten staff. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 14 15 Service users appear satisfied with the activities provided by the activities organiser, however it is possible that care staff do not have time to take service users out. Service users are satisfied with the meals provided. A review of service users’ abilities to make informed choices would identify where advocacy is required. EVIDENCE: The home employs an activities organiser. A list of activities was seen on the pre inspection questionnaire received by the Commission prior to the inspection. Activities include painting, bingo, massage, and an organist visits weekly. The home has a Tuck Shop that is open two days a week. A service user said that she would like to go out in the garden in her wheelchair however she said staff say they are too busy. This is the second time a service user has said this during an inspection. Some daily records showed that service users go out and have visitors. The pre inspection questionnaire showed that advocacy arrangements had been made for a service user. The menus were not seen on this occasion, however, there were no complaints made about the meals provided, one service user said that the food is very good. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Not all staff would be aware of the action to take should incidents occur in the home that need to be referred for investigation under Adult Protection Procedures. EVIDENCE: The training records seen showed that some staff have not had Adult Protection training. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 The home is clean, well maintained and decorated to a good standard. Service users’ privacy and dignity could be compromised if they do not have locks on their bedroom doors. EVIDENCE: The general impression of the home was very good; all bedrooms were clean and free from unpleasant odours on this visit. A service user said that their bedroom was lovely and the bedrooms seen were personalised. Two bedrooms had been decorated since the last inspection. Door locks had not been fitted to the bedroom doors located on the first floor of the home, Prior to the inspection the Commission had been told that this was to be arranged. A wheelchair had caused some damage to one bedroom wall and there was an area on a wall in the upper main lounge that was dirty where a picture had been taken down and cleaning had not removed the marks. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 14 The gardens were unkempt at the rear of the home, however there were signs that the newly appointed maintenance person has completed some work at the front. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 On some occasions the staffing levels are not sufficient to ensure that all service users’ needs are met. The recruitment procedures do not ensure service users safety. The training records do not confirm that staff training is provided on a regular basis. EVIDENCE: The nurses in charge of the home said having only one qualified staff on duty was difficult as the nurse had responsibility for clinical nursing, writing records, administering medication, contacting GP’s and supervising care staff. The staff rosters seen showed shortfalls in care staffing levels had occurred regularly some months. The nurses were seen to be very busy throughout the day. A service user said that staff did not always respond to her emergency call bell when they needed the toilet or when they want to go into the garden in their wheelchair as staff say they are too busy or short staffed. Two newly recruited staff files seen did not have a record of their induction or contract and it was unclear who had provided one reference and there was no record of their induction programme or contract of employment. A member of staff had started work without a CRB and POVA first check. A reference for another member of staff only contained the dates when they had been employed Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 16 Information on the pre inspection questionnaire showed that induction training, Palliative care, continence, dementia care and some mandatory training has been provided during the past twelve months and eight staff have NVQ level two qualifications Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35,37,38 The management systems in the home do not totally ensure the safety of service users. EVIDENCE: The service users personal allowance records seen showed that staff signed most transactions. There was only one record of the advocacy arrangements for handling service users’ finances. A record of staff supervision was seen on some staff files and showed that some staff still need more regular line management supervision sessions. Some staff files and service users care plans did not include all information needed and an accident that had occurred resulting in a service user being sent to hospital had not been reported to the CSCI. Also there was no record Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 18 on the service user’s file to show if the accident had been report to the Health and Safety Executive. There was no evidence that the monthly Regulation 26 visits carried out by the provider have been sent to the CSCI The records showed that the fire officer had visited the home in June 2005 and a recommendation was made in his report for some remedial work to be completed. The staff training matrix showed that some staff require training and some update training in, health and safety, first aid, moving and handling, infection control and fire prevention. A bath hoist located in a ground floor bathroom was broken and the nurse in charge was informed at the time. A record was seen of bedrail checks, one bedrail was recorded as broken, this was checked and the rail on the right side of the bed was loose, this was reported to the nurse on duty and to the area manager the day after the inspection who said a new bedrail would be provided. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 1 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 1 3 x STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 1 x 1 x 2 2 3 1 1 Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)© 5(1)(a-f (2) Schedule 1 Requirement The statement of purpose must include all information required in schedule 1. The service users guide must include a standard form of contract, description of individual accomodation provided, staff qualificiations, service users views of the home and an up to date copy of the last inspection report. Service users care plans must be specific to their individual needs. Risk assessments must be completed and the action to be taken included in the care plans, particualry where a review of accident records identify that service users have recurring falls. Service users must be weighed on admission to the home and on a monthly basis or as directed by a GP or dietician The medication records must be signed by staff at the time that medicationis administered. Adult Protection training must be provided for all staff. The registered person shall Timescale for action 31 August 2005 2. OP7 15(1) 13(4) 14th July 2005& Ongoing. 3. OP8 17(1)(a) 14th July 2005 & Ongoing 14th July 2005 & Ongoing 31 August 2005 & Ongoing. 31 August Page 21 4. 5. 6. OP 9 OP18 OP24 13(2) 13(6) 16(1) Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 7. OP27 15(1) 8. OP29 19(4) Schedule 2 9. OP30 18(1)(i) 10. OP37 17(1)(a) 11. OP32 26(2)© (5)(a) 12. OP38 13(4)(6) 23(4)(d) provide facilities and services to service users in accordance with the statement required by regulation 4(1)(b) in respect of care homes. Doors to service users’ private accommodation located on the first floor of the home must be fitted with locks suitable to service users capabilities.Previous timescale of 15th October not met. The current staffing arrangements must be reviewed to ensure that the number of qualified and care staff on duty are sufficient to meet service uses needs at all times. POVA first and CRB checks must be completed before staff are employed in accordance with the Department of health guidance, and any required supervision shall occur. Previous timescale of 15th October 2004 not met. Staff must receive training appropriate to the work that they perform. Induction training must be provided for all staff. Service users records must include all information required to ensure that their needs are met particularly relating to care plans reviews and medication records. Where the registered provider is an organiation an employee who is not directlly concerned with the conduct of the home must complete monthy unannounced visits to the home and provide a copy of the visit report to the Commission. The registered person must ensure that the recommendations made by the fire service are completed within the timescales agreed by them. 2005. 14th July 2005 & Ongoing 14th July 2005 & Ongoing. 14th July 2005 & Ongoing. 14th July 2005 & Ongoing. 14th July 2005 & Ongoing 31 August 2005 & Ongoing Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 22 The registered person must ensure that mandatory training is povided for all staff and updated as required by regulation. The bath hoist located on the ground floor of the home must be repaired or if required replaced. Risk assessments must be completed for the use and storage oxygen cylinders. The bed rail that was loose must be repaired or if required, replaced. The medication room must be ventilated to ensure medications are stored at recommended temperatures and the environment is comfortable for staff to work in. All admissions to accident and emergency, deaths or any situation that occurs in the home that affects service users well being must be reported to the Commission and where applicable other Regulatory bodies immediately. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP2 OP7 OP13 OP14 Good Practice Recommendations Service users should be provided with a statement of the homes terms and conditions at the point of admission to the home. The daily records should include details of how the assessed needs have been met. The registered person should establish a named service user’s needs in relation to being assisted to go out into the garden and include this is in the care planning. A review of service users abilities to make informed J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 23 Earls Lodge 5. 6. OP28 OP35 choices should be made to identify where advocacy is required. The registered person should continue to make NVQ level 2 training avaiable for staff in order to achieve 50 of the number of qualfieid staff by December 2005. The service users personal allowance records should be signed by the person depositing or withdrawing monies from the fund and then countersigned by staff. Earls Lodge J51J01_s44498_Earls Lodge_v230278_140705.doc Version 1.30 Page 24 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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