Inspection on 28/11/05 for Earls Lodge Care Home

This inspection was carried out on 28th November 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 21/08/05

Earls Lodge Care Home 14/07/05

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 Care Home Queen Elizabeth Road Wakefield Yorkshire WF1 4AA Lead Inspector Susan Vardaxi Unannounced Inspection 28 November 2005 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 Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Earls Lodge Care Home Address Queen Elizabeth Road Wakefield Yorkshire WF1 4AA 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) 01924 372005 01924 372011 Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care) Mrs Amanda L Cockell Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing arrangements for a maximum of 25 nursing and 25 personal care places Daytime 1 RN and 4 care assistants (upstairs) 4 care assistants (downstairs), one of whom is a senior care assistant Night-time 1 RN and 2 care assistants (upstairs) 2 care assistants (downstairs), 1 of whom is competent to administer medication Maximum of 25 nursing at any one time Can accommodate one named service user who is under 65 years of age 14th July 2005 2. 3. Date of last inspection 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 Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection completed by two regulation inspectors on 25th November 2005 over a period of 6.5 hours. The service provided on the first floor of the home only was inspected on this occasion following two complaints investigated by the Commission since the last inspection. The issues from one complaint were referred for investigation under Wakefield Metropolitan District Council’s Adult Protection procedures. The inspection process included talking with service users, visitors, the manager and staff, a walk round the first floor of the home and inspecting some records. Some requirements outstanding from the previous inspection and complaints have been carried forward onto this report. The inspectors would like to thank the service users, visitors, staff and manager for their hospitality and cooperation throughout the inspection What the service does well: What has improved since the last inspection? The home has maintained the standards observed at the previous inspection. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 the following standard(s): 1,3 The statement of purpose and service users guide do not provide accurate information for service users and their relatives/representatives. EVIDENCE: The statement of purpose and service users guide were seen, further development is required for both documents, this was discussed fully with the manager. Records seen showed that pre admission assessments are completed. Intermediate care is not provided at the home. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9 Service users health and general wellbeing are at risk due to inadequate care planning. EVIDENCE: A number of care plans were seen and the following problems were highlighted. • A care plan specified that a complete social assessment was needed, the assessment had been completed but not used to formulate a care plan. The treatment of an infected wound had not been included in the care plan. An assessment had included the risk of pressure sores, however a care plan had not been completed A service user’s care plan did not record the correct first name. There were no care plans in place for a service user on respite care who had Alzheimer’s disease. The care plan for a service user with depression was not appropriate following bereavement. • • • • Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 10 • • • A service user’s care plan recorded that they were at risk from choking and required observation when eating, however they were given sausages and left unattended to eat their meal. Information was recorded once only in the daily records regarding the poor condition of sores on a service users neck. A service user’s night catheter bag could be seen through the open bedroom door it had not been emptied and was bulging with urine. There was no care plan for catheter care seen on the service user’s file. A total of 53 accidents to service users were recorded in the records seen from the period March 2005 to November 2005. Nutritional assessments and weight checks had been completed on the records seen, however there was no record of a service user’s weight being checked on their admission to the home in June 2005. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 the following standard(s): 14,15 A choice of breakfast was available. However service users’ personal choices are not always respected. Service users’ privacy and dignity are not protected by some care practices. EVIDENCE: Staff were seen taking some service users’ breakfast to them in their bedrooms. One service user said they have a cooked breakfast everyday and enjoy it. Care staff serve the food from a hot trolley located in a small kitchenette on the first floor, the carers had prepared the toast. A service user was heard to tell staff that they would like scrambled egg for breakfast, however they were given sausage and tomatoes and toast. Staff working on the first floor said scrambled egg had not been sent up from the main kitchen. Four trays of eggs were seen in the refrigerator in the main kitchen located on the ground floor. The cook said she had not been asked for scrambled egg. Service users spoken with in the dining room said they had enjoyed their breakfast. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 the following standard(s): Some poor care practices could put service users at risk. EVIDENCE: The Commission has investigated two complaints received in respect of the service prior to this inspection. The issues in the second complaint were referred for investigation through Wakefield Metropolitan District Council’s Adult Protection Procedures and a strategy meeting was held. Requirements were made to the responsible individual as a result of both complaints. Complaint 1: Included Night Staffing arrangements, pressure area care, concerns about the times that service users are got up and recruitment checks. Four of the issues were upheld, one was not upheld and 2 were unresolved. Complaint 2: Included issues regarding Personal Care, Care planning and cross infection. Three of the issues were upheld and two were unresolved. The manager said that letters are handed out to service users regarding their votes at local and general elections. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 the following standard(s): 21,24,26 It is concerning that in the wake of a complaint including cross infection issues that personal items of clothing and wet flannels and other equipment are being left in bathrooms. EVIDENCE: Bathrooms and shower rooms located on the first floor were seen; wet flannels and personal clothing had been left in one bathroom. Four suitcases, personal belongings and a mattress had been left in a second bedroom. Communal toiletries and a wet used flannel were also seen. A member of staff said service users prefer to use one particular bathroom. There was a very strong odour of faeces in the shower room; this was brought to the manager’s attention who said the maintenance person had not been able to locate the source of the odour. Some service users have recently had the Norwalk virus; the manager had reported this to environmental health services. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 14 The manager said that door locks for the doors on the bedrooms located on the first floor have been received and are to be fitted in the near future. A service user spoken with in their bedroom said they were using a kidney dish, as a fruit bowl was not available. The bed linen had been pulled over the bed, however when checked the bottom sheet had not been pulled over the mattress and was crumpled. The service user said staff had made the bed. A recommendation was made in the fire service inspection report dated 21 June 2005. This has been addressed in standards 30- 38 of this report. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 There are not enough qualified staff on duty on a shift by shift basis to ensure that care planning is adequate, service users’ clinical needs are fully met and to supervise care staff throughout the delivery of personal and emotional care effectively. EVIDENCE: Some staff rosters seen for October and November 2005 showed that on nine occasions a senior carer was not on duty on the ground floor and a qualified nurse had not been on duty at night on 2nd July and 24,25,26 August 2005. The manager said a nurse would have been on duty, however was unable to show evidence. Agency staff were not shown on the rosters. It was established through discussions with qualified staff that there are six service users who have peg feeds, requiring the assistance of qualified staff only. Some service users require clinical dressings to be changed. Their duties also include writing care plans and completing the daily records on a shift basis and responsibility for the daily and formal staff supervision, administering medications, arranging for GPs to visit and accompanying them during their visits, supporting service users and their relatives. Files for staff recruited since the last inspection showed that two staff had started work prior to satisfactory CRB checks being received and three files had only one signed reference. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 16 A staff file seen recorded that the member of staff had completed an induction programme; however there was nothing filled in the induction programme. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 Staff and service user meetings provide opportunities for discussion and involvement in the running of the home. Action is needed to ensure service users are not at risk from outstanding health and safety issues. EVIDENCE: The manager said that she has held six staff meetings in the past 2 months, and four service users meetings are held annually. The service users’ records for monies held by the home are kept on computer, records of monies paid to the hairdresser were seen and two signatures had been obtained. The bath hoist located on the ground floor had not been repaired as required at the last inspection. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 18 Fire records showed that fire systems are checked weekly, however no reference is made to confirm which areas in the home have been checked. A record is kept to show when bedrails are checked. Portable appliance checks had been completed in May 2005. The environmental health officer’s report for the visit on 26 September 2005 was seen, 5 recommendations and 3 legal contraventions were made. A recommendation was made in the fire officer’s report for his visit in June 2005. Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 X X 1 X X 1 X 1 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X 1 1 Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(1)(c) 5(1) Requirement Timescale for action 31/03/06 2 OP3 4(1)(6) 14(1)(a) 3 OP7 15(1) 13(4) 4 OP10OP7O P8 12(1)(a) Reg: 4(1)(c) 5(1)(a-f (2) Sch 1 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 accommodation provided, staff qualifications, service users views of the home and an up to date copy of the last inspection report. Previous timescale of 31 August not met. The responsible individual must 20/12/05 ensure that service users whose needs are not within the home’s category of registration are not admitted to the home. Service users care plans must 15/12/05 be specific to their individual needs. Previous timecale of 14th July 2005 and 24 August 2005 not met. Regs: 12(1)(a)13(1)15(1) 18(1) 20/12/05 (c) (i) 12(4)(a) The responsible individual must ensure that the home is conducted so as to promote and make proper provision for the DS0000044498.V254137.R01.S.doc Version 5.0 Earls Lodge Care Home Page 21 5 OP10 18(1)©(i) 6 OP14 12(2) 7 8 9 OP38OP21 OP18 OP27 23(2)(j) 23(1)(a) 13(6) 18(1)(a) 10 OP27 17(2) Sch 4 health and welfare of service users. Service users’ privacy and dignity must be respected at all times, particularly where catheter equipment is in use. Service users’ choices particularly regarding choice of meals bathing facilites must be respected. Regs: 23(2)(j)23(1)(a)13(4)(a) Bathrooms must not be used to store equipment. Adult Protection training must be provided for all staff. The responsible individual shall, having regard to the size of the care home, the statement of purpose, number and needs of service users, ensure that at all times suitably qualified competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. Previous timescales of 14th July, 24th August 2005 not met The responsible individual must ensure that where agency staff provide cover for staff holidays, sickness and vacancies their names, the dates and hours worked are included on the staff roster The responsible individual must ensure that two satisfactory references are obtained and are signed prior to staff commencing employment POVA first and CRB checks must be completed before staff are employed in accordance with the Department of Health guidance, and any required supervision DS0000044498.V254137.R01.S.doc 20/12/05 20/12/05 20/12/05 31/08/05 15/12/05 15/12/05 11 OP29 19(4)(c) Sch 2 20/12/05 12 OP29 19(4) Sch 2 20/12/05 Earls Lodge Care Home Version 5.0 Page 22 13 OP30 18(1)(i) 14 OP37 17(1)(a) 15 OP38 23(4)(d) 13(4)(d) shall occur. Previous timescale of 24th August & 15th October 2004 not met. Staff must receive training 20/12/05 appropriate to the work that they perform. Induction training must be provided for all staff. Previous timescale of 14th July 2005 not met. Service users’ records must 20/12/05 include all information required to ensure that their needs are met particularly relating to care plans reviews and medication records. Previous timescale of 14th July 2005 not met The registered person must 31/03/06 ensure that the recommendations made by the fire service are completed within the timescales agreed by them. The registered person must ensure that mandatory training is provided 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, be replaced. Previous timecale of 31 August 2005 not met. The medication room must be ventilated to ensure medications are stored at recommended temperatures and the environment is comfortable for staff to work in. The registered person must ensure that the recommendations and legal contraventions made by the environmental health officer are completed within the timescales agreed by them. 16 OP38 23(5) 31/03/06 Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 23 13(3)(4) © The responsible individual must ensure that all service users are not at risk from cross infection. Timescale 15/12/05 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 OP7 Good Practice Recommendations The daily records should reflect the actual care delivered on a shift-by-shift basis. Beds should be made appropriately to prevent pressure sores occuring from rumpled bedlinen. Service users should be provided with fruit bowls if needed. The registered person should continue to make NVQ level 2 training avaiable for staff in order to achieve 50 of the number of qualified staff by December 2005. 2 3 OP24 OP28 Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Brighouse Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Earls Lodge Care Home DS0000044498.V254137.R01.S.doc Version 5.0 Page 25 - 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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