Inspection on 03/10/06 for Earls Lodge Care Home

This inspection was carried out on 3rd October 2006.

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

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

Other inspections for this house

Earls Lodge Care Home 13/03/07

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 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 Gillian Walsh Key Unannounced Inspection 3rd October 2006 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.V313246.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. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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 www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Ms Amanda L Bennett 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.V313246.R01.S.doc Version 5.2 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 13 June 2006 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 Road, Wakefield, close to main bus routes from Wakefield town centre. The home is surrounded by gardens that provide a pleasant environment for service users to sit in. It is a two storey building with nursing care provided on the first floor of the home. There are pleasant lounges and dining areas on both floors. 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 proprietor is Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited). The manager informed the Commission for Social Care Inspection on 13/06/06 that fees range from £370 to £420 per week and that these charges were unchanged on 3/10/06. Additional charges include hairdressing, private chiropody and newspapers. A small charge is made for some activities such as Bingo and trips out. Information about the home is available to potential residents via the Statement of Purpose, Service User Guide and the last inspection report, all of which are available in the home’s reception and are given to all potential and current residents. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection two inspectors from the Commission for Social Care inspection (CSCI) undertook a visit to the home. The visit started at 10am and finished at 2.30pm on 3rd October 2006. The visit included a tour of the building, discussion with residents, some relatives, staff and management. Time was also spent reviewing documentation. On this occasion the service provider was not asked to complete a preinspection questionnaire as one had been completed in June 2006 and the manager confirmed that there were no changes. Questionnaires were sent to residents, their relatives, visiting professionals and GPs for the inspection in June 2006 and therefore were not sent out prior to this inspection. Comments received in June were generally positive about the care practices at the home. In writing this report, information and evidence was not only obtained by way of visiting the home but also from notifications and information obtained by CSCI and from the last CSCI inspection report. In gathering evidence, CSCI undertook case tracking, reviewed documentation, sought feedback from service users and their families, staff, the home’s manager and undertook relevant observations and discussions appropriate to needs of the service users, taking into account their needs and communication needs. Inspectors would like to thank residents and staff for their time and assistance during this inspection. What the service does well: Residents and visitors spoken with, or who returned questionnaires, made positive comments about the care provided at the home. A visitor said that they were well informed about the condition of their relative. One relative said that staff “are really friendly and treat you like part of a big happy family”. Staff were observed to be treating residents with respect and kindness. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 6 Complaints or concerns are dealt with thoroughly and the majority of residents and relatives spoken with, indicated that they knew who to speak to if they had any problems. 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. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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.V313246.R01.S.doc Version 5.2 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): 3 and 6. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The systems operated by the home ensure that people only move into the home after having had their needs assessed and are assured that these will be met. Standard 6 is not applicable as the home does not provide intermediate care. EVIDENCE: All of the residents’ files seen included a comprehensive pre-admission assessment based on activities of daily living, which included past medical history as well as current needs. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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 and 10. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service and is particularly affected by the outcome for standards 7 (care planning) and standard 9 (Medications). Not all of the individuals’ health and personal care needs are set out in the plans of care. People are not protected by the home’s policies and procedures for dealing with medicines. The work of the staff ensure that people feel they are treated with respect and that their right to privacy is upheld. EVIDENCE: Two care plans from both the residential and nursing units were examined. Although care plans contained some good detail which, if followed, would ensure good outcomes for the resident involved, all of the care plans examined failed to give specific detail about residents’ specific needs in relation to Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 10 pressure area care and moving and handling. Of the four care plans seen, three of the residents, one on the residential floor and two on the nursing floor, had been assessed as being of high or very high risk of tissue damage but care plans to detail what preventative measures were being, or needed to be, taken had not been developed. The nurse said that both of the residents on the nursing floor were being nursed on air mattresses and other pressure relieving equipment was in use although none of this information had been included in the care plans. Concern was expressed to the manager that record had been made that one of these people had recently developed a small broken area to the buttock. Similarly, moving and handling assessments had been completed but care plans had not been developed to inform staff of which specific equipment needed to be used to maintain the individual’s safety whilst carrying out moving and handling procedures. Not all of the care plans seen had been reviewed on a monthly basis which could result in the information not being up to date. As identified during the last inspection, daily records continue to be very clinical, giving detail only of care interventions made rather than including how the resident had chosen to spend their time. Evidence is available in care plans that residents’ health care needs are being met appropriately. Each file contains a professional visits form which indicates when GPs, district nurses, speech therapists etc have been to see the resident. Systems for the receipt, storage and administration of medication were checked on the nursing unit as anomalies identified on that unit during the last inspection had resulted in a requirement being made. On this occasion it was found that medications are not always being correctly received into the home as the MAR (medication administration record) sheet was not being completed to detail how many of each medication had been received and by who. Where this detail had been completed, the amounts of medication in the home could not be reconciled with the information on the MAR sheet about how many had been received and how many had been administered. One of the blister packs seen had had the nine doses of medication removed and signed for as administered but a further dose had also been removed without any explanation for this being recorded. Care plans seen referred to maintaining residents’ needs with regard to privacy and dignity. From observations of staff interventions with residents, there was no evidence that these needs are not considered and maintained. None of the residents spoken with felt that their privacy and dignity needs were not met. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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): 12, 13,14 and 15. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are happy that their social and recreational needs are being met. Residents maintain contact with family and friends as they wish and are helped to exercise choice and control over their lives. Residents receive a wholesome appealing balanced diet in pleasant surroundings. EVIDENCE: The manager said that, since the last inspection, the company has agreed to increase the number of hours for activities staff but this is yet to commence. All of residents spoken with said that they were happy with the activities in the home with one person saying they particularly enjoyed the “play your cards right” and “music to movement” activities and another said they were happy with the activities and “I can do what I want here”. Records of activities undertaken by residents are kept within the care plan files. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 12 Two visiting relatives were spoken with, both of who expressed their satisfaction with the care their relative receives. One person said, “Staff are really friendly and treat you like part of a big happy family”. From speaking to residents it is evident that residents are offered choices within their daily lives although this is not always reflected within care plans. Meal times were not observed during this visit but residents spoken with said that they enjoyed the meals at the home and one person said that there was plenty of choice and large amounts available. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 13 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): 16 and 18. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The systems operated by the home ensure that people can raise concerns and complaints, and feedback shows that they are confident that their complaints will be listened to, taken seriously and acted upon. There are appropriate systems in place to protect people from abuse. Staff know what to do if alerted to suspected or alleged abuse. EVIDENCE: The complaints log was seen and evidenced that complaints received by the home are properly investigated and dealt with in line with the home’s complaints procedure. A copy of the complaints procedure is displayed in the reception area and is included in the Service User Guide. One relative said that they knew who to complain to should the need arise. Staff training is ongoing in protection of vulnerable adults and previous matters have been referred appropriately through Wakefield’s adult protection procedures. Recent referrals to adult protection regarding residents at the home are currently being investigated through Wakefield’s adult protection policies and procedures. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 14 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Maintenance routines at the home are sufficient to protect residents’ safety. Standards of hygiene in the home are adequate. EVIDENCE: Generally, the home was clean and tidy although there was a slight odour of urine present in the downstairs corridor and the carpet in one of the lounges upstairs was in need of cleaning due to a stain in the doorway. Both of these issues were dealt with during the visit. A maintenance man is available in the home five days each week to deal with repairs and redecoration as the need arises. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service and is particularly affected by the lack of induction for new staff. Systems are in place for recruitment and training but the lack of induction, particularly relating to fire procedures, of staff on duty could put residents at risk. EVIDENCE: Staff duty rotas indicated that care staff are usually available in sufficient numbers to meet the needs of the current residents. Staff said that, although they were busy, the current reduced occupancy levels meant that staff were comfortable that they were able to spend sufficient time with residents making sure that their needs are met. One resident said that sometimes they had to wait for staff assistance but this was not a problem for them and a visiting relative said that there has never been a time when there doesn’t seem to be enough staff on duty. Concern was expressed to the manager that, on the morning of the visit, two of the five staff working on the nursing unit had only been employed at the home for two and four days respectively. The manager said that one of these members of staff was having one of their three allocated supernumerary days as part of their induction but both were being shadowed by more experienced care staff. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 16 Further concern was expressed that, when asked by the inspector, neither of the new members of staff working on the nursing unit had been informed what to do should the fire alarm sound. This information should have been covered during the first day of their induction. The manager said that all new employees have three supernumerary days of induction which do not have to be consecutive and do not have to be within the first week of employment. This situation could potentially put residents and staff at risk. Staff training is ongoing; the training matrix indicated that mandatory training is mainly up to date but where updates are necessary these have been organised. NVQ training is ongoing, the manager confirmed that 17 of care staff have achieved the award and two care staff are currently studying for the award. Documentation contained within staff personnel files indicated that recruitment policies and procedures to protect residents are being followed. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home’s manager demonstrates abilities in many areas of her work at the home but actions are required in relation to management of the implementation and quality monitoring of care practices, eg. care planning and systems relating to medications, in order to ensure the safety and wellbeing of residents. EVIDENCE: The home’s manager is a Registered Nurse who has completed the registered managers award. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 18 The manager said that quality monitoring is done on an ongoing basis and that she conducts weekly audits in areas such as pressure sore management, weight loss, accidents, infection control and POVA (Protection of vulnerable adults) issues. Monthly audits are then completed by the manager in medications, health and safety and staff training. The manager explained that, for a number of weeks since the last inspection, weekly audits of medications had been undertaken but this had reverted back to monthly which was why she was not aware of the issues found in this inspection. Discussion took place with the manager about how auditing processes must be improved to ensure that she has an awareness of the quality of care plans within the home. On an annual basis, questionnaires are sent to approximately half of the residents for their comments on the service they receive at the home. The manager does not see the full results of this survey, only a very brief report from head office which does not include any comments and only states what percentage of people are satisfied with each of the identified areas. It does not state the reasons for the dissatisfaction of the remainder of the residents completing the questionnaires and an action plan is not developed in respect of this. Residents’ meetings are held every 3 months and the minutes of these meetings are displayed on the notice boards. Small amounts of money are kept in the home on behalf of some residents. An accurate accounting system for a selection of these monies was seen. Discussion took place with the manager about the availability of residents’ money out of office hours. The home’s health and safety file was seen to contain all relevant and up to date certification for maintenance of systems relating to health and safety of residents and staff. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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 3 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 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 OP7 Regulation 15(1) Requirement Care plans must be developed to detail how pressure area care is to be carried out for all residents who have been identified, through assessment as being at risk of developing pressure sores. Care plans must include details of pressure relieving aids being used and what equipment is being used to maintain safety during moving and handling procedures. A safe system of recording, handling and administration of medication must be followed by staff at the home. All staff working in the home must have had training in and be familiar with procedures in the event of a fire. Timescale for action 31/10/06 2 OP9 13(2) 03/10/06 3. OP30 OP38 18(1)(c)(i ) 23(4)(d) 31/10/06 Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 21 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 Care plans should: Give specific detail of resident’s current needs. Detail actions necessary to maintain residents safety. Be newly developed when a review indicates a change of needs or an assessment highlights specific needs. Include details of resident’s abilities. And Daily records should give detail other than just clinical interventions made. 2. 3. OP26 OP33 OP31 Cleaning schedules should ensure that good standards of hygiene are maintained in all areas. Quality monitoring should be developed to include the views of staff and other professionals involved in the care of resident’s at the home. The report based on these findings should detail any dissatisfaction and an action plan should be developed in response to this. And The home’s manager should develop monitoring procedures, as part of the quality monitoring process, to ensure that all practices within the home, including the formulation of care plans and medication checks are carried out to a standard which will ensure the health, safety and welfare of residents. Earls Lodge Care Home DS0000044498.V313246.R01.S.doc Version 5.2 Page 22 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.V313246.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!