Inspection on 15/07/08 for Eden Lodge Care Home

This inspection was carried out on 15th July 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

Eden Lodge Care Home 14/08/07

Eden Lodge Care Home 14/02/07

Eden Lodge Care Home 26/04/06

Eden Lodge Care Home 28/09/05

Eden Lodge Care Home 09/06/05

Eden Lodge Care Home 09/02/05

Eden Lodge Care Home 06/10/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Eden Lodge Care Home Park Road Bestwood Village Nottingham NG6 8TQ Lead Inspector Meryl Bailey Unannounced Inspection 15th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Eden Lodge Care Home DS0000008666.V368627.R03.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. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Eden Lodge Care Home Address Park Road Bestwood Village Nottingham NG6 8TQ 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) 0115 977 0700 0115 9770786 tracyt@edenlodgecarehome.com Sai Om Limited Manager post vacant Care Home 60 Category(ies) of Dementia (60), Old age, not falling within any registration, with number other category (60) of places Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP. 2. Dementia, over the age of 55 years - Code DE. The maximum number of service users who can be accommodated is 60. 14th August 2007 Date of last inspection Brief Description of the Service: Eden Lodge is situated in Bestwood Village, north of Nottingham. There is public transport to the wider community and the city centre. The home is registered to cater for the needs of older people, aged 65 years and over as well as people with a diagnosis of dementia who are aged 55 years and over. The accommodation is on the ground floor. There is level access throughout. All of the bedrooms are single, and eight have en-suite toilets. The fees range from: £300 - £360 per week. Hairdressing and chiropody charges may be added to this. Eden Lodge Care Home DS0000008666.V368627.R03.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 0 star. This means that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did not receive this in time to help in planning the visit. We did the majority of this inspection with two inspectors on 15 July 2008; it was unannounced and lasted ten hours. One inspector returned two days later for a further three hours to look at the effect of increased staffing levels. The main method of inspection we use is called ‘case tracking’ which involves us choosing a sample of people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. As we were unable to communicate effectively with all of the people with dementia, we observed people closely and watched how staff interacted with them to help us understand their experiences of life within the home. We did speak to four people who live at the home and three relatives and we had discussions with four members of the care staff. English is the first language of all of the people who live at the home at the moment and the staff team have some varied cultural backgrounds and experiences, but use English to communicate with the people at Eden Lodge. During the course of our visit we began to find evidence of a continued breach of the a regulation about how medication is recorded and under The Police and Criminal Evidence Act 1984 we took copies of documents from the home with a view to assessing the findings in relation to enforcement action. We also took photographs of one bedroom that we did not feel was of an adequate standard to be occupied. We required immediate action in several areas to improve the quality of life for the people living at the home. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure care plans include action plans to guide staff about how to meet assessed needs relating to Dementia and challenging behaviour in order to provide appropriate care for people living at the home. Arrange chiropody treatment according to people’s needs in order to promote good health and mobility. The acting manager must monitor the charts completed by staff to ensure that, if people are in their beds during the day sufficient care and attention is given to promote their health and welfare. Put a system in place to ensure that all medication is offered as prescribed and that it is recorded correctly so that people receive their medication safely and as prescribed by a doctor. Make arrangements to ensure all bedroom doors close properly to ensure privacy. Arrange suitable stimulating activities for people with Dementia in order to promote their well-being. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 7 Review meal menus and mealtimes to ensure people always receive a varied, appealing, wholesome and nutritious diet. Make the complaints procedure accessible to all people living in the home so that they know how to make their concerns known. Ensure there is an appropriate, up to date policy and procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) and that all staff are aware of their responsibilities under these procedures in order to ensure that all people at the home are safeguarded from abuse. Produce a programme for routine maintenance and renewal so that the home is always well maintained for people who live there. Provide sufficient assisted baths and showers in good working in order to meet the assessed needs and preferences of all people accommodated at the home. Ensure that ripped and otherwise damaged bedding is no longer used so that people have clean, comfortable and safe beds to sleep in. Replace all damaged mattresses, headboards and furniture so that each person’s bedroom is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the individual. Commodes must always be properly cleaned, replaced and covered to protect people from risks of infection. Consider all the needs of all people who live at the home and calculate how many staff are needed to meet these needs, taking account of the size and layout of the home. This is so that they can ensure the health, safety and wellbeing of the people in the home at all times. All staff must be competent when moving and handling people and this includes using appropriate equipment. This is in order to ensure people are moved safely at all times. Ensure there is a manager in place who is given full responsibility to take day to day control of the running of the home. This is to ensure people benefit from a well run home. Ensure all staff receive training in infection control and that this including hand washing and that their competence is monitored. This is so that people are protected from the risk of infection. The call system must be made fully functional and maintained in all rooms so that people are able to call for assistance at all times Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 8 The Commission must be notified of every serious incident in order to monitor that appropriate action has been taken to promote the health and welfare of people living at the home. 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. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 9 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 Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 10 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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at Eden Lodge have their needs assessed before they move in. Eden Lodge does not offer intermediate care. EVIDENCE: We looked at the files of seven people and saw that there were assessments, which had been completed prior to each of them moving into Eden Lodge. Assessments had been carried out by the local authority in most cases, but there were some assessment forms completed by a manager at the home. Eden Lodge Care Home DS0000008666.V368627.R03.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 and 10 Quality in this outcome area is poor. Current care practices and the lack of monitoring of administration of medication poses risks to the people who live at Eden lodge, particularly those with needs relating to Dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were care plans for all the people that live at the home and these were stored in the manager’s office. Care staff recorded daily notes in a file held in each unit and summaries of the care needs were also held in each unit with medical records. Care plans described care relating to everyday needs, but did not specify how to meet needs relating to Dementia. Also, we did not see any action plans in relation to dealing with managing behaviour, though there was some mention of the need for this in the assessments. There were no signatures to give evidence that anyone had agreed to how they wanted to be cared for. However, there were monthly reviews of the care plans and some had been updating. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 12 We observed one person’s aggressive behaviour towards staff. One care staff did not know how to deal with this and we had to suggest she move away for her own safety. We observed people in there own rooms, the lounges and the dining rooms and saw that people were transferred from chairs to wheelchairs by drag lifting with a staff member on each side holding under their arms. This can be painful for the people being moved as well as causing back injuries to staff (see under regulation 38). We did not see anyone moved with the use of a hoist. When we visited the home in May 2008 we found there was one person who was in bed most of the time. A senior care assistant told us that staff did not complete charts at that time and, therefore, we were unable to determine if sufficient care had been given. During this inspection the same person was being looked after in bed and there were charts in her room for staff to record the care given. At 16.54 we went into her room and found the last recorded entry on the chart was at 12.45 when she had “Dinner and 2 drinks”. The top of the bed was still raised to support a sitting position for eating and we saw that she had slipped down whilst she was sleeping and was in need of attention. A care assistant found that the person’s feet were wedged between the bed and the rail. We noticed that there was a need for attention from a chiropodist. We later asked the manager about this and we were informed that no chiropody attention had previously been arranged as the person’s relative did not agree to pay. Since the inspection, the provider has given us further evidence with a letter from a chiropodist stating that treatment had been offered at six weekly intervals, but was not always completed thoroughly due to the person concerned refusing to cooperate. We checked the care plan for this person and could find no explanation for her being cared for in her bed. The manager said that it was a decision made by a previous deputy manager because there was a high risk of falls. A few days after the inspection visit the manager informed us by telephone that this person had been assisted to sit in the lounge with other people. There was evidence that community nurses and General Practitioners had made regular visits to the home. On the second day of the inspection we saw one nurse treating someone who had injuries from a previous fall. A relative told us that the manager accompanied one person to the hospital to ensure his condition was monitored. At the random inspection in May 2008 we found that medication was not accurately recorded and we required that a system be put in place to monitor this. At this full inspection we again examined medication records. We found gaps in the recent recording and we took away photocopies of some of the records as evidence. There was no record that some people had received their medication on some days and changes had been made with printed instructions crossed out and changed. For example the pharmacist had printed “TWICE a day”, but someone had crossed this out and handwritten “tea time only”. This change was not signed or checked as correct by a second person. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 13 There were also instances of some people not having received prescribed medication, because it had not been obtained from the pharmacist or repeat prescriptions had not been submitted on time. We had received information anonymously alleging that some people were washed and dressed before 5am everyday and this was not their choice. We were unable to establish from people living at the home whether or not this was the case. The acting manager said that she has instructed staff to wash and change people where necessary, but to help them back to bed. She reported that the time of the first person moving into the lounge in her presence was 5.45am. We found that several bedroom doors would not close properly. One man had wedged some card in the door to ensure some privacy. We observed some staff holding respectful conversations with people, but people were not always spoken to with respect and were often ignored. One person we observed was not given any information about how or why they were being moved. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is poor. In one part of the home people experience an acceptable lifestyle, but those with Dementia are not provided with suitable stimulation to meet their needs. Some people enjoy meals, but others have no choice and hygiene practices put people at risk of infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We did not see any activities taking place that were suitable for people with needs relating to Dementia, but there was evidence that someone had been “colouring in” in the front section of the home. Otherwise, between meals people were in their rooms on bed rest or in the lounges asleep with the televisions on in the background. Two people appeared happy wandering in the corridors and lounges. There was a poster to advertise a Rock and Jive session that took place on 19 June 2008. The manager said everyone had enjoyed it. She also said that there was currently no activity worker available. We saw relatives visiting three people during the day. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 15 We observed two mealtimes mostly in the rear section of the home. At lunchtime there was a choice of chicken and bacon casserole or corned beef hash followed by apple crumble. The menu written on a board in the dining room was for the previous Friday, when corned beef hash was also served. Records of meals served showed little variation. At lunchtime no drinks were served until everyone had finished the meal. Some people indicated that they wanted a drink, but they were not acknowledged. There were two staff assisting in the dining room. They served the meal and then sat to help people who needed assistance with feeding. One person who required 1:1 help did not have a table for her dinner. She sat in her wheelchair in the dining room shouting out to request her meal, but she had to wait until everyone else had been served so that someone was available to help her. The staff person then held the plate and fed her. We were told this was to prevent her pushing the plate off a table. One woman did not want her dinner and a man on the same table was eating it from her plate with his fingers. Staff were too busy to notice this. A member of staff assisted one person who is looked after in bed with meals. Some other people had meals taken to their own rooms. One person told us the meals were “rubbish” and another said, “I like most things they give me”. In the dining room of the front section of the home there was a more relaxed atmosphere and people said they enjoyed their meals. However, we saw that one of the care staff, who had been attending to someone’s personal care, rinsed a soiled towel in a wash basin and then placed it in a bin. Hands were not washed and the person went directly to assist in the dining room. At teatime sandwiches were served and soup was also available. At one point there were 19 people with dementia in the dining room with one staff member who was not trained in Dementia Care. Sandwiches were served first, but some people were unable to take solid food. They wanted food and helped themselves to sandwiches. A member of staff took a sandwich out of one person’s hand and threw it in the bin. This person was then served with some soup, which was steaming hot. The soup was then removed until it had cooled. There was an alternative arrangement of tables in this dining room when we returned on the second day of the inspection and an increase in staff, which should allow staff to provide meals in a more dignified manner. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are not fully able to make their views known, but some relatives know how to complain. Low staffing levels and the lack of available policies means that the health and welfare of people living at the home is not fully safeguarded. EVIDENCE: The manager said that she had no records of any complaints. Since the last inspection the Commission has received complaints concerning food and staffing levels. We asked the provider to investigate, but we did not receive a satisfactory response about the low staffing levels. On another occasion we carried out a random inspection to look at a range of concerns raised. We required action to be taken and have included reference to this in this report. We asked some of the people who lived there if they knew how to make a complaint and three responded. One reply was “Haven’t a clue”, another said “No” and the third said “Yes, of course”, but then was unable to tell us who they would speak to. The complaints procedure is not displayed in all areas of the home, but is included in information given to relatives and is on display in the reception area of the home. Two relatives told us they would speak to someone in the office if they were not happy with something. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 17 Certificates for safeguarding adults training were found on some staffing files. Staff said the training was a two-hour session about awareness of what constituted abuse and the certificates we saw stated that the training in February 2008 included the reporting of any abusive behaviour. We did not see any evidence of a policy available to staff about protecting or safeguarding adults. There was evidence on staff files of appropriate checks being carried out regarding their fitness prior to commencing work. Our records show that an allegation made in October 2007 was investigated and resulted in disciplinary action. An increase in the number of staff was advised to help to prevent a repeat of that situation. However, the Commission has continued to receive information about insufficient staff being provided. The acting manager told us that there had been another safeguarding investigation in May 2008 concerning neglect of care needs, but we had not been notified of this at the time. During the course of this inspection we identified that some needs were being neglected and have asked for action to be taken by the local authority to safeguard some individual people in the home. (See previous sections.) Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 18 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, 21, 24 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many of the people who are accommodated at Eden Lodge have been living in a poorly maintained and unhygienic environment. EVIDENCE: We made a full tour of the premises. There were two distinct sections of the home, which were separated by a locked door. The section further from the reception area accommodates people with the highest needs relating to mobility and Dementia. In this section we saw beds and mattresses that were ripped and stained, but still in use. Some furniture was damaged with handles missing and bed headboards were worn and unstable. There were no carpets and some floor coverings were stained and damaged. One bedroom had wallpaper hanging from the wall, unclean bed linen and soiled bed rail cover, missing tiles around the washbasin and the floor was unclean. There was no Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 19 pillow provided. We immediately required that the person concerned be allocated an alternative room and this was arranged before the end of the first day of the inspection. On further visit on 17 July, we saw that the person was occupying another room, but the bedding was damaged. In the dining room in the rear section of the home there was a bin with no lid and the edges of tables were unclean. A sluice room was not locked and this led to the boiler room, which contained various discarded objects. None of the staff could find the key for the lock so the padlock was immediately replaced. We saw one shower room, which contained a very strong malodour. There was a razor and two pairs of scissors left in the room. These were immediately removed to prevent them being misused and causing injury. There was a bath with a block of soap and there was no liquid soap available in a toilet either. Paper towels were provided and there were gloves available for staff use. A further stock of gloves was seen in the staff room. Other bathrooms with baths were not available for use. In one we found an extractor fan was not working and hoisting equipment was damaged in another. This left no option for people to have a bath. In the front section of the home many of the rooms had carpets and eight had ensuite facilities. One of these had a badly stained carpet and staff told us it had been the same for several months. In a number of rooms throughout the home the doors would not close properly. One man had wedged some card in the door to ensure some privacy. We also saw that wall lights next to beds were not functional and some had coloured tape on them as a result of being identified by an electrician as unsafe to use. Others had no tape and sharp metal casings posed potential risks to people in the home. We required that these be made safe immediately to reduce the risk of injury. In some cases this meant that people were moved to alternative rooms. On 17 July 2008 we noted that new wall lights had been fitted. We found that the alarm call system was not fully functional for all people to call for assistance when needed. We required that appropriate equipment be provided and on 17 July 2008 we found that all alarms were in working order in the rooms that were occupied as some more people had been moved. There was written evidence of an agreed estimate to complete the work on the system. In the laundry there were appropriate machines, but the floor was damaged and in need of replacement. Cleaning was taking place during our visit, but we Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 20 could see that door handles, tables and chairs were not thoroughly cleaned and malodours were evident in several areas of the home. We saw that a number of commodes had not been properly cleaned and several did not have lids or covered seats. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Skilled staff are not always provided in sufficient numbers to be able to appropriately meet the needs of people with Dementia, but recruitment practices offer protection. EVIDENCE: There were six staff on duty caring for 46 people, most of whom had needs relating to Dementia. Previously when we visited in May 2008, there were five staff caring for 44 people. We required a review of the needs of the people who live at the home to calculate appropriate staffing levels to meet their needs. When we visited on 15 July 2008 we were concerned that the six staff were not able to meet the needs of all the people at the home. The acting manager said that a ratio of one care staff to eight people was being used, but this gave no regard to physical dependency or needs relating to Dementia. As already reported, at one point there were 19 people with dementia in the dining room with one staff member. Three people were still sitting in the dining room two hours after their tea. They were waiting for assistance to move to another room, but there were not enough staff available to do this. Data information completed by the acting manager showed that 43 people needed some help with washing and dressing and 29 needed help with using the toilet. 15 people required two or more staff to help with their care. We Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 22 found at the further visit on 17 July 2008 that the number of staff had increased to eight. Staff we spoke with felt this was some improvement, but meant they were working extra hours to cover shifts. The acting manager was contacting agencies to supplement the number of staff available. We saw a senior care assistant on duty in each section of the home and the rota confirmed that there are always two seniors on duty. The manager has told us that half the care staff employed have achieved National Vocational Qualification level 2 or above in Care. In discussions with staff they showed varying degrees of understanding of the needs of people with Dementia. One staff member told us she has not received any training in Dementia Care. Others said that they had received Dementia Awareness training lasting two hours and included watching a video. Some had seen a workbook. One person described some more extensive training she had completed prior to working at Eden Lodge. Other essential training in moving and handling people had been given in the past. We saw certificates that confirmed that some staff had not had training in this area since 2005, but others had received updated training in February 2008. We witnessed some poor practise in moving people as described earlier in this report and this shows that staff require further training in this area. (See also standard 38) The staffing records we examined all contained evidence that checks had been made through the Criminal Records Bureau and references had been obtained prior to people starting work at the home. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 23 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, 33, 35, and 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 responsibly managed and the health, safety and welfare of people is not promoted or adequately protected by current arrangements. EVIDENCE: There was an acting manager, who commenced as manager in October 2007, but had not applied to be registered with the Commission. There was also a representative from a management consultancy agency appointed by the provider to support the acting manager on a part time basis. Both stated that they were aware of improvements needed at the home, but had not made any changes as they had not been given full responsibility to take day to day control of the running of the home. By the second day of this inspection they Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 24 had started to make some improvements as a result of the urgent action we had requested. The Annual Quality Assurance Assessment form that the Commission requested was not completed on time. It was returned three weeks later and stated that meetings had been held with residents and families. The form showed us that some policies and procedures were not in place and others needed to be reviewed. The relatives we spoke with on the day of the inspection were pleased with the service they had received and found the staff very helpful. They had not seen the rear section of the home and one person said that they had heard it was not pleasant and were pleased their relative was in the section nearest reception. Another said that they lived locally and were happy that their relative was able to be in a local home. The administrative staff dealt with all financial matters. One of these told us that receipts were held for all money spent on behalf of people using the service. The hairdresser gave a list of names of people she had seen and the fee was taken from each person’s money. We did not check any records or see the money held during this inspection. Staffing records held copies of certificates in safe working topics, but during this inspection we observed poor practises in moving and handling and in infection control as already recorded in this report. We found the sluice room unlocked due to a lost key and in the laundry there was no evidence that the iron and other electrical equipment had been tested. There had been a recent visit from an Environmental Health Officer who had drawn attention to the need to take action to meet the Workplace (Health, Safety and Welfare) Regulations 1992 and the Management of Health and Safety at Work Regulations 1999. There was a file of accident records kept in the manager’s office. Some of these referred to injuries where people had required treatment at hospital or by paramedics. The Commission had not received notification of these incidents and the assistant manager was reminded of the need to notify the Commission under Regulation 37 of the Care Homes Regulations 2001. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 N/A 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 1 X X 1 X 1 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES from the random inspection of 15 May 2008 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 Ensure care plans include action plans to guide staff about how to meet assessed needs relating to Dementia and challenging behaviour in order to provide appropriate care for people living at the home. Arrange chiropody treatment according to people’s needs in order to promote and maintain good health and mobility. The acting manager must monitor the charts completed by staff to ensure that, if people are in their beds during the day sufficient care and attention is given to promote their health and welfare. Put a system in place to ensure that all medication is offered as prescribed and that it is recorded correctly, so that people receive their medication safely and as prescribed by a doctor. This requirement previously had a timescale of 31/05/08, but was found not met on 15/07/08. Urgent action is needed. DS0000008666.V368627.R03.S.doc Timescale for action 31/08/08 2. OP8 13(1)(b) 31/08/08 3. OP8 12(1)(a) 15/07/08 4. OP9 13(2) 15/07/08 Eden Lodge Care Home Version 5.2 Page 27 5. 6. OP10 OP12 12(4)(a) 16(2)(n) 7. OP15 16(2)(i) 8. OP16 22(5) 9. OP18 13(6) 10. OP19 23(2) 11. OP21 23(2)(j) 12. OP24 16(2)(c) 13. OP24 16(2)(c) Make arrangements to ensure all bedroom doors close properly to ensure privacy. Arrange suitable stimulating activities for people with Dementia in order to promote their well-being. Review meal menus and mealtimes to ensure people always receive a varied, appealing, wholesome and nutritious diet. Make the complaints procedure accessible to all people living in the home so that they know how to make their concerns known. Ensure there is an appropriate, up to date policy and procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) and that all staff are aware of their responsibilities under these procedures in order to ensure that all people at the home are safeguarded from abuse. Produce a programme for routine maintenance and renewal so that the home is always well maintained for people who live there. Provide sufficient assisted baths and showers in good working order to meet the assessed needs and preferences of all people accommodated at the home. Provide an alternative clean and appropriately equipped room for the occupant of room 3 to ensure this person is shown full respect provided with clean and comfortable private accommodation. This was required immediately and met on 15/07/08. Ensure that ripped and otherwise damaged bedding is no longer DS0000008666.V368627.R03.S.doc 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 30/09/08 15/07/08 17/07/08 Page 28 Eden Lodge Care Home Version 5.2 14. OP24 16(2)(c) 15. OP26 13(3) 16. OP26 13(3) and 23(2)(d) 17. OP27 18(1)(a) 18. OP30 13(5) 19. OP31 8(1) and 9 used so that people have clean, comfortable and safe beds to sleep in. Replace all damaged mattresses, headboards and furniture so that each person’s bedroom is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the individual. Commodes must always be properly cleaned, replaced and covered to protect people from risks of infection. This was required immediately, but not fully met as new equipment had to be ordered. Review cleaning schedules in order to ensure the premises are always kept clean, hygienic and free from offensive odours throughout the home, for the benefit of people who live there and their visitors and to protect people from risks of infection. The holistic needs of the people who live at the service must be reviewed and a calculation produced for staffing levels to meet these needs and ensure the health, safety and wellbeing of the people in your care at all times, taking account of the size and layout of the home. This requirement previously had a timescale of 31/05/08, but was found not met on 15/07/08. Urgent action is needed to avoid enforcement action. All staff must be competent when moving and handling people and this includes using appropriate equipment. This is in order to ensure people are moved safely at all times. Ensure there is a manager in place who is given full DS0000008666.V368627.R03.S.doc 31/08/08 15/07/08 31/08/08 15/07/08 31/08/08 31/08/08 Page 29 Eden Lodge Care Home Version 5.2 20. OP38 13(4)(a) 21. OP38 13(3) 22. OP38 23(2)(c) 23. OP38 37 responsibility to take day to day control of the running of the home. This is to ensure people benefit from a well run home. Ensure all wall lights above beds are safe in order to protect people from harm. Where the light fittings still pose risks alternative rooms must be made available This action was required immediately and met on 15/07/08. Ensure all staff receive training in infection control including hand washing and that their competence is monitored. This is so that people are protected from the risk of infection. The call system must be made fully functional and maintained in all rooms so that people are able to call for assistance at all times. This action was required immediately. The Commission must be notified of every serious incident in order to monitor that appropriate action has been taken to promote the health and welfare of people living at the home. 15/07/08 31/08/08 17/07/08 15/07/08 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 OP33 Good Practice Recommendations Ensure all policies and procedures are regularly reviewed and updated. Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Eden Lodge Care Home DS0000008666.V368627.R03.S.doc Version 5.2 Page 31 - 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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