Inspection on 26/04/06 for Eden Lodge Care Home

This inspection was carried out on 26th April 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

Eden Lodge Care Home 15/07/08

Eden Lodge Care Home 14/08/07

Eden Lodge Care Home 14/02/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Eden Lodge Care Home Park Road Bestwood Village Nottingham NG6 8TQ Lead Inspector Sharon Rosenfeld Unannounced Inspection 26th April 2006 10:15 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.V290781.R01.S.doc Version 5.1 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.V290781.R01.S.doc Version 5.1 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 Sai Om Limited Position Vacant Care Home 60 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (60) of places Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories: Old Age (OP) (60) Dementia (DE) (44) The category DE applies to service users aged 55 years and over, and is included in the total number of registered users. The maximum number of service users to be accommodated is 60. Date of last inspection 28th September 2005 Brief Description of the Service: Eden Lodge is situated in Bestwood Village from which there is access to 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. The bedrooms are single some of which have en-suite toilets. There are four lounges, one is a designated smoking area and residents do not use the other one. There is an activities room and two dining rooms. The grounds are expansive and mainly set to lawn. There is a large car park to the front of the home. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over ten hours and was part of the statutory inspection programme. The responsible individual was present for the majority of the inspection. A tour of most of the building took place and a range of records, including five care plans were seen. Eight staff, four residents one relative and one social worker was spoken with during the inspection process. What the service does well: This report contains a number of criticisms particularly about the way that the needs of people with dementia are understood and managed. There were however examples of very good practice which, if recognised and encouraged, could benefit people directly. One staff recognised some of one residents remaining abilities even though this person had lost the ability to communicate, she still responded to clear concise instructions. These kinds of observations form the basis of person centred care planning, which is good practice. It was clear from direct observations and feedback given that many of the staff provide support to the residents and their relatives and work hard to ensure their personal care needs are met. The care plans produced are written in a format that is easily read and understood. They describe some of the actions staff must take to meet the needs of the residents and this again is good practice. The staff responsible for the administration of medicines is well trained and confident in their role. The management of residents finances and record keeping generally is very good. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home has experience a high staff turnover and the registered provider is experiencing difficulties in recruiting a suitable manager. The responsible individual stated that this is placing a great deal of pressure on her to ensure that the standards across the board are met. The absence of a registered manager means the home is not being managed effectively, poor practice is not being spotted and improved and positive outcomes for the residents are not being promoted. The following requirements remain outstanding from the last inspection and urgent action is now required to ensure these are met to avoid enforcement action: • No one must be admitted to the home without an appropriate assessment of need. • Activities, that meet the individual needs of the residents must be introduced. • Although some staff have received an introduction to dementia care it is clear that staff need additional guidance, support and supervision to ensure that a person centred approach is introduced into every aspect of the homes day-to-day running. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 7 The inspection revealed other serious shortfalls. Complaints received by the home are not being addressed appropriately to ensure people’s concerns are listened to and resolved. The staff do not know the content of the care plans and the views of residents are not incorporated into an effective quality monitoring process that informs how the home operates. There are serious ongoing problems with the water supply to some areas of the home that affects a number of residents. 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. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are not always assessed before they move into the home. People are not assured that their needs will be met. The home does not provide intermediate care services. EVIDENCE: The files of two people who were most recently admitted to the home were seen. One person’s needs had been assessed in full by social services using a community care assessment. The other persons’ needs had not been assessed prior to admission by social services or by the home. The responsible individual stated that a previous manager had approved the admission of this person without an assessment. The manager had subsequently left. The resident has been living at the home for approximately three months and because social services did not commission the placement, it is not funded. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 10 This situation is further complicated as the person was admitted after living in another part of the country. There are, therefore, two different funding authorities involved and they are yet to agree responsibility for paying for the persons placement. This has serious implications for the individual whose placement may be terminated unless this situation can be resolved. The responsible individual does not ensure that the home provides prospective residents with written confirmation that their assessed needs can be met. The responsible individual could not adequately demonstrate ways in which the home meets the specialised needs of people with dementia. Some of the staff have recently received a short course in dementia care and mental health awareness. One staff member said it had helped her to understand what happens to a person with dementia however her knowledge about how to provide person centred care was limited. The responsible individual stated that external specialist advice on care for people with dementia is not sought by the home. Each file seen contained a care plan. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The staff are not clear about the needs of individual residents and how they should be met. The staff do not consistently value and respect residents rights, privacy and dignity. EVIDENCE: The care manager has delegated responsibility for the formulation of care plans for all residents. The care plans were well presented and written in a style that made them accessible to care staff and some residents. This is good practice. When interviewed, one care staff said she had never read a care plan. The reason given was that they are inaccessible, stored as they are at the furthest end of the building in the office. One resident believed she was not allowed to see her care plan and said she had not been consulted on it’s content. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 12 Five care plans were seen. Some of the care plans contained some very useful information about residents’ personal preferences and summarised how people’s needs were to be met. On closer examination, it was found that the content of some care plans, notably those for dementia and medication, were the exact duplicates. Some care plans for people with dementia contained a ‘life history’ and this is good practice as it enables the care staff to get to know the person as an individual and gives them an opportunity to plan for their care and support needs more appropriately. However one staff member said she knew nothing of the residents’ histories, only that one person ‘used to play the piano’. The home has two electric organs and when asked, the staff did not know if the resident was still able to play or if she enjoyed sitting at the instrument. The ‘life histories’ have not been further developed with information about what experiences people have enjoyed since admission. The majority of the residents nursing needs are met by district nursing staff. The records seen showed that people attend hospital appointments and have consultations with dentists, chiropodists and opticians. Individual continence assessments have been undertaken where appropriate, although the care plans do not contain information about personal prescriptions for continence products and about how continence is to be promoted. One persons’ file confirmed a history of depression. There was no useful information about how this manifests and how the person’s psychological health is to be monitored or whether there is any involvement from the local psychiatric services. Another person has a diagnosis of Crohn’s disease. When asked, the staff did not know what this was and the home had no information about it or how the condition might affect the resident. Equipment is available for the promotion of tissue viability and this was well documented in one care plan. The care plans are all reviewed on a monthly basis. One staff member was observed administering medicines. She was confident in her abilities and confirmed she had received training from the local pharmacist. The home uses a monitored dose system (MDS). The majority, but not all of the medication administration records (MAR) were signed to confirm the medication had been taken. One resident who has type 1 diabetes chooses to administer her own Insulin by injection. She draws up the prescribed dose into the syringe herself and is observed by a member of the care staff to ensure she does this safely. The local pharmacist has informed the staff about safe practice, however the staff confirmed that the district nurse is not currently involved with this person and it was unclear if her continuing competence in administering her own Insulin was being assessed Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 13 during visits to the diabetic clinic. The care staff are not qualified to assess her competence in preparing and administering her own Insulin. A referral must be made to the district nurse who should monitor this in accordance with the Nursing and Midwifery Council (NMC) guidance on delegated duties. The Insulin container stored in the fridge next to other medicines and was covered in blood. This medicine must be stored appropriately and in line with infection control guidance. A copy of a policy and procedure on the protection of residents and staff from blood borne viruses should be available in the clinic room where it will be accessible. The medicine storage areas are not included on a cleaning schedule. The medication trolley and fridge required thorough cleaning. The fridge contained medication, dated 2002, for a resident who had since died. One of the cupboards in the clinic room also contained medication of a person now deceased. The temperature of the medication fridge was too high at 10˚C and the temperature of the medication storage room is not routinely recorded to ensure that drugs are stored no higher than 25˚C. The full medication policy was not seen on this occasion however the policy to manage a medication administration error was read. This was formulated in the year 2000 and had not been updated to reflect current practice requirements. The arrangement for the provision of personal care in a manner that preserves the individuals’ privacy and dignity requires review. One resident was seen standing alone, naked by a bathroom door that opened onto the corridor. The shower had been left on and water was running into the corridor. A carer arrived soon afterward carrying the resident’s belongings. Staff were seen entering bedrooms, toilets and bathrooms without first knocking and waiting for a response. Three staff talked about residents’ personalities and described their care issues in front of them, and in communal areas of the home where others could easily hear. The signage on one bedroom door on the ‘dementia wing’ showed a series of names, which had been crossed out when the occupants had died. This is insensitive to the current occupant and is something that could be easily rectified. One staff member recognised that a resident with dementia whose ability to speak had diminished significantly, did still respond to clearly spoken instructions; for example, when staff were assisting her to dress she would lift her leg when asked to do so. Observations such as these are essential elements to good quality dementia care and need to be incorporated into the care planning processes. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 14 At periods throughout the day, staff were also observed offering kindness, support and comfort to residents with dementia, some of whom were restless and distressed. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 15 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, 15. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Activities that provide interest and stimulation to residents with different needs are not provided. The home promotes contact with relatives and friends. There are few opportunities for residents to exercise real power and choice. EVIDENCE: Activities that are planned around people’s preferences and strengths are not organised. The responsible individual stated the company has been trying to recruit an activities co-ordinator but without success. The lounges contain a television and music centre. There were no other resources readily available to residents to pass the time. When a tour of the building was undertaken, one staff member was seen singing and dancing with a resident, and in another lounge, in the ‘Dementia Wing’ a staff member was throwing a ball to people. This room provided seating for up to twenty people, some of the chairs used were from the dining room. There were no spare chairs for staff to use to sit with residents. There was a lot of background noise from both the television and music centre in this room and people were talking Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 16 loudly over the noise to be heard. Some of the residents were shouting and appeared to be agitated. There is an activities room however this is not used to it’s full potential. One resident said she was very happy when she first moved into the home and that it met her expectations and needs. She said things had changed now and she attributed this to changes in management. She now feels unhappy at the home and wishes to move to alternative accommodation. She said she is not involved in activities and staff are too busy to spend very much ‘social’ time with the residents. This person has no immediate family. The staff knew she has expressed a desire to leave however she has not been referred to social services for re-assessment. One regular visitor to the home said that she is very happy with the quality of the care provided for her mother. She believes the staff care very deeply for the residents and work beyond their day to day responsibilities to, for example, raise money for special extras at key times such as Christmas and Easter. She stated the staff are always very friendly and she feels welcome and supported by them. Some of the ways that people have exercised choice about their life at the home is detailed in the care plans. This information is not effectively used by the care staff to benefit residents. One resident was asked to describe the ways in which she could exercise choice and control over her life. She felt that there were few opportunities to do this. One care staff said that all residents are woken and dressed ready for breakfast. The responsible individual and care manager denied this however and said that if people wish to stay in bed they can. They were asked to check if the care staff were enabling this to happen. A decorator was visiting the home to quote for re-painting some of the corridors. The residents have not been consulted about their preferred colour schemes. A choice of food at meal-time was offered. One person did not like what she had ordered and she was promptly offered an alternative. There is a fourweek rotating menu on display. However, on closer examination it was found that weeks one and three and two and four were identical. The responsible person said she was not aware of this and said the new cook would be expected to review the menu. One resident spoken with requires a diabetic diet. Another person is a vegetarian. There was no evidence from an inspection of the kitchen or from records about how these individual diets are catered for in a way that offers variety, choice and appropriate nutritional value. The fridges contained limited produce, there was no cheese or yoghurts and there was only a small amount of fresh fruit, some of which was past it’s best, and no fresh vegetables. The majority of food is kept under strict control under lock and key. The responsible individual said this was because food had previously been stolen. The responsible individual stated that deliveries were Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 17 to be made to the home the following day. The availability of a range of food that is wholesome and nutritional is one element of a complaint that has subsequently been raised with the CSCI. It is also alleged that the cook had recently left the home because she was not allowed basic ingredients to improve the quality of food. A replacement cook has been appointed and was soon to commence in post. Three people have a liquidised diet. One of these people was case tracked. The different elements of her meal were liquidised separately to preserve individual flavour and colour. The records did not show why she required a liquidised diet. The staff said she once choked on some toast. A speech and language therapist has never been asked to assess her and advice has not been obtained from the community dieticians about the provision of ‘soft’ diets. The home does not have information available to the cook about the nutritional needs of older people and nutritional screening does not take place. Some residents appeared to have very dry mouths. There was a plentiful supply of drinks available at lunchtime but drinks are not always available in between mealtimes. The care manager said they used to have a drinks trolley always available and they would review this. There was confusion about who is responsible for the co-ordination of the cooks work and for ensuring she receives appropriate information about resident’s dietary needs. Previous reports indicate this is an historic problem. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 18 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, 18. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Complaints are not acknowledged and responded to in accordance with the written procedure. A lack of knowledge about abuse procedures amongst some staff may mean that residents are not adequately protected. EVIDENCE: The responsible individual stated that no complaints had been received at the home recently. Three have been received since the last inspection. Two were made directly to the home and one has been received by the CSCI via the Nottinghamshire County Council Commissioning Team from a person who wishes to remain anonymous. The responsible individual stated that two previous managers have been responsible for the investigation of the complaints received at the home on 11/10/05 and 17/10/05 respectively. However, these remain unresolved as both managers left before they completed the investigations. The responsible individual stated that the care manager was now responsible for addressing these, however, when asked she did not understand this to be the case. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 19 One complaint alleges there is a lack of opportunity for meaningful social interaction and occupation, limitations on resident’s personal movement and restrictions placed on a resident to access money to buy cigarettes and to have opportunities to smoke. It is also alleged that the care is basic and the staffing levels are kept at a minimum. The second complaint alleges poor care practice. The responsible individual must ensure that these complaints are be fully investigated, that outcomes are determined and the complainants notified of the outcomes and any action to be taken to in response to the outcomes. The inspection covered some elements of the complaint received by the CSCI. The detail of the complaints will be sent to the responsible individual and the CSCI and the Commissioning Team will require evidence that they have all been investigated fully. One visitor to the home said she complained approximately two months ago that there was no water supply to her relatives’ bedroom. She has not received a response to her concern and the problem has not been resolved. Two key members of the staff were asked if they were aware of the adult protection procedures. One did and one did not. One of the staff files contained a certificate of attendance on an adult abuse awareness course. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 20 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, 21, 26. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Some improvements to the décor are planned, there are a number of other serious matters outstanding that need to be addressed to make the home safe and comfortable. EVIDENCE: A decorator was at the home quoting for re-decoration work. A decision has been taken to change the colour of the corridors to make them more easily identifiable. They are all currently one colour. This is good practice in the care of people with dementia as having bedroom corridors, for example, painted a distinctive colour can help recognition of different areas. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 21 One bedroom had ripped wallpaper and the furniture was in poor condition. The furniture and décor in another bedroom was generally in good condition. An audit is required of all rooms so that an improvement plan for the home can be made. The ‘handyman’ has recently left and a replacement has recently been recruited. An inspection of the bathroom and toilet facilities revealed a serious problem with the water supply to many parts of the home. The water supply in twelve bathrooms was checked. The water supply to five baths was poor or nonexistent. One shower did not have a water supply. Three of the baths mixer taps were not working. One bathroom was inaccessible and was being used as a storeroom. One bathroom was inaccessible and padlocked. A notice on the door stated it was out of order. A staff member stated it had been out of order for ‘a long time’. An immediate requirement was left with the responsible individual to obtain professional assessment of the problem and get it resolved. One visitor said she complained approximately two months ago that her mother’s room did not have a water supply. Her complaint was not acknowledged or resolved. The container staff use to ferry water from other areas of the home was in her relatives room. The responsible individual and care manager stated they were not aware of these problems. The responsible individual then stated that there have been historical problems with the water supply and plumbers have previously been employed to rectify this. The premises were clean in many areas however there were some places that require more thorough attention. The chairs and tables in the dining room used by people with dementia had food debris stuck to them. Many of the toilets in the home did not have a supply of toilet paper and none had useable toilet roll holders. One bathroom, parallel with the lounge in the ‘dementia wing’ had poor décor and was heavily soiled. There were few mal-odours however. Many of the staff were observed wearing disposable gloves throughout the day including when they were not engaged in personal care tasks but simply, holding the hand of a resident. When asked one person said she wore gloves ‘all the time’ for infection control purposes. The cleaner was alerted to a communal area in the home where a person had been incontinent. She did not respond to requests to clean the area. The responsible individual said this was because English is not her first language. The laundry facilities are appropriately sited and a new laundress has recently been recruited. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 22 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, 30. 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 recruitment procedures are adequate, ensuring a degree of protection to the residents. The deployment of staff appears appropriate for the numbers and needs of the residents. EVIDENCE: The responsible individual and care manager stated there are six care staff on duty on the morning and afternoon shifts and three or four on duty at night. Separate domestic staff are employed through out the day. Of the twenty-nine care staff employed four have been trained to NVQ level 2 in care. Three have almost completed this level of training and funding has been acquired for a further six people to commence the training. The target that 50 of care staff are trained to NVQ 2 in care by 31st December 2005 has not therefore been achieved. Two staff files were seen. One was for the most recent recruit. The files were well-organised and contained all of the required documentation. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 23 One file contained an induction checklist. This identified the topics to be covered at induction. It did not cross reference to more detailed information about each induction heading therefore the quality of the information given to new staff could not be assessed. The two long-standing staff spoken with had no knowledge of the General Social Care Council Code of Conduct. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 24 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, 38. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has no manager and the staff lack effective leadership, guidance and direction to ensure that residents receive good quality of care in line with current good practice. Some practices do not promote the resident’s health, welfare and safety. EVIDENCE: There has been a high turnover of managers and the position is currently vacant. The absence of consistent management may be a contributory factor in the confusion about the lines of accountability within the home and the roles undertaken by different disciplines of staff. It is essential that a skilled manager be recruited to deliver the care required and secure positive Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 25 outcomes for the residents. One of the two acting managers was not aware of the existence of National Minimum Standards. There is no quality assurance programme although one of the two administrators employed has been delegated responsibility to develop and carry out a quality monitoring system. The way that resident’s money is managed and recorded has improved. An administrator is responsible for this and good accounting records are kept. There is a notice in the reception area instructing relatives and representatives to hand money in for safe-keeping, however the administrator stated that this is not compulsory and people would be able to manage their own finances if they wished. None of the residents currently manage their own finances. Residents are only able to access their money when the administrator is at work. Finances are therefore not available from approximately 4:00pm each week-day and at weekends. One person has complained about not having access to their funds to make purchases. Another resident said she didn’t mind this system although it did necessitate advance planning so that money could be made available should she need it at weekends. One person has not received any personal allowance since his admission to the home. The administrator confirmed she will check who has control over this persons finances and ensure that he can access this. One administrator said she has recently been delegated responsibility for keeping records of staff training. These did not include records of training that has taken place previously. The responsible individual confirmed that training in mandatory areas had taken place however there were no records or certificates to evidence this. The maintenance records for the homes gas and electrical systems and lifting equipment were seen and were up to date. The battery operated bath hoist needs charging and the load bearing weight of all hoists needs to be displayed in accordance with the findings of the maintenance contractor. The fire system testing records were seen. The system is not tested on a weekly basis as it should be and this puts the residents and staff at risk. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 2 Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 27 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 OP3 Regulation 14(1)(a) (b)(c) Requirement Timescale for action 19/05/06 2 OP3 14(1)(d) 3 OP7 12(1)(a) (b) 15(1)(2) 4 OP7 12(1)(a) (b) 15(1)(2) The registered provider must ensure that all service users have an assessment of need prior to admission. This requirement remains unmet from the last two inspections dated 05/06/05 and 28/09/05. The registered provider must not 19/05/06 provide accommodation to a service user unless written confirmation has been given to them that having regard to the assessment, the home is suitable for the purpose of meeting their health and welfare needs. The registered provider must 30/07/06 ensure that individualised plans of care are produced in consultation, wherever practicable, with each service user or their representative about how the service users health and welfare needs are to be met. The registered provider must 30/07/06 make proper provision for the care, treatment, education and supervision of service users by DS0000008666.V290781.R01.S.doc Version 5.1 Eden Lodge Care Home Page 28 5 OP7 12(3) 15(1)(2) (c)(d) 6 OP9 13(2) 37 7 OP9 13(2) 8 OP9 13(1)(b) (2) 9 OP9 13(3)(4) 10 OP9 13(2)(4) (c) 11 OP10 12(4)(a) making all appropriate staff aware of the action they must take to meet the needs of the service users in accordance with the care plan. The registered provider should ensure that staff have access to information about residents medical conditions and that the care plans contain information about how these needs are to be met. The registered provider must update the policy,(dated 2000) on the action staff must take in the event of a medication administration error so that it reflects current agreed practice including the submission of a regulation 37 notification to the CSCI. The registered provider must ensure that unwanted medications are disposed of appropriately. The registered provider must ensure that an appropriately qualified person such as a district nurse periodically assesses the competence of service users who are responsible for the administration of their own medication by injection. The registered provider must prevent infection and the spread of infection by producing a policy and procedure on the protection of residents and staff from blood borne viruses. The registered person must ensure that medication is stored at appropriate temperatures in accordance with the manufacturers instructions. The registered provider must ensure that the home is conducted in a manner that DS0000008666.V290781.R01.S.doc 30/07/06 31/05/06 19/05/06 19/05/06 31/05/06 19/05/06 19/05/06 Eden Lodge Care Home Version 5.1 Page 29 12 OP12 16 13 OP15 17(2) 14 OP15 13(1)(b) 15 OP16 22(3)(4) 16 OP18 18(6) respects the privacy and dignity of residents with particular regard to:1. Personal care-giving including bathing and washing. 2. Entering bedrooms, toilets and bathrooms. 3. The sharing of personal information about service users. Provide a schedule of activities to meet the needs of the service users. This requirement remains unmet from the last inspection dated 28/09/05. The registered provider must record the food provided in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and of any special diets prepared such as for vegetarians and diabetic service users. The registered provider must ensure that advice is obtained for people with swallowing difficulties from the community dietician and if necessary the speech and language therapist. about appropriate diets, food preparation and feeding and that the care needs are entered into a care plan. The registered provider must ensure that all complaints referred to the home are fully investigated and the complainant is informed within 28 days of the action that is to be taken in response to the outcome of the complaint. The registered provider must ensure that all staff receives training or information on how to respond to suspicion or evidence of abuse or neglect. DS0000008666.V290781.R01.S.doc 30/06/06 19/05/06 31/07/06 14/06/06 31/07/06 Eden Lodge Care Home Version 5.1 Page 30 17 18 OP19 OP19 23(2)(d) 23(2)(j) 19 OP26 23(2)(d) 20 OP30 18 21 OP33 24(1)(2) (3) 22 OP38 17(2) 23(4)(c) (e) The registered provider must ensure that bedrooms are kept in a good state of decoration. The registered provider must ensure there is a water supply to all bathrooms and bedroom sinks. An immediate requirement was made regarding this issue. The registered provider must ensure that all parts of the home are kept clean including: 1. The dining room chairs and tables in the ‘dementia wing’. 2. 2. The medication storage areas. Ensure dementia training is sufficient in order that staff are able to understand and meet the needs of the service users at the home. This requirement remains unmet from the last inspection dated 28/09/05. The registered provider must establish and maintain a system for reviewing and improving the quality of care provided at the care home. The service users must be consulted as part of the quality review. A copy of the report of any review must be supplied to the CSCI. The registered provider must ensure that the fire system is tested on a weekly basis. 31/07/06 31/05/06 19/05/06 31/07/06 31/07/06 19/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 31 1 2 *RCN OP4 3 OP9 4 OP10 5 OP14 6 7 OP14 OP38 The registered provider should make the Care Manager, who is currently the acting manager aware of the National Minimum Standards for Older People. The registered provider should ensure that the care plans for people with dementia are demonstrably based on current good practice and reflect relevant specialist and clinical guidance. The registered provider should ensure that a policy and procedure on the prevention of blood borne viruses is available in the clinic room where blood samples are taken. The registered provider should ensure that attention is given to the needs, preferences and capacities of people with cognitive impairment and dementia when providing opportunities for leisure activities. Good practice guidance should be sought in this area. The registered provider must ensure that the person who has stated she no longer wishes to live at the home is referred to social services for necessary assessment and advice. The registered provider should ensure that service users are consulted about the new colour schemes for the home. The registered provider should maintain a written record of the training staff have undertaken. Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Eden Lodge Care Home DS0000008666.V290781.R01.S.doc Version 5.1 Page 33 - 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. 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