Inspection on 09/06/05 for Eden Lodge Care Home

This inspection was carried out on 9th June 2005.

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

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

Other inspections for this house

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 26/04/06

Eden Lodge Care Home 28/09/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Eden Lodge Park Road Bestwood Village Nottingham NG6 8TQ Lead Inspector Elaine Cray Judith Avill Unannounced 9 June 2005 10:00 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Eden Lodge Address Park Road Bestwood Village Nottingham NG6 8TQ 0115 977 0700 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sai Om Limited Ms Heather Carol King CRH 60 Category(ies) of DE Dementia Both Male and Female 44 registration, with number OP Old Age Both Male and Female 60 of places Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following catgories : 1 The catgory DE applies to service users aged 55 years old and over, and included in the total number of registered users. 2 The maximum number of service users to be accommodated is 60. Date of last inspection 9th and 10th February 2005 Brief Description of the Service: Eden Lodge is situated in Bestwood Village and 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 as well as people with a diagnosis of dementia. Accommodation, comprising of single bedrooms, is on the ground floor and there is level access throughout. Some bedrooms have en-suite toilets and there is sufficient adaptive equipment in the toilets and bathrooms to meet the needs of service users with a physical disability. There are a number lounges 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 C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors on 7th June 2005 over a period of 9.5 hours. The second inspector returned to the home on the 8th June 2005 to check care plans. The manager was present throughout both visits. This inspection focused on five main areas; staffing arrangements, health care, management of medication, diet and catering arrangements and fire safety practices. The financial arrangements for residents were also inspected. These identified areas had been raised as previous requirements and cause for concern by other professionals who visit the home. Several residents were spoken with at the lunchtime meal. A social worker and visiting medical professional were spoken with and evidence was gained by observation of staff practices. Four care plans, 8 staff files and a variety of records were inspected and a partial tour of the building was made. What the service does well: What has improved since the last inspection? The home has improved the recruitment and selection process in terms of maintaining up to date staff files, including reference and criminal background checks. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 6 Attention has also been given to addressing requirements and recommendations from a recent fire inspection. What they could do better: This home has experienced staffing difficulties and the requirement from the last inspection to increase staffing levels remains outstanding. The owner and manager need to ensure that new staff are adequately inducted and provided with necessary training. Staffing levels need to be adequate and include competent and experienced staff. Additionally, the manager must dedicate her role to management tasks and stop working as many care hours, in order to improve record keeping and provide adequate staff supervision and development. Menus need to be expanded to provide better choice and greater nutritional balance and value to the meals. The catering arrangements and surroundings require attention in order to ensure that residents enjoy their meals in a pleasant and comfortable environment. The owner, manager and staff need to look at the needs of the service users before they move in and make sure that the staff can meet these needs. Additionally, the home needs to provide an environment that responds to people with dementia, short term memory loss and needs for regular orientation and stimulation. Staff need to improve ways in which they promote the privacy, dignity, choice and self control of the residents. The physical environment in the dementia wing needs to brought up to the same standards as the other lounges in the home, which are well decorated, comfortably furnished, but unused by the people who live in the home. Additionally, cleaning routines need to be improved in order to stop the malodour in the home. Staff need to improve their awareness of procedures for the prevention of cross infection, improve procedures for the management of medication and ensure that wheelchairs are adequately maintained at all times. Please contact the provider for advice of actions taken in response to this Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The formats for the assessment of needs and social work assessments were inconsistently recorded and maintained. The lack of an initial assessment process raises concerns, and on this inspection led to one resident being admitted without an assessment of need and being placed in an inappropriate part of the home. EVIDENCE: The home’s assessment of need format covers a range of needs, including hearing, sight, mental capacity, behaviour and medical needs. Some assessments had not been fully completed and had not been dated or signed. One service user had been recently admitted for a short stay after discharge from hospital and prior to returning to her own home in the community, where Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 10 she had lived all her life. The home had not obtained an assessment from the hospital placing social worker and had not completed an assessment of need, or a care plan and knew little about her background or her needs. Whilst this service user had a diagnosis of dementia, she had remained independently in her own community and had only been admitted to hospital and then to the home due to a physical injury. However, the service user was placed in the dementia unit. The resident looked intimidated and very distressed in this environment. Discussion with the service user’s community care worker confirmed that she had expressed concern about her environment and a transfer to the residential wing of the home was carried out on the day of this inspection. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Health care and medical needs were inconsistently assessed, identified and recorded. Whilst the home has made some progress in addressing requirements and recommendations for the policies and the procedures for managing medication, the overall management of medication was poor. Staff practices in the prevention of cross infection were poor. Whilst, the manager verbally presented a commitment to promoting the privacy and dignity or residents in her personal approaches to service users, the interaction by staff with residents lacked sensitivity and, at times, respect for residents. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 12 EVIDENCE: The home has a record sheet for recording visits by the doctor, district nurse and other health professionals. Tracking the medical and health care needs of residents was difficult. For example the last entry for visits by the doctor and district nurse to one resident was at the end of 2003, however, other records indicate that visits should have been carried out, but these were not recorded. Additionally changes in the dosage of medication should have coincided with a visit by the doctor but records did not substantiate this. Furthermore, creams prescribed by the doctor had not been entered on the record of medication. One resident’s weight had not been recorded since October 2004. Another resident had no record of weight and had lived at the home for 10 months. The manager reported that the weighing scales had been recently repaired. The lunch time medication round was observed and the member of staff was observed to be wearing the same gloves throughout the process. The home uses a blister pack system for the administration of medication. Gloves are not usually worn as tablets do not need to be touched as they are popped directly into the pot. Medication was administered and signed for appropriately. However, the medication policies and procedures were not available in either medication room and were not explicit in what staff had to do, despite being reviewed following a previous CSCI pharmacy inspection. Records of medication checked and stocks of tablets in storage did not tally and this could indicate that medication has not been given but staff have signed the record sheet. Some dressings were observed to have been stored from three years ago. The Commission had received concerns relating to poor practices in the prevention of cross infection. Staff were observed to be wearing the same gloves for carrying out different care practices with a variety of residents, including assisting residents along corridors. Gloves and aprons are not stored in bathrooms and toilets but in the staff room. Concerns about the privacy and dignity of residents can be evidenced. Some residents were observed to be unkempt. On arriving at the home, inspectors observed some residents with uncombed hair and a member of staff was leading a resident, who had no shoes or slippers on, along a corridor. Another resident was observed to be having difficulty with her cardigan and was becoming distressed, the member of staff in the lounge ignored the resident and the inspector helped the resident to rearrange her clothing. Such practices do not promote the dignity of residents. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 13 Further examples of not promoting the dignity and privacy of residents were evidenced at the lunchtime meal. A member of staff shouted across the room that a resident did not like the pudding, the cook shouted back “he can have fruit” and the resident was not personally spoken with or asked. Additionally when residents were asked about their meal by the inspector, staff would interrupt and answer for the resident. Some residents were often spoken about rather than spoken with. More positively, one member of staff was observed to be helping a resident to eat her lunch and was sensitive and discreet in her practice. The home has a number of lounges, but on the day of this inspection the majority of residents in the dementia wing of the home remain in one lounge, which presents as cramped and provides residents with little privacy. A visiting professional said that residents remain in the lounge when blood tests are taken and when discussions about medical conditions are held, residents are not given the choice to go to their owns rooms in order to promote their own privacy. Additionally residents may not wish to observe blood being taken from other residents. Reports of inappropriate comments from staff in relation to incontinence difficulties were also received. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 and 15 Residents are able to exercise minimal choice and control over their lives. The arrangements in the dining room and the provision of a choice of well balanced meals were poor. EVIDENCE: Care plans did not provide information about the individual choices and preferences of service users and did not record personal routines that may give residents control over their daily living experiences. Whilst there are a number of lounges, the residents use two lounges. One is situated in the dementia wing and the other on the residential wing. The lounge in the dementia wing presents as crowded and noisy, with chairs located along the outside of the four walls of the room. There is a TV, which was on during the whole of this inspection. Some residents could not see the TV due to the location of the chairs. The manager reported that there is another lounge along the corridor from this main lounge, which is used for Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 15 activities, however, staffing levels do not always permit for this lounge to be used. There is a small seating area off the main corridor, but this is open plan and provides little privacy. Consequently, the majority of residents in the dementia wing spend the majority or their time in the main lounge. There is little choice for service users who may not wish to watch TV, want to watch a different channel or sit in more quiet and private communal environment. There was no evidence of residents following any of their personal interests. Residents were observed to be either sat in a lounge watching TV or wandering the corridors. The corridors do not offer any form of stimulation, such as pictures or colour coding to help residents find their way around the home. Similarly, the lounge did not have any stimulation and orientation aids. One member of staff said that some residents had enjoyed helping to clean down the dining room furniture in the garden the previous day. A choice of meal is not provided on the menu. The menu is not displayed in either dining room. When in the dementia wing, the inspector asked if the menu is displayed, a staff member replied “no, because they don’t bother looking at it”. All residents had the same meal of fishcake, mashed potato and mushy peas and residents were unsure if they could have an alternative if they did not like the meal. None of the residents spoken with at this meal time knew what was being offered for pudding. The dessert of rice pudding was placed on the table for each resident and an alternative of fresh fruit was only offered when the resident stated they did not want rice pudding. A direct choice was not offered and residents appeared surprised when fresh fruit was eventually supplied. The fresh fruit had been cut up in a bowl and placed on the serving trolley in the hot dining room and had turned brown. The menu is rotated on a two weekly basis and is repetitive, there is no choice and a minimal supply of fresh vegetables was available in the home. On the day of this inspection, which took place on a Thursday, there was a bag of carrots and three cabbages, which were to be served for Sunday lunch. The inspector was informed that fresh vegetables are only served on a Sunday. The kitchen was poorly organised and lacked cleanliness. The trolley used to serve hot and cold drinks was very dirty and the kitchen door was wedged open. The surroundings in the dining rooms were poor, a table cloth in the residential wing was dirty and the dining room in the dementia wing was particularly overcrowded, noisy, hot and lacked ventilation. Residents and staff had difficulty in manoeuvering in between the chairs and table, consequently staff had to shout across the room to communicate. The room was very hot. The inspection took place on a hot sunny day. The room has two patio doors and no windows. The patio doors could not be opened as there is a steep drop from one door and staff are concerned that residents may wander off from the second door. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 16 Meals and drinks were served directly to the residents. A choice of a hot or cold drinks was given, but drinks were not provided until midway through the meal. The weather and the room were hot and sunny and residents may have been thirsty. There were no jugs of water, glasses , serviettes or table decorations on the tables. The overall management of the catering arrangements were poor. The manager is not directly involved in the recruitment of catering staff, the content of the menus or the ordering of food supplies. Staff stated that shopping lists are drawn up, but items placed on the lists are sometimes missing. The owner of the home obtains the fresh fruit and vegetable supplies. The requirement to provide fresh fruit and vegetables was set at the previous inspection in February 2005. An immediate requirement to provide fresh produce and a choice of menu was set on this inspection. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected. These standards were not inspected and will be addressed at the next inspection of the home. EVIDENCE: Not Applicable. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 25 and 26 Whilst a full tour of the building was not undertaken, the communal and corridor areas of the home were observed. The lounge and dining areas in the dementia wing are poorly arranged, present as crowded, are poorly decorated and furnished and lack ventilation. The dementia wing lounge was poorly personalised, presented as institutionalised and did not reflect the standards of other communal areas in the home which are of a good standard, but remain unoccupied by the residents at the home. There was a malodour in some areas of the home. EVIDENCE: The main lounge in the dementia wing is poorly decorated, furnished and personalised. Furnishings are ill-matching and chairs, some of which present as past their best, are arranged around the four walls of the room, creating an institutionalised appearance. There is a TV in this lounge, which was on Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 19 throughout the inspection. There is another lounge area, adjacent to the main lounge, which was not being used on the day of this inspection due to the allocation of staff. There is also a seating area in a small open plan annex to the main corridor, where some residents choose to sit. However, this area is glazed and was very hot on the day of the inspection. Furnishings here were of poor quality. There are two other lounges at the other end of the home, which are well decorated, furnished to a high standard and efforts have been made to personalise these lounges with pictures and flowers. One lounge has a musical organ. However, on this inspection and on previous visits these lounges have not been used by the residents. There are concerns that the poor furnishing and conditions in the dementia wing lounge are provided when other, better quality, facilities already exist, but remain unused, in the home. As stated earlier in this report, the dining room in the dementia wing is over crowded, cannot be easily ventilated, was high in temperature and lacked personalisation. The corridor areas also lack personalisation and also lack effort to adapt these areas in order to aid residents to orientate themselves as they wander around the home. There was a stale malodour or urine in some areas of the home. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Whilst the home has made efforts to improve recruitment and selection procedures, staffing arrangements in the home are inadequately managed. EVIDENCE: Eight staff files were checked and the home’s evidence of reference and background checks had been placed in the files. However, there are inconsistent approaches to the recruitment and selection of staff. The manager does not recruit the domestic and catering staff; this is carried out by the administrator of the home, who then continues to support these staff in their employment. However, the registered manager is responsible for the day to day cleaning and catering outcomes for the residents at the home. A requirement to improve the staffing levels in the home was set at the previous inspection in February 2005. On the day of the inspection staffing arrangements were inadequate. Calculations from the staff rota and agency Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 21 staff invoices for the previous week to this inspection evidenced further deficiencies. Forty six service users were living at the home on the day and two weeks previous of this inspection. The weekly amount of required care staff hours for 46 service users, the majority of which are high dependency, is at least 603 hours per week. For week commencing 30th May 2005, 529 care hours for the week were calculated. Additionally, 92 catering hours and 92 domestic hours per week are required for 46 service users. Calculations evidenced 70 domestic hours and 49 catering hours for week commencing 30th May 2005. Further concerns can be evidenced by the high turnover of staff. Due to difficulties with employment checks, 8 staff have recently left the home and there has been an increase of new staff and some use of agency staff. Some staff have some experience of working in other homes, but not necessarily with residents who have dementia. There was evidence that the mix of experience and skills on some shifts were not adequate. For example, one member of staff was being inducted by a relatively new member of staff, who had not received required training, including Moving and Handling. There have also been reports that some staff have resisted working with other staff on the grounds of their ethnic origin and have therefore not worked as the set rota. There have also been concerns about how staff who’s first language is not English have been enabled to communicate with other staff and residents about the needs of the residents. Additionally, the manager of the home works extensive hours, often covering care shifts. The manager is also on call 7 days per week. The manager’s opportunities to complete management tasks are minimised by covering care hours and also raises concerns about the amount of hours and resulting tiredness experienced by the manager. The manager is supported by senior care workers, but their role and responsibility are care based. There is no management team in the home, other than the registered manager, which provides accommodation for up to 60 residents. Consequently, there is a lack of formal staff supervision and no line management process for when the manager is off work. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 22 Whilst some training has been provided there is an inconsistent approach to the assessment of training needs and the provision of training. Induction has been poorly arranged with relatively inexperienced staff inducting new staff. The recording format for induction was incomplete and is not dated and signed by the new employee. Some staff had not received core basic training such as Moving and Handling. Immediate requirements to address staffing levels and training were set at this inspection. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 37 and 38 The manager’s ability to effectively manage the home is compromised by the amount of care hours she works and by a lack of managerial support in such a large home. EVIDENCE: As previously stated in this report, the management processes in this home are compromised by a diversity of roles and responsibilities. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 24 For example, the registered manager is not responsible for the recruitment and supervision of domestic and cleaning staff and does not have responsibility for the overall catering arrangements in the home. Additionally, the manager works long hours and often covers care shifts, leaving less time to address the management issues, such as staff training, supervision, quality assurance and maintaining recording systems. It is difficult for the manager to develop a clear management ethos when she is working alongside carers during periods of staff shortages. Checking of the individual service user financial records was not possible on this visit as all residents monies are combined in one large amount. Records are not countersigned and individual receipts were not provided for each transaction. Record keeping was poor and gaps in care plans, medication records, lack of assessment of needs and poorly recorded staff induction, training and management of residents financial affairs and records do not promote the safeguarding of the residents’ rights and best interests. Requirements and recommendations made by the fire officer on an inspection in March are being gradually addressed by the home. However, the kitchen door was wedged open. Additional health and safety concerns were raised when the majority of wheelchairs did not have foot rests attached and an immediate requirement to safely maintain wheelchairs was set at this inspection. Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 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 x 2 x 3 1 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score x 2 x x x x 1 1 Score Standard No 7 8 9 10 11 Score 1 1 1 1 x Standard No 27 28 29 30 1 2 2 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 1 15 1 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score x x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 x 34 x 35 2 36 x 37 1 38 2 Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The manager must develop a service user guide to the home which meets the requirements of regulation 5 and standard 1.2. This must be given to each service user. This requirement was set at the previous inspection Ensure that all service users have an assessment of need prior to admission. Ensure care plans are fully completed for all service users. Ensure that the health care needs of all service users are assessed identified met and recorded. Ensure that the homes medication policy and procedures are available, inform staff practice and are adhered to. Ensure that the care home is conducted so as to promote the privacy and dignity of service users. The home must develop a planned programme of regular activities for service users. This C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Timescale for action 1st September 2005 2. 3. 4. 3 7 8 14 15 12 1st September 2005 1st September 2005 1st September 2005 1st September 2005 1st September 1st September 2005 Page 27 5. 9 13.2 6. 10 12.4 7. 12 16 Eden Lodge Version 1.30 8. 14 12.3 9. 15 16 10. 20 23 11. 25 23 12. 13. 26 27 23 18 requirement was set at the previous inspection. Ensure that service users are provided with choice and control over their day to day experiences and their wishes and feelings are taken into account The home must provide a nutritious and wholesome diet, which includes choice of meals, fresh vegetables, fruit and juice. Ensure that the communal facilities are adequately decorated, furnished and the physical design and lay out of the premises meet the needs of the service users - i.e. in the category of dementia. This must also include adequate lounge and dining room space for each service user. Ensure the home is suitably ventilated and a reasonable room temperature is maintained in order to promote the health and safety of the service users. Particular attention should be made to the dementia wing dining room and small lounge annex from the corridor. Ensure the home is free of malodour. Ensure that staffing hours are increased to meet the minimum requirement and to meet the needs of the service users and takes into account the layout of the building Ensure that the home is staffed at all times with suitably qualified, competent and experienced persons. Ensure that the registered manager has overall responsibility for the recruitment and selection of staff working in C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc 1st September 2005 Immediate 1st September 2005 1st September 2005 1st September 2005 Immediate 14. 28 18 Immediate 15. 29 18 1st September 2005 Page 28 Eden Lodge Version 1.30 the home. 16. 17. 30 31 18 24 Ensure that all staff receive induction and training. The provider must reassess the management arrangements to ensure all management tasks are fully completed. This requirement was set at the previous inspection. Provide appropriate storage for individual residents finances and ensure receipts are issed and maintained. Ensure all required records are maintained accurately and up to date in order to safeguard the rights and interests of the service users. Ensure safe procedures for the prevention of cross infection are promoted and maintained. Ensure all wheelchairs have been made safe. Do not wedge open fire doors. Ensure the owner manager and staff maintain good personal and professional relationships and with service users. Immediate 1st September 2005 18. 35 17. Sched 4.9 17 1st September 2005 1st September 2005 Immediate Immediate 1st September 2005 1st September 2005 19. 37 20. 21. 22. 23. 38 38 38 29 16 13 13 12.5 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 Good Practice Recommendations Eden Lodge C53 C03 S8666 Eden Lodge V231389 090605 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection 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. 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