Inspection on 20/06/07 for Fallings Park Lodge

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Fallings Park Lodge 26/02/08

Fallings Park Lodge 04/12/07

Fallings Park Lodge 20/08/07

Fallings Park Lodge 16/01/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fallings Park Lodge 99 Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8BH Lead Inspector Rosalind Dennis Key Unannounced Inspection 20th June 2007 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 Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fallings Park Lodge Address 99 Old Fallings Lane Fallings Park Wolverhampton West Midlands WV10 8BH 01902 722700 01902 722700 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) Aplin Care Homes Ltd Yvonne Margaret Lavender Care Home 48 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (35) of places Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. In the OP category Females 60 years and above and males 65 years and above The home should only accommodate up to 13 service users with dementia. Up to seven service users aged 55 years plus, other service users must be over 60 years. The Second floor lounge and bedrooms are used for the thirteen service users with dementia. 16th January 2007 Date of last inspection Brief Description of the Service: Fallings Park Lodge is a new purpose built care home situated in the residential area of Fallings Park and is close to local shops and amenities. The home has three floors with wheelchair and disabled access throughout. There are 48 bedrooms all of which have en-suite and a modern nurse call system. There are five communal lounges each incorporating dining facilities for the residents. The top floor has thirteen rooms, which are registered for use by residents with dementia. The home has extensive gardens and grounds, which has raised flower beds and there is car parking at the front of the building. At the inspection in January 2007 the home’s fees ranged from £336 to £385 per week. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors who arrived at the home at 09.30 and concluded the inspection at 16.45. All ‘key’ standards were assessed during the day- that is those areas of service delivery that are considered essential to the running of a care home. Inspectors spent time speaking with staff, people living at the home as well as looking at records and observing staff in their work. It became apparent during the inspection that the home is not functioning well and people living, visiting and working at the home are being placed at risk of harm through inadequate adherence to health and safety practices. This home was registered in October 2006 and the first key inspection in January 2007 identified that the home had not taken into consideration the safety and welfare needs of the people for whom it is registered, this included locks fitted to fire doors at the top of a staircase, which because of how they were fitted would have restricted immediate access to the stairs in the event of an emergency. Window restrictors had not been fitted to windows to reduce the risk of them being opened wide and staff had not been provided with an induction programme. A visit to the home in March 2007 found that recruitment processes were not robust and people living at the home were being placed at significant risk of harm as a result of a lack of awareness regarding the safe fitting of bed rails. This is the third inspection of the home within six months and from the evidence available we conclude that this home is not providing a service which promotes positive outcomes for people, or that meets legal requirements and the National Minimum Standards. The provider needs to take urgent action to provide a home which is ‘fit for purpose’. What the service does well: People who were spoken with during the inspection spoke of how the staff are kind and helpful, comments included ‘I love it here’, staff are very good’, I’m more than happy here, staff always come quickly to help’ ‘the home is better than where I was before’. Observations of staff working showed that staff treated people with dignity and respect and a good rapport appeared to exist between care staff and people living at the home. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 6 Individual bedrooms and communal areas such as lounges are spacious, which ensures that there is plenty of room for wheelchair access and also provides people with a choice of places to relax. The food served during the inspection looked appetising and this was supported by many comments about the food confirming that ‘it is always good’, with choices offered at all meals. What has improved since the last inspection? What they could do better: The Management team at the home do not seem aware of how to make improvements to the service or how to prioritise areas for improvement. This gives us cause for concern as it is expected that the manager and provider can initiate improvements without the need for guidance from CSCI or other agencies. The most significant and potentially serious shortfalls identified at this inspection were regarding fire safety in that fire exits doors on the ground floor were found to require the use of keys to open, the doors were locked and the keys were missing. This meant that in the event of fire, people would have been unable to get out of the building through these exits. Padlocks in place on two side access gates, stairwells used as storage areas, a lack of training in fire safety and a risk of residents from the dementia unit accessing stairs unsupervised, resulted in the issuing of an immediate requirement. This required the manager to take immediate action to provide adequate staffing to ensure the safety of people living in the dementia unit and take steps to make sure that people can exit the home in case of emergency. We requested an urgent visit from the fire officer who visited the day after the inspection and confirmed concerns about the safety of the building and lack of appropriate training for all staff. During a tour of the home a cupboard housing a hot water cylinder could be easily opened, a random check on hot water outlets found that some exceeded the recommended 43°C and yet hot water was not available from other outlets. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 7 Some toilets were missing seats and the bed rails fitted to a bed were not high enough to reduce the risk of the person falling out of bed. The home has not developed quality monitoring systems to seek the views of people living at the home, their representatives and other stakeholders. An annual quality assessment document sent to the home by CSCI some weeks before the inspection and which the home is required to complete had not been returned to CSCI. Staff have not received induction or training considered essential for meeting the needs of people living at the home. Recruitment processes are poor, which means that the home is failing to safeguard the people living at the home and a reduction in staffing levels means that only basic care needs can be met. Care staff spoke of how staffing levels are restricting them from increasing the range of activities provided and enhancing the lives of people living at the home and in particular those people living on the dementia care unit. One person living on this unit commented ‘all I do is sit here’, staff confirmed how the issue of insufficient activities has been raised at staff meetings, but spoke of their frustration that ‘nothing appears to be done’. The manager confirmed that people are visited and assessed prior to admission to the home, however documentation to confirm these assessments could not be found for two people whose care was examined in detail. Observation of care files shows that the care planning and risk assessment process does not give reassurances that staff are competent at assessing and implementing care based on a risk assessment framework. Although care plans for some individuals are good, this is not consistent and means that people are at risk at not receiving adequate care to meet their needs. At the end of the inspection the manager was provided with feedback and informed that the failings identified at this inspection are considered serious and require urgent action. 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. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 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 Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not applicable to this home Quality in this outcome area is poor. The information provided to people about the home is insufficient and would not enable people to make a considered choice about the service. The admission process does not always show how the home assesses and consults with people to ensure that it is able to meet their individual needs, this could result in the admission of people whose needs cannot be met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s service user guide is in the form of a brochure, which provides an overview of the service. There is little information about the dementia care Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 10 unit and how it operates or how it is equipped to deal with this particular client group. The information is not available in any alternative formats which would enable people with particular disabilities to access the information e.g. in languages other than English, in large print or on tape. The brochure states that residents’ and relatives’ meetings take place, which is not the case. Although the latest inspection report was available in the home, it, or a summary, is not provided to people along with the brochure at the point when choices and decisions may be made. The statement of purpose provided by the manager comprised of information from other care homes and therefore was not an accurate description of the home or services offered. The manager stated that the home would be able to cater for people from a variety of racial and cultural backgrounds, based on her previous experience. However, there was no evidence that the service can cater – for instance in providing information, care, diets or activities - for people from a range of ethnic or cultural groups. Observation of three people’s care files found that only one file contained a detailed assessment of the person’s needs, which had been completed at the time of their admission to the home using information provided by the person and their relatives. The assessment documentation in the other two files seen had not been completed. Although the manager confirmed that people are visited by the home prior to admission for the purpose of undertaking an assessment of their needs, a lack of robust recording means that the home is unable to show how it consults with people either before or on admission to the home. A ‘terms and conditions of residency’ form was found in all three care files, a section for inclusion of the fees charged by the home had not been completed, one form had not been signed and another form had been signed by the person living at the home, who as a result of their illness may not have understood the implications of signing such a document. Fallings Park Lodge DS0000068603.V337903.R01.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 on balance adequate. The care planning and risk assessment process does not give reassurances that staff are competent at assessing and implementing care based on a risk assessment framework. Although care plans for some individuals are good, this is not consistent and means that people are at risk at not receiving adequate care to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In March 2007 a random inspection was carried out by CSCI to look at how the home was caring for people with an increased risk of skin breakdown, the inspection was triggered following concerns raised via the local safeguarding adults procedure that the home was not providing adequate pressure area care. At the time of the inspection in March 2007 the home had purchased pressure-relieving equipment such as mattresses and documentation showed Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 12 that people were being routinely assessed for their risk of skin breakdown, with the deputy manager taking responsibility for completing care documentation. At this inspection the care file for an individual admitted to the home fairly recently shows that home has not yet assessed or planned for this person’s care needs. This is particularly concerning as it became apparent during a discussion with the manager that this person requires the assistance of district nurses in the management of pressure sores. The home had not implemented the use of a skin assessment tool or devised a care plan to provide information to staff on how to care for this person’s skin. Other risk assessments had not been completed, despite a written entry in the home’s daily notes, which detailed that the person, who has dementia and lives on the second floor, had been found by staff in someone else’s bedroom on the first floor. Looking at the care notes for another person living at the home showed that this person had recently been found on a staircase after leaving the dementia unit and on another occasion had wandered out of the home. Other examples of poor risk management were seen during the inspection, such as the availability of denture cleaning tablets in the room of a person with dementia and documentation which described how a person had mistakenly sprayed deodorant on their face - with no evidence to show how the home had reduced the risk of this happening again. Incidents such as those described above and described throughout the report provide examples of how the home and staff group are not sufficiently skilled or equipped with the knowledge to care for people with dementia and other related conditions. The deputy manager confirmed that all staff who administer medication have completed a ‘Safe Handling of Medication’ course as well as further training from the supplying pharmacist following a change in the type of system used for medication administration. Observation of a selection of Medication Administration Record (MAR) sheets found these to be completed accurately, with all staff signing to confirm administration. The deputy manager confirmed that photographs, usually attached to MAR charts had recently been removed during a change in medication systems and the manager was advised that systems to assist with identifying people living at the home need to be reintroduced promptly. Records showing that the manager monitors a daily minimum and maximum temperature of the drugs fridge required clarification from the manager as one temperature consistently exceeded the maximum limit of 8°C –the manager was unable to provide explanation to clarify why this excessive temperature was recorded on a daily basis, with no recorded action taken to address this apparent deficit. The temperature of the rooms used to store medication is not currently monitored and the manager was advised to start monitoring the temperature of these rooms to ensure they are maintained below 25 °C. During a tour of the home a cream prescribed for a named person was found in the room of another individual and a prescribed cream for someone no longer Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 13 living at the home was found in a bathroom – both creams were given to the manager for disposal. People who were spoken with during the inspection spoke of how the staff are kind and helpful, comments included ‘I love it here’, staff are very good’, I’m more than happy here, staff always come quickly to help’ ‘the home is better than where I was before’. Staff were seen treating people with dignity and respect and a good rapport appeared to exist between care staff and people living at the home. Fallings Park Lodge DS0000068603.V337903.R01.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, 14 and 15 Quality in this outcome area is adequate. The home needs to increase the level of activities offered to ensure that the home meets the social/recreational needs of all people living at the home. The meals at the home are good with choices offered at each meal to ensure that people’s preferences are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has started to record activities and social events attended by people living at the home and observations of these records show that the home only offers a limited range of activities. The only structure to these activities appears to be a monthly visit by musical entertainers and an ‘exercise to music’ class weekly. Each visit to the dementia unit during the inspection found people seated in the lounge with little in the way of stimulation apart from the television. One person who lives on this unit was very specific in her views of her daily life at the home stating Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 15 ‘all I do is sit here, I would love to do some baking and get outside more-I love the fresh air’. A visitor to the home also spoke of how people are ‘sitting all the time’. However another person spoke of how she liked to sit and watch television and just ‘enjoyed being with other people’. People who require less help from staff to assist with their care spoke of how they enjoy ‘board games’ but all commented that they would like to ‘get out more’. Two members of staff spoke of how they would like to provide more activities for people but reductions in staffing levels have resulted in less opportunities to spend ‘quality time’ with people. Observation of minutes for a recent staff meeting shows that the issue of insufficient activities has been raised by staff, but a discussion with the manager indicated that insufficient resources are available to enable staff to provide these in their day to day work with people living at the home. A lack of staff training in the care of people with dementia and other conditions generally associated with older people also means that staff are not equipped with the skills to develop this area. Two of the care records checked showed that people’s likes and dislikes had been asked at the time of admission to the home, however for another person there was no record of staff establishing these. Copies of minutes for a staff meeting held earlier in the year suggested that individual preferences were not being adhered to, so it is pleasing to note that discussions with people living at the home at this inspection confirms that staff are trying to be flexible within the confines of the current staffing arrangements. People living at the home commented that the meals provided by the home are good, with a wide variety of choice. A member of staff was seen assisting people to order from the menu for that day and alternatives to the menu were routinely offered. The main home kitchen was observed briefly and food from the lunchtime meal was seen labelled for refrigeration, although the manager was unable to confirm the maximum time that food could be stored in this way. After the inspection CSCI made contact with the local environmental health department to request a visit to enable processes such as food preparation and storage to be looked at in more detail. It appears from our contact with environmental health that the home has not registered as a food premises. Fallings Park Lodge DS0000068603.V337903.R01.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): 16 and 18 Quality in this outcome area is poor. The home has a complaints procedure but this is not being followed, so that people cannot be reassured that concerns raised are dealt with effectively. Records are not being maintained, so there is no record of investigations or satisfactory outcomes reached for people living at the home. There are no systems in place to enable abuse to be recognised, reported and dealt with appropriately. People accommodated within the home are not being adequately safeguarded from abuse This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a basic complaints procedure but records of complaints, their investigation and follow up are not being kept. It is evident from a number of other sources – staff meeting minutes, personnel files, individual resident records – that concerns, complaints and possible allegations were being raised but no indication that these have been dealt with appropriately. The manager stated that all complaints were directed to one of the directors of the company through a letterbox in the home’s hallway but that this system had caused significant delay in dealing with an issue. One person’s family said that they Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 17 had raised a complaint and that it had eventually been addressed to their satisfaction. Although the manager stated that she had undertaken training relating to dealing with abuse, actions taken earlier this year in relation to an allegation and the response to concerns raised within the service did not comply with safeguarding procedures. Staff have not been provided with training relating to abuse awareness or reporting procedures and the home’s policy document does not provide them with adequate guidance. Staff have not been provided with training for dealing with people who show verbal or physical aggression and/or use of physical interventions. Shortfalls highlighted in other areas of this report – failure to manage risk appropriately, lack of compliance with fire safety procedures, poor recruitment procedures, lack of induction, training and supervision of staff – mean that people accommodated within the home are not being adequately safeguarded from abuse, and there are no systems in place to enable abuse to be recognised, reported and dealt with appropriately. Fallings Park Lodge DS0000068603.V337903.R01.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 and 26 Quality in this outcome area is poor. The home is failing to provide an environment that is safe and well maintained and this is putting people living at the home at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers spacious individual bedrooms, all of which have an en-suite facility and communal lounges provide people with a range of places to relax. Observation of a selection of individual bedrooms found them decorated to a good standard, with photographs and pictures providing personal touches. Corridors in the home although nicely decorated, may benefit from the use of pictures to create a more ‘homely feel’. Lockable storage cabinets provide a Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 19 place for people to keep items private and safe. Since the last inspection the home has fitted mechanisms to windows to reduce the risk of them being opened wide. All the people who were spoken with were pleased with their accommodation. During a tour of the home it became apparent that the home is failing to ensure that all parts of the home to which people have access are safe, clean and well-maintained. Of particular concern are serious deficits regarding fire safety and further information on these failings is included in the Management and Administration section of this report. Observations of bathrooms and toilets identified that not all the toilets had toilet seats, there was no hot water available in two of the bathrooms checked and yet the hot water temperature checked at three other outlets measured at 48°C - the maximum recommended temperature is 43°C. The carpet in the dementia care unit was soiled in places, in other areas of the home the carpet created a potential trip hazard as did a metal strip secured to the floor in one of the shower rooms - the carpet directly outside of this room was discoloured and a relative commented on how chairs and carpets had become soiled so soon after opening. Since the last inspection a sink has been fitted in the laundry room although it was not clear whether this is used for the purpose of hand washing only. Staff were seen using protective clothing appropriately, however discussions with staff and manager provided confirmation that staff have not yet been provided with training in infection control. Observation of medication to treat an infectious illness was seen in one of the medication rooms, and a discussion with the deputy manager suggested that the home sought medical advice appropriately, but had failed to notify CSCI and the infection control team. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 20 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. The home has a poor recruitment procedure which is failing to safeguard the people living there. Staffing levels have been reduced with the consequence that only basic care needs can be met. Staff have not received appropriate induction or training and do not, as a group, have the necessary skills and knowledge to meet the needs of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently accommodates 33 people, 10 of whom are on the dementia unit. Staffing levels at the home, as illustrated by rosters and confirmed by the manager, are that five care staff are on duty between 7.30a.m. and 10p.m. and three care staff on at night. During the day Monday to Friday there is also a member of management on duty, plus support staff covering kitchen, laundry and domestic duties. The home has access to an “odd job man”, but this is irregular and means that sometimes faults do not get put right promptly. Staffing levels have recently been reduced from having Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 21 six carers on duty during the day, said by management to be due to the requirement to make reductions in the wages bill. Given the nature of the client group, the layout of the home and the current position that the dementia unit cannot be secured, it is considered that this level of staff is insufficient to meet the needs of the residents. The consequences are lack of activities and, in some cases, lack of individual supervision and attention for people who are particularly challenging or have particular needs e.g. to promote continence, or are unwell. The home’s management stated that all staff at the home either have a national vocational qualification at Level 2 (NVQ2), are undertaking it or about to be enrolled on it. However, without a training matrix this was not possible to confirm. The records in the home relating to staff recruitment did not demonstrate a robust approach to ensuring that people living at the home are safeguarded. Files were muddled and systems mixed, with some evidence relating to criminal record disclosures (CRBs) on individual files, some on a checklist and some in a folder which was not adequately secured. It appeared that some staff are working at the home without the necessary CRB, and it is clearly evident from comparison of staff start dates and dates of CRBs that people have started work without this information. Some staff files contained two references; approximately 50 had only one or no references on record. It was also evident that insufficient care had been taken to ensure that references were sought from the most appropriate or significant sources such as most recent employer, employment involving care provision, or the most senior person in that organisation. As an example, one member of staff who had just left a care agency had references sought from a next door neighbour and an employer who had not known her since 1999. The manager stated that an orientation type induction had been provided to staff, but there was no record of this. Staff spoken with confirmed that they had been ‘shown around the home’ at the time of starting employment but could not recall being provided with specific guidance or training, some staff spoke of how they had not received any training since starting at the home. Induction training to “Skills for Care” standards has not been provided and the manager appeared unclear about how this might be done, although she has obtained the standards. Basic training such as Fire Safety (April 2007), Moving and Handling (May and June 2007), Health and Safety (April and May 2007), Basic Food Hygiene (June 2007) has now been provided (although there is no overall matrix to demonstrate levels of attendance and/or further need) and training in Infection control and 1st Aid awareness is planned for the near future. Of particular significance is the lack of planning for training to enable staff to meet the needs of the people accommodated on the dementia care unit; to build awareness of abuse and how to deal with complaints and allegations; and to promote and provide appropriate activities. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 22 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, 32, 33, 34, 35, 36, 37 and 38. Quality in this outcome area is poor. The home is currently poorly managed with no systems to promote policies and good practice, no systems to measure its performance, and the views of people who use the service are neither sought or acted upon. There are inadequate systems in place to protect people living at the home from harm and poor fire safety measures are putting people at risk. This judgement has been made using available evidence including a visit to this service. Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager of the home, Yvonne Lavender, is both experienced and qualified to run a care home. However, the evidence throughout this inspection report demonstrates that the service is not being managed well or safely at the moment. There is no clear direction or leadership within the home, best practice and positive outcomes for people living there are not being promoted, and there are no systems in place to highlight shortfalls and address them such as through a quality assurance process. The views of residents and/or their representatives are not being sought through meetings or questionnaires and they have little influence on how the home is being run or developed. The manager stated that lack of time is the cause of shortfalls within the home. Requirements and recommendations made within previous CSCI reports have not been responded to and the annual quality assessment information requested by the commission to assist in assessing the home’s performance had not been returned by the deadline. Completion and return of this document is required by the regulations. The home is not being run in line with regulations and the service appears to pay little attention to legal requirements, which safeguard the people for whom it provides a service. Records relating to the management of small amounts of residents’ personal monies appeared satisfactory, although it would be prudent to introduce a practice of having two staff signatures for transactions for people who lack capacity or who are otherwise unable to sign. It is noted that the responsible individual recommended that this should be implemented during a visit to the home in March 2007. Some staff supervision has been done, although not to required frequency and not for all staff. The manager stated that she did not know how to provide supervision but had found a training DVD with which she is planning to equip herself and senior carers to undertake supervision sessions. Record keeping is not adequate as evidenced by the completion and maintenance of personnel records, gaps in service user records, and failure to maintain health and safety documentation. Health and safety practice is poor. Individual risk assessments are not being maintained or amended and there are no effective management plans when risks are identified. The accident book showed a number of falls for one particular resident at the home; his file contained a blank falls risk assessment and no management plan to minimise the reoccurrence of falls. It was identified at an inspection at the end of March 2007 that a set of bed rails was Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 24 fitted unsafely to a bed. The bed has been replaced but the bed rails fitted are not high enough to prevent the person falling out of bed as they have an air mattress on top of the normal mattress and the person remains at risk. Of most significant risk on the day of inspection was that the fire exit doors require the use of keys, the doors were locked and the keys were missing. In the event of a fire, people would not have been able to get out of the building through these exits. Padlocks were observed on two of the side access gates, which again could impact on escape in the event of fire or impede emergency services access. The stairwells are being used as storage areas, one of these areas contained wooden materials. The door to the cupboard/room with the hot water cylinder within has a sign on which says “Keep locked shut” but has a simple turn lock on the outside which is easily opened and thus poses a risk to residents. Service users on the dementia care unit on the second floor are being placed at risk of accessing the stairs as suitable locks have still not been fitted to the exit doors of this unit. One of these exit doors would not stay closed in the door recess and the manager reported that the self-closing device on this door is broken. One service user with dementia has been found outside the home in the street. Records relating to fire safety have lapsed, although the manager stated that checks have been undertaken but not recorded. A record of a weekly fire test/drill ceased on 20.3.07; weekly fire alarm tests ceased on 22.5.07; emergency lighting was checked monthly up to 2.4.07. An immediate requirement was made that the manager must provide adequate staffing to ensure the safety of the dementia unit and take steps to make sure that people can exit the home in case of emergency. We requested an urgent visit from the Fire Officer who visited the day after the site visit and confirmed concerns about the safety of the building and the lack of appropriate training for all staff. Checks on hot water temperatures throughout the home had been done monthly by the manager; these again had lapsed and there is no routine procedure for staff to check water temperatures on a regular basis to ensure people aren’t scalded. The manager was informed that during the inspection random checks of hot water from wash hand basins found the temperature in excess of the recommended 43°C and was not aware that in other areas hot water was not available. Fallings Park Lodge DS0000068603.V337903.R01.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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 1 1 Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 5 Requirement Timescale for action 01/08/07 2 OP3 14 3 OP7 15 4 OP8 13 (4)(a)(b) (c) The statement of purpose and service user guide should be reviewed and amended. This will ensure that people admitted to the home are provided with accurate and up to date information on the services offered by the home. People must be assessed and 20/07/07 consulted with prior to admission to the home. This is to ensure that the home is certain it can meet the person’s care needs. People living at the home must 20/07/07 have their care needs assessed and planned in the form of a care plan. This will provide information to staff on how the person’s care needs are to be met. The home must ensure that any 20/07/07 risks to the health, safety and well-being of people living at the home are identified, recorded and managed according the persons wishes and capabilities. This is to ensure that unnecessary risks to the health and safety of service users are DS0000068603.V337903.R01.S.doc Version 5.2 Fallings Park Lodge Page 27 5 OP9 13(2) 6 OP12 16(2)(m) identified and as far as possible eliminated. Medication must be stored in accordance with manufacturers’ instructions This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication People living at the home must be provided with a range of activities that meet individual needs and capabilities. This is to promote well-being and ensure that the social needs of people living at the home are met. (Previous timescale of 01/03/07-not achieved) 20/07/07 20/07/07 7 OP16 22 8 OP18 13(6) The home must ensure that a 20/07/07 record is kept of all complaints made, the detail of any investigation or action taken and provide a response to the complainant. This will reassure people that their concerns are dealt with effectively so as to reach a satisfactory outcome. Arrangements must be made to 20/08/07 ensure that all staff have a clear understanding of adult protection and whistleblowing procedures. This is to ensure that people living at the home are protected from harm or abuse. The registered person must ensure that replacement suitable locks are fitted to the doors to the stairs on the dementia care unit. This is to ensure that people who require assistance are not able to access staircases without direct supervision of staff. The registered person must consult with the local fire officer to ensure that the locks will DS0000068603.V337903.R01.S.doc 9 OP19 23 15/07/07 Fallings Park Lodge Version 5.2 Page 28 provide for an adequate means of escape in the event of fire. (Previous immediate requirement for locks to be removed or wired up to the fire alarm-timescale for action 18/01/07. On 29/03/07-Locks observed to be disabled, requirement made for the home to ensure that suitable locks are fitted without delay-timescale for action- 04/05/07. Assessed as not achieved on 20/06/07 10 OP19 23(5) 11 OP27 18(a) 12 OP29 19 Schedule 4 13 OP30 18(1) (c ) (i) The registered person must ensure that the home registers the service as a food premises. This is to ensure that people are protected by the home’s food hygiene processes and to comply with legislation. Staffing levels in all areas of the home and for all shifts must be reviewed to take account of peoples’ needs, dependency, layout of the home and because the home and dementia unit is not currently safe. This is to ensure people’s needs are met safely and promptly. Staff recruited by the home must have all required preemployment checks undertaken. This is to protect people from the employment of inappropriate staff. The registered person must ensure that an induction programme is introduced that meets the Skills for Care standards. This is to ensure that staff are trained and competent to do their jobs. (Previous timescale of 01/03/07 not achieved) 20/07/07 15/07/07 20/07/07 01/08/07 14 OP30 18(1) (c ) (i) Staff must be provided with training appropriate to the work they are required to perform. This will ensure that staff have the skills and knowledge to meet the needs of the people living at the home. DS0000068603.V337903.R01.S.doc 01/08/07 Fallings Park Lodge Version 5.2 Page 29 15 OP33 24 A system for evaluating the quality of the services provided at this home must be implemented, which actively seeks the views of people using the service, their representatives and other stakeholders. The results should then be used to improve the home’s performance based on the feedback from others. The registered person must ensure the all staff receive formal supervision at least six times a year and that records are kept. This will ensure that staff are competent to do their job and that this competency is maintained through a process of monitoring and reflecting on practice. (Previous timescale of 01/03/07 not achieved) 01/08/07 16 OP36 18(2)(a) 01/08/07 17 OP38 13(c) Bed rails must be assessed, fitted and maintained by a competent person in accordance with MHRA/HSE guidance. This is to protect the person from the risk of harm and promote their safety 15/07/07 (29/03/07-Immediate requirementassessed as not achieved on 20/06/07) 18 OP38 23 (4) The home must take immediate action to ensure that people living at the home are protected from the risk of harm in the event of fire. After consultation with the Fire Authority, adequate precautions must be taken against the risk of fire including making adequate arrangements for containing and extinguishing fires, for evacuation in the event of fire, for the maintenance of all fire equipment and for reviewing DS0000068603.V337903.R01.S.doc 15/07/07 Fallings Park Lodge Version 5.2 Page 30 fire precautions. (20/06/07-Immediate requirement issued for home to ensure that access/egress to/from the home is reviewed immediately and to ensure that sufficient staff are on duty to ensure health and safety of service users is maintained.) 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 OP2 Good Practice Recommendations The home’s ‘terms and conditions’ should include accurate information on the fees charged by the home, detail who is responsible for ensuring payment of these fees and be drawn up in consultation with the service user and his/her advocate. This will ensure that people are fully informed of the total fees payable and the arrangements in place for the payment of fees. Processes to enable identification of people living at the home must be implemented. This is to avoid the risk of medication being administered to the wrong person. The temperature of the rooms used to store medication should be monitored and recorded. This is to ensure that medication is stored at the correct temperature. It is recommended that a record is kept of minor concerns/complaints (Recommendation made on 29/03/07. Assessed as not achieved on 20/06/07). The registered person should consult with the local environmental health department to ensure that food is being stored at the correct temperature. All parts of the home, including bathrooms and toilets must be kept and in a good state of repair. This is to ensure that people are provided with a clean, homely and safe place to live and where their dignity is not compromised. . DS0000068603.V337903.R01.S.doc Version 5.2 Page 31 2 3 4 OP9 OP9 OP16 5 6 OP19 OP19 Fallings Park Lodge 7 8 OP26 OP27 9 OP29 Staff should be provided with training in infection control. This is to reduce the risk of infection and to ensure people are protected by the home’s infection control systems. It is recommended that staff files are audited. This is to ensure that all required pre-employment checks have been completed, to meet legislation and protect people living at the home. It is strongly advised that the manager obtains a copy of the CSCI Policy and Guidance document regarding CRB checks. (Recommendation made on 29/03/07. 20/06/07-No evidence to suggest that this guidance has been put in practice.) Records to show that staff have attended training should be fully completed. This is good practice to enable training needs to be identified. (16/01/07-recommendation made for training matrix to be implemented. 20/06/07-assessed as not achieved) To ensure staff are competent in the use of the use of the newly acquired pressure relieving mattresses training should be provided. (Recommendation made on 29/03/07. 20/06/07-no evidence to confirm that staff have received training). Care staff to receive training in dealing with challenging Behaviour (Recommendation made on 16/01/07 Assessed as not achieved on 20/06/07.) People living at the home and their representatives should be provided with regular opportunity to consult with the registered person about the services offered by the home. This should ensure that the home is run in the best interests of the people living there. (16/01/07-requirement made for residents meetings to be held. 20/06/07-assessed as not achieved) Hot water at all outlets accessible to service users should be monitored to ensure that the temperature is maintained at 43°C. This is to reduce the risk of scalds to people at the home. The action taken following incidents or accidents should be recorded (Recommendation made on 29/03/07. 20/06/07 assessed as not achieved). 10 OP30 11 OP30 12 OP30 13 OP33 14 OP38 15 OP38 Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Fallings Park Lodge DS0000068603.V337903.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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