Inspection on 28/06/07 for Fenland Lodge

This inspection was carried out on 28th June 2007.

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

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

Other inspections for this house

Fenland Lodge 07/01/10

Fenland Lodge 12/08/09

Fenland Lodge 11/02/09

Fenland Lodge 11/06/08

Fenland Lodge 28/11/07

Fenland Lodge 02/02/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR Lead Inspector Joanne Pawson Key Unannounced Inspection 28th June 2007 10:10 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 Fenland Lodge DS0000067620.V344648.R02.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. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fenland Lodge Address Soham Road Stuntney, Ely Cambridgeshire CB7 5TR 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) 01353 668971 01353 668971 European Care (Central) Limited Vacant Care Home 49 Category(ies) of Dementia - over 65 years of age (49), Old age, registration, with number not falling within any other category (49) of places Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2007 Brief Description of the Service: Fenland Lodge is registered to provide care to 49 elderly people (all of which may have dementia). European Care owns the home. The home is situated between Ely and Stuntney. There are 45 bedrooms for single occupancy and two shared rooms. All bedrooms have en-suite facilities. The weekly fees are £540. The inspection report is available in the front entrance area. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted by two regulation inspectors and one pharmacy inspector on the 28th June 2007 and two regulation inspectors on the 5th July 2007. Methods used for the inspection included speaking to the acting manager, staff and the people living in the home, observation of care, reading documentation and a tour of the home. A shorter inspection was carried out by two inspectors on the 20th March 2007. As a result of the inspection a notice was served to the European Care on the 29th March stating they had to ‘Make sure that care plans are prepared to provide guidance for staff in how to meet the health and welfare needs, including the changing health and welfare needs, of service users and kept under review and revised as required.’ Two inspectors visited the home on the 16th May 2007 to check if the notice had been complied with. Two care plans were inspected and were found to be inaccurate and did not reflect the current needs of the people whom they were for. A meeting was held with the dementia care specialist and the acting manager for Fenland Lodge to discuss the non-compliance. However during this inspection it was found that the notice had still not been complied with and important information was missing from the care plans which could place the health of the people living in the home at risk. The commission is taking legal advice on this matter. A letter of serious concern was also sent to the home on the 30th March informing them that a management review had been held by the Commission and that they are a poor service and must meet the requirements in our inspection reports. An acting manager has been appointed and commenced working at the home on the 14th May 2007. The acting manager stated that she would be making an application to the Commission to become the registered manager. What the service does well: The inspectors observed some of the staff working with the people that live in the home in a warm and caring manner. The activities coordinator was dancing with some residents to some music in the afternoon. One of the residents who wasn’t dancing seemed to be enjoying singing along to the music. The activities coordinator obviously knows the people living in the home well and told the inspector that she always tries to treat them with respect and dignity and the main criteria is that they have fun taking part in activities. A visitor of someone living in the home stated ‘ the meals are out of this world’. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 6 One member of staff was asked to help get a person living in the home to the dining room as he was refusing. The carer talked in a gentle and encouraging manner and the person walked through to the dining room. Another member of staff was seen talking to a person who lives in the home who was upset. The carer talked to her gently and gave her time to talk about what was worrying her. What has improved since the last inspection? What they could do better: People who are considering moving to the home must have their needs assessed to ensure that the home has the facilities and staff skills to meet their needs. The care plan must accurately reflect the needs of the people living in the home and give the staff the information they need to meet those needs. All residents are offered sufficient drinks and those residents who require support or assistance to drink must be provided with this. Procedures for the storage, recording and administration of medication must be improved to safeguard the health and well being of residents. The staff must offer choices in a way that are understood by the residents. For example showing them what the choice of food is rather than just asking them verbally. All parts of the care home are in a good state of repair internally and externally and must be kept clean. Resident’s bedrooms must be treated as their own personal space and must not be used as storage area for other people’s wheelchairs. There must be enough staff on shift to meet the needs of the people living there. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 7 Staff must not start working in the home until the POVA first check has been received. This will help to ensure the safety of the people living there. There must be a clear procedure for recording money held and spent on behalf of the people living in the home. Staff must receive regular supervision in order to carry out their role effectively. A copy of the hours worked must be kept to provide evidence that staffing levels are sufficient to meet the needs of the people living in the home. Risk assessments must be completed and reviewed for the people living in the home so that risks can be reduced where practicable. 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. Fenland Lodge DS0000067620.V344648.R02.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 Fenland Lodge DS0000067620.V344648.R02.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): 3,6 Quality in this outcome area is poor. Pre admission assessments do not have enough information about the person to ensure that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The pre admission assessment was inspected for one gentleman that had recently moved into the home. The pre-assessment form consists of 37 different areas that need to be completed so that the assessor can make a judgement as to whether the home can meet the needs of the prospective resident. However only 8 of the 37 areas had been completed. The acting manager stated that she had informed the person completing the assessment that all areas of the form must be completed. The pre assessment form was not signed or dated by the person who had started to complete it. A resident dependency assessment was partly filled out for the same resident. Again the form had not been fully completed and no score was given at the Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 10 end of the form so that the staff were aware of the residents level of dependency. The name and date of the person completing the assessment had not been completed. The falls risk assessment for the same resident had not been completed. The pre assessment for another person living in the home was also inspected and although it had been completed the details were very brief. For example in the personal care section the only comment made was ‘very bright, very chatty will need assistance from one carer, like to have hair done, very proud of hair’. There was no information about what the person could do for herself or exactly what the staff would need to do. Standard 6 is not applicable as intermediate care is not provided. Fenland Lodge DS0000067620.V344648.R02.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): 7,8,9,10 Quality in this outcome area is poor. The health care needs of the people living in the home are not fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the people who had recently moved into the home had a very poor pre admission assessment. This was also reflected in the care plan which did not contain enough information about him so that the staff could meet his needs. The person was observed throughout the inspection and obviously had a high level of anxiety about being in the home and when he would be leaving the home. He was given four different answers by different members of staff about when he was due to return to his home. The persons care plan stated that staff should not ignore him when he is asking repetitive questions although this was seen to happen on three occasions. The care plan for one person stated ‘one carer to assist with dressing/ undressing and he will choose his own clothing’. This is insufficient information Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 12 for the staff. The care plan should tell the staff exactly what the person can do for himself and what he needs assistance with. One person living in the home had been prescribed lorazepam ‘in the morning when required’. The medication is normally given when someone is very agitated to try and help to calm them. However there was no care plan telling the staff when the medication should be given. The medication administration sheets from the 5th June to the 28th June 2007 showed that the person had been given the medication every morning. The daily statements of well being for the 5th June to 28th June 2007 had no recording of any agitation or reason given why the medication had been given. There must be a care plan put in place informing staff when they should offer the people living in the home medication that has been prescribed on a discretionary basis. This will help to ensure that the people living in the home are not given medication unless necessary. One senior member of staff stated that they only give the medication if the person is wandering round asking to go home but if she is happy then they don’t give it. However this was not reflected in the daily statement of well being and medication sheets. The care plan for one person living in the home stated ‘ to chat to them so she is aware people are around’ however the inspector observed no one talking to the person for at least an hour. During a random unannounced inspection of Fenland Lodge, on the 20 March 2007 a requirement was made ‘Ensure that where needed service users are helped to prevent pressure sores and maintain their fluid levels. This includes the accurate completion of fluid and turning charts.’ Timescale for action to be taken to meet this requirement was 1 May 2007. During the inspection on the 5 July 2007 a service user stated to an inspector that he needed the staff to assist him with drinks as he is blind and has a bad hand tremor. He stated that he would like to be helped by the staff to have a drink every 30 minutes during the day. He also stated that he usually went for long periods in the afternoon when no staff would come to assist him with a drink and that he had complained to carers about this. The care plan for the gentleman stated ‘fluid intake has been poor, not helped by his blindness and offer a variety of drinks and record fluid intake daily’. However when his fluid intake charts for a period from the 21 June 2007 until the 26 June 2007 were inspected they showed that he went from 14.30hrs until 17.00hrs without being offered fluids on at least 5 occasions and from 14.30 until 17.00 on one occasion. A visiting health care professional recorded in the daily statement of wellbeing for the same person on the 21 June 2007 at 14.30hrs that there had been blood in his urine and ‘carers to encourage fluid’. However he had 250mls of tea at 17.00 hrs on the 21 June 2007 and then no other drink is recorded until 20.30 hrs. The same person had been prescribed antibiotics for an eye infection. When the inspector asked one member of staff about how often they bathed his eyes she stated that she done it daily and that she knew she had to do this as she Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 13 had spoken to his GP about it. However there was no care plan stating that this had to be done. The person living in the home stated that he wasn’t supported to bathe his eyes everyday. During the inspection on the 5 July 2007 the care plan for another person living in the home was inspected. The care plan stated ‘offer fluids hourly when awake’. However the fluid intake charts for the same person dated 29 June 2007 showed that she went from 11.30hrs until 14.30hrs (3 hours) and 18.00 until 01.00 hrs (7 hours) with no recording of a drink being offered. The fluid intake charts for the same person dated 30 June 2007 showed that no recording of a drink being offered was made from 6.00 hrs until 10.00hrs (4 hours) and only every two hours between 14.30hrs and 20.30hrs. The fluid intake chart for the same person showed that on the 4 July 2007 there was no record of a drink being offered between the hours of 18.15 and 22.00 (3hr 45 minutes). Practice and procedures for the safe handling, administration and recording of medicines were examined by a specialist pharmacist inspector. Policies and procedures for the safe use and recording of medicines are adequate but need updating for use in the home since they refer to practices to be done by registered nurses and so are not applicable in this home. There is evidence that staff do not follow theses procedures. Facilities provided for the storage of medicines is adequate but the temperature of the room, which was at the maximum recommended temperature at the time of the inspection, is not monitored or recorded. It is important that medicines are stored under appropriate environmental conditions since failure to store medicines at the proper temperature could result in residents receiving a treatment that is ineffective. Most medication was stored securely for the protection of the residents. Medication cupboards and trolleys were clean and orderly with the keys being held by the care staff. The fridge used to store medicines was not locked; despite this being a requirement of the homes own policy. The cabinet used to store controlled drugs would comply with the Misuse of Drugs Regulations if it were fixed to a solid wall properly. There were some medicines still in stock that were no longer prescribed for residents and were not listed on their medication record. A medicine was found in one resident’s room that wasn’t prescribed for him and it carried another resident’s name. A tube of cream was found in the medicines trolley without a label on it so there was no indication of who it was for or how it was to be used. Clear records were kept of the date and quantity of medicines coming into the home. Records were kept of when medicines were given to residents. However there were some problems with these records. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 14 • • • • • • • • • • There was no record of some medicines being given to the residents when they were due, as the entries on the charts had been left blank. This means that it is not possible to tell whether residents got their medicines on these occasions. If medicines were not given to residents the reason why was not always being clearly recorded. The use of creams and ointments was not being always being recorded so it was not possible to tell whether people were receiving these treatments. In some cases, creams and ointments had been recorded as being used twice. Medication prescribed to be taken regularly was being given on a discretionary basis. Medication prescribed to be given “when required” was recorded as being given regularly every day and there was no guidance for staff on what these medicines were required for. Where residents regularly refuse to take their medicines, this was not reported to the GP. Creams and ointments prescribed “as directed” without any clarification of what this direction means or where the cream might need to be used. When medicines are prescribed in a varying dose e.g. one or two tablets, the record of when they were given didn’t show how many were given. The number of signatures on the medication record form didn’t correspond to the number of tablets taken from the container in use at the time. So the record might have been signed to show that medication had been given when it had not. Hand-written medication record chart did not clearly indicate the date that medication was given. One carer was watched giving medicines to some residents during lunchtime. She was seen to give medication to people with respect and in a way that reflected their choice, and to handle the medication safely. Staff who give out medicines to residents have received some basic training in the safe use and handling of medicines but given the problems with medication handling and recording stated above, there is a need for more in-depth training and an assessment that people who do administer medicines to residents are competent to do so safely. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. The people living in the home have a choice of activities that they can take part in This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an activities coordinator who offers a variety of activities to the people living in the home. In the mornings she does gives out newspapers and has a chat with the people living in the home about the newspapers and updates the boards with the day and date and menu for the day. She then takes the tea trolley round and assists anyone with their drinks who needs support. She also helps the people living in the home at mealtimes. There is usually an activity in the afternoon. At present the carers do not join in with the activities but it is the vision of the acting manager and activities coordinator that in future the carers will be involved in activities. Activities offered include ball games, hand massage, drawing, painting, puzzles, Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 16 crosswords, board games, crafts, bingo, song and dance, gardening, fresh flower arranging, knitting and sowing and one to one sessions. The activities coordinator said that the home would benefit from an activities room where the people living in the home can leave a work in progress such as a painting and go back to it at a later time. At present the majority of the activities are held in the lounge or dining rooms and have to be cleared away for mealtimes and overnight. The kitchen staff used to ask the people living in the home what they would like for lunch from the available choices. The programme leader for the development of the dementia services had ordered hot trolleys so that the people living in the home could make a choice at mealtimes by looking at the food when it was served up to avoid confusion. However on the 28th June 2007 the staff were seen asking the people who live in the home what they would like rather than showing them what the choices were. Although the hot trolley was in the dining room this could still cause confusion for people with dementia as they might not understand the choice being offered. It was also observed on two occasions were the people living in the home were not asked what they would like but there food was just served up and given to them. The acting manager has changed the procedure around mealtimes to try to ensure that there are enough staff to support those people that need help with eating. A visitor to the home stated that he has a meal with his relative once a week and that the food is ‘out of this world’. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 17 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 good. Staff are aware of the complaint procedure and follow it when necessary. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken to were aware of the procedure to follow if anyone living in the home wanted to make a complaint. The complaints procedure is on display throughout the home. One carer spoken to stated that she had passed a complaint on to the manager and recorded it in the complaints log. A relative of one of the people living in the home stated that they had made a complaint that there relative had not been dressed for four weeks when he visited. The complaint was dealt with and the relative had been dressed when he visited after making the complaint. Staff spoken to on the day of the inspection were aware of what to do if they thought anyone living in the home had suffered any abuse. Fenland Lodge DS0000067620.V344648.R02.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): 19,20,21,23,25,26 Quality in this outcome area is poor. Various areas of the home and furnishings were found to be in a poor state of repair and dirty which compromises residents dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has devised a maintenance schedule so that all of the domestic and maintenance staff are aware of their responsibilities. A requirement was made as a result of the inspection on the 2nd February and the inspection on the 20th March 2007 that all parts of the care home must be in a good state of repair and be kept clean and reasonable decorated. During this inspection there was evidence that the requirement had not been met. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 19 The flooring in the kitchen was in need of repair in several areas. There were areas where the kitchen floor was unclean. There were lots of areas in the kitchen that were unclean such as cupboards, extractor fan and the tiles. The dishwasher was dirty on the sides of the door. The covers of a number of chairs and sofas throughout the home were stained and torn. The acting manager stated on the first day of the inspection (28th June) that that she had been told the cover for one of the stained and faded sofas was in the wash. There was also a slipper under one of the sofa cushions. However on the second day of the inspection (5 July) the same stained and faded cover was still on the sofa (the slipper had been removed). The footplate on one hoist was very dirty. There was brown matter that looked like human faeces on a wall in a service users bedroom, and on a windowsill in a hallway. There were several badly stained toilets. There were drinks stains down a wall in one corridor. One of the people living in the home has a bedroom with a door that opens directly into the dining room next to Sidney’s lounge. The bedroom had been used for storage of other people’s wheelchairs and a hoist during the day. There were four wheelchairs, a large hoist and two footplates in the bedroom at the time of the inspection. Bedrooms should be respected as personal space and should not be used for storage of other people’s wheelchairs or the hoist. On the 28th June in one of the double rooms there was only items belonging to one person living in the home even though there were two names on the door. The acting manager explained that the other person had been moved to another room and the name would be taken down to avoid confusion. However on the second day of the inspection the second name was still on the door. In many of the rooms the furniture had labels on it to show which clothes went where. The acting manager confirmed that this gave the bedrooms an institutional appearance and was not for the benefit of the people living there but for the staff. The acting manager stated that the labels would be removed. In one of the bedrooms the windowsill had been stained but the stain was also on the net curtains. The carpet in one bedroom was very dirty and in need of cleaning or replacing. Several of the bedroom doors did not close properly when released this could pose a fire risk. On the 28th June 2007 the fire extinguisher was not on its hook in one of the corridors but was beside the sofa. In the case of a fire the staff would not have Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 20 known where to find it. The fire extinguisher had been replaced on the hook on the 5 July 2007. There were several areas of damp in service users bedrooms, the paint and plaster were peeling away from the wall. The doorguards have damaged the carpets in some of the bedrooms. The acting manager stated that she was aware of this. One ensuite had a strong unpleasant smell that remained even after the cleaner had been in. The area around the toilet was not sealed so it was possible that the smell was coming from under the flooring. A toilet in one of the bedrooms was blocked. The acting manager stated that there was an ongoing problem with the septic tank as it was not big enough and had to be emptied at least weekly. The acting manager arranged for the tank to be emptied as soon as she knew there was a problem. The septic tank was emptied during the inspection and caused a very strong unpleasant smell throughout the home. The acting manager had organised for a larger septic tank to be fitted. There is a courtyard area off Sidney’s lounge which people living in the home where using on the day of the inspection. The paving slabs are uneven and could pose a health and safety risk. Large weeds were growing in the courtyard area. Staff were seen on both days of the inspection smoking in the courtyard. The windows leading onto the courtyard were open and the smoke could be smelt in the corridors for quite a distance. The pictures throughout the corridors had been put at a low level so that people walking through could see them. Several of the corridors had been painted. The people whose bedroom was on the corridor were asked what colour they would like it to be painted. Each corridor is being given a theme with pictures and items to reflect each theme to help people living in the home to orientate themselves. The home plans to have a sensory garden in one of the courtyard areas. A visitor to the home stated that the laundry was a good service but that his relative did not always have her own clothes on. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Staff have the necessary training to meet the needs of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff files of three members of staff were inspected. The file for one member of staff showed that he had commenced work at the home on the 5th June 2007. However his criminal records bureau check was not requested until the 7th June 2007. The POVA first check was not received by the home until the 15th June. It is the homes policy to request three references two of which were received before he commenced work but the third reference was not received by the home until the 11th June 2007. The application form included information in two different styles of handwriting and it was not signed or dated. The acting manager stated that she had not been aware that the recruitment checks had to be completed before the member of staff commences work. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 22 The recruitment record for one member of staff showed that the reason for gaps in employment had been investigated and recorded. The staff files showed that staff had received training in basic food hygiene, COSHH, basic health and safety, protection of vulnerable adults, fire, moving and handling and the Alzheimer’s society yesterday, today and tomorrow course. One member of staff said that she was more aware of the needs of people with dementia and that she could read there body language better since completing the yesterday, today and tomorrow training. All staff who have not completed an NVQ in care are currently working towards one. A European Care induction booklet was seen for one member of staff but it had only been partly completed. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an acting manager in position who will be applying to the commission to become the registered manager. She has many years managerial experience in the care field. The care plan for one person living in the home contained forms for a pressure sore risk assessment and a falls risk assessment neither of them had been completed. The falls risk assessment for one person living in the home had been completed and the score indicated that she was at high risk of falling. However Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 24 the care plan for the same person stated that she was ‘chair bound’ and could only be helped to move with the assistance of staff. The home keeps small amounts of money for some of the people living there. During the first day of the inspection the records and money held were checked for three of the people living in the home. One person’s balance stated that there should have been £35 but there was only £25. On the second day of the inspection the systems for recording the money had started to be improved. The staff supervision records show that no staff have received any formal supervision since March 2007. The deputy manager said she had not had a formal supervision for so long she couldn’t remember when the last one was. The records for the testing of the fire alarms were inspected. The records showed that the alarms had only been tested twice in February and April. The fire alarms should be tested weekly. The rota must accurately reflect the hours that have been worked so that there is evidence of how many staff were available to support the people living in the home. The rota for the 25th June showed that there were only two members of staff on shift between 18.00hrs and 20.00hrs to care for 33 people. The deputy manager stated that there had been three people on shift but the rota had not been updated to show this. The home has recently sent out a customer satisfaction survey. When the surveys have been returned a report will be put together stating what the strengths and weaknesses are of the home and highlighting any action that needs to be taken. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 X 1 X 1 1 STAFFING Standard No Score 27 2 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 1 2 1 Fenland Lodge DS0000067620.V344648.R02.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 OP3 Regulation 14(1)(a) Requirement Before a service user moves into the home there must be an assessment to ensure the home can meet their needs. Make sure that care plans are prepared to provide guidance for staff in how to meet the health and welfare needs, including the changing health and welfare needs, of service users and kept under review and revised as required. This was a requirement from a previous inspection. Make sure that all service users are offered sufficient drinks, and those service users who require support or assistance to drink are provided with this. This was a requirement from a previous inspection. Medication must only be given to service users as prescribed and only to the person it is prescribed for. This is to ensure they receive the correct treatment. Medication must be stored DS0000067620.V344648.R02.S.doc Timescale for action 31/07/07 2 OP7 15 20/08/07 3. OP8 12(1)(a) 31/07/07 4. OP9 12(1) 03/08/07 5. OP9 13(2) 03/08/07 Version 5.2 Page 27 Fenland Lodge properly, not kept beyond its prescribed use and records of medication administered (or not administered) must be accurate and complete. This is to ensure service users receive the correct medication and that it is effective. This is a repeat requirement. Previous timescale of 02/02/07 not met. 6. OP9 13(6) 18(1) All staff authorised to administer medicines must be suitably trained and assessed as competent to do so. This will ensure service users are protected from harm. There must be a record of all medicines kept in the home for service users and an accurate record of the date it was administered to service users. This will ensure that medication is given correctly. The staff must encourage service users to make choices such as what they would like to eat. Make sure all parts of the care home must be in a good state of repair internally and externally. Make sure that all parts of the home are clean. This was a requirement from the previous inspection. Service users bedrooms should be respected as their private space and not be used for the storage of other people’s wheelchairs and the hoist. A carer must not work until the POVA First has been received. They must be supervised until the full CRB has been received. DS0000067620.V344648.R02.S.doc 31/08/07 7. OP9 17(1)(a) 03/08/07 8. 9. OP14 OP19 12(3) 23(2)(b)( d) 03/08/07 31/08/07 10. OP24 12(4)(a) 03/08/07 11. OP29 19(1)(b)(i ) 03/08/07 Fenland Lodge Version 5.2 Page 28 12. 13. 14. OP35 OP36 OP37 17(2), Sch 4(9) 18(2) 17(2) Schedule 4 Accurate records of service users monies must be maintained. Arrangements must be made to ensure that staff receive regular supervision. A copy of the duty roster of persons working at the home and a record of whether the roster was actually worked must be kept. This was a requirement from the previous inspection. Unnecessary risks to the health and safety of service users must be identified and so far as possible eliminated. Risk assessments must be reviewed regularly and updated when necessary. This was a requirement from the previous inspection. 03/08/07 03/08/07 03/08/07 15. OP38 13(4)(c) 03/08/07 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 OP9 Good Practice Recommendations The record of the receipt and disposal of controlled drugs should clearly indicate the name and address of the supplier or the recipient on disposal. Fenland Lodge DS0000067620.V344648.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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