Inspection on 21/05/07 for Forest Lodge Care Home

This inspection was carried out on 21st May 2007.

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

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

Other inspections for this house

Forest Lodge Care Home 21/05/08

Forest Lodge Care Home 12/12/07

Forest Lodge Care Home 02/05/06

Forest Lodge Care Home 28/11/05

Forest Lodge Care Home 28/07/05

Forest Lodge Care Home 10/01/05

Forest Lodge Care Home 30/07/04

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

CARE HOMES FOR OLDER PEOPLE Forest Lodge Care Home 20 Forest Road East Nottingham NG1 4HH Lead Inspector Linda Hirst Unannounced Inspection 21st May 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 Forest Lodge Care Home DS0000002198.V341405.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. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Lodge Care Home Address 20 Forest Road East Nottingham NG1 4HH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 978 0617 0115 942 2582 Mr Riaz Khan Mr Riaz Khan Care Home 28 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia - over 65 years of age (6), Old age, of places not falling within any other category (28) Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mr Riaz Khan is registered to provide personal care and accommodation for service users of both sexes whose primary needs fall within the following categories: - Old age, not falling in any other category (OP) up to 28 Dementia, over 65 years (DE(E)) up to 6. Within the maximum number of 28 service users Mr Khan may continue care of the following: one service user aged 55 years of age with Alcohol Dependency as identified in an application dated 22/8/03 and one service user aged 61 years as identified in an application dated 19/3/05 2nd May 2006 2. Date of last inspection Brief Description of the Service: Forest Lodge provides care for a maximum of 28 people. The service is registered to accept older people and up to six people who have Dementia. There are also two people whose needs are outside of the registration category who are also accommodated. The home is a large, detached house within one mile of the city centre and close to the tram route. It overlooks the Forest recreation ground and is also close to the Arboretum Park. The accommodation is arranged over two floors and includes some bedrooms with en-suite toilets. There is a vertical lift and a chair lift to provide access to the first floor. There are two lounges, a dining room and a conservatory offering a choice of communal space. There is an external patio area and ample car parking. A sloped entrance provides access for wheelchair users. Staff are multi-lingual and current service users are from various cultural backgrounds. The manager is only giving out brochures to potential residents at the moment, not a copy of the service user guide which includes the last report summary. The last two give residents more information they can use to make informed decisions about placements. The deputy manager said the latest inspection report is displayed on the notice board in reception for about three months so that residents and relatives can read about the inspection findings. It was not on display during this inspection. The cost of the service is currently between £298.21 and £323.36 per week. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 5 This fee does not include hairdressing, chiropody, toiletries, magazines, external transport or holidays. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 9.5 daytime hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Several people living at the home speak languages other than English and three people were “case tracked” to check that staff understood and provided for their cultural, religious and communication needs. Some people living at this home have a limited ability to understand and communicate. Therefore some judgements in this report are from observation of staff and resident interactions Two members of staff and two sets of relatives/visitors were spoken to as part of this inspection. Documents were read and medication was inspected to form an opinion about the quality and safety of the service provided to residents. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. 28 resident questionnaires were sent out before this inspection and 28 were sent for relatives to complete to give their views about the service provided at the home. Seven residents (four of whom were assisted to respond by staff members) returned questionnaires and four relatives completed a survey, their views have been added in to this report. Comments received included, “both residents and staff are multi racial and appear to get on together in real harmony,” and “If she (mother) were considerably younger and possessed her faculties I might wish that a bit more stimulating activity were provided.” People indicated that they got the care they needed and all said the staff listen and act on what residents want. There was however some confusion about who to speak to if they were unhappy and one did not know how to make a complaint. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The manager could make sure that all residents and their relatives have an up to date copy of the service user guide and a summary of the last report to Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 8 make sure that they have current information about the care home. This could also be given to prospective residents/relatives to help them make informed choices about care services. The manager could do more detailed initial assessments before agreeing to admit people to the home so he is sure their needs can be met there. Care plans could be more detailed, reflect the current needs of residents and be developed in consultation with residents to ensure staff know how to support them. Person centred care planning could be used for people who have Dementia to ensure that care is delivered in line with best practice and in a way which recognises and supports their individual needs. The health care needs of residents could be more detailed and accurate so that staff know what support is needed for each person. Medication could be stored, administered and recorded more safely to ensure residents receive their tablets at the correct potency, as prescribed and in a safe manner. Staff could have training on the most commonly prescribed medications at the home, to understand what the medication is for and any side effects it may have to give them a better understanding of why it is prescribed for residents and how it helps them. Some staff could treat the residents with more respect for their privacy and dignity. There could be more detailed information on the first language of residents and their religious and cultural needs so that all of the staff understand and uphold the wishes and beliefs of residents. The level and range of activities provided could be much better so that residents who cannot occupy themselves are entertained and engaged. The menu board could be kept up to date so that residents know what is available for each meal and can make informed choices about what they eat. The arrangements for meals could be better if residents who are able to could help themselves to their meals and drinks rather than having their food plated up and brought to them. The managers could be more aware of local safeguarding adults procedures to make sure that they take appropriate action if allegations are made and they protect the residents. Non-smoking residents could be better protected from the dangers of passive smoking, and the trip hazard between the small lounge and the conservatory. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 9 Odour control in the home could be managed more effectively. More steps could be taken to protect residents’ personal belongings in their rooms. The recruitment processes could be improved to ensure that the documentation and information needed to protect residents is obtained on all staff who work at the home. The manager could take steps to address the areas of weakness highlighted in this report and improve the service for the benefit of residents. The manager could undertake a quality assurance audit based on the views of residents and their relatives and develop action plans to address any areas of weakness. 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. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 10 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 Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 11 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, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Potential residents are not given enough up to date information about the service to make an informed choice. All residents are assessed before admission to make sure the service can meet their needs and to avoid unnecessary moves. EVIDENCE: The statement of purpose and service user guide about the home has recently been updated to reflect the change in registration to accept people with Dementia at the service. However, the deputy manager said that the service user guide is not given out to all potential residents before admission, and this means they would not be in a the best position to make informed decisions about the service. The service user guide did not contain a copy of the summary of the last report on the service as the Law requires and the report Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 12 was not on display in the home for residents and relatives to read. Again, this results in people not having up to date information about the inspection of the service and the results of this. A relative confirmed that she had some information given about the service, but could not remember what this was, and staff members did not know what information is given to prospective residents. The last person to be admitted to the home was “case tracked” to make sure his needs were properly assessed and could be met at the service. The person was funding his own care, although there was a copy of a Social Work assessment on his file as he moved into the home from another service which indicated that the service was considered suitable for his needs. The initial assessment undertaken by the manager was very basic and not dated so it was impossible to determine whether it was done before he moved into the home. The staff said they were not involved in pre admission assessments as the manager or Deputy tends to do this. They said they are informed about new admissions by the manager at handover and they can see the pre admission assessment information. Only one member of staff was able to tell me how she helped residents to settle when they are first admitted, and spoke about individuality, reassurance and making people comfortable and happy. The last person who was admitted was interviewed, he could not remember the events leading up to moving in to the home, but he said he feels he has settled well there. Intermediate care is not provided at the home, this standard is not applicable. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 13 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, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are not properly assessed or recorded and staff are not fully aware of the needs of residents as individuals. Medication practice is not safe and this places residents’ health at risk. EVIDENCE: The care plans of the “case tracked” residents were inspected to make sure they covered people’s needs in enough detail to properly guide staff. The care plans were not detailed enough to properly guide staff on meeting needs and this was evident during staff interviews as some were not aware of which service users were at risk of pressure areas developing or what the first language and religion of residents was. Risk assessments are undertaken but these are not up to date and do not always reflect the current needs of the Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 14 resident in question meaning staff are potentially left to decide what action is needed if risks present themselves. There is also no evidence that residents (or their relatives) are involved in the development of care plans to enable them to understand how staff intend to help them with their needs. The residents who were interviewed did not know what their care plan was. The service is now registered to accept people with Dementia, and staff confirm they have had training on supporting people with this need. However, neither the care plans, nor (from observation) the care being delivered are in line with person centred approaches (considered to be best practice for people with Dementia.) The health care needs of residents are covered in their care plans, however the plans are not always up to date and accurate (for example one plan indicated that a person had Percutaneous Endoscopic Gastrostomy feeds, when this was checked with staff the resident was now taking food and fluid orally.) There is evidence that appropriate pressure relieving equipment is provided but some staff did not know who was at risk of pressure sores developing which could place residents at risk of ill health. Some residents have mental health needs, but their diagnosis, treatment and ways of supporting them with behaviours that challenge are not documented in enough detail for staff to be clear about how to help and monitor their wellbeing. One member of staff gave good evidence that she understands and supports residents when they experience mental ill health. Residents and relatives said they were happy with the health care support provided, although one relative was concerned about the frequency of falls her loved one was having. The number of the falls prevention service has been given to the providers for support, advice and guidance in managing this issue. The arrangements for medication were inspected to make sure they are safe and ensure residents receive their medication as prescribed by their Doctor. Medication is stored securely, but not in a manner which ensures the correct potency of medicines is maintained (E.g. perishable medication is not dated when opened, or disposed of within the timescale indicated on the medication instructions). The administration of medication is not adequate, in one case a resident who was prescribed antibiotics had not received this at the intervals required to ensure the treatment was effective. Furthermore, the evidence demonstrates that the staff had signed the Medication Administration Record on occasions when they had not administered the tablets. The deputy manager and staff members indicated that medication was administered by putting the tablets into residents’ mouths. This is not acceptable and presents a risk of cross infection to residents. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 15 One person self administers medication which is commendable, however, there was no written assessment to demonstrate that staff had assessed her ability to undertake this task safely and correctly. Staff had been signing the Medication Administration Record to indicate she had taken her tablets without being present during the administration; this led to inaccurate records being maintained. An examination of the Medication Administration Record provided evidence of multiple gaps without any explanation to indicate why the medication had not been given as prescribed. Some of these matters were attended to on the day of the inspection. One member of staff indicated that although she had received training in medication from the Pharmacist, she did not know what the tablets she was administering were for. Better understanding of commonly prescribed medication may lead to improved and safer practice, ensuring that residents get their medicines as prescribed. The residents who were interviewed said the staff give them their tablets with drinks and make sure they have taken them. The policy on residents’ privacy and dignity could not be found during the inspection so it is not possible to comment on this. Residents and relatives said that members of staff treat people with dignity and respect and they said they deal with difficult situations well. One staff member struggled to give any examples of how she ensures residents’ dignity is preserved but gave some examples about maintaining privacy, (E.g. curtains and doors closed.) Another gave good examples of how she maintains residents’ privacy and dignity and said if a resident addresses her in Urdu or Punjabi she always speaks to them in their chosen language as she thinks it would be disrespectful not to. She talked about sitting with people asking about their need, wishes and preferences and trying to meet them. The observations of resident and staff interactions during this inspection provide conflicting evidence about issues of privacy and dignity. There were some examples of good practice (people sitting next to residents and helping them discreetly.) However, there were also issues of concern (residents were not asked discreetly about going to the toilet, confidential information about residents was discussed openly in front of residents, some residents were assisted to eat by staff who were standing up.) These matters must be addressed. Residents at the service come from a wide range of backgrounds and faiths. There are records in care plans to indicate that people want Sikh or Muslim religious rites observed when they die, but some of the staff interviewed were Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 16 not able to tell me what these were. The administrator indicated that other staff may know, but this is not acceptable, all staff must understand and uphold the religious rites which apply to the residents in order to properly support their needs and wishes. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. Lifestyles at the home meet the needs and expectations of the more able residents, but are not so effective in terms of those who have less visitors or higher levels of need. EVIDENCE: The statement of purpose for the home indicates encouragement will be given to engage in activities. The staff said they try and do board games in the afternoon if they have time, which sometimes they don’t. No-one is currently employed to support residents who have Dementia with their social needs. There is no evidence on the care plans that this aspect of need is properly assessed or provided for. Observations and comments from relatives on the day of the inspection and in returned surveys indicate that the range and level of activities are not adequate. Comments included, “if she were considerably younger and possessed her faculties I might wish that a bit more stimulating activity were provided,” and “the service can improve by having regular outings for clients at least once a week for change of scenery and stimulation.” Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 18 Some more dependent residents were observed to be unoccupied throughout the day. The service provided at the home is multi cultural as many staff speak languages other than English and are able to converse freely with the residents in their care. This is a real strength in the service. Relatives commented, “Both residents and staff are multi racial and appear to get on together in real harmony.” I spoke to a resident who is a Muslim, he is given the chance to pray, and said he studies his Holy Books, he is provided with Halal meat and his diet reflects his likes and preferences, he said the food is very good. However, the documentation on care plans in respect of people’s faith, rites, rituals and cultural needs could be far more detailed to enable all staff to understand and support residents better. From observation, comments from residents and staff it is clear that relatives are encouraged to visit the home when they choose, and they were observed being welcomed into the home. Two sets of visitors commented on how happy they are with the service, and they said they are kept well informed about residents’ needs. They spoke warmly about the staff and the managers. The comments made by residents and staff indicate that routines on the home are flexible and residents have choices in terms of how they spend their day, for example on resident has her husband to visit for a significant portion of every day and they spend their time together. This arrangement works out well for those who are active or who have the active involvement of their relatives and friends. One person who was interviewed said he gets up around 10 and goes to bed at midnight. He said he goes out a lot. Another said he would like to get out more often than he does but he would need staff support to do this. Lunch observed to ensure that residents receive a suitable and nutritious diet. There is a menu board in the dining room, but this was not up to date and accurate. Two meals are cooked every day, one of which is suitable for Muslim residents. The meal provided looked and smelled appetising, and the residents, staff and relatives said the food is very good. People were very positive about the quality and quantity of food. However, it was noted that drinks are not available on the table and meals were plated up before being brought to residents, even those who could potentially help themselves. Some residents need assistance to eat, but two staff were observed offering this assistance whilst standing up. Other staff were observed sitting beside people to assist them to eat, and the staff who were interviewed confirmed that they have been trained to sit down to assist people to eat, give eye contact and tell the resident what they are eating, encouraging them to eat. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 19 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an appropriate response to complaints and residents feel confident that the manager would act on any issues of concern. The lack of understanding of the local procedures in terms of safeguarding adults results in a failure to take appropriate action in accordance with local procedures in the event of allegations. EVIDENCE: The complaints procedure for the service is clearly displayed on each resident’s bedroom door. The procedure is easy to read and understand, but two residents and one relative said they did not know what the procedure was, although they would feel confident to make a complaint. Residents and relatives felt that the manager would respond appropriately to any complaints, one commented in a survey that, “whenever I’ve raised a problem, it is evident that staff have already acted on it having noticed it.” Staff members said they had never dealt with a complaint but they knew what they should do if they did. There has been one complaint since the previous inspection which was investigated by a Social Worker and is now resolved. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 20 The residents who were interviewed said they get on well with the staff at the home, and they said they feel safe at the home. Relatives said they had never seen staff respond to residents in an inappropriate way, and one visitor told me the staff have “the patience of a saint,” in their dealings with residents. There have been two allegations of abuse made since the last inspection, these have both been investigated by Social Services, one allegation was not proven, in the other case the issues were resolved and appropriate action taken to protect the individuals concerned. The staff who were interviewed showed some understanding of the types of abuse and one understood what action to take to ensure the safety of residents. However, there was reluctance on the part of the deputy manager to accept that safeguarding referrals were justified in the cases highlighted. There was a lack of understanding about the procedures in place to safeguard adults and although staff have attended training, this was some time ago and not about the local procedures which are in use in Nottinghamshire. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 21 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, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is generally homely and well maintained, but there are some risks to residents’ health and safety in respect of some parts of the home. EVIDENCE: A partial tour of the accommodation was undertaken to ensure the home is clean, hygienic and comfortable for the residents living there. The accommodation was tidy throughout but there was a noticeable odour in reception, the smoke lounge and one identified bedroom. The deputy manager said this is managed by cleaning the carpets and airing the rooms, Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 22 unfortunately this means the bedroom doors are left open which runs the risk of residents’ personal items going missing. There were one or two areas of concern from the point of view of health and safety; the access from the small lounge to the conservatory has a small slope which presents a trip hazard but there is no warning of the uneven ground, and some non smokers sitting in the smoker’s lounge are being exposed to passive smoking as the extraction system is often switched off. The deputy manager said that residents choose to sit in this lounge but there is no written evidence to indicate this is their choice and even if they do make this decision, the manager is responsible for maintaining their health by ensuring adequate extraction. There is another lounge which is for non smokers available. Residents who were interviewed said they are happy with their rooms and with the home generally which they think is kept clean. A friend of one resident remarked that the home has a nice atmosphere as soon as you come in. The staff expressed no concerns about the environment. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 23 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 poor. This judgement has been made using available evidence including a visit to this service. The staff are trained and competent in their role, but the failings in the recruitment procedure means that residents cannot be properly protected from people who may harm or abuse them. EVIDENCE: Observation, comments from relatives, residents and staff would indicate that the staffing levels are adequate to meet the dependency needs of the residents. The information given by the provider on the pre inspection questionnaire indicates that the service has already achieved the target of 50 of care staff trained to National Vocational Qualification Level 2. Some of those interviewed were in the process of undertaking their qualification. A random selection of staff files were inspected to check that the information and documentation needed to check that people are suitable to work with vulnerable adults have been received. The staff files inspected were not adequate, some application forms were only partially completed, one person had only one written reference on file, and the Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 24 Criminal Records Bureau check for two people could not be found. The pre inspection questionnaire indicates the month and year these were received. Staff records indicate that staff have all undertaken training in understanding Dementia, First Aid, Moving and Handling and administering food and medication through the Percutaneous Endoscopic Gastrostomy. Staff who were interviewed confirmed that they had undertaken this training. Residents and relatives who were interviewed indicated that they felt the staff were competent and able at their job. The residents who were interviewed said the staff were nice and good at what they do. Relatives commented, “The way they look after my mother is exemplary. She is invariably treated with respect and real affection.” “The staff are second to none.” However, some relatives during this inspection and on comment cards said that some of the care staff whose first language is not English do not speak clearly enough or slowly enough for residents to understand.” These comments were passed on to the manager for his attention. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 25 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the service has some strengths but there are areas of particular weakness which have a direct and potential negative impact on residents. The lack of quality assurance audits means the service is not being checked to ensure it is being run in the best interests of service users. EVIDENCE: The registered manager of the service is also the provider; he has 21 years experience in the care field and obtained his Registered Managers Award in 2006. Staff records indicate that he has undertaken training on Dementia, Moving and Handling and Percutaneous Endoscopic Gastrostomy feeding. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 26 Residents, relatives and staff said the home runs well, and visitors particularly praised the Deputy Manager and said she was “very approachable.” There are, however areas of managerial weakness highlighted through this report (see OP7, OP9, OP10, OP18, OP29) which have an impact on residents at the home and their wellbeing and safety. The last quality assurance audit was undertaken in 2006 and one has not been done so far in 2007. This outstanding recommendation has yet to be addressed. The deputy manager raised the difficulty of getting residents to complete the questionnaires and asks staff to help with this process, it was suggested that an Advocacy project might be able to assist with this issue. Residents and relatives who were interviewed said they had not been asked for their views on the service provided. The pre inspection questionnaire provides evidence of resident deaths and other events which should have been notified to the Commission for Social Care Inspection to enable proper monitoring and risk assessment of the service. The proprietor is not the appointee for any of the residents, though staff accompany some residents to collect their benefits. One person is under a Court of Protection Order, but the financial arrangements have been slow to come into effect. The proprietors have been paying for anything he needs and keeping receipts to claim this money back. The staff who were interviewed said they do not have any input regarding residents’ finances. Those who were interviewed managed their own money. Information supplied by the provider on the pre inspection questionnaire indicates that all Health and Safety testing and servicing is conducted at the required intervals. The staff who were interviewed feel their health and safety is properly protected at the home. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 27 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 3 Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 28 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 5 Requirement A copy of the service user guide must be given to each resident/their relative. The guide must include a summary of the last inspection report undertaken at the home to enable them to have up to date information about the service. Care plans must address all identified needs and risks and must reflect the current needs of residents to ensure staff know how to support them. This requirement is outstanding from 03/05/06 and 31/3/07. It must be addressed to avoid further enforcement action. There must be evidence that residents/their relatives have been involved in the development of their care plans, unless there are valid, recorded reasons for this not to occur. This is to ensure that people are consulted about how their care needs will be met. The health care needs of DS0000002198.V341405.R01.S.doc Timescale for action 15/07/07 2. OP7 15(1) 31/08/07 3. OP7 15 15/07/07 4. OP8 12(1) 31/08/07 Page 29 Forest Lodge Care Home Version 5.2 5. OP9 6. 7. OP10 OP12 residents must be recorded in detail and be up to date and accurate so that staff know what support is needed for each person. 13(2) Medication must be stored, 21/05/07 administered and recorded safely to ensure residents receive their tablets at the correct potency, as prescribed and in a safe manner • All perishable medication must be stored at the correct temperature, be dated when opened and discarded according to the instructions provided. • Staff must not use their fingers to administer medication. • Medication must be given at the correct intervals (especially antibiotics) to ensure effective treatment. • Staff must only sign the Medication Administration Record after they have administered the medication. • Residents who self medicate must be risk assessed to ensure this is safe. • Medication must be given as prescribed or a code entered on the Medication Administration Record to indicate why it was omitted. This is an immediate requirement. 12 Residents must be treated with 15/07/07 dignity and respect at all times. 16(2)(m & There must be evidence that 31/07/07 n) residents have been consulted about their social interests and that these are provided for to ensure they are purposefully engaged. DS0000002198.V341405.R01.S.doc Version 5.2 Page 30 Forest Lodge Care Home 8. OP18 13(6) 9. OP19 13(4) 10. OP26 16(2)(k) 11. OP29 19, Sch 2 12. OP31 37 The managers in the home must have training on the local safeguarding procedures to ensure they are clear about the action to be taken in the event of an allegation of abuse in order to properly protect residents. Residents’ health and safety must be protected by • Providing hazard warnings of the uneven ground between the small lounge and the conservatory • Ensuring that non-smokers are protected from the dangers of passive smoking. Steps must be taken to eradicate the odour in the corridor, smoke lounge and the bedroom identified to provide a clean and pleasant environment for residents living at the home. Staff files must contain all of the documentation and information required by Law to check that people are suitable to work with vulnerable adults. An urgent action letter was sent about this issue. All incidents as specified in this Regulation must be notified to the Commission in writing without delay to enable proper monitoring and risk assessment of the service. 21/10/07 15/07/07 15/07/07 21/06/07 15/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 31 1. 2. OP1 OP3 3. OP7 4. OP8 5. 6. 7. OP11 OP12 OP16 8. 9. 10. OP24 OP31 OP33 A copy of the service user guide should be given to all prospective residents/their relatives to enable them to make informed decisions about care. The initial assessment of residents should cover all of the areas specified in standard 3 to ensure there is adequate information available to decide whether residents’ needs can be met at the home. Person centred care planning should be used for people who have Dementia to ensure that care is delivered in line with best practice and in a way which promotes “personhood.” Staff should have training on the most commonly prescribed medications at the home, to understand what the medication is for and any side effects it may have to give them a better understanding of why it is prescribed for residents and how it helps them. There should be more detailed information on the religious rites to be observed on death so that staff understand and uphold the wishes and beliefs of residents. All staff should be aware of the first language, religious and cultural needs of the residents so that they can support them properly with their needs. The menu board should be up to date and an accurate reflection of the meals available each day. The arrangements for mealtimes should be reviewed to enable residents who are able to help themselves to drinks and food rather than relying on staff to do this for them. Residents’ bedroom doors should be kept closed to make sure that their personal possessions are secure. The registered manager should take steps to address the areas of weakness highlighted throughout this report. A quality assurance audit should be carried out in 2007. The outcome of this audit should be made available for inspection. An independent advocacy service would ensure more objective results on the service. Outstanding. Forest Lodge Care Home DS0000002198.V341405.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Forest Lodge Care Home DS0000002198.V341405.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!