Inspection on 14/04/10 for Pine Tree Care Home

This inspection was carried out on 14th April 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pine Tree Care Home 09/06/09

Pine Tree Care Home 16/07/08

Pine Tree Care Home 09/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Gwendolen Lodge Residential Home 305 Gwendolen Road Leicester Leicestershire LE5 5FP     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 1 5 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: Gwendolen Lodge Residential Home 305 Gwendolen Road Leicester Leicestershire LE5 5FP 01162738381 01162738381 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sudera Care Associates Limited care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No person under the age of 55 who falls within categories MD, DE or PD may be admitted into the home. To be able to admit the named person of Category A(E) identified in variation application number V17739 dated 17th February 2005. Date of last inspection Brief description of the care home Gwendolen Lodge Residential Home is owned by Sudera Care Associates and is registered to provide personal care and accommodation for up to twenty-three older people who may have additional needs including Dementia. The home is located near to the centre of Leicester and is accessible by bus. There is limited off road car parking to the front of the Home. Care Homes for Older People Page 4 of 39 Over 65 23 23 23 23 23 23 0 23 0 9 0 6 2 0 0 9 Brief description of the care home Gwendolen Lodge has several communal rooms, which includes a conservatory overlooking the rear garden. The home has two floors and access is provided by a pasenger lift. The home has an enclosed courtyard to the side of the home and a garden to the rear. Gwendolen provides information about the service to prospective and current service users and incudes the terms and conditons of their stay, this information is referred to as The Statement of Purpose and Service User Guide. There is information available in the reception area including the Certificate of Registration along with a copy of the most recent Inspection Report carried out by the Care Quality Commissions. Information regarding fees is available by contacting the Regsitered Manager of Gwendolen Lodge. Care Homes for Older People Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a self-assessment tool completed by a representative of the service, reviewing previous Inspection Reports, and any other information we have received. The unannounced site visit took place over two days the 14th and 15th April 2010 taking twelve hours. We sent surveys to health care professionals, of which one was returned, we sent surveys to staff of which three were returned and we received one survey from a relative of someone who resides at Gwendolen Lodge. The focus of the inspection is based upon the outcomes for people who use the service. Care Homes for Older People Page 6 of 39 The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are met by the staff of Gwendolen Lodge. Three people were chosen and observations were made, we also spoke with visiting relatives and a health care professional alongwith staff who work at the home. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 39 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process is not always robust or timely which has the potential to impact on the homes ability to meet the needs of service users admitted into the home. Evidence: We wanted to find out whether the information provided to prospective service users and their relatives provided them with sufficient information to enable them to make an informed decision as to whether Gwendolen Lodge was the right home for them. At the previous Key Inspection of Gwendolen Lodge we found that the homes Statement of Purpose and Service User Guide contained inaccurate information, so we required that both documents were reviewed, and an up to date copy be provided to the Care Quality Commission. We the Care Quality Commission have not received a copy. Care Homes for Older People Page 10 of 39 Evidence: When we visited Gwendolen Lodge as part of the Key Inspection we asked for a copy of the information provided to individuals who are considering moving into the home, the Registered Manager told us that the last copy was given to someone who visited the home the day prior to our visit. We were therefore unable to ascertain as to whether documentation has been updated and provides information which reflects the services provided. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that the Statement of Purpose and Service User Guide are always available but no information was supplied as to whether the documents have been reviewed. We wanted to find out how individuals who require residential care can be confident that Gwendolen Lodge can meet their needs, we did this by looking at the self assessment tool completed by the Registered Manager (AQAA) and by looking at records in the home. The AQAA told us that assessments are carried out prior to admission to ensure that the needs of people can be met, with an additional assessment being carried out upon admission. We found in some instances assessments provided by Social Services were not up to date, and that assessments carried out by a representative of Gwendolen Lodge had been carried out after the persons admission into the home. We looked at the records of three people currently in residence at the home. We found that assessments had been undertaken by the home, within days of the persons arrival at the home, these were not always dated or signed. We also noted that assessments were in place for two people which had been carried out by a representative of Social Services, we found one assessment provided by Social Services had been undertaken ten months prior to the persons emergency admission in the home, and that the information it contained differed significantly to the assessment carried out by the Registered Manager, upon the persons admission to the home. There is a risk that individuals needs may not be met by the service where people are admitted into the home without an up to date assessment. Discussions with the Registered Manager highlighted that a significant number of those in residence are admitted for respite which is either planned or as a result of an emergency placement, this means that the staff at the home are having to adapt their day to day care practices to support and care for people who they do not know whilst continuing to support those who reside at the home on an ongoing basis. This has the potential to impact on the quality of care people receive. Care Homes for Older People Page 11 of 39 Evidence: We sent surveys to people who live at the home, which were displayed by the Registered Manager in the foyer for service users and their relatives/friends to complete of which one was returned, information in the survey told us that they received enough information to enable them to make a decision about the service. Care Homes for Older People Page 12 of 39 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and social care needs of service users are not recorded within an up to date care plan reflective of their needs which impacts on the quality of care they receive. Evidence: We wanted to find out how the health and personal care needs of people living at the home were met. We spoke with relatives visiting the home when we visited, and a visiting Community Staff Nurse. We also observed the care and support provided by staff and looked at the care plans and records of three people in residence at Gwendolen Lodge. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that the service provides in depth care plans to ensure the best care and support for each individual and that risks are identified, acted upon and documented. We found that care plans were not comprehensive, accurate or regularly reviewed and that risk assessments were not carried out for all areas of risk. The AQAA also stated that additional support is provided by visiting health care Care Homes for Older People Page 13 of 39 Evidence: professionals, by looking at records we found that service users have access to health care professionals, however we have been notified of one incident which is being investigated by Social Services under safeguarding policies and procedures, where concerns have been expressed that health care advice may not have been sought in a timely manner. The AQAA stated that all service users admitted into the home have nutritional screening carried out, we found no evidence of this. We sent surveys to people who live at the home, which were displayed by the Registered Manager in the foyer for service users and their relatives/friends to complete, of which one was returned, information in the survey told us that they are confident that the service meets the needs of their relative. The survey asked service users and relative what they thought the home does well they wrote:Treat relative as an individual, know their personality, keep me informed. To the question what could the service do better they wrote:Due to my relatives health care needs which are managed by the District Nurse, my relative has not had a shower or hair washed for many weeks/months. I know they have spoken to the District Nurse about this but nobody has made a decision on what or when. We received one survey which we had sent out to health care professionals which was completed by a General Practitioner. Information gathered from the survey told us that in the opinion of the General Practitioner the health and social care needs of those in residence are usually monitored, reviewed and met by the care service, and that the service usually seeks and acts upon advice. To the question in the survey, what does the service do well, they wrote:Caring. Prepared to invest time and effort to address their clients needs. We received three surveys from staff who work at the home. Information gathered from surveys told us that in the main staff believe that they are given up to date information about the needs of people at the home, and that information about people in the home is managed well. Our observations and reviewing of documentation disputes this. To the question what does the home do well, one member of staff wrote:- Care Homes for Older People Page 14 of 39 Evidence: The home caters well for each individual resident. We looked at the records of three people who currently reside at Gwendolen Lodge. One person who has resided at the home for six months did not have a care plan for any of their needs, and the assessment that was carried out by a representative of the home subsequent to the persons admission to Gwendolen Lodge contained information which conflicted with our observations of the persons needs on the days of our site visit. We discussed the anomalies we had identified with the Registered Manager, who told us that they were in the process of updating the persons records, this impacts on the care provided to the person, in that staff do not have access to up to date and accurate information. We found that for the second person whose records we viewed, inconsistencies and a lack of information in their care plan and the actual care and services provided. We also noted that care plans were not in place for some of the service user needs, in particular with regards to the support the person required in relation to their Dementia and minimal information with regards to management of their Diabetes. Care plans that were in place were not comprehensive and did provide staff with guidance as to how they should provide care and support, and what actions they should take to changes in the persons needs or health. The care plan and records for the third person we viewed were not comprehensive and were not detailed. Records were in place with regards to the support they received from a Community Staff Nurse. We spoke with a visiting Community Staff Nurse who told us that they believe the home responds well to the health care needs of those in residence, and sought and acted upon advice. We asked them as to their views as to the ability of staff to meet the needs of those at the home, they told us that in their view some staff had an awareness of peoples needs. They also commented that their had been an increase as to the number of people in residence who required support in relation to their mental health and or dementia. We spoke with two relatives who were visiting on the day of our visits, they told us that they were generally satisfied with the care and support their relative had received, but that they had expressed a concern to the Registered Manager and Social Services that health care advice had not been sought swiftly following an incident concerning their relative. Records we viewed did not contain risk assessments for risks identified such as falls, Care Homes for Older People Page 15 of 39 Evidence: whilst we noted handling assessments were in place for some service users who we observed did not require support with mobilisation. We spoke with staff and asked them about their role in providing care and support to people, they told us it was their role to make sure service users were safe and looked after. Staff said that they were aware of care plans, but they were not responsible for reviewing them, but that the Registered Manager and Senior Carers asked if theyd observed any changes in relation to service users. Staff said that in the main they relied on verbal information on a day to day basis to keep them up to date as to the needs of those in residence. Discussions with staff and our observations noted that staff have very limited understanding and awareness of service users needs, where specialist support is needed, including supporting those with dementia or mental health needs. We looked at daily records and found that they contained limited information about a person, information was restricted to sleep, elimination and eating. We found that care plans were until recently signed as being reviewed monthly, however evidence we read shows that care plans were inaccurate and not up to date. Monthly review comments in the main read no change. It is difficult to understand how staff could review the changing needs of people based on the limited written information available. The Registered Manager stated that she and Senior Carers are responsible for the reviewing of care plans. We looked at the medication and medication records of three people and found that the monitored dosage system and records were in good order. We also looked at the Controlled Drug Register which was consistent with the number of tablets in the home. We asked to see the Pharmacy Reports from the supplying Pharmacist. The Registered Manager told us that no routine medication audit had been carried out by the supplying Pharmacist consistent with the contract. When we visited the following day the Registered Manager told us that she had contacted the Pharmacist, and we saw a fax from them stating they would carry out a routine medication audit within the next fourteen days. It is of concern that the Registered Manager does not monitor and ensure that such periodic checks are carried out. At the previous Key Inspection we required that the home ascertain whether the cabinet in which Controlled Drugs are stored complied with legislation in reference to the storage of such medication. We noted that a letter had been provided by the Pharmacist stating that the homes storage facilities comply with the Misuse of Drugs Act. Care Homes for Older People Page 16 of 39 Evidence: We asked about medication training for those staff who dispense medication, the Senior Carer told us that they were trained by another Senior Carer many years ago, however the Registered Manager was going to organise training to be provided by the Pharmacist. Care Homes for Older People Page 17 of 39 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gwendolen Lodge does not provide a stimulating environment for people to live in with service users having no opportunity to comment on their lifestyle including the meals provided. Evidence: We wanted to find out about how people spend their day, and how staff working at the home support people to make decisions and take part in activities and lead a meaningful life. We did this by looking at information provided to us by the Registered Manager and by observing people throughout the day, talking with people including visitors. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that the local Church undertakes monthly visits along with personal religious visits. We did observe a representative of a Church visiting someone living at the home, and visitors we spoke with said that they were aware of a Church Service taking place at Easter. The AQAA also stated that activities are offered and that staff interact with service users well, and that emphasis is placed upon one to one contact to promote conversations. In addition in the evening residents can engage in jigsaws and board games if they choose, and that the home has frequent entertainers Care Homes for Older People Page 18 of 39 Evidence: that visit. We sent surveys to people who live at the home, which were displayed by the Registered Manager in the foyer for service users and their relatives/friends to complete of which one was returned responses to questions indicate that their relative is supported to live the life they choose. We found their were no care plans in place to support people with their social needs, and our observations were that the home did not provide any activities or stimulation for those in residence with the exception of televisions, at the time of our visit. We did observe one person on the first day of our visit accessing day care external to the home, for which transport was provided. We noted that some people chose to spend time in their room, whilst others sat in one of the four communal rooms of the home, of which three have a television. We observed that the television was on in rooms providing one, however a majority of those in the room were not watching the television and sat with their eyes closed, and in some instances with their chins resting on their chests. There was minimal contact between staff and residents, with contact often being restricted to offering refreshments mid morning and mid afternoon, or inviting people to the dining table for lunch. We did note that two people who are confused and have dementia chose to wander around the home, however staff had no insight into providing meaningful activities for them to engage in, but frequently redirected them to other areas of the home. We spoke with the visiting Community Staff Nurse and relatives who said that they had not observed any activities taking place in the home when they had visited. When we looked at a service users records and care plan we found it had been identified by both the persons family and Social Services that the service users awareness of day to day issues and communication had decreased since theyd ceased to access external day care services. We noted by viewing documentation that this had not resulted in the person care needs being reviewed by the home, to look at how the service users needs could be met within Gwendolen Lodge. We observed that a member of catering staff asking each service user in the morning what they wished to eat for their lunchtime meal from the two choices available. We observed staff supporting people to the dining room, some residents require the use of a hoist, and the layout of the dining room and the style of dining chairs, make the moving and handling of residents unnecessarily difficult, when we mentioned the use of glider dining chairs to the Registered Manager, they told us that theyd been mentioned the day prior to our visit, when the staff have received moving and Care Homes for Older People Page 19 of 39 Evidence: handling training. We noted that the care plans for some detailed that service users were independent and able to feed themselves, however discussions with care staff and observations evidenced this not to be accurate as those we viewed did require assistance. We noted that the meal of one service user was placed in front of them, however they made no attempt to feed themselves and remained sitting with their eyes shut. Staff continued to support others to the dining tables, before offering the service user assistance. We noted one service user asleep at the dining table, leaning to one side and looking uncomfortable with no meal presented to them, when we asked staff about the service user, they brought the persons lunch, however the person showed no interest in their meal, and therefore staff using moving and handling equipment removed the service user from the dining room, they continued to keep their eyes closed during this process. There is a lack of awareness of staff as to the individual needs of those in the home, and lunchtime is seen as a task by which everyone sits in the dining room to eat, with no thought as to how one to one assistance is going to be provided, enabling all to enjoy their meal in a relaxed environment. We read in one service users care plan that appropriate cultural dietary meals were provided two to three days a week, discussions with staff evidenced this not to be accurate, in that the person did not receive any culturally appropriate meals as per their care plan. We found no evidence that service users living at the home are consulted about any aspect of the care and support they receive, which includes their views about activities and the meals provided. Care Homes for Older People Page 20 of 39 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users rights and safety are not protected as the Registered Manager and staff have limited training and awareness as to the rights, policies and procedures which are in place to protect vulnerable adults. Evidence: We wanted to find out how peoples rights were supported, and whether people living at the home know how to raise concerns, we also wanted to find out whether people felt safe and are protected. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that staff are trained to be aware of service users rights and choices, along with being able to recognise signs of distress and neglect, discussions with staff did not substantiate this, and the lack of awareness demonstrated by the Registered Manager as to policies and procedures tells us that training received has not resulted in practices being reviewed or understood. We sent surveys to people who live at the home, which were displayed by the Registered Manager in the foyer for service users and their relatives/friends to complete, of which one was returned. The relative indicated that they do not know how to make a complaint. We received two surveys from staff, information gathered from surveys indicated that Care Homes for Older People Page 21 of 39 Evidence: they are aware of how to manager concerns. We asked to look at complaint records for the home and noted that whilst concerns and complaints are recorded, these are not always recorded by the person who takes the initial complaint, but are verbally given to the Registered Manager who records them. The complaint did not always provide the name of the complainant, but stated relative of and then the service users name. The investigation process and outcome of the complaint were not always recorded in full, neither was it recorded within the complaints records as to the outcome of the complaint and how this had been communicated to the complainant. Documentary evidence was in some instances located in other records such as health care records, making it difficult to understand the process and outcome of the complaint management system of Gwendolen Lodge. We looked at the training records for staff at the home, the Registered Manager advised that they were not up to date, but staff had attended training. We spoke with staff and asked them about the training they had received, all could recall that they had received training about the protection of vulnerable adults from abuse, but could not recall when this was, but did say the training consisted of watching a DVD and answering questions. Staff we spoke with demonstrated minimal awareness or understanding as to the types of abuse to which adults in care are at risk of, neither could they tell us as to the signs that could indicate abuse was occurring. Staff knowledge was limited to their role of keeping people safe and looking after them, and reporting any concerns to the Registered Manager or Senior Carer. Discussions with the Registered Manager highlighted that they had limited awareness as to their role and responsibilities in reporting issues of concern to the relevant agencies, such as Social Services and the Care Quality Commission. We are aware that their are three safeguarding investigations being carried out by Social Services, all of which were brought to the attention of Social Services by relatives and not by the Registered Manager or staff of Gwendolen Lodge. Care Homes for Older People Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gwendolen Lodge does not provide furnishings and furniture which are in all instances well maintained, and ongoing maintenance is not planned. Evidence: We wanted to find out whether the environment in which people reside is appropriate to their needs and is safe and well maintained. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that the home offered a safe, well-maintained and comfortable and homely environment for service users, when we undertook a tour of the premises we found areas of concern with regards to maintenance, the standard of furnishings and safety. We undertook a tour of the home, which including viewing all communal areas of the home, and some of the bedrooms. We found that the carpet of the entrance foyer and corridors in places was not fitted well, creating a potential trip hazards. The Registered Manager told us that repairs had been undertaken through the use of glue, however the carpet continued to lift in places. We were advised that the area has been measured and that new flooring will be laid, however their is no confirmed date for this work to be undertaken. We advised the Registered Manager that the trip hazards needed to be dealt with as a matter or urgency to ensure the safety of service users. Care Homes for Older People Page 23 of 39 Evidence: The Registered manner contacted the Registered Person for the home, and during our visit on the first day carpet fitters arrived and fitted strips to the identified areas, removing the trip hazard. We noted all areas of the home were painted in neutral colours, some rooms having pictures on the walls. We noted furniture such as nests of tables and television cabinets were damaged and not in a good standard of repair. The armchairs in communal rooms in some instances were missing their seating cushion, we also noted that when we sat on some armchairs their was an odour of urine. Armchairs in two bedrooms were ripped and stained with dried food, and conservatory furniture in the conservatory was ripped in places. Curtains in some bedrooms were not fitted well, with missing curtain hooks. The windows of all communal rooms are fitted with blinds, which are in many instances broken and in a poor standard of repair, their are no alternative window dressings for communal rooms. Care Homes for Older People Page 24 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by staff who have a limited awareness of their needs and who do not receive training and guidance that enables them to care and support people well. Evidence: We wanted to find out whether the care and support people receive is provided by staff who have the relevant training and experience, and who have been recruited using a robust recruitment process. We found that the personal care needs of service users were met, in that people were assisted to get up and receive personal care. Observations at meal times showed that the management of staff did not take account individual service user needs or the assistance service users required. This meant that some service users sat with their meal in front of them waiting for assistance with eating, whilst staff continued to assist others to the table. We observed that staff did not have time to carry out activities with service users, and we also observed one member of staff undertaking cleaning duties for a majority of the late morning and early afternoon. Staff struggle to meet the needs of service users beyond physical care and support. A contributory factor to this is that a significant number of service users who stay at the home access the home for respite, Care Homes for Older People Page 25 of 39 Evidence: whether it be planned or as a result of an emergency, this means that the collective day to day needs of service users is continually changing, with many of the service users living at the home having specific health and social needs including dementia. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that staff work to wards meeting the needs of individual service users, promoting independence and respecting dignity, information also told us that 62 of staff have a National Vocational Qualification in Care. The AQAA told us that staff are recruited following a robust recruitment process. We looked at the records of three members of staff who have recently been recruited to work at Gwendolen Lodge, staff were employed from overseas and their recruitment had been managed by an agency. The Registered Manager advised that she had had no involvement in the recruitment of these staff. We asked the Registered Manager about the induction for the newly recruited staff, she told us that their was no documentary evidence, but she had advised them as to their duties and they were aware of the fire procedure and had attended moving and handling training. Newly recruited staff do not have a planned induction programme, which impacts on their ability to meet the needs, and promote the welfare and safety of service users, putting service users at risk. The Registered Manager was unaware of organisations such as Skills for Care who provide induction and ongoing training for care homes. We spoke with two of the three recently recruited members of staff, however due to their first language not being English they found it difficult to answer our questions about their recruitment and induction. The AQAA also stated that their are on-going training appraisals and that all staff have an individual training matrix, whilst additional training courses, have enabled staff to have a better knowledge and understanding in many areas. We found this not to be accurate. We asked to see staff training records, the Registered Manager told us that whilst staff had received training, records detailing training were not up to date, we found that training records were not completed for the majority of the previous and current year. The Registered Manager told us that staff do not have an individual training matrix and staff do not receive training appraisals as stated with the AQAA. We asked three members of staff who have worked at the home in some instances for several years about the training they had received, staff were able to tell us that they Care Homes for Older People Page 26 of 39 Evidence: had received moving and handling training, which had included a refresher course earlier in the week. We asked staff if they had received training relevant to the care needs of service users at the home, such as Dementia Awareness. They told us that they had received training some time ago, which included watching a DVD and taking part in a discussion and completing a questionnaire, staff however could not give examples as to how this training had enabled them to provide the relevant care and support to those service users with Dementia. Our observations of staff interaction with service users, and the lack of stimulation which service users experience on a day to day basis, along with inadequate and out of date care plans, results in service users not receiving the specialist care and support that they require. We sent surveys to people who live at the home, which were displayed by the Registered Manager in the foyer for service users and their relatives/friends to complete, of which one was returned, they wrote:All the staff are great with my relative, they make them laugh and keep them calm if and when required. We received three surveys completed by staff, information in surveys told us that in their view their induction covered everything they need to know and that they receive training relevant to their role. Care Homes for Older People Page 27 of 39 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Gwendolen Lodge suffers from a lack of leadership and awareness as to the needs of its service users, and lacks insight into changes that are needed to improve the quality of their lives. Evidence: We wanted to find out whether Gwendolen Lodge was managed effectively and well and run in the best interests of service users. The Registered Manager has worked at Gwendolen Lodge for many years and has attained a National Vocational Qualification (NVQ) in Care and has attained the Registered Managers Award. Training, development and supervision of staff does not take place, and there is no strategic planning and reviewing of the day to day running of the home and the service it provides. The quality of lives of service users is not reviewed and their are no formal opportunities for them to comment on the service they receive and influence Care Homes for Older People Page 28 of 39 Evidence: the running of the home. Document management is poor, with many records not being completed or reviewed. Accidents and incidents in the home including vulnerable protection issues are not reported to the relevant outside agencies, and the Registered Manager and staff have little understanding and knowledge in these areas. The Annual Quality Assurance Assessment (AQAA), which was completed by the Registered Manager stated that in many aspects of the day to day running of the home, that they were unaware of any areas of concern in the service provision, discussions with the Registered Manager highlighted that they are aware of shortfalls in the service. Our observations and findings from our site visit found information provided in the AQAA was inaccurate and we could find no evidence to support much of its content. We spoke with the Registered Manager and looked at their training records, their individual training records are not up to date, and the Registered Manager told us that they have attended little training in the previous and current year. Training they have received has been for a duration of a day or less in a particular topic, but is not related to management. The Registered Manager continues to work alongside staff at the home, providing personal care and support to service users, and is responsible for the administration of medication in the morning. The Registered Manger also has responsibility for all administration, including document management, reviewing and updating of care plans, and other day to day duties including answering the telephone and front door. The home does not benefit from internet access. The Registered Person is required by legislation to visit the home at least monthly, unannounced and write a report as to their findings, which should include speaking with service users and any visitors and staff, viewing documentation in the home including complaints and inspecting the premises. The Registered Manager told us that the Registered Person frequently visits, however their are no reports as to his findings. The Registered Manager stated discussions between herself and the Registered Person are not documented, and therefore their is no evidence to suggest that the Registered Person is aware of any shortfalls in the service or has any plans to improve the quality of the service. Care Homes for Older People Page 29 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 5 The registered person to 07/08/2009 provide a service user guide to the Commission which is also made available to people who live at or are considering accessing services at Gwendolen Lodge, which is accurate and provides information about the home, and services. To enable people to make an informed decision as to whether the home is appropriate for their needs. 2 1 4 The registered person to 07/08/2009 provide a Statement of Purpose to the Commission which is made available to people who live at or are considering accessing services as Gwendolen Lodge, which is accurate and provides information about the home, and services offered. To enable people to make an informed decision as to whether the home is appropriate for their needs. 3 7 15 The registered person in consultation with service users and/or their representatives, ensure that care plans are regularly 11/09/2009 Care Homes for Older People Page 30 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action reviewed and comprehensive, reflecting all aspects of care, including care and support to people with Dementia, and provide information as to how the person wishes their care to be carried out including their preferred daily routine. To provide people with an opportunity to influence and receive the care and support they require in a manner which they expect and wish. 4 12 16 The registered person to 11/08/2009 consult with service users and/or their representatives about their social interests and activities, which are then to be provided, as detailed within the Statement of Purpose. This would promote and enable individuals to live a lifestyle of their choosing, and reflect their individual interests and wishes. 5 30 18 The registered person to 11/08/2009 review the training provided to staff, and establish a training plan which enables staff to meet the needs of people living at the home, and enables staff to understand and promote the rights of people. Training to include:- 1) safeguarding adults from abuse. 2) Dementia Awareness. 3)Mental Capacity Act Page 31 of 39 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action training to include deprivation of liverty safeguards. 4) Mental Disorder To ensure that the needs and rights of people are being met and supported by staff who are trained and are competent to do so. 6 33 24 The registered person to 11/08/2009 establish a system which reviews and improves the quality of care people who live at the home receive, that includes consultation with people who live at the home, and their relatives. To enable people who receive care and support to influence the day to day management of the home and improve the service they receive. Care Homes for Older People Page 32 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 14 The Registered Person to ensure that an up to date assessment of a persons needs is provided or undertaken prior to an individual being admitted into Gwendolen Lodge To ensure that an individual accessing the services of the home can be met. 16/06/2010 2 7 15 The Registered person to 16/06/2010 ensure that all service users have up to date and accurate care plans detailing the needs of service users, and that the care plan is kept under review. To ensure that the needs of service users are met. 3 10 18 The Registered Person to 16/06/2010 ensure that staff responsible for the administration of service users medication receive training which is accredited an assesses staffs Page 33 of 39 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action ability to manage and administer medication well. To ensure that the health needs of service user including the management of their medication is manage well by staff who are competent and trained. 4 12 16 The Registered person to consult with service users/and or their representative as to a service users hobbies and interests and develop a care plan to support their social needs. To promote the lifestyle choices of service users enabling them to continue to lead a rewarding and fulfilling life. 5 18 13 The Registered Person to 16/06/2010 provide training to staff employed at Gwendolen Lodge that enables them to understand their role and responsibility in protecting adults from abuse, and enables them to understand their role in reporting issues to external agencies, consistent with multi agency policies and procedures. 16/06/2010 Care Homes for Older People Page 34 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To promote and protect the welfare, safety and rights of service users. 6 19 23 The Registered Person to 16/06/2010 undertake an audit as to the cleanliness and standard of decor and soft furnishings in the home, and develop a planned schedule of maintenance and improvements, which is implemented. To ensure that the home provides a clean, safe and well maintained environment for service users to reside. 7 27 18 The Registered Person to review the staffing levels at the home to ensure that staff are available in sufficient numbers to meet the changing needs and numbers of service users in residence at the home at any one time. To ensure that the collective and individual needs of service users are met. 8 28 18 The Registered Person to 16/06/2010 ensure that persons employed to work at the care home receive training appropriate to the work they are to perform including 16/06/2010 Care Homes for Older People Page 35 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action structured induction training. To ensure that service users are supported by staff who receive the appropriate training and guidance. 9 30 18 The Registered Person to 16/06/2010 provide a training plan that include confirmed dates to the Commission that details when staff will receive training to ensure that staff working at the home receive training relevant to their role and the needs of service users, which is to include but not necessarily limited to:a. dementia awareness b. diabetes awareness. c. mental disorder. d. deprivation of liberty safeguards. To ensure that service users are supported by staff who receive the appropriate training and guidance. 10 31 37 The Registered Person to ensure that notifications of death, illness and other events are reported to the Care Quality Commission. 16/06/2010 Care Homes for Older People Page 36 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the Care Quality Commission is aware of issues affecting service users in the home. 11 33 26 The Registered Person to 16/06/2010 visit the home to carry out their statutory responsibilities to interview service users and their relatives, inspect the premises, its record of events and any complaints prepare a write report on the conduct of the home and to provide a copy of the report on a monthly basis to the Care Quality Commission and Registered Manager. In order that the Registered Person is aware of the service provided and to address and make provision to rectify any shortfalls identified, to ensure the health and safety of service users whilst improving the quality of service user lives. 12 33 24 The Registered Person to establish a system which reviews and improves the quality of care people who live at the home receive, that includes consultation with people who live at the home, and their relatives. 16/06/2010 Care Homes for Older People Page 37 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To enable people who receive care and support to influence the day to day management of the home and influence the service they receive. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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