Inspection on 16/07/08 for Pine Tree Care Home

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pine Tree Care Home 14/04/10

Pine Tree Care Home 09/06/09

Pine Tree Care Home 09/08/06

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Gwendolen Lodge Residential Home 305 Gwendolen Road Leicester Leicestershire LE5 5FP Lead Inspector Ms Rajshree Mistry Unannounced Inspection 09:45 16th July 2008 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 Gwendolen Lodge Residential Home DS0000066523.V368398.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. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gwendolen Lodge Residential Home Address 305 Gwendolen Road Leicester Leicestershire LE5 5FP 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) 0116 2738381 0116 2738381 Sudera Care Associates Limited Miss Janet Tailor Care Home 23 Category(ies) of Dementia (23), Dementia - over 65 years of age registration, with number (23), Mental disorder, excluding learning of places disability or dementia (23), Mental Disorder, excluding learning disability or dementia - over 65 years of age (23), Old age, not falling within any other category (23), Physical disability (23), Physical disability over 65 years of age (23) Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 9th August 2006 Date of last inspection Brief Description of the Service: Gwendolen Lodge Residential Home is registered to provide care for up to 23 older people. The home is located near to the centre of Leicester and is accessible by bus. There is off the road car parking to the front of the Home. The Home has a number of lounges where people can choose to sit. The rear garden and conservatory is accessible to people living at the Home. All parts of the Home are accessible to people with a physical disability. The Home’s brochure that includes the Statement of Purpose and the Service User Guide are available on request, which provides information on how the home is organised and what services they provide. The Statement of Purpose and the Service User Guide are provided to all the people living at the Home. The Registered Manager provided the following information on fees during the site visit on 16th July 2008, which ranges from £390.00 to £400.00 per week. There are additional charges for services such as Chiropody, hairdressing services newspapers, clothing and personal toiletries. The latest CSCI Inspection Report is available at the home. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool, completed by the Registered Manager; the last inspection report of the Home dated 9th August 2006; the Annual Service Review dated 7th March 2008, which was based on the information we had about the service and review of the significant events the affects the people living at the Home. We carried out an unannounced site visit to the Home, on 16th July 2008, and took place between the hours of 9:45hrs and 17:00hrs. The Registered Manager assisted us during the site visit to the service. The main method of inspection we used was ‘case tracking’. This means looking at the care given to people in different ways. This was done by: • Selecting people who receive a range of care and support from the agency; people that have diverse needs; are new to Home and those that have been receiving care for some time. • Talking with the people we identified for case tracking; • Talking with visitors to the Home, such as family and friends; • Reading the care files which contained information about the individual people and their choice of lifestyle and support required; • Talking to staff and the Registered Manager; • Reading the written records relating to people living at the Home, staff records, the policies and procedures and records that demonstrate the effective day-to-day management of the service. We sent ‘Have Your Say About Gwendolen Lodge surveys to sixteen people who use the service of which one were returned. We sent out twenty surveys to staff of which one was returned. We took surveys with us to the site visit to see if people wanted their relatives or main carers to comment of the service provided at the Home and left some in the reception area along with other information the Home provides. We received comments directly from the people living at the Home and from their visitors who were present at the time of the visit, the staff and the Registered Manager. The comments have been included in the relevant sections throughout this report. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 6 What the service does well: Gwendolen Lodge is homely and comfortable. People have a choice of lounges they can use. Many of the people living at the Home have lived there for a number of years and are cared for by a stable staff group. The staff and management have developed good relationships with the individual people, their relatives and health care professionals such as the General Practitioner to promote health and wellbeing. Comments received from people living at the Home, visiting relatives, a General Practitioner and staff directly and through surveys included: “Visiting the Home with their sister and thought it was ok for them at the time”. “Used to go out for the day when she walked and talked but now I visit her everyday and we would have a cup of tea and biscuits”. “She is always well dressed when I come to visit and I know staff have to do everything for her”. “The staff do respect their dignity and privacy when helped with bathing or dressing”. “They do speak to relatives knowing they may have to make certain decisions” “The staff do recognise the needs of the clients, follow instructions such as monitoring and observations, know how to help people with complex mental health needs especially as people are living longer” “Has occasionally supported the home when hospital discharge team insist the person goes home without satisfying the manager” “They always have the music on but I don’t listen to it” “People like the music and they really enjoy the karaoke we have” “My sister visits me regularly and I do go out with her”; “Goes to . . . . . . . day centre where we plays different games, talk with other people and likes to go out sometimes”; “There are many visitors to the home, some visiting their husbands, wife, parents and they come at all times of the day”. “I visit . . . . everyday, we use to go home for the day when she was well, go to the caravan for a week at a time when she was well”; “now I come here and we sit, chat and have a couple of biscuits and a cup of tea”; “I know staff Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 7 do sit and spend time with . . . in between seeing other residents, they have to feed her and so she gets some quality time with the staff”; and “I’m quite happy with the care she gets”. “You know the same faces but can’t always remember their names”. “Prospective resident and their family often ask about the turnover of staff and I’m quite proud to say the newest member of staff has been working here for 5yrs”. “Have daily meetings and supervision with the manager to discuss any issues that affect the people living at the Home”. What has improved since the last inspection? What they could do better: The quality of life people receive whilst living at Gwendolen Lodge should be improved through detailed assessments and care planning. These should be focused on the whole person, with consideration to people’s individual preferences, wishes and daily routines, especially where the person has dementia, mental illness or any other associated disability in line with the Home’s registration. Regular staff training to meet people physical, emotional and mental health needs and regular staff supervision and team meetings would promote the health and wellbeing of people to have individual and quality care. Comments received from the staff and the manager: “Since there has been a change of ownership, we haven’t had training as the organisation has focused on the other care home”. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 8 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. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 9 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 Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 10 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 and 4. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People considering moving into the Home have information about the services provided but are placed at risk through lack of appropriate assessment of care needs. EVIDENCE: People considering using the services of Gwendolen Lodge are provided with information in the form of the ‘Statement of Purpose and Service User Guide’. This document outlines the services provided by the Home, ranging from personal care to social and leisure opportunities, the key policies and procedures including ‘how to complain’, the range of fees, the staffing structure, including the manager’s qualification and how quality assurance process that measure the quality of the service people receive. This information is at the entrance to the Home. The contact details of an Advocacy Agency are displayed on the notice board at the entrance to the Home. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 11 We spoke with three people living at the Home and two visitors. They told us that they had been at the Home for a number of years. One person recalled they “visited the Home with their sister and thought it was ok for them at the time”. One visitor said a relative found the Home for the person they were visiting and continues to visit them on a daily basis. We respected the wishes of the newest person living at the Home who did not wish to speak with us but said they “don’t mind you looking at my file”. We looked at the records of four people who were case tracked living at the Home, all were funded by Social Services, one person was new to the Home, whilst the others had lived at the Home for a number of years and had changing care needs. We saw assessments carried out by the social workers, which were used as information before the manager agrees to visit the person. The manager said she does her own assessment of the person, if they are in hospital. We looked at the assessment form that the manager completes, which was basic and mainly looked at the physical needs such as mobility levels. There was no record of people’s emotional and mental health needs or wishes in relation to their lifestyle, as the Home is registered to care for people with dementia and mental illness. Staff told us they get information about the new person from the handover meetings with the manager and they can look at the assessment done by the manager and the social worker, which are always available but lack detail. We spoke with the manager about how they gather this information to be satisfied that the Home is able to meet the needs. The manager acknowledged that the assessment carried out by her does not allow key information to be known. The manager then demonstrated herself that the Home’s assessment process is inadequate assessment. The manager acknowledged that she tells staff about the person’s emotional and mental wellbeing from memory, which is not always recorded. She gave examples of how little information gathered affects the person, other people living at the Home and the staff. The example given by the manager related to a person who becomes very agitated and vocal after lunch, which took the staff a little while to understand and support and an incident of a person’s needs were not met by the Home because not enough information was gathered about the person’s daily routines, likes and dislikes. The evidence we found on during the site visit did not support the information we received from the manager before the site visit, which stated there is a ‘robust pre-admission assessment’. This demonstrated that the impact of inadequate assessment paying little attention to the whole person and their daily routines may results in people not receiving the quality of care and shows inconsistency with the Home’s policies and procedures. Gwendolen Lodge is not registered to provide intermediate care. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are met though not through Personalised Care Planning and staff do not have detailed information and regular training. EVIDENCE: We looked at the care plans of four people living at Gwendolen Lodge. We found the care plans were basic and reflective of the information gathered from the assessment of needs. The care plans were not ‘person centred’ that showed people’s personal routines and preference were either not known or not met and did not guide staff in how to deliver and provide the care that suited the person. This may have a negative outcome for people living at the Home, whose daily routines and preferences are not known. We found the care plans were held in individual care files, along with review meetings carried out by the social workers and the health care visit reports Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 13 whilst staff looked at the daily reporting folder several times a day. Information we received from the manager before the site visit stated, “individual care plans are linked with risk assessment and have intensive assessment tools for the prevention of pressure sores”. We did see risk assessments in place for moving and handling and managing pressure sores but the information in the care plans was limited and did not show how people’s individual care and support needs were met with measures to ensure their safety, other than the need for two carers or the use of a hoist. We saw staff did not refer to the care plans. We spoke with two care staff who said they “know the people living at the Home, their individual care needs, routines and were told about changes during handover meetings with the manager or the senior carers” and “it is difficult to know individual residents wishes due to their mental health or dementia, so we try to find out about people through their family or when staff generally speak with them”. Whilst staff know and are able to provide the care needs, it was difficult to confirm whether everyone living at the Home have their individual and lifestyle needs met as some people were not able to express themselves due to limited speech, dementia or other mental health difficulties. We observed the manager working alongside care staff throughout the day although there were three care staff on duty. We spoke with visitors on the day, who said “the Home was providing good care to their relative”. One visitor said they “use to go out for the day when she walked and talked but now I visit her everyday and we would have a cup of tea and biscuits”. The visitor said “she is always well dressed when I come to visit and I know staff have to do everything for her”. We saw people were well dressed which supported the comment we received from visitors that showed people’s dignity was respected. Surveys we received from people living at the Home, which were completed by a relative indicated their relative received the care and medical support needed. Three people we spoke with including one person we case tracked said “the staff do respect their dignity and privacy when helped with bathing or dressing”. We observed staff handing a tissue to a person at the dining table, so that they would be able to wipe their mouth after having a drink. Staff we spoke with described how they respect people and encourage them to do as much for themselves as possible. This showed people were being supported and staff recognised and understood the importance to encourage people to be as independent as possible. Care files we read showed record of visits from the District Nurse and the General Practitioner (GP), which demonstrated people have access to the appropriate health care support when required. We spoke to the GP who was visiting a very poorly person and receiving ‘end of life care’ in bed. The comments we received from the GP included: Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 14 “I have no concerns about the home. What’s good about the home is that it is a small home and has a stable core group of staff” “They do speak to relatives knowing they may have to make certain decisions” “The staff do recognise the needs of the clients, follow instructions such as monitoring and observations, know how to help people with complex mental health needs especially as people are living longer” “Has occasionally supported the home when hospital discharge team insist the person goes home without satisfying the manager” People we spoke with said they get their medication on time. We saw people were having their medication when they came for breakfast given by the manager at breakfast and lunchtime. The medication and medication records of four people living at the home were viewed and found to be in good order. The trained manager and senior carers give all medication only. The management and system for ordering, receiving and returning medication is good and auditable. The Home does not have controlled medication at present. We spoke with the manager about the storage of controlled medication and strongly advised that they seek advice from the Pharmacy to ensure that the existing storage for controlled medication conforms to the new legislation. The manager confirmed the controlled medication storage meets the regulation after advice was sought from the Pharmacist. We spoke with staff about the training they have to look after people living at the Home. Some said they had completed the NVQ level 2 in care although the training records showed no evidence of recent training completed by staff, specifically to work with older people and people with dementia or mental health needs. The manager told us six staff were attending first aid training. We asked staff about what training has been planned for them, but staff were not aware of the Yesterday, Today and Tomorrow (YTT) training planned as stated in the information we received from the manager before the site visit or the first aid training we were told during the site visit. We looked at the monthly visit records carried out by the Responsible Individual and showed a random sample of care files were checked and number of people spoken with during the visit, staff and checks on the environment. This shows internal audits are regularly carried out. The information we received from the manager before the site visit stated ‘there has been no improvements over the last 12 months as the overall standards in this area are very high’ and ‘plan to have YTT training in the next 12 months’. However, during the site visit we found care plans were basic, staff were not receiving regular training and updates, staff were not aware of the YTT training or the first aid training that would improve the quality of care people living at the Home can receive. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Gwendolen Lodge experience a lifestyle that suits them; having visitors, socialising and have a healthy choice of meals. EVIDENCE: On the day of the visit to Gwendolen Lodge, we saw people receiving visitors throughout the day. We saw people were making their way to the dining room for breakfast, which showed people woke up at times, that suited them. This showed there were no strict timings when people got up or had their meals and people had individual routines. We saw staff speaking with the people individually when helping them or trying to calm them down, when they were upset. Staff were polite and confident when they spoke with people. We saw the programme of activities displayed in reception that ranged from bingo to movement to music and karaoke. Throughout the day, we heard the local radio station playing mainly pop music and mainly heard staff singing along to songs. One person sitting in the dining room said, “they always have the music on but I don’t listen to it”. We spoke with one member of staff on Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 16 duty who said, “people like the music and they really enjoy the karaoke we have”. We spoke with the people living at the Home including those that were case tracked and some visitors. We received the following comments: “Like to watch ‘Heir Hunters’ in the morning after breakfast, it is fascinating to find out about people who have died and left their wealth behind”. “My sister visits me regularly and I do go out with her”; “Goes to . . . . . . day centre where we plays different games, talk with other people and likes to go out sometimes”; “There are many visitors to the home, some visiting their husbands, wife, parents and they come at all times of the day”. “I visit . . . . everyday, we use to go home for the day when she was well, go to the caravan for a week at a time when she was well”; “now I come here and we sit, chat and have a couple of biscuits and a cup of tea”; “I know staff do sit and spend time with . . . in between seeing other residents, they have to feed her and so she gets some quality time with the staff”; and “I’m quite happy with the care she gets”. The assessments carried out by the social worker indicated people’s faith. However, the care plans we read did not show whether people wanted to continue practicing their faith or how they were supported to do so. The manager confirmed that ‘all residents have a choice to practice their faith and they have a Jehovah witness, father of the Afro-Caribbean church visiting the home and a church service once a month in the Home where everyone is welcome’. Staff told us some people like to do art, and showed the paper artwork, themed ‘here comes summer’, to brighten up the home. The senior carer has developed ‘life histories’ folders for six people living at the Home. The life history folders we read showed the individual person’s interests, life, employment, which ranged from supporting a football club to working in the large hosiery company in Leicester. The senior carer said the folders are used to stimulate people’s mental and emotional wellbeing and help ease anxiety or agitation. This was a good example of how staff support people with dementia and mental illness in a positive way. We spoke with the chef who said they find out the dietary needs of a new person when they move to the Home. At present, special meals are provided to a few people, such as diabetic meals and soft diets for people who find it hard to chew. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 17 The majority of people we spoke with and a visitor said they liked the meals, having a choice of lamb hotpot or corn beef. The meals are served at the dining table individually, which are formally laid out with tablecloth and cutlery that created a homely feel. We observed a staff member assisting two people with their meals, individually, which showed people’s dignity was respected. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Gwendolen Lodge can raise concerns with staff, and can be confident that their issues will be addressed. EVIDENCE: Gwendolen Lodge has a complaints procedure, which is displayed within the Home, it is available in larger print and the manager would look at the possibility of producing it in other languages, if required. Alongside the complaints procedure is information about Advocacy services, which includes the contact details, should people living at the Home, wish for an independent person to act on their behalf. We looked at the Complaint Book and the log of concerns, which stated the Home had received no complaints or concerns. This was consistent with the information we received from the manager before the site visit. However, we found two letters from the local authority expressing concerns, they related to a safeguarding matter of a person living at the Home. The manager admitted she forgot to record this, in the information sent to us. The manager recalled the issue, conversations and visits by the social worker but was unable to demonstrate how these were concluded. The manager accepted that she needs to improve the recording of information relating to people living at the Home. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 19 We received no concerns or complaints about the Home. We asked three people living at the Home if they received information about making a complaint. Not everyone could recall this but said they “would tell their relative if there was a problem”. We spoke with a visitor, who was confident that any concerns raised would be addressed quickly. The survey from a person living at the Home was completed by a relative who indicated they ‘were aware of how to make a complaint’. The manager said people have family and friends that visit regularly who can raise issues and the contact details for Adovcacy service are displayed or they receive them through social worker’s review meetings. We spoke with three members of staff to ascertain their knowledge and understanding of safeguarding issues, which means promoting the well being of people using the service from abuse. All were aware of the policies and procedures and that issues of concerns should be reported to the person in charge and were confident to report poor or bad care practices using the Home’s ‘Whistle-Blowing’ policy. Although staff demonstrated their knowledge of their roles and responsibilities, there was no evidence of recent updates in ‘safeguarding’ training. The manager said, “Since there has been a change of ownership, we haven’t had training as the organisation has focused on the other care home”. Staff recruitment files and the training records viewed showed that all staff underwent recruitment checks in line with the law and all had undertaken training, which provides information on the types of abuse. This demonstrated that staff recruitment processes protects the people living at the Home. We spoke with the General Practitioner to see if they had received any concerns about the Home. They said they have not received any complaints and “I have no concerns about the home. What’s good about the home is that it is a small home and has a stable core group of staff”. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Gwendolen Lodge provides a clean, comfortable, homely and well-maintained environment for people who live there. EVIDENCE: Gwendolen Lodge is a situated in a residential area. The Home is easily accessible for people using walking aids or wheelchairs. Information about the Home and other publications related to care services is located at the entrance. There are several information boards detailing social and leisure activities and events planned at the home. There are a number of communal lounges and dining room on the ground. Two people said, “the two lounges and dining rooms at the front of the Home were recently decorated and had new carpets fitted”. Staff said they “now have a Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 21 new washing machine and dishwasher”. This supported the information we received from the manager before the site visit stating that the home is continuing a programme of decoration. The living and communal areas were clean, homely and welcoming and people living at the Home appeared to be very relaxed The layout of the Home and choice of lounges, promoted people to be independent, make choices and have the opportunity to live a lifestyle that suits them. We saw people using the bathrooms and toilets, which were located throughout the Home. People had shower and bathrooms with hoist and equipment that helped them with their physical needs and mobility, which ensured people’s safety. We looked at two people’s bedrooms; all of which were personalised with pictures and some had photographs of family and friends. The bedrooms are on the ground and first floor, which can be accessed by the stairs or the passenger lift. The representative for the responsible individual for the Home conducts the formal monthly visits to the Home and completes a check of the Home and reports of the finding. A report of the last monthly visit showed that the Home environment is audited and identifies the areas for improvement. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the Home have their needs met although they are placed at risk through lack of staff training and supervision to care and support the people using the service. EVIDENCE: People living at the Home and the visiting relatives said that there was always sufficient numbers of staff on duty: both domestic staff and care staff. We made observations of the interaction between the staff and the people living at the Home, and they appeared confident with the staff helping them. We looked at the staff rota for the day, which showed that three care staff, a senior and the manager were on duty on the day. We observed the manager helping the care staff to look after the people and give medication at meal times. The manager said staffing level is based on the need to meet the care needs of the people living at the home, ranging from people requiring some daily assistance to looking after a person requiring ‘end of life’ care. We spoke with two people living at the Home and visitors about their views on the staff; they all said the staff were helpful, confident and were polite at all Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 23 times. Comments received included: “you know the same faces but can’t always remember their names”. We viewed the records of three members of staff: care staff and senior carer. All the files contained a completed application form, protection of vulnerable adults (pova) first check, a criminal records bureau (CRB) check and two written references. This was consistent with the information received from the manager before the site visit. Staff told us that “prospective resident and their family often ask about the turnover of staff and I’m quite proud to say the newest member of staff has been working here for 5yrs”. The information we received from the manager before the site visit stated that the majority of staff have attained National Vocational Qualification in care level 2 and on the day of the site visit was told 100 of staff have attained NVQ level 2 and a senior carer has attained NVQ level 3. This showed Home has trained the staff to the national minimum standards. Staff we spoke with said they were appointed after the crb check and references were received. We looked at the training records of staff and noted that staff had not received training and updates on a regular basis. For example, staff files we checked showed staff had not received an update in training on moving and handling since 2006. We spoke with the manager regarding accessing training and she said “since the change of owners for the Home, training has not been available as before”. The manager said training has been organised for six staff to have first aid training and Yesterday, Today and Tomorrow (YTT) training in August yet staff we spoke with were not aware of this. Staff we spoke with said they have daily superivison and team meetings, although records in staff files showed staff had not received formal superivison since 2005 and 2006. This also demonstrated that staff had no formal opportunity to identify training needs and discuss any individual work issues. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Management at Gwendolen Lodge is not robust or consistent which places residents at risk from not having their health and wellbeing protected. EVIDENCE: The information we received from the manager before the site visit stated that they have attained the National Vocational Qualifications level 4; the Registered Manager’s Award; having updated herself in changes of procedures and legislation to incorporate in the day-to-day running of the Home and is ‘proud that the home runs very efficiently with an open door policy’. In response to ‘what the Home could improve’, it was stated that they “do not feel they can improve in this area, other than continue to gain knowledge and Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 25 updates on legislation and provide training across the board”. However, when we spoke about the development and training the manager has completed, she said she “had not attended any training since the home had a change of ownership”; had briefly met the area manager to look at staff training and improving the service. Other evidence we found during the site visit that was inconsistent with the information we received from the manager related to: the assessment of people’s care needs and care planning, information about the safeguarding, staff training and staff supervision. This showed the information we received before the site visit and findings during the site visit showed the management of the service was inconsistent. The manager said the staffing levels and responsibilities have been structured with staff being clear about their duties that benefits the people living at the Home. However, observations made during the site visit and records viewed showed that manager is actively involved in the day-to-day care, doing assessments of care needs and little time spent managing the service that ensures the wellbeing of people living at the Home. The manager said it was difficult to hold regular ‘residents meetings’ although she would speak to people individually and relatives, where the person is unable express themselves. We saw the contact details of Advocacy services but it was unclear whether the Advocacy service visited the Home or how people at the Home were supported to contact the service for assistance. The monthly visits carried out by the responsible individual take place. Records we read showed the last visit took place on 30.06.08 and involved speaking to four people living at the home and looking at the improvement to the home environment. This showed there is an internal system of monitoring the service. We read in the statement of purpose that the Home conducts annual quality assurance surveys. We read some of the survey questionnaires completed by the people living at the Home in July 2007. The manager said they try to address issues from the surveys individually, but was unable to show the overall results from the quality assurance, which measures the service provided. People living at the home either manage their own money, some with the support of their families, whilst others prefer to have their money held in safekeeping by the Home, for which records of the expenditure and balances are kept. We saw the records, which showed there was an audit of finance and required the signatures of two staff signature and the relative. Staff we spoke with said that they “have daily meetings and supervision with the manager to discuss any issues that affect the people living at the Home”. We read the Home’s policies on staffing, which stated, “staff supervision every 2 months”. However, staff files we looked at showed staff had not received any Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 26 formal supervision since August 2005/06. Staff training records seen showed staff had not received regular updates or specific training to meet the needs of the people living at the Home, such as dementia and mental health training. This demonstrated the service does not recognise the importance of training, staff supervision and team meetings that promotes consistency and skills that the staff team need to meet the needs of the people living at the Home. The records we looked at for the people living at the Home, the staff and the day-to-day management of the service, lacked detail. From the observations we made of the management of the Home, was that whilst most people have their needs met, the quality of the care provided could be improved through better management of the service and staff using the knowledge they have gained through training already undertaken and planned updates and training. The information received from the home before the site visit stated that the servicing and testing of equipment, gas and electrical testing are carried out at annually. Risk assessments are in place for the home, the people living at the Home and the staff. Gwendolen Lodge has a planned programme of maintenance and records of checks carried out are kept up to date. Gwendolen Lodge Residential Home DS0000066523.V368398.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 3 X 1 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 1 3 Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 24/08/08 2 OP7 15 (1) (2) 3 OP30 13 (5)(6) 18(1)(2) The provider must ensure that a assessments of care needs contains all the relevant information about the persons care needs, that includes their mental health needs, information about risks and their individual daily lifestyle to promote the health, safety and wellbeing of people living at the Home. The provider must ensure that 24/08/08 the care plans are person centred, reflective of the person’s care needs, daily routines and wishes, accessible to staff and that gives staff clear guidance on the level of support required that promotes people’s health and wellbeing. 24/08/08 The provider must ensure staff receive training such as safeguarding adult procedures, moving and handling, dementia and mental health awareness help provide care and support the needs of people living at the home that promotes their wellbeing and gives them a quality of life. DS0000066523.V368398.R01.S.doc Version 5.2 Gwendolen Lodge Residential Home Page 29 4 OP36 18(2) 5 OP37 17 The provider must ensure that staff receive regular supervision that ensures people receive care from staff that are competent that ensures people’s health and wellbeing. The provider must ensure accurate records are kept of people living at the Home, staff and the management of the service that that ensures people’s health and safety is protected. 24/08/08 24/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP33 Good Practice Recommendations To ensure music played in the Home is of the choice and preference of the people living there. To ensure quality assurance system used to seek the views of people living at the Home suits the individual needs, with consideration to people’s ability to communicate or express themselves due to their disability. Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gwendolen Lodge Residential Home DS0000066523.V368398.R01.S.doc Version 5.2 Page 31 - 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. 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