CARE HOMES FOR OLDER PEOPLE
Hilsea Lodge London Road Hilsea Portsmouth Hampshire PO2 OTX Lead Inspector
Richard Slimm Unannounced Inspection 11th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 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. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Hilsea Lodge Address London Road Hilsea Portsmouth Hampshire PO2 OTX 023 92 660152 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) www.portsmouthcc.gov.uk Portsmouth City Council Mrs Joan Patricia Tidd Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Seven service users in the category DE(E) may be accommodated, within one group living wing of the home 11th April 2005 Date of last inspection Brief Description of the Service: Hilsea Lodge provides accommodation and personal care for up to thirty-nine older persons and is owned and managed by Portsmouth City Council Social Services Department. The home has recently registered a condition of registration with the Commission for Social Care Inspection, to accommodate seven residents with dementia in a wing of the home. The commission has also been advised of longer term plans to develop the home into a specialist dementia care home. The home is single storey and is broadly divided into five units, all bedrooms are single occupancy. Each wing of the home has a dining and sitting area, and there is a large communal lounge in addition to this, and a specified smoking area. Service users have their meals in the dining rooms in the designated units, provided from the main kitchen by heated trollies. There is recreational space outside, with seats, a fishpond and fountain. Gardens surround the home and consist of courtyards with shrubs, trees and plants; there is a lawned area also. Service users who use frames and wheelchairs are able to access the garden via ramps. At the time of the inspection the Commission were advised of plans to develop the home into a provision solely accommodating older people with varying dregrees of dementia. This will call for further variations in the homes registration, and a clear plan of action stating how the transition to dementia care is to be managed, and existing residents consulted about the future of their home. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 11th October 2005 over 1 day. The day was spent visiting service users in their own rooms, and communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home, the inspector also joined residents’ for lunch. Fourteen residents were spoken to during the visit. The inspector checked records and other relevant documentation, interviewing care, kitchen and management staff. Two professional visitors were spoken to each of who made positive comments about their experience of services provided at the home. Other sources of information included the pre-inspection questionnaire provided by the home to the CSCI prior to the visit. What the service does well: What has improved since the last inspection?
The manager of the home has now registered with the CSCI, as required. The certificate of registration is now being prominently displayed at the home. The conditions of the home’s registration were being complied with as required. The registered persons had consulted with an officer of the environmental health team regarding the storage of COSSH chemicals next to fresh foodstuffs, and staff practices regarding the movement of soiled laundry near to food preparation areas. One resident has been re-assessed in line with the recommendations of the last report, and action had been taken to provide photographs of residents to aid recognition. Some action had been taken to develop systems that ensure that relevant staff records are kept at the home; development of systems that ensure residents monies and valuables are handled and banked appropriately, and actions taken to monitor activities provided for residents at the home. Action had been taken to record residents’ special dietary needs, and to ensure these records are kept in the kitchen area for staff reference. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 7 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 Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home does not record assessment information adequately. The home does not actively / adequately consult and involve residents in their own assessments and the development of their care plans. The home does not adequately assess short stay residents prior to admission. EVIDENCE: While the home has a system of assessment and care planning, these systems did not appear to have developed in line with the needs and wishes of residents and the national minimum standards (NMS), since the last inspection. A number of residents spoken to were not fully aware of the existence of their care plans or assessments. Consequently there was a lack of clarity for these people of what they could expect in the context of their daily support from staff, and other provisions of service. Assessment materials were variable, and while work had been done around generic risk assessment, there was a lack of information around residents’ wishes and/or interests. Life histories that should form an essential aspect of this area of assessment were incomplete in some cases. Management indicated that they were planning to
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 9 increase the activities at the home, but little work appeared to have been done to establish residents’ views in the areas of interests and wishes. However, on a more positive note a number of residents were appreciative of recent efforts to provide regular craft style activities at the home. Care planning systems did not appear to be well organised, and there appeared to be differing arrangements for care planning medical/healthcare needs and day to day needs in the home. In one case a care plan for a resident with a specific health care need did not have this issue identified on their plan of care where care staff would have access to immediately if needed. The home often relies on assessment materials from outside of the service, provided by care managers and other operational staff that have no direct knowledge of the service or it’s legal registration. This is mainly in the context of short stay residents, but still undesirable, from the perspective of ensuring appropriate admissions. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-10 The home does not fully record on care plans all aspects of resident health care needs. The home does not fully consult residents in the development of their care plans. Personal and some aspects of residents’ social care needs are known and understood by the staff team. The home promotes independence where possible, and supports residents to access appropriate health care support when needed. The home promotes the residents’ right to self – administer their own medications where appropriate. Residents are treated with respect by the staff of the home. EVIDENCE: The inspector was advised that systems of care planning are still under review. There are plans to introduce new systems of assessment and care planning to the home. Care plans in place continue to provide documented information to guide staff in meeting only certain, more practical needs of residents. Care plans and assessments of need could still be shared more with residents. Care planning systems did not appear to be very well organised, and systems were disjointed, leading to a separation of information about residents’ needs in such areas of social, recreational, medical, and daily support needs. Residents
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 11 said that staff members always treat them with respect, and some confirmed that they were happy with the staff working at the home. Staff members were observed to interact in a professional, sympathetic and polite manner with residents’. Assessment and care planning materials still need to be developed further for all residents including residents with age related mental health problems. One resident‘s care plan was incomplete, and failed to identify a specific medical problem that could potentially require PRN medications, this information being held on a separate sheet not attached to the plan of care. Care plans did not appear to provide clear, adequate guides for staff to ensure a consistent approach to meeting all of the residents’ needs. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 The home does not always consult formally and actively listen to the wishes of residents. The home promotes residents rights to stay in contact with family and loved ones, and to maintain links with people from outside of the home. The home could promote further resident choice and control over their lives. The home provides a full varied and nutritious diet. EVIDENCE: Two residents stated that the quality and amount of activity that interested them had improved recently by the provision of some craft based activities at the home. Resident assessment materials continue to fail to focus adequately on areas such as social and recreational interests. Other residents stated that they felt activities could be improved, and there were very few opportunities for outings from the home. Residents did not feel that they were consulted on a regular basis, and could not recall the last time they had a questionnaire about the home, and residents spoken to were unaware of planned changes to their home. A visiting community nurse and student were interviewed, and the nurse made positive comments about the home. Residents’ confirmed that they are free to contact family and friends whenever they chose, and visitors are welcomed at any reasonable time. Residents had freedom of movement
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 13 around the home, including those residents accommodated in the wing for more confused people, which is also staffed at all times. This indicated that restrictions in place at the time of the last inspection for more confused residents had been reduced. All residents spoken to indicated that they were happy with the variety, quantity and quality of food provided at the home. There is a need to monitor residents’ without naturally existing social/family networks in order to ensure that additional opportunities of support to journey out from the home is provided. It may also be useful to access advocacy for these residents, external to the home. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 Not assessed – see previous report EVIDENCE: Not assessed – see previous report Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 The home provides a safe valuing environment for residents. The home was cleaned to a good standard. The home needs to monitor staff practices to ensure cross infection risks are minimised, by ensuring that doors from the kitchen and the laundry into the shared corridor are kept closed. The home does not consider the needs and wishes of residents that are non-smokers. EVIDENCE: The home provides separate domestic staff who work hard to keep the home clean and tidy. The home was well presented, maintained and decorated to a good standard. There continues to be a need to ensure that staff are vigilant when taking soiled laundry past the kitchen/food store area, to ensure that all doors are closed to reduce risk of cross infection. The doors to the laundry and the kitchen were both open at the time the inspector checked this area of the home. Residents confirmed that they liked the colour schemes around the home and the way their individual rooms had been decorated. Residents were appreciative of the efforts made by care, kitchen and domestic staff. The site
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 16 of the smoking area in the centre of the home should be reviewed, in consultation with all residents. Consideration should be given to a more appropriate area where non-smoking residents do not have to put up with the smell of smoke in their communal lounge area. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-28-29-30 Staffing levels at the time of the visit were in accordance with guidance. The home provides staff with some training and development opportunities. The home does not have sufficient staff trained in first aid. The home was unable to evidence safe staff recruitment practices. Staff are not deployed to cover the five wings of the home adequately. Care staff cover to the five wings of the home is in need of review. EVIDENCE: The inspector was assured that the PCC human resources department undertake all checks on staff necessary to protect residents. A staff member from PCC is currently working across all seven PCC care homes and other registered services to ensure that staff records that need to be kept on the premises of the registered service, are collated and appropriately stored in order to ensure these records are always available for inspection. The requirement from the previous report will be repeated, as this work had not been completed at the time of the inspection. The staff roster indicated that the home was providing adequate staffing numbers for the 33 residents accommodated and the declared levels of dependency for the week of the inspection. However, it would appear that staffing deployment is in need of review. As the inspector noted that for a one-hour period during the visit, there were only 3 care staff members to cover the 5 wings of the home. The home continues providing opportunities for staff to be trained to NVQ 2. Other training opportunities are provided to ensure that baseline training is given to staff in such areas as food hygiene, manual handling and moving, fire training
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 18 and health and safety. However, there were not sufficient staff members trained in first aid to provide 24 hour cover at the home. Residents’ made positive comments about the staff team and were found to be appreciative of their efforts. Staff members were observed interacting well with residents during the visit. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33-35-38 The home needs to improve consultation with residents. Residents are not always fully consulted about the daily running, or the future development of services to be provided at their home. The registered persons fail to comply with their legal responsibilities when handling residents’ personal monies. The home does not fully promote the health and safety of staff and residents, in the areas of cross infection and first aid trained staff. The responsible individual is arranging monthly visits to take place, and a report of visits provided, as required. The home complies with conditions of registration. EVIDENCE: A number residents’ interviewed felt they could be consulted more in the daily running of their home. The homes’ manager is now registered with the CSCI. The certificate of registration is prominently displayed. The registered persons still need to implement appropriate arrangements for any residents’ money deposited with the home for safe - keeping. Resident consultation needs to be
Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 20 increased about the running of the home, and the homes’ ongoing development, including planned changes to the registered category of resident. The monthly visit from a representative of the registered body took place in on the day of the visit. There are insufficient staff members trained in first aid. The doors to the kitchen area and the laundry area had been left open onto the shared corridor. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 x 18 x 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 2 X X 2 Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP3 Regulation 14-15 Requirement The registered persons must ensure that assessments are recorded fully. Assessments should be carried out with the full involvement of the resident wherever possible. Care plans must be developed that take account of the needs of all residents including confused residents, and identify clearly their specialist needs and the support to be provided on a daily basis by staff. Care plans must ensure that quality of life issues are addressed as well as practical support needs. Aspects of this requirement are repeated from the last inspection report. The registered person must make arrangements to ensure that care staff are deployed across the 24 hour day in sufficient numbers to provide adequate cover to all 5 wings of the care home. The home must keep records relevant to the recruitment process for staff as identified in Schedule 2. These records must be available for inspection in the
DS0000044077.V249863.R01.S.doc Timescale for action 01/12/05 2 OP27 18 01/12/05 3 OP29 Schedule 4– 17 (2) 01/12/05 Hilsea Lodge Version 5.0 Page 23 4 OP35 12-20 5 OP38OP26 12-13 home. Aspects of this requirement are repeated from the last inspection report. The home must not pay money into a bank account on behalf of a resident unless that account is in the name of the individual resident concerned. Aspects of this requirement are repeated from the last inspection report. The home must ensure that staff practices when moving soiled laundry past the rear kitchen door into the laundry area is monitored in order to reduce risk of cross infection. Doors to the shared corridor must be kept closed at all times. Aspects of this requirement are repeated from the last inspection report. 31/12/05 07/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33OP14 Good Practice Recommendations It is important that the registered persons consult fully with current residents with regard to the future plans for the home, changes to the statement of purpose and conditions of registration. Hilsea Lodge DS0000044077.V249863.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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