Inspection on 24/09/07 for Ladyville Lodge Nursing Home

This inspection was carried out on 24th September 2007.

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

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

Other inspections for this house

Ladyville Lodge Nursing Home 29/09/06

Ladyville Lodge Nursing Home 16/11/05

Ladyville Lodge Nursing Home 23/09/05

Ladyville Lodge Nursing Home 21/03/05

Ladyville Lodge Nursing Home 02/02/05

Ladyville Lodge Nursing Home 27/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ladyville Lodge Nursing Home Fen Lane North Ockendon Upminster Essex RM14 3PR Lead Inspector Harbinder Ghir Unannounced Inspection 24th September 2007 9:35 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 Ladyville Lodge Nursing Home DS0000015597.V351533.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. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ladyville Lodge Nursing Home Address Fen Lane North Ockendon Upminster Essex RM14 3PR 01708 855 982 01708 854 899 ladyville.lodge@ashbourne-homes.co.uk 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) Ashbourne Homes Limited Alison Jane Graham Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 26 BEDS FOR ELDERLY INFIRM 18 BEDS FOR RESIDENTIAL CARE MINIMUM STAFFING NOTICE Date of last inspection 29th September 2006 Brief Description of the Service: Ladyville Lodge is a 44- place care home for older people. Twenty-six of the beds are registered for nursing care and 18 for residential. Southern Cross Healthcare Limited runs the home. The home consists of a large, two storey house, with a large purpose built annex, set in spacious grounds. All bedrooms are spacious, airy and bright. They all have hand basins, TV points and a call system. There is a passenger lift in place. There are two lounges and a dining room overlooking the garden with disabled access. There are car-parking facilities to the front of the property for staff and visitors. The home is situated in a rural part of Upminster and is not convenient to access by public transport. It is close to the M25, A127 and the A12 and easily accessible by car. The range of fees currently charged by the service for residential care can range from £416 to £520 and for nursing care can range from £520 to £650, further information regarding fees can be obtained directly from the home. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 24th September between 9.35am and 4.00pm. The manager of the home was available throughout the day of the inspection. During the inspection the inspector was able to talk to residents residing at the home, staff and relatives who were visiting. The tissue viability nurse was also spoken to, comments are included in the report. The London Borough of Havering who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. They did not provide any feedback to be included at this inspection. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? At the last key inspection six requirements were made in the following areas; safekeeping of medication, correct medication recording; two areas relating to redecorating and repair of identified areas in the home; staff supervision; to achieve a ratio of 50 NVQ qualified staff; and the manager to register with the Commission for Social Care Inspection. At this inspection two of these requirements had been complied with, for the safekeeping of medication, and for the manager in post at the time of the last inspection to register with the Commission for Social Care Inspection. I was Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 6 pleased to see that two of these requirements had been complied with at this inspection although the outstanding requirements remain a concern. This is again referred to in the relevant sections of this report and further requirements made. 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. The summary of this inspection report can be made available in other formats on request. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 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 Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5, 6 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst pre admission assessments are undertaken, the service does not complete these comprehensively, to ensure they can fully meet the needs of residents. Trial visits are offered to all prospective residents, to ensure residents have the information on the services and facilities provided at the home. Residents and their representatives cannot be ensured that the home they enter will meet their needs. The service does not provide intermediate care. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 9 EVIDENCE: Three care plan files were closely examined, which all included a pre-admission assessment. The service had obtained copies of the assessments carried out through the care management arrangements for residents. Assessment viewed included the spiritual, communication, mobility, and social needs of individuals. However, the pre-admission process was service led and was not always personalised with consideration of the individual needs, concerns and anxieties of the prospective resident and their families and some assessments were not completed in full. One pre-admission assessment was not completed in full and very briefly identified the care needs of an individual who had been diagnosed with Parkinson’s disease. The inspector found it very concerning when viewing a second assessment that the mental health needs of an individual had not been identified. The social work assessment and information from the family highlighted that the individual was confused and had been found wandering when at home. The pre-admission assessment did not include any of this information. A letter received 13 days after the admission to the home by a Consultant Physician and Geriatrician further stated that his “Impression is that this lady is suffering from dementia.” The service does not have a registration to provide dementia care, and therefore must ensure they admit individuals who fall into their correct registration categories, as they cannot ensure they can meet the needs of those with dementia. It will be Requirement 1 that individuals are not admitted to the home unless a pre-admission assessment is completed in full, and the process of admission ensures that the service is able to fully meet the needs of prospective residents. Trial visits are offered to all prospective residents and their relatives and representatives are also invited to visit the home. A resident spoken to stated “I visited the home for a day, and we decided that this was the one.” Another resident stated “I was in hospital and could not visit, but my daughter and son visited the home before I moved in. Residents are offered the opportunity to move in on a trial basis to ensure they are happy with care and facilities provided by the service. The service does not provide intermediate care. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans. Care plans are detailed, but need to ensure all the information in the documents is consistently implemented in the day-to-day care of residents and is correct to ensure the needs of residents can be met effectively. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the management of medication, which may result in unsafe practices. Residents may not be always treated with respect, as their needs and wishes are not ascertained and recorded. All residents cannot be assured, that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 11 Three care plans were closely examined and case tracked. Care plans were comprehensive, and clearly set out residents’ health, personal and social care needs. Care plans covered individuals’ medical history, their environmental needs, communication, and mental states. On one care plan, information was clearly recorded on how to meet the communication needs of a resident who was very hard of hearing. The care plan stated “X is profoundly deaf so needs all conversation written on his paper pad. Please communicate by writing on a pad in big black letters. Other information included whether individuals required the assistance of one or two carers and the personal care tasks the resident could complete independently. Information was also found specific to the religious, cultural and social care needs of residents and how the service was to meet these. However, not all care plans viewed were consistently followed and there was little evidence that care plans were a live working document which staff read and implemented. A care plan viewed identified a resident’s high risk of falls and her need for close supervision by staff, to clear her way, making sure there were no tripping and slipping hazards and for her to wear correct fitting footwear. During the inspection the lady was seen without wearing any footwear and on one recent occasion she had two falls in one day. She was consistently seen wandering around the home without the use of a Zimmer frame. Another resident was also found to be sitting in urine due to not wearing incontinent pads. The resident and family informed the inspector that the incontinent pads had been stopped following a assessment by Havering Primary Care Trust and the family received a telephone call on Friday evening by the home to inform them that Mrs X would go to bed without a pad on. Mrs X’s daughter informed the member of staff that her mother was incontinent at night and informed that the member of staff told her that she did not know about this. The lady was left without incontinent pads over the weekend and it was only on Monday when the family came to visit that they realised that their mother had been sitting in urine. The resident was very distressed and stated “I feel very embarrassed.” The service had made no attempt to contact the health care service involved to request a re-assessment and to inform them of the resident’s needs or provide pads themselves on a temporary basis in order to meet the needs of the resident and to avoid the distress caused. This act of omission is neglectful and may be considered as abusive practice. Care plans must be followed and provide consistent and accurate information on the identified needs of residents and ensure these are being met correctly by the service. This is Requirement 2. Health records indicated other health professionals such as the district nurse, optical, dental and chiropody services saw residents. The tissue viability nurse was also spoken to, who informed that she had no concerns regarding the service. However, due to the incident stated above it is Requirement 3 that Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 12 health care professionals are contacted promptly to ensure the health care needs of residents are met. The documentation/ health records relating to pressure care areas; management of diabetes, falls were examined. Routine pressure care area risk assessments, dependency level, nutritional assessments were completed and residents underwent monthly weight checks. The records for these were found to be detailed and were adequately maintained. There was evidence that care plans were being reviewed at least monthly. Risk assessments are routinely undertaken for all residents around nutrition, manual handling, continence, falls and pressure care areas and were reviewed on a monthly basis. Assessments were completed but these tended to be a paper exercise and of limited practical use, as risk assessments were not always reviewed and updated according to the changing needs of residents. For example a resident who was at risk of falls had fallen twice in one day. Her risk assessment did identify strategies and measures to reduce the risks posed to her but evidence was found as discussed earlier in the report that her care plan was not being followed. Her risk assessment had not been reviewed or updated following her falls to ensure staff were aware of the risks posed to her and find other ways and strategies to minimise the risks. It is Requirement 4 that risk assessment are updated to reflect the changing needs and current objectives for health and personal care are actioned. The accident and incident book was reviewed. Accidents were recorded in full, and residents received follow up checks to ensure there were no further health associated risks, and follow up sheets were completed, which were counter signed by the registered manager. The Commission for Social Care Inspection in line with Regulation 37 has been informed of these accidents. Three care plans viewed did not contain information on the end of life wishes for residents, to ensure that at the time of their death, staff will treat residents and their family and their representatives with sensitivity and respect. A requirement to these findings will be stated as Requirement 5. At the last inspection a recommendation was made that where appropriate residents were to have an ‘end of life’ care plan, which would give information on the involvement of relatives in their final hours, and what they would like to happen. This has not been met and will be repeated at this inspection. There are policies and procedures for the handling and recording of medicines. An audit was undertaken of the management of medicine within the home and a random sample of Medication Administration Records (MAR) charts were examined. The following issues were discussed with the manager of the home. During an audit trial of the medication for one resident, the Medicine Administration Records identified that 29 tablets had been administered. On counting the medication only 25 tablets had been administered. DS0000015597.V351533.R01.S.doc Version 5.2 Page 13 Ladyville Lodge Nursing Home - On viewing the controlled drugs register, a second signed entry for the witness of administration was missing. It is Requirement 6 that medication practices are reviewed to ensure the safety of residents. Residents and relatives gave a mixed response in regards to the care they receive at the home. One resident spoken to stated, “Staff are friendly, they are ok.” Another resident stated, “They are lovely here.” However, other comments made by residents in regards to the care they receive and the evidence included in this report suggests that staff in the home treat people who use the service in a way, which does not always respect their privacy or dignity. Please see the further evidence under Staffing. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a varied programme of activities available and residents are given the opportunity to take part in a variety of activities, which meet their recreational needs. There is a choice of meals in the home, which meet the needs and choices of residents. Visiting times are flexible and people are made to feel welcome in the home, so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: The service employs a full time activities co-ordinator, to ensure activities meet the needs of people living at the home. The activities programme, which is devised for each month, was seen displayed around the home. Activities Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 15 included chair aerobics, sing-longs, games, bingo mornings and quizzes. Entertainers were invited to the home and mobile clothes and shoe shops were invited to come to the home at least twice year. Residents had recently been out to Southend. Residents were also regularly taken around the grounds for a walk and during the inspection and two residents were seen to be sitting outside in the grounds relaxing. The manager informed that they also liked having their meals out there. For those residents who are bed bound or are unable to participate in group activities, one to one sessions were provided by the co-ordinator where she would chat, sing a song, read books with residents and provide activities of their choice. Daily case recording sheets evidenced this. The home has also organised garden parties and barbecues of which photos are displayed of in the reception area. There is also a monthly library service provided to residents. Each resident’s spiritual and religious needs were identified on their care plan, and a monthly church service was provided to residents who wished to attend at the home. People who use the service have the opportunity to develop and maintain important personal and family relationships. A resident spoken to informed that “I moved to the home with my wife and the home ensured that we were given a room a together.” Relatives and family were seen to visit throughout the day and were made to feel welcomed by the staff at the home. A resident spoken to informed “My family visits anytime.” Daily routines are flexible within the home. Each care plan viewed identified the time each individual likes to go to bed and get up. However, staffing levels could not ensure that residents’ preferences of daily routines would be met. This will be discussed in more detail under standard 27 of the report. The inspector sat with residents during lunch. Care staff were observed to be sensitive to the needs of those residents who found it difficult to eat and gave assistance with feeding. They were aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Condiments were placed on each table and residents were offered a choice of drinks by staff. There was a menu selection of two hot meals, and the meals were well presented and looked appetising. The menu was seen which included a variety of fresh fruits and vegetables and a choice of two meals at lunchtime and at suppertime and snacks throughout the day. Records were seen of residents’ choices of meals for each day that they had chosen when consulted with by carers. On speaking to one resident he stated, “We get a full breakfast here, I’ve just had a bacon sandwich. The chef has also been very helpful in providing the right foods for my wife, as she has had to have a liquidised diet.” Another resident stated, “The meals are good, they are good portions.” Residents were given the choice of having their meals in their rooms. One resident was seen having her breakfast in her room. She Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 16 stated “I always have my breakfast in my room on a Monday morning, the girls bring it up to me.” On speaking to the chef, he was able to demonstrate his knowledge of those residents requiring special diets, for example diabetic and pureed diets. A tour of the kitchen was taken, which was kept clean and in good working order by the chef. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that their views are always listened to and acted on. The service needs to broaden its way of recording complaints to include concerns to ensure any dissatisfaction is recorded and acted upon regardless of source. Adult Protection policies, procedures are in place, but up to date staff training has not been provided to all staff in adult protection and does not ensure the protection of residents’ from abuse EVIDENCE: The service has a complaints procedure that meets the National Minimum Standards and Regulations. The procedure includes timescales within which a complaint will be investigated and was displayed on a notice board in the reception area. The complaints file was viewed. One written complaint has been received this year, which was responded to within the specified timescales and was responded to appropriately. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 18 However, not all residents felt their complaints were listened too. One resident spoken to stated that he has made several verbal complaints at the home, and stated “I spoke to the manager about it, who never did anything about it.” On case tracking the complaint to the complaints file, no record was found of the complaint. All complaints about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to ensure their complaints will be listened to, taken seriously and acted upon. This will stated as Requirement 7. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. The Commission for Social Care Inspection has been alerted by the service and by the London Borough of Havering of a Safeguarding Adult Protection investigation, which is in the process of being investigated. It is also concerning to find that not all staff have attended training in Safeguarding Adults. The manager informed that the deputy manager administers all training in Safeguarding Adults. On case tracking their file, no records were found to evidence they had the qualifications to administer this training. The service has a current Safeguarding Adults investigation pending and therefore must ensure all staff receive training in this area by a qualified practitioner, to ensure residents are protected from harm at all times. This will be stated as Requirement 8. The attitude of some staff, and their failure to attend to the needs of residents is described in the section under staffing. The Commission is gravely concerned that the poor standard of practice identified does not ensure that residents are protected from abuse. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home was satisfactory but needed redecorating in some parts of the home. Residents may be at risk due to infection control issues. EVIDENCE: The home provides a physical environment that meets the specific needs of the people who live there. The home has two main lounges, a dining room, which is homely, and adequately furnished. A number of residents’ bedrooms were seen. Bedrooms were personalised by furniture residents had brought with Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 20 them when moving to the home and by personal family photographs, pictures, televisions and radios. During a tour, it was identified that hallways and some bedrooms needed to be redecorated as the paintwork and walls were scuffed in places. Some bedroom furniture is showing signs of wear; chipped bedside cabinets, which need to be replaced. The home has a programme to improve the decoration fixtures and fittings. The chairs in the lounge have all been replaced and there is a rolling programme to change the carpets in 14 of the residents bedrooms. However, the home must be maintained to ensure the safety and comfort of the residents. This is a repeated requirement and will be stated as Requirement 9. On viewing one resident’s bedroom and their en-suite bathroom, the bathroom smelt of urine and the floor was sticky as result of not being cleaned. The resident informed that staff empty his wife’s commode into the toilet and leave spillage all over the floor, which is not cleaned thoroughly. He also informed that his wife’s bed pan is not cleaned after being emptied which he has complained about, and stated the manager in post at the time failed to take his concerns on board. The resident informed that he has been very upset by the cleaning practices at the home. On entering other residents’ bedrooms, some rooms were malodorous, and carpets had not been cleaned. On viewing the regular upkeep of fridge, freezer and food temperatures, these had not been completed when the chef was not on duty. To ensure the risk of infection is reduced and adequate facilities for the storage of food, fridge; freezer and food temperatures must be regularly taken. It is Requirement 10 that the registered person must make suitable arrangement to prevent infection and the spread of infection by keeping the home clean and hygienic and unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff does not meet residents’ needs effectively. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is not provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. EVIDENCE: Staffing levels do not meet the needs of the people using the service, with the health and welfare of people being adversely affected. The service does not recognise the importance of individualised person centred support and sees the personal care needs as the limit of support provided. During the inspection 2 members of staff were on duty on the residential unit, providing care and support to 17 residents. On the nursing unit 6 members of staff were providing Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 22 care to 23 residents with a high level of complex nursing care needs. The majority of these residents are bed bound. On visiting one resident in her bedroom, at 10.05am she was still waiting to be washed and dressed. Her husband informed that she likes to be up and dressed at 9am. Another resident was still waiting for her personal care to be attended to at 1.30pm. A member of staff spoken to highlighted her concerns regarding the low staffing levels at the home and stated “We have been short staffed for about 4 to 5 months now and we are constantly rushed.” On arrival of the inspector the emergency call bell was consistently heard to be sounding. It was timed to be sounding for over 5 minutes from a resident’s bedroom. It was only when the inspector approached a member of staff and alerted her about the call bell, did she go in and see the resident. On speaking to residents about the call bell, one resident stated, “Just because the call bell has stopped doesn’t mean staff are attending to that individual as they go in and switch it off and then leave.” Another resident stated “I have rang the bell at night, as I need assistance to use the commode, but they never come.” The Commission for Social Care Inspection is gravely concerned at the staffing levels at the home, and the services inadequacy in providing person centred care and meeting the needs of individuals the way they prefer. The service must review and increase its staffing levels as a matter of urgency. This will be stated as Requirement 11. It was concerning to find that some residents expressed concern at staff attitudes and the way they are treated by staff at the home. One resident spoken to stated, “One fault with most staff, is they talk amongst themselves when attending to personal care and they just take over.” A relative informed “My mother has told me on occasions that staff are a bit rough with her and that she is treated like a piece of meat.” On the morning of the inspection, it was identified that a member of staff had walked out due to other staff members’ attitudes. She informed that she called for two other members of staff but could not find them and later found them hiding. She stated, “Members of staff hide in residents’ bedrooms and go in there to talk on their mobile phones”. This practice is unacceptable and does not value residents’ rights to privacy and dignity. It causes the Commission for Social Care Inspection grave concern at the staffing complement, practices and attitudes of staff. The service must review its staffing complement and ensure training is provided to all members of staff to ensure they can provide care, which is person, centred and care which promotes the privacy and dignity of people who use the service. A training rota has been devised which identified that the service has provided training to staff in Fire Safety, Fire Drills, Food Hygiene, Moving and Handling, C.O.S.H.H, Health and Safety, Infection Control and Nutrition. However, not all staff had received training in all of these areas. It is Requirement 12 that staff receive training appropriate to the work they are to perform, to ensure they Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 23 are quipped with the competences and skills to meet the needs of people who use the service. The service has not achieved a 50 ratio of NVQ qualified staff complement. This was a repeated requirement at the last inspection and will be repeated again at this inspection as Requirement 13. Failure to comply with repeated requirements will result in the Commission for Social Care Inspection considering enforcement action. Ladyville Lodge Nursing Home DS0000015597.V351533.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, 38 People using the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users cannot be confident that the staff team who care for them benefit from regular supervision. Service users’ financial interests are safeguarded. The systems for service user consultation must also include views from all residents and stakeholders to ensure the home is run in the best interests of residents. The welfare of staff and residents is not always promoted by the home’s completion of health and safety documentation. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has been in post since the 10th September 2007. She is a qualified Nurse and has previously worked in a residential setting in the role of a deputy manager. The service has not had a consistent manager in post in the last year, which has had an adverse affect on staff. Staff morale is low, and staff feel devalued and overworked. One member of staff stated “The changes of manager has made things hectic and it has had an effect on staff, we haven’t had regular staff meetings, there hasn’t been a lot of training and we are short staffed. No one listens to us.” The manager informed that she is aware of the issues at the home and is in the process of the dealing with them. She has arranged a full staff meeting in a week’s time. The new manager must submit an application to the Commission and must be registered as required by the Care Homes Regulations 2001 within the next six months (24th February 2008). This is Requirement 14. There is an annual quality assurance programme. Residents’ views on the running of the home quality of services provided at the home are acquired through residents meetings; families and representatives are also invited to attend. However, the views of residents are only going to be attained from those who attend and have some representations. Those residents who may be bed bound or have no representation are not going to be included in the quality assurance programme. Completed surveys were seen which had been sent out to families, relatives and representatives but other stakeholders in contact with the home had not been included. In the surveys seen, where there was dissatisfaction with the service, no evidence was seen of how the service intended to action those dissatisfactions and the results had not been communicated to residents or relatives. The service must develop effective quality assurance and quality-monitoring systems based on seeking the views of all of its residents, relatives and any other stakeholders in contact with the service. It must demonstrate how it has actioned any dissatisfactions, and must communicate the results back to people who use the service, to ensure the home is run in their best interests. This will be stated as Requirement 15. Services users’ records of finances were viewed and the inspector tracked the amount of money the service held for three service users. All amounts were accounted correctly and were in order. The latest supervision records were viewed for all staff. A supervision programme is in place but staff files evidenced that staff members are not supervised regularly (at least six times a year). It is Requirement 16 staff are supervised regularly, to ensure staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. This requirement has not been met and will be repeated at this inspection. Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 26 Health and Safety records were inspected. The gas and safety certificate, gas safety inspection, fire system and emergency lights check and a controlled waste certificate were all in good order and appropriately completed. However, on viewing the maintenance books for wheelchair and bed rail and profile bed checks the information had not been appropriately recorded. Dates of checks were missing for some days and the information recorded was difficult to understand, as the documentation had not been completed in full. All documentation in relation to any health and safety checks must be completed in full, which can be case tracked to ensure the health, safety and welfare of service users and staff are promoted and protected. This will be stated as Requirement 17. On viewing the accident and incident record book, there was evidence of a high number of accidents with in the home. From the 21/09/07 to 24/09/07, 9 accidents had been recorded over the three-day period, 7 of which were falls. As previously discussed under staffing this might be due to staff not having received sufficient or recent training to enable them to work safely and be aware of any policies and procedures that do exist. One member of staff spoken to stated, “I have to stop staff from using lifting equipment because they have not had the training”. These practices do not ensure that people who use the service are adequately protected or are safe in this home. Regulation 26 visits reports were viewed. The last report found completed this year was dated for August 2007. No other reports for the remaining year were found. It is imperative that Regulation 26 visits must be completed on monthly basis, due to the high level of concerns raised at this inspection, and to provide evidence of how the registered provider is identifying poor and possibly abusive practice and to provide a measure of good practice and ensure residents are protected. This will be stated as Requirement 18. Ladyville Lodge Nursing Home DS0000015597.V351533.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 X X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) (C) Requirement The registered persons must ensure that service users’ have a comprehensive pre-admission assessment of need before they are admitted to the home. The registered persons must ensure that all service users have comprehensive care plans in place that detail the actions required of staff to meet service users’ needs and that there is evidence of the plans being implemented in day to day care. The registered persons must ensure that health care professionals are contacted promptly to ensure the health care needs of residents are met and promoted. The registered persons must ensure that risk assessments are updated to reflect the changing needs and current objectives for health and personal care are actioned. The registered persons must DS0000015597.V351533.R01.S.doc Timescale for action 31/12/07 2 OP7 15 31/12/07 3 OP8 12 (1) (a) (3) 30/11/07 4 OP8 12 (1) (a) 31/12/07 5 OP11 12, 15 31/12/07 Version 5.2 Page 29 Ladyville Lodge Nursing Home ensure that residents’ wishes concerning death are identified and recorded. 6 OP9 13 (2) The registered persons must ensure that medication practices are reviewed to ensure the safety of residents. 31/12/07 7 OP16 22 (3) 8 OP18 13 18 (i) 23 16 9 OP19OP21 The registered persons must ensure that all complaints about the care of service users, regardless of source or how they are made, must be recorded and thoroughly investigated and responded to ensure their complaints will be listened to, taken seriously and acted upon. (6) The registered persons must (1) (c ) ensure a qualified practitioner adequately trains staff in Safeguarding Adults. (b) (d) The registered persons must 1) (c ) ensure that the home is in a good state of repair internally and that it is reasonably decorated. Repeated Requirement. Previous timescale of 31/01/07 not met. The registered person must make suitable arrangements to prevent infection and the spread of infection by keeping the home clean and hygienic and unnecessary risks to the health and safety of residents are identified and so far as possible eliminated. 31/12/07 31/12/07 31/12/07 10 OP19 OP26 13 (3) 16 (j) (k) 31/12/07 11 OP27 18 (1) (a) 12 OP30 The registered persons must ensure adequate numbers of staff must be on duty to ensure the health and welfare needs of all residents are met. 18 (1) (c ) The registered persons must DS0000015597.V351533.R01.S.doc 31/12/07 31/12/07 Page 30 Ladyville Lodge Nursing Home Version 5.2 (i) 13 OP30 28 ensure all members of staff receive training in person centred care and training appropriate to the work they perform to ensure they can meet the needs of service users effectively. The registered person to ensure a minimum ratio of 50 NVQ trained staff is achieved by 2005. Requirement repeated for the third time. The manager must submit an application to the Commission and must register as required by the Care Homes Regulations. The registered persons must ensure that a effective quality assurance and qualitymonitoring system is developed, based on seeking the views of its residents, relatives and any other stakeholders on contact with the service and must demonstrate how it has actioned any dissatisfactions and must communicate the results back to people who use the service, to ensure the home is run in their best interests. The registered person shall ensure that persons working at care home are appropriately supervised. In that: staff are supervised at least 6 times a year and receive a yearly appraisal. Requirement repeated for the third time. The registered persons must ensure all documentation in relation to any health and safety checks must be completed in full which can be case tracked to ensure the health, safety and welfare of service users and staff DS0000015597.V351533.R01.S.doc 31/12/07 14 OP31 8,9,10 24/02/08 15 OP33 24 31/12/07 16 OP36 18 (2) 31/12/07 17 OP38 13 (5) (4) (c) 17 31/12/07 Ladyville Lodge Nursing Home Version 5.2 Page 31 18 OP26 Schedule 4 26 are promoted and protected. The registered persons must ensure that Regulation 26 visits are completed on a monthly basis and any report made under the regulation is to be kept at the care home. 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP11 Good Practice Recommendations For each resident to have an ‘end of life care plan’ Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Ladyville Lodge Nursing Home DS0000015597.V351533.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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