Inspection on 24/07/06 for Lennox Wood

This inspection was carried out on 24th July 2006.

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

Lennox Wood 04/12/07

Lennox Wood 16/01/07

Lennox Wood 31/10/05

Lennox Wood 10/05/05

Lennox Wood 17/01/05

Lennox Wood 24/11/03

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

CARE HOMES FOR OLDER PEOPLE Lennox Wood Petham Green Gillingham Kent ME8 6SY Lead Inspector Sue McGrath Unannounced Inspection 24th and 27th July 2006 10:00 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 Lennox Wood DS0000028942.V305375.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. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lennox Wood Address Petham Green Gillingham Kent ME8 6SY 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) 01634 869880 01634 264187 www.kcht.org Kent Community Housing Trust Glynis Margaret Bingham Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Fifty (50) Older People with a Mental Infirmity 60 years of age and over. 31st October 2005 Date of last inspection Brief Description of the Service: Lennox Wood is purpose built on two floors with a basement that is used as separate offices and for training. There is a courtyard garden in the centre of the quadrangle building, which houses a sensory garden. The home is situated in a residential area close to local shops and amenities. There are local bus routes nearby. Gillingham and Chatham town centres are approximately 2 miles away where there are main line stations. The service has limited access to transport. The home has 46 single rooms and 2 shared rooms, none have en-suite facilities. To support care staff there are additional staff employed to undertake regular activities with service users. Lennox Wood DS0000028942.V305375.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 key inspection under the terms of the Care Standards Act 2000 and took place on the 24th and 27th July 2006. One inspector was in the home and the main focus of the inspection was on the progress of the home in meeting with requirements made at the last inspection, the general environment and the well being of the residents. During the inspection documentation and records were read, including care plans. A tour of the building was undertaken and many of the residents and some visiting family members/friends were spoken to. Time was also spent talking to staff and members of the management team. Some families who completed comment cards were contacted. The home cares for Residents with Dementia from the age of 60 years old. The Registered Manager was not available on the days of the inspection and had not been at the home for several months. An Acting Manager had recently been appointed. What the service does well: What has improved since the last inspection? What they could do better: Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 6 There were several areas of concern raised during this inspection. Issue in reordering medication and some procedures indicated that the home was not administering medication in line with the guidelines issues by the Royal Pharmaceutical Society of Great Britain and that residents could be put at risk. Some issues raised at the last inspection had not been addressed including work in the laundry area and new sinks and beds for the residents’ rooms. The care plans did not always give sufficient information to staff, however these were due to be replaced with new care plans that were being introduced across all of the organisations homes. The home’s call system was not adequate or safe due to the low number of handsets for staff to use. It was also noted that a high number of falls had occurred, manly at night. This indicates insufficient staff at night. Mandatory training had not been kept up to date. Poor practice concerning the disposal of clinical waste was also seen during the inspection. It was felt by the inspector that staff at the home had been left without a Manager for too long and this is reflected in the report below. Blurred lines of responsibility and accountability within the home added to these problems. The new Acting Manager had only been at the home for two weeks but was already having an impact and the future did look brighter. However some urgent issues have been raised and need to be dealt with as a matter of priority. Ten requirements and eleven recommendations have been made. An improvement plan will be required. 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. Lennox Wood DS0000028942.V305375.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 Lennox Wood DS0000028942.V305375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 The overall quality of this service is good. This judgement has been made from the evidence gathered both before and during this visit. Prospective residents are provided with the information they need to make an informed choice about moving into the home. Residents benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: The home’s Statement of Purpose and Service User Guide were viewed and provided comprehensive and detailed information about the service as required by regulations. Both documents were presented in a clear and concise format. Consideration should be given to include details of the current situation regarding the current Acting Manager. Copies of both documents were given to Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 9 residents prior to admission and were readily available via the manager. Each room had a copy of the homes Service User Guide. As seen during previous inspection, the last report was available on the residents’ notice board. Evidence seen in residents’ files confirmed that each resident was provided with a statement of terms and conditions. A relative or representative had signed the ones viewed. Evidence was also seen that each resident had a full needs assessment completed by a senior member of staff prior to admission to ensure all assessed needs could be met. The normal practice was to visit the prospective resident in their home or hospital setting to ensure the necessary information was current and appropriate. If the resident was admitted through Care Management then information gained from both assessments formed the basis of the care plans. Families were also encouraged to become involved in the care planning process. One visitor to the home confirmed this. The Acting Manager confirmed that trial visits were encouraged and these were an opportunity for the prospective resident and their family to identify how appropriate the home was from them in meeting their needs. The home does not provide intermediate care or nursing care. Lennox Wood DS0000028942.V305375.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The overall quality of this service is poor. This judgement has been made from the evidence gathered both before and during this visit. Some Residents are at risk due to poor care planning. Residents are not protected by the home’s policies and procedures for dealing with medicines. Residents are treated with respect and can be assured the home will handle the issue of illness and ageing sensitively. EVIDENCE: The Acting Manager stated that new care plans were currently being introduced by the organisation and that work had just started on their completion. Three of the existing care plans were viewed and were muddled and in some cases, poorly written. In some areas of care, issues had been highlighted, such as diabetic care, but instructions to staff were general rather than specific and this had meant that monitoring of the client had been haphazard. The home will be required to formulate a clear procedure for caring Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 11 for residents with diabetes and to give clear and precise instructions as to how their care is to be managed. It will need to identify who is to take responsibility for the management of the monitoring and how often this monitoring needs to take place. Foot care needs to be included. Some residents’ details were found later during the inspection but these should have been included in the individual’s care plan. One resident had suffered several falls during the last month. Although he had been seen by the Falls Co-ordinator, who had made some recommendations, these had not been followed through by the management team. Discussions with his wife had been recorded but little action had been actually taken. Hip protectors had not been used as recommended by the falls co-ordinator. The Acting Manager agreed to make this a high priority. Not all residents had a completed nutritional assessment in their care plans as mentioned in the last report. It was of some concern to the inspector that the care plans inspected were not as effective at this inspection as at the last. The Acting Manager confirmed that this should improve following the full introduction of the proposed care plans. It was noted during the inspection that several of the residents’ mouth care could be improved. It was also noted that very little mention of mouth care was seen in the care plans. This needs to improve. Little evidence could be found of regular dental check ups or visits. Poor dentures or poor condition of natural teeth can have a major impact on residents’ abilities to enjoy a normal diet and care needs to taken to ensure this is fully managed. All of the residents were registered with a local GP and had access to other professionals such as opticians and chiropodists. The Acting Manager did discuss how difficult it was to obtain a home visit from some of the local G.P’s. Four residents had pressure areas but these were being care for appropriately with the help of the District Nurses. The administration of medication was assessed and was found to be poor. On close examination it was noted that two residents had run out of medication the previous day. Someone had written on the MAR sheet that it had run out. The Team Leader on duty was unsure if it had been ordered or what was happening about the error. The next supply of medication was not due to start until the following Monday, the 31st August, seven days away. The medication supply had arrived from Boots, but had not been checked in and was still in sealed containers on the floor. The inspector was told the new medication was not due to be signed in until at least the following day. The inspector suggested the new stock be opened to see if the missing medication was there. It was found to be there and due to start on the 31st August. This would have meant that these two residents would have been without their medication for over one week. It was of serious concern to the inspector that it had not been noted by staff that the medication was nearly running out several days ago Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 12 and questions should be asked of staff as to why an urgent request was not made to cover the extra week’s supply. The inspector would also challenge the home’s practice as to why staff waited for all of the medication to be checked in if several items were very urgent. This was a serious error and procedures must urgently be put into place to prevent this situation occurring again. It will also be a requirement that a named person is responsible for the management of the ordering and auditing of the supply of medication. Residents were at risk due to poor practice. This was discussed with the Acting Manager who agreed this was a priority. Warfarin administration was also a concern. The home’s needs to ensure that written instructions are obtained, if necessary by fax if urgent, before dosages can be changed. These should not be accepted over the phone. This is poor practice and carries a high risk. The home will be required to produce a policy and procedure on the correct administration of Warfarin. All residents required a photograph to be displayed on their medication files to ensure proof of identity however, several photos were missing. The medication room was untidy and very warm; this was discussed with the Acting Manager who stated that it was her intention to move the medical room to another large vacant room. The move was expected to happen the following week. Staff practices seen on the day indicated that residents were well respected at all times and that preferred terms of address were used. Good interaction between staff and residents was observed. Several residents were spoken with and all said they were happy at Lennox Wood. Some of the comments made by residents were ‘I have no problems here and staff have always been ever so kind to me’ One resident said that she had been very unsure about coming to Lennox Wood but now she had settled in she was very happy and would not want to leave. She also commented on a recent ‘Fun Day’ and said how much she enjoyed the day out. The organisation had a policy on death and dying and relevant information was seen on some, but not all of the ones viewed, care plans and on residency contracts. At such difficult times relatives can stay with their loved ones for as long as possible. If necessary a bed could be made available. The home does not provide nursing care. As stated in previous reports, if the home is to provide palliative care then formal training must be provided. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 13 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): 12-15 The overall quality of this service is adequate. This judgement has been made from the evidence gathered both before and during this visit. Residents are able to maintain contact with family and friends as they wish. Residents receive a wholesome, appealing, balanced diet in pleasing surroundings. EVIDENCE: The home cares for people with varying degrees of dementia and lifestyles can be very challenging for some. The home does have designated activity staff but they were unavailable during this inspection. The activity room was being revamped and was not in use. During the course of the inspection no activities were happening. Comments from several family members, via comment cards, stated that activities were often limited and that ‘outings were rare these days’. Some residents were going on a day out the following day to The Friary for the organisations annual Fun Day. The home did not have any transport available but it was hoped to have access to a new bus for one day a month in the near future. Several residents were spoken with and those that could communicate were mainly happy to be at Lennox Wood. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 14 Several visitors were spoken with and comments such as ‘Mum gets well looked after’ and ‘We are always informed of any changes’ were made. They confirmed that they could visit at any time and were always made welcomed by staff. One visitor stated that he had looked at four other homes before his wife had moved into Lennox Wood and that he was very pleased with her care. He confirmed the home was always clean and tidy and that he was informed of any accidents or incidents. A care manager was seen completing a six monthly review and a key worker from the home was assisting. She confirmed that Care Management was normally informed of any accidents or incidents. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible gave full support and consideration. One disappointing area was that the sensory garden had been allowed to become overgrown and looked untidy. Last year this had been an important project that had been well received by the residents and it was sad to see the decline in its condition. Other concerns were that no sunshades were provided for the residents to use. Staff confirmed that these had been left out in the winter and eventually thrown away. Replacements should be purchased. The Trust was currently developing new nutritional and wholesome menus that followed dietary guidelines approved by experts. The food at Lennox Wood had always been to a high standard but this should improve choices and make the monitoring of nutritional values easier. Several comments from families, via comment cards, highlighted concerns over the levels of weekend staffing. This was discussed with the Acting Manager who was in the process of reviewing staffing rotas to ensure the weekends were appropriately staffed. Comments were also made regarding the lack of outside visits and how much the bus was missed. Hopefully this situation would improve when the new bus arrived. A high number of comment cards were returned from families and the majority were complimentary. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 15 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): 16 and 18 The overall quality of this service is good. This judgement has been made from the evidence gathered both before and during this visit. Residents are protected by a robust complaints system and service users and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures to ensure that residents are protected from abuse. EVIDENCE: The home had a complaints procedure in place, which included all the information required by this standard. Discussion with the Acting Manager confirmed that the home tries to resolve issues informally in the first instance. Evidence was seen of appropriate recording of complaints. There had been one complaint this year and this had been dealt with appropriately. The home had an Adult protection Policy including Whistle Blowing, which complied with the Public Disclosure Act 1998 and the Department of Health’s guidance No Secrets. Some staff spoken with were able to demonstrate a good understanding of Adult Protection issues. Some staff still required training in Adult Protection. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 16 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 overall quality of this service is adequate. This judgement has been made from the evidence gathered both before and during this visit. Some areas of the home needs to be refurbished for the benefit of service users. The level of infection control procedures needs to be improved to ensure residents live in a safe, hygienic environment. Residents are at risk due to the low number of handsets for the call system EVIDENCE: Some improvements had been made to the environment, including new flooring to the dining room and a new secure entrance area. The home was clean and generally tidy. Some of the bedrooms were viewed and again several sinks (7) were found that were badly chipped and /or cracked. This was mentioned during the last inspection and the inspector had been assured these Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 17 were to be replaced. This had not happened, so a requirement will be made to ensure the work is completed. It was also noted that several of the beds were very old and very low to the floor. This must make getting into and out of bed very difficult for some of the residents. It is also a manual handling issue for staff. It will be requirement that these be replaced with more appropriate beds. Again this had been discussed at the last inspection. The laundry was again inspected and it was very disappointing to see that requirements made at the last inspection had not been complied with. The very old Butler sink had not been replaced and the new access that was agreed had not materialised. Discussion with the Acting Manager confirmed that this work had been approved but not completed. The requirement will remain in place. Unfortunately soiled incontinence pads were found in an open bin just outside the laundry door. With the temperature on the day of the inspection being in the eighties this again was poor practice. A member of staff was seen walking up the corridor holding a soiled incontinence pad. It was not in any sealed bag and was openly carried. A suitable system for the disposal of soiled items must be introduced. This had been discussed with the previous manager at the last inspection. At the last inspection the refurbishment of the hairdressing room was discussed. Funding had been approved but the work had not started. It will be recommended that this work be completed for the benefit of the residents. As mentioned earlier in the report it was disappointing to see the run down state of the sensory garden. Sunshades also need to be provided. The wheelchairs storage was seen and it was noted that the wheelchairs were all clean and properly stored. Some work had been done in the kitchen including the fitting of new stainless steel benches and storage areas. The ceiling had also been repainted. However the trays inside the dishwasher and fridge were damaged and rusty shelving was evident. These trays must be replaced, if they cannot be obtained new fridges and dishwasher must be provided. Some of the crockery seen was badly chipped and crazed and was in need of replacing. It will be recommended that all of the equipment in the kitchen is examined and if found to be in poor condition, it should be replaced. One major area of concern was the lack of bleepers that were used for the call system. The home only had three in place; there should have been a minimum of ten. This compromised the safety of the residents at all times. The Acting Manager confirmed that new pagers would be ordered with immediate effect. This has highlighted serious concerns regarding the daily running of the home. Staff confirmed that the number of pagers had been low for several months, with no action taken by management. The inspector was very aware that the Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 18 Registered Manager has not bee in post for several months, but this issue should not have been ignored for so long. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 19 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): 27-30 The overall quality of this service is poor. This judgement has been made from the evidence gathered both before and during this visit. The resident’s benefit from being cared for by staff who have a good understanding of their needs though staff shortages have resulted in residents not always receiving consistent care at weekends. Residents are at risk due to insufficient night staff. The care of residents may be compromised because the staff do not receive sufficient mandatory training. EVIDENCE: Comments from several relatives included concerns over the staffing levels, particularly at weekends. This was discussed with the Acting Manager who confirmed that the structure of the weekend rota was often changed to accommodate staff needs. It will be a requirement that the home has a robust rota that reflects the needs of the service and it is adhered to. Another major concern was the number of falls occurring at night. Some night staff were spoken with and were asked to detail the normal pattern of their shift. It was evident that they were spending a lot of time completing washing on top of their care duties. On closer examination of the number of falls it was noted that out of 25 residents who fell in July, twenty were at night and all Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 20 were recorded ‘as found on the floor’. One of the residents fractured a hip. A requirement will be made to increase the number of night staff on a permanent basis. The home’s dependency level was high, particularly at night, and this high number of falls cannot be allowed to continue without positive action being taken. The Acting Manager was unable to produce a training matrix due to the short amount of time she had been in post. The home did not appear to have an updated one. A copy of the updated training matrix was supplied the following week. It confirmed that several areas of mandatory training had either lapsed or had not been completed. Moving and Handling was a major concern, as several staff had not been trained. A total of 14 care staff and 9 domestic staff required training. Not all members of staff had been trained in Dementia Care or Challenging Behaviour. Considering Lennox Wood specialises in caring for dementia clients this needs to be addressed urgently. Fire training was also sketchy. This was discussed with the Acting Manager who was aware of the issues and was working hard to remedy the shortfalls. The concern was why was this not picked up by the regular regulation 26 reports that were completed. Other areas or required training were Adult Protection, Health and Safety and COSHH. Information given on the pre inspection questionnaire stated that eighteen staff were responsible for administering medication but the training matrix showed that only thirteen had received training. The Acting Manager will be required to ensure that all staff that administers medication are fully trained and competent to do so. NVQ training was ongoing; with five staff currently undertaking NVQ level 2 and one undertaking level three. The home employs thirty-seven care staff and 28 have completed NVQ level two or above. The administrator has also completed an NVQ level two in administration. These figures indicate that seventy–five percent of the staff are qualified to NVQ level two or above. It will be a requirement that all mandatory training is completed as soon as possible. An action plan will be required detailing how this is to be achieved. The home has sound recruitment procedures to ensure the protection of residents. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 21 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): The overall quality of this service is adequate. This judgement has been made from the evidence gathered both before and during this visit. The care of residents is compromised because of a lack of stability and accountability in the senior management team. Residents are safeguarded by robust financial procedures. Current arrangements were sufficient to protect the health, safety and welfare of residents and staff. EVIDENCE: As mentioned several times in the report, the Registered Manager was currently not available. Within the previous two weeks an Acting Manager had been appointed on a secondment basis. The Acting Manager was working hard Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 22 to support the existing team and to remedy some of the issues that had arisen. The Inspector does want to demoralise the existing team, but does ask the question as to why were they left to cope on their own for such a long time. Some of these issues raised during this inspection should have been raised earlier by the Regulation 26 visits. The home clearly is in need of some robust changes within the way it manages the service. These were discussed with the Acting Manager who stated that she was working towards improving lines of management and accountability within the team. Work has already started on several of the areas of concern and the Acting Manager produced an action plan detailing how the most immediate concerns were to be addressed. Quality Assurance had always been addressed within the organisation and the Acting Manager was confident this would continue to be the case. The results of these surveys should be made available to the Commission. Staff meetings and Team Leaders meetings were to be re-introduced immediately, as were residents’ meetings. Residents’ personal monies were well managed. Families were encouraged to handle financial affairs but the home did deal with minimal amounts of personal monies for use within the home, such as hairdressing and chiropody. These accounts were seen to be well maintained and accurate. Three accounts were checked and found to balance. The home does have a safe and correct procedures for the receipt and storage of items were maintained. Staff confirmed that supervision was happening on a fairly regular basis. This needs to be evidenced for the next inspection. All of the records seen were secure and mainly in good order. Checks to ensure the Health and Safety of the residents and staff were undertaken and found to be satisfactory. It was recommended that the call system be serviced, as the last date for such action was 07/11/03. The First Aid boxes need to be maintained and it was suggested that this was made a specific responsibility of one member of staff. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 2 2 2 3 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 3 3 3 Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 24 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 OP26 Regulation 13(3) Requirement Timescale for action 30/09/06 2. OP27 18 The Registered Person shall make suitable arrangements to prevent infection; toxic conditions and the spread of infection at the care home in that the laundry is refurbished to the required standards. This has been carried on from the last inspection. 30/09/06 The Registered Manager shall ensure that staffing numbers and skill mix are appropriate to the needs of the residents. In that extra night staff need to be employed to ensure the needs of the residents are met at night This has been carried on from the last inspection. The previous requirement did not specify night staff, but staff on the high dependency unit. Action plan required 3 OP7 15 A written procedure must be produced stating how service users with Diabetes have their needs met. A dedicated procedure should be produced highlighting the care that must DS0000028942.V305375.R01.S.doc 30/09/06 Lennox Wood Version 5.2 Page 25 4 OP8 12(1) 5 OP8 12(1) 6 OP9 13 7 OP19 23(b) be offered. Action plan required. The registered person shall ensure that the care home is conducted so as it promotes and makes proper provision for the health and welfare of service users in that oral hygiene is maintained. Action plan required. The registered person shall ensure that the care home is conducted so as it promotes and makes proper provision for the health and welfare of service users in that professional advice is followed and monitored. Action plan required. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home in that 1. Adequate medication supplies are maintained at all times. 2. Warfarin dosage changes are confirmed in writing/fax The registered person shall having regard to the number and needs of the service users ensure that the premises are of sound construction and kept in a good state of repair in that 1. Damaged hand basins in service users rooms are replaced. 2. Low divan beds are replaced. 3. Damaged shelves in the dishwasher and fridges in the main kitchen are replaced. Action plan required. The registered person shall DS0000028942.V305375.R01.S.doc 30/09/06 30/09/06 31/08/06 30/09/06 8 OP22 23(2)(n) 31/08/06 Version 5.2 Page 26 Lennox Wood 9 OP25 13 having regard to the number and needs of the service users ensure that there is a working call system. The registered person shall make 30/09/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home in that the home should follow policies and procedures for the control of infection, including the safe handling and disposal of clinical waste. The registered person shall 30/09/06 having regard to the number and needs of the service users ensure that persons employed at the care home are trained appropriate to they work they are to perform in that 1. All staff receive all mandatory training 2. All staff receive training in Dementia. Action plan required. 10 OP30 18(1)(c) 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 OP26 Good Practice Recommendations It is again recommended that a door is provided in the clean laundry area to access the main corridor and prevent clothing being taken through the ‘dirty laundry’ area It is again recommended that training be provided in Palliative care It is again recommended that future maintenance planning DS0000028942.V305375.R01.S.doc Version 5.2 Page 27 2 3 OP30 OP19 Lennox Wood takes into consideration the poor state of the window frames in some areas of the building. 4 5 6 7 8 9 10 11 OP7 OP9 OP9 OP19 OP13 OP19 OP19 OP27 It is again recommended that care plans continue to be developed It is recommended that the Acting managers completes an audit on the number and qualifications of the staff who administer medication It is recommended that photos of residents are included in the medication records. It is recommended that the grounds are kept safe, tidy, attractive and accessible to service users. It is recommended that more outside activities be considered. It is recommended that the proposed work on the refurbishment of the hairdressing room be completed. It is recommended that an audit is undertaken on the condition of the homes cutlery and crockery and that any damaged equipment is replaced. It is recommended that a permanent rota be drawn up to ensure the same level of care is offered over weekend periods. Lennox Wood DS0000028942.V305375.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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. 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