Inspection on 11/02/08 for The Old Lodge Nursing Home

This inspection was carried out on 11th February 2008.

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

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

The Old Lodge Nursing Home 18/06/08

The Old Lodge Nursing Home 06/08/07

The Old Lodge Nursing Home 24/04/06

The Old Lodge Nursing Home 15/02/06

The Old Lodge Nursing Home 28/09/05

The Old Lodge Nursing Home 15/12/04

The Old Lodge Nursing Home 08/06/04

The Old Lodge Nursing Home 04/11/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Old Lodge, The Nursing Home Sandypits Lane Etwall Derby Derbyshire DE65 6JA Lead Inspector Helen Macukiewicz Unannounced Inspection 11th February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Lodge, The Nursing Home DS0000002135.V359027.R02.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. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Lodge, The Nursing Home Address Sandypits Lane Etwall Derby Derbyshire DE65 6JA 01283 734612 01283 733067 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) Folcarn Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 Places for OP 5 Places for younger PD aged 50 years and over included in the total above 6th August 2007 Date of last inspection Brief Description of the Service: The Old Lodge is a detached house, which has been adapted and extended to provide nursing care for up to 40 people, aged 65 years and over. However, up to 5 of the bedrooms can accommodate disabled people, aged 50 years and over. The Home is situated in a rural position, approximately a mile from Etwall village centre. The village has several local shops and is on a bus route for Derby. The Old Lodge has 32 single and four double bedrooms across two floors. 10 of the bedrooms have en-suite facilities. Access to the first floor is by stairs or by a passenger lift. The Home has 2 lounges, a conservatory and dining room. The Home also has a well laid out garden. The range of weekly fees on 6th August 2007 was between £487.00 and £560.00 per week. Extras to pay include private chiropody, dentist and optician. The Inspection reports are made available in the Managers’ office. The Manager provided this information during the Inspection. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. Two Inspectors undertook this Inspection. It was unannounced and lasted 7 and a half hours during one day. Computer held records of all contact between the Home and the Commission for Social Care Inspection since the last Inspection were referred to in the planning of this visit. During this Inspection discussion with nine people who use the service and three relatives took place. Time was spent in discussion with the Manager and staff. Seven care files were looked at in detail and their care was examined to see how well records reflect care practices within the home. Relevant records belonging to the home were also examined such as staffing and policy documents. A brief tour of the home took place including some bedrooms. Throughout this report ‘we’ refers to the Commission for Social Care Inspection. ‘Us’ refers to the inspector(s) who undertook this Inspection. What the service does well: What has improved since the last inspection? The manager had organised one trip out that was enjoyed by all people who attended. There had been some new carpets fitted. A manager has been appointed and she had started to make improvements to the care documentation and had recruited some more staff. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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 Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 1 and 3, standard 6 did not apply on this occasion. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have the information they need to choose a home that will meet their needs. However, inconsistency in the application of pre-admission assessment means that some people may not be admitted appropriately. EVIDENCE: The registered person sent us an up to date copy of the service users guide at the beginning of January 2008, this, and the statement of purpose for the home generally reflected the services offered, and included information about the range of fees and what is included in these. Some information about the manager, smoking arrangements and the contact details for us needed updating. The copies in peoples’ bedrooms were dated 2004 so did not provide them with accurate information about the home. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 9 Five care files for people who have recently been admitted into the home were looked at. One person who had been at the home for about 6 months had a pre-admission assessment that had been carried out by the home. Two more recently admitted people only had a care management assessment, not one undertaken by the home. Finally, there was no assessment of any kind for the last two people to be admitted into the home. Although the manager said that she was sure both these people had been assessed. The lack of documented evidence to support that people are assessed as to their suitability to live in the home means that people may not be admitted appropriately. People who were asked, said that family or friends had sorted out their admission so they were unable to comment about the level of information they had been given before coming to live at the home. However, one said that he was happy with his room. One visitor said that they had the chance to look around the home before making a decision as to whether to place their relative in the home. One person said “I like it here – my family chose it for me. I have been here for 5 years”. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 7,8,9,10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are put at risk due to poor identification, recording and review of care needs and insufficient systems for self-medicating. EVIDENCE: Seven care files were seen; these contained some of the required basic information. However, most were missing a photograph of the person, which would help staff to ensure they were recording in the correct file. There was no space on the form to record diversity and/or cultural needs. Marital status was not always fully recorded, and the basic information form did not account for people who may have civil partnerships. The persons’ religious preferences were not always recorded. There was no space on the front sheet for social workers contact details. Some files lacked a date of admission and one file did not have any contact details for the persons’ next of kin. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 11 Everyone had a written plan of care generated from the assessment of needs except for the two most recently admitted people. They had a plan of care but this was a ‘stand alone’ document due to the absence of an initial assessment. The quality of the care plans varied. One that had been reviewed by the current manager contained a good level of detail and accurately reflected the persons’ needs following a safeguarding issue. Some showed evidence of reviews of care. However, most of the care plans seen did not provide sufficient information to guide staff as to all the persons current care needs. One care plan had not been fully reviewed since June 2007 and did not fully reflect the persons’ current palliative needs. Care plans for expressing sexuality were not well completed and did not reflect individual circumstances. One person was taking 2 laxatives but nothing was recorded in the diet section about fluids or fibre. One had no care plan for a skin tear, which required a dry dressing after a fall in January. One person had recently been seen by their G.P. to discuss end of life wishes. The G.P. recommended these were put into the care plan. We found no records of this in the care plan. Care plans did not include the person’s preferences and were therefore not person centred. For example: ‘1 staff to assistant and maintain and encourage independence’. However, there was no specific information about care of teeth, eyes, and feet etc. Elimination:- stated to establish routine, but no written routine was in place. In one care file under the heading ‘Eating and drinking’ were instructions to undertake a weekly weight record. However, there was no weight chart in the care file, or on the chart in the persons’ bedroom. These omissions means that people may not receive the care they require. Two safeguarding issues had recently occurred. Both these issues related to shortfalls in the basic care of people living in the home and failure of staff to provide adequate records. The audit of the homes’ care records showed that there is still potential for errors in the provision of care. However, the recently employed manager has made improvements to some care records, and the monitoring of peoples’ basic care needs. Nursing staff had made some basic recording errors that were inconsistent with the Nursing and Midwifery Council guidelines to good record keeping. One care plan for maintaining safety was not signed. Deletions in one care plan were not dated and signed or crossed out by use of a single line. Later additions to one care plan were not dated and signed. Daily logs were recorded and provided basic information about the care provided. However, these records were not always written in legible handwriting so did not provide a clear record of changes to care needs or care provided. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 12 One person told us they had not seen their plan of care, or been asked to sign to agree its contents. In the care files seen there was little evidence of the involvement of people and their families in the development of the care plans, or their agreement to them. People told us that the G.P., chiropodist and optician visited them at the home. One file recorded evidence of an assessment by health professionals in the community and hospital. One person told us ‘I’m more than cared for and think the staff are very good’. There was assessment of some areas of need such as nutrition and skin care. However, only two files had a risk assessment for falls. In one case this was despite having a fall recorded in daily log when they were first admitted. In one file a falls risk assessment was done 3 weeks after admission. One file contained a risk assessment for manual handling. However, this had not been regularly updated despite this being a request at last Social Services review. No continence risk assessments were seen. The lack of accurate care assessments means that people may be exposed to avoidable risks, which could adversely affect their health and well being. Nursing staff were following correct procedures when giving medicines out during the Inspection. However, a tablet was found on a bedroom floor, which suggests that not all nursing staff were ensuring that people took their medication. The manager was able to identify which tablet had not been given and said she would take appropriate action with the member of staff concerned. People administering their own medicines did so without proper risk assessment, agreed consent and adequate storage facilities within their bedrooms. Care files did not contain a risk assessment or agreed consent. One person told us they had not been asked to sign a self-medication agreement and was administering their own inhalers. Two people did not have a place where they could safely store their medication in their bedroom. In the controlled drugs register, one persons’ name had been incorrectly spelt on the index sheet and this was potentially confusing. All medications recorded on the medication administration sheet were signed for. Some medicines had been discontinued; the person recording this had not signed their name against this entry making it difficult to see which nurse had written these instructions. People and their visitors told us that staff treated them with respect. One visitor said that their relative was always well dressed when they visited. People also told us that their privacy is maintained, saying staff usually Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 13 knocked on the bedroom door to request permission before entering. Peoples preferred form of address was recorded on the care records. There were a few examples where the privacy and dignity of people was not fully upheld by staff. On one care file the persons’ preferred name was recorded but daily logs and the care plan continued to refer to the person incorrectly. One person told us that he had found it strange that young staff had referred to him by his first name when he first came to live at the home, but he had got used to it. One member of staff knocked on a persons’ bedroom door but did not wait for permission to enter, just walked into room. One Visitor was shown around home and not introduced to anyone and people were not informed whom she was. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples needs and choices in terms of social care are not well identified and so their lifestyle does not meet their expectations. EVIDENCE: On Saturday 9th Feb 11 people went on a trip to the Hilton House Hotel organised by the manager, the people spoken with said they really enjoyed this and wanted more activities like it. Three people told us that there is not much to do during the day. One said they got bored. One person said ‘there nothing ever going on. It’s boring here, there are no suitable activities for me I just sit here’. Another person told us ‘there’s never any staff around until its lunch time, they don’t have time’. There was no information on the notice board about regular activities or planned outings but there was some information about a singer in the manager’s office. One person told us that the home used to have bingo every week but this has now stopped. They enjoyed the trip out to Hilton and this was an improvement as no trips had organised previously before the new manager arrived. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 15 There were no orientation cues within the environment such as the day of the week, what the weather was like to assist those people who may have memory problems or mild dementia. There were no activities observed on the day of this visit. Most people in the ground floor lounge were asleep with little stimulation from staff other than during the tasks of assisting them to the toilet or with a drink. Staff told us that they had been short staffed and this meant they did not have quality time with people. The new manager told us that she was very aware of the lack of social care within the home and said she intended to focus on improving this aspect of daily life. In the care records there was also a lack of evidence to support that peoples’ social care needs were well met. In one file the life history form was blank. Two more people had no social assessment. There was space for recording social interests in the care plan but for at least two this only recorded ‘likes T/V and radio’. In terms of peoples’ autonomy and choice within the home. Individual preferences and routines were not well recorded in care plans although three people told us that the daily routine was flexible; they could rise and retire to bed when they wanted and could choose where, and how to spend their day. One person said ‘everything’s as homely as it can be’. Individuals’ preferred rising/retiring times were recorded in some care files that were seen, but no preferences were stated for most other areas of daily life. In two files the person had stated their preferred form of address on admission but there was constant reference to a different form of address on the care plans and in daily logs, which indicated a lack of regard for peoples’ choices. In one file, preferred rising/retiring times were stated as being ‘normal’. There was no further explanation of what ‘normal’ was. One person had their bedroom changed without proper consultation and this led to a minor concern being raised by their family. One person told us that they would like to go to church – but there was not enough staff to accommodate this. One person was asking for the toilet for a long period of time due to the fact they did not have access to a call bell. People could record their food preferences on a food preference sheet. Most people had theirs recorded. The kitchen contained a board recording special dietary requirements. There was a 4-week rolling menu in place, which was not changed throughout the year. Choices on the menu sometimes overlapped, with the same food provided i.e fish fingers on a Friday. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 16 The cook had completed a basic food hygiene course and there were intermediate food safety certificates on the wall. The kitchen assistant had been employed for one week and was due to go on course. Feedback about the menu was obtained from staff and the cook does go out at lunch and speak with people – this was observed on the day. People told us that they enjoyed the food. The last visit from environmental health awarded the home 4 stars. One person told us ‘you get well fed, the food is alright’. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have their rights to complain upheld. Lack of staff training in safeguarding has the potential to place people at risk. EVIDENCE: There was a complaint procedure at the home. This was clearly stated in the information available for people and their visitors although the information about how to contact us was out of date. People told us they would speak to the manager if they had any concerns. One visitor said that members of their family had raised a minor concern with the manager, which had been sorted out. The manager was unable to locate any complaints records that preceded her employment at the home. We were able to find some old complaints that had been filed in a cabinet. Concerns that had been addressed by the new manager had been recorded in the persons’ care files but not in a complaints file. We were notified of two concerns that had been raised about the home. These had been reported to us by social services. Both led to safeguarding procedures being enacted. We were not notified of either concern through the Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 18 regulation 37 notifications systems, which should be in place within the home. (see management section) Several of the staff, both nursing and care staff told us that they had not had any training on how to keep people safe (Safeguarding Adults). Two nurses were not fully aware of the correct reporting procedures should an incident occur. They told us that the safeguarding policy was in the office should they need to refer to it. The manager told us that the safeguarding adults policy had been temporarily removed from the home so it could be reviewed. The manager had co-operated fully with social services in the investigation of safeguarding issues and had taken some action as a result. . Some people had been assessed as needing bedrails on their beds to keep them safe. These risk assessments were documented. However, bedrails could be considered as a form of restraint and require consent for their use. No consent was documented in four of the care files seen. One person told us they did not want bedrails on their bed and felt they didn’t need them. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is suited to the needs of people who live there. EVIDENCE: Some of the carpets had been replaced. Two people told us they were happy with their bedrooms. Several people had their own televisions in their rooms and had been able to bring small items of furniture and belongings in to make them more personalised. A handyman was employed full time and was seen making small repairs and putting pictures up for people in their bedrooms. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 20 Some areas of the home were in a good state of repair and had been decorated and furnished to a high standard. Other areas needed redecoration and some items of furniture had become worn and in need of replacement. The manager said there was a programme of renewal in place, although this was not recorded to provide timescales and an itinerary of things to replace. Two people told us that they do not have a lock for their bedroom door, or a place to lock their possessions within their bedroom. One said they were not bothered about this, but the other said they would like both these options. It was very sunny on the day of the visit and the sun was beaming through the conservatory windows. Some people were unable to move in order to reduce the sun on their body and face; two people told us they were too hot. As there were no staff around to assist, we shut the blinds to reduce the sunlight on people and later opened the door as it was too hot, people then thanked us for ‘letting some fresh air in’. There did not appear to be any method of monitoring the temperature in this room, or action by staff to ensure the comfort of people sitting in this room. The laundry was clean and tidy and contained suitable equipment for laundering soiled items. However, a build up of soiled laundry was seen in an unlocked sluice area, which could put people at risk of infection. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 27-30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Current staffing arrangements mean that people are not always given the care they need by appropriate numbers of suitably skilled staff. Gaps in the recruitment of staff means that people are not safeguarded. EVIDENCE: Staffing rotas showed there were always two nurses and around five care staff on duty during the day. The manager was recorded as extra to the nursing staff complement. Two of the nurses were working very long hours but told us this was a short-term measure to cover a staff member who was temporarily off work. The manager said both had signed an agreement to work such long hours. Both of these staff provided most of the nursing input at the home, but had only recently completed an adaptation course to enable them to practice as a nurse in the UK. The manager was aware of the need to ensure close supervision. One nurse said they had an induction to the home and had received supervision. People told us that the availability of staff was variable. People said that staff were around to help them with basic care needs, but they did not have time to provide extra care such as sitting and chatting, do exercises with them, and Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 22 activities. Two people felt there had been shortages in staffing. We observed people having to wait a while for basic care needs such as being assisted to the toilet and assistance to eat. One person said that staff had arrived more quickly than usual to assist another person who was calling for assistance. Staff told us that in their opinion, the home was short of staff. They said they were always rushing around and never have time to sit or talk to people. One said ‘staff do there best and more is required’. The manager said she was looking to appoint another nurse and some more care staff, and was interviewing care staff on the day of the visit. The manager told us that she had been unable to locate any training records for staff that pre-dated her employment at the home so there was no complete record of staff training, or identification of gaps in training recorded. Care staff told us they had received training in fire safety and skin care. One staff member told us they had started an NVQ but this had been put on hold Two nurses told us that they had been on fire safety, infection control, palliative care (Liverpool care pathway), health and safety, wound care and accountability training since they had worked at the home. They were due to attend a moving and handling course in March, which had been organised by the new manager. The new manager showed us a diary entry for that, and other training. Some staff had not received basic food hygiene training and the manager told us that she was aware that some staff need their mandatory training this year. The recruitment files for three of the most recent staff employed were seen. This included a registered nurse. The following gaps in the records were noted, which means that people were being put at risk:• • • • • • • • One file had no declaration of criminal offences One file had no health declaration One file had no employment history One file had only 1 reference One file did not contain written verification why the person had ceased to work with vulnerable adults in former employment One file contained no certificates to support the person’s qualifications The registered status of a nurse was not recorded as having been checked One person had an old Criminal Records Bureau check from a time when they were previously employed None of the files contained a copy of the contract of employment, proof of identity or record of interview, which are all good practice. The manager said there were no induction records left when she took over so could not demonstrate the level of induction people had. Newly appointed staff were working with others who had been employed for longer but not all staff Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 23 received a formal induction. One member of staff who had worked at the home for a number of weeks said they had not had an induction. One member of staff said they had started, but not completed an induction. They had been employed for several weeks. Where induction had been received, staff told us this did not provide guidance on values or dignity issues, rather it was task orientated. Old Lodge, The Nursing Home DS0000002135.V359027.R02.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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not effective in keeping people safe. EVIDENCE: The new manager was appointed about 4 weeks prior to this Inspection. The manager said that she has yet to apply to us to register her. She said she was applying to undertake the registered managers award. Prior to this there was a 4 to 5 month period where interim managers ran the home. The manager is a registered nurse with management experience, although this has not included experience in care homes. She was not fully familiar with the Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 25 care homes regulations or national minimum standards, although she had copies and had started to look through both. She told us that the registered provider was in most days to give her support. There were some requirements that the manager was not aware of. For example, she was not aware of the need to report complaints or issues affecting peoples’ wellbeing through the regulation 37 notifications systems, which should be in place within the home. She was also unaware of some of the recording requirements such as recording of complaints. She told us that she has used her time to focus on making improvements to the nursing care of people. People knew the registered person and said he does visit the home from time to time to ask them how they are, and said they felt that they could speak freely to him. At the time of this Inspection there was no overall quality assurance plan in place or systems for formally ascertaining peoples’ views about the service. We wrote to the registered person about gaps in their recruitment procedures last year. They told us that their systems had been improved. However, we found that the required improvements had not taken effect, which means that people were being put at risk. Some policies had not been updated since 2003 so provided outdated information to guide staff. The Manager was aware that she needed to update these, but had not had time. The systems for managing peoples’ ‘pocket money’ were seen. There were records of all transactions, and a receipt accompanied expenses. Everyone had a balance sheet. The Administrator told us that an Accountant audited the financial records once a year. The system for payment of goods out of a ‘pool’ of cash does not fully protect people and needs review. The manager told us that she had been unable to locate any staff supervision records that pre-dated her employment at the home. Therefore there was no evidence to support that all staff have been regularly supervised. At the time of this Inspection, there were no formal arrangements in place for the manager to receive regular supervision. Staff told us that morale is currently low and so they need one to one support. A check of some service records showed that equipment was regularly maintained. At the last Inspection in August 2007, several matters relating to health and safety needed attention. In a response to the Inspection, the registered provider told us that these would be attended to. These were checked during this Inspection. Of the nine concerns raised, only three measures to ensure the safety of people living in the home had been undertaken, to provide a fly screen for the kitchen, to secure an uneven carpet and to provide a risk assessment of the environment. However, this could not be located. This Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 26 means that people were still being put at risk. The following matters had not been addressed:• • Some chemical cleaning agents were being stored in bathrooms; these must be safely stored. One of the first floor bedroom windows could still be opened wide, which created a falls hazard. A further bathroom window was the same. The handyman took immediate action at the time of this visit to secure these. There are 3 steps leading to the laundry, which could create a potential falls hazard. Some jugs and a urinal for the collection of urine were stored in toilet and bathroom areas, these were not labelled for individual use. The sluice on the ground floor was unlocked with the door open and this contained both fouled laundry and soiled waste. The general risk assessment for the home could not be located. There are steps leading from the patio outside the dining room, these had not been subject to risk assessment. • • • • • In addition to this, we noticed that some fire doors had been wedged open with items of furniture. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 X 2 2 X 1 Old Lodge, The Nursing Home DS0000002135.V359027.R02.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) Requirement The Registered Person must not provide accommodation to a person unless a suitably qualified person has assessed their needs. There must be documented evidence of a needs assessment. Care plans must document evidence of peoples’ involvement and agreement to their plan of care. Previous timescale of 30/09/07 not met. 3. OP7 15(1)(2)( b) The plan of care must provide sufficient detail as to how the persons’ needs in respect of health and welfare are to be met, including any social care they require. These must be reviewed and updated as needs change. There must be risk assessments of all care needs in place which are reviewed as needs change. To ensure that people are not exposed to avoidable risks, which could adversely affect their health and well being There must be safe arrangements in place for people who wish to self-administer their DS0000002135.V359027.R02.S.doc Timescale for action 29/02/08 2. OP7 12(3) 30/04/08 30/04/08 4. OP8 14(2)(a)( b) 31/03/08 5. OP9 13(2) 29/02/08 Old Lodge, The Nursing Home Version 5.2 Page 29 medication. Previous timescale of 30/09/07 not met. Staff administering medications must ensure that people have taken their medications as prescribed. 6. OP12 16(2)(n) Work undertaken to improve peoples’ social care must continue to meet peoples’ varying needs. Previous timescale of 30/09/07 partially met. People must be allowed the opportunity to exercise personal autonomy and choice with regard to their care. This must be supported in their care documentation. Regard must be paid to their chosen preferred form of address. Their choice with regard to the provision of door locks and/or personal lockable space must be ascertained and upheld. There must be documentation to support that all complaints received are fully investigated. This is to ensure people are protected and that their rights are upheld. There must be a safeguarding adults policy available for staff at all times. All staff must receive training in safeguarding adults. To ensure the protection of people living in the home. Any equipment that carries a degree of restraint must only be used following a full assessment of need, regularly reviewed and documented with consent in the DS0000002135.V359027.R02.S.doc 30/04/08 7. OP14 12 (2) 30/04/08 8. OP16 22(3) 31/03/08 9. 10. OP18 OP18 13(6) 13(6) 29/02/08 30/04/08 11. OP18 13(7) 31/03/08 Old Lodge, The Nursing Home Version 5.2 Page 30 service users plan of care. To ensure service users are safeguarded and that regard to the Mental Capacity Act has been given. Previous timescale of 30/09/07 not met. Soiled laundry must not be stored in an area that is accessible to people using the service as this could put people at risk of infection. There must be adequate delegation of staff to ensure all care needs can be met. Staff must not be employed by the home until all recruitment checks required by regulation 19 and schedule 2 have been acquired. Staff must receive induction and training appropriate to their role to ensure they safeguard people living in the home and provide them with the care they require. Previous timescale of 31/10/07 not met. All staff training must be individually documented to identify any training gaps. 16. OP31 9(2)(b)(i) The manager must have the necessary skills to run the home in order to safeguard the people living there. There must be evidence of internal quality assurance within the home that includes consultation with people who live in the home, their relatives and other interested parties. This system must allow for updating policies and ensuring there are safe systems in place for the running of the home. Money kept on behalf of people DS0000002135.V359027.R02.S.doc 12. OP26 13(3) 29/02/08 13. 14. OP27 OP29 18(1)(a) 19 and schedule 2 18(c) 31/03/08 29/02/08 15. OP30 31/05/08 30/04/08 17. OP33 24 30/06/08 18. OP35 20(1)(a)( 29/02/08 Page 31 Old Lodge, The Nursing Home Version 5.2 b) 19. 20. OP36 OP38 18(2) 13(4) living in the home must only be used for their own transactions. All staff working in the home must be appropriately supervised. All potential hazards arising from the environment must be identified and so far as practicable removed. The risk assessment of the environment must be accessible. All areas of the home must be kept safe from hazards. Previous timescale of 30/09/07 partially met. 30/04/08 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Nursing staff should ensure compliance with the Nursing and Midwifery Council guidelines for good record keeping. Written entries to care records should be legibly made. Records in the controlled drugs register must be legible, with correct spelling of peoples’ names to avoid confusion. Staff should ensure that people are treated with dignity and respect in their day to day care. All people who are dependent on staff to be moved should have access to a bell to alert staff that assistance is required. Consultation with people about menu choices should occur. The contact details for receipt of concerns should be up to date. Replacement of worn items of furniture and carpets should continue. Bedrooms should have a lockable space for residents to keep their possessions/medications safe. Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 32 2. 3. OP9 OP10 4. 5. 6. OP15 OP16 OP19 Residents should all be given the option of a lock for their bedroom door, subject to risk assessment. 7. OP26 There should be monitoring of the temperature in the conservatory and due regard to peoples’ comfort on hot, sunny days. The working hours of the two nurses covering for a nurse who is absent should be monitored to ensure this does not affect their safe practice. Staff recruitment files should contain a copy of the contract of employment, proof of identity or record of interview, which are all good practice. The home should ensure all staff training needs are identified through a training plan. The Manager should register with the Commission for Social Care Inspection. The Statement of Purpose and Service Users Guide should be available for people using the service in an up to date format. There should be a system in place for regularly checking window restrictors. 8. 9. OP27 OP29 10. 11. 12. 13. OP30 OP31 OP1 OP38 Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Old Lodge, The Nursing Home DS0000002135.V359027.R02.S.doc Version 5.2 Page 34 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!