Inspection on 16/06/05 for Penerley Lodge

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Penerley Lodge 03/08/07

Penerley Lodge 10/08/06

Penerley Lodge 12/01/06

Penerley Lodge 03/03/05

Penerley Lodge 10/08/04

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 Penerley Lodge 36/40 Penerley Road, Catford London SE6 2LQ Lead Inspector Rehema Russell & Vashti Maharaj Unannounced 16 & 24th June 2005 th 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 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. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Penerley Lodge Address 36/40 Penerley Road, Catford, London SE6 2LQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 695 6029 0208 698 1153 penerley@aol.com Mr H A Cole CRH Care Home 27 Category(ies) of PC Care home only registration, with number of places Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for 27 elderly persons of whom up to 2 may have dementia Date of last inspection 3rd March 2005 Brief Description of the Service: Penerley Lodge provides accommodation and care for 27 older men and women who are physically frail, up to two of whom may have dementia. The home was formed by combining two formerly private houses and is located in a quiet residential road in Catford. It is within 10 minutes walk of a main shopping centre, which is also accessible by buses available a few minutes walk from the home. The main shopping area has good transport links to other areas of London by both bus and rail. There is space for 2/3 cars to park on the forecourt of the home and nearby on-street parking is available. The home has a patio and garden at the rear. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspectors found during the inspection. This unannounced inspection took place over 2 days, one day on Thursday 16th June and one afternoon on Friday 24th June. On the first day the inspectors concentrated on the physical condition of the home and checked compliance with the large number of requirements arising from the previous report. On the second afternoon the inspectors spoke with residents and staff, looked at documentation and toured the building again to check on developments over the past week. The proprietor and administrator were present on the first day, and the administrator on the second afternoon. At the time of the inspection the home was in a period of several months instability, during which several staff had left the home. The previous manager had left, a new manager had stayed only a few months, five care workers had left, and both the weekday and weekend cooks had left. In addition to the home having no manager, extensive building works were being carried out. The overall effect of these changes were low staff morale and poor documentation, both of which can negatively impact on the quality of care for residents. This was a particular concern in regard to care plans and medication administration. However there was evidence of change and progress at the home. The majority of the previous requirements had been met or were in the process of being met. New carpet was being laid in the communal areas, some bedrooms had been completely refurbished and made en-suite, a large conservatory was being built to provide activities and visiting and smoking space. An activities organiser had been employed and a new manager was due to start. In addition, the kitchen is to be expanded and the current main lounge rearranged to include a separate dining area. The proprietor has bought the property next door to the home and intends to develop this as a home for elderly people with dementia, and building works had begun to the area of the current home which will become the “link” area between the two homes. The benefit to the current home will be that the link area will contain a passenger lift, whereas currently the home has only stair lifts. Immediate requirements were left at both inspections, all relating to physical features at the home that compromised health and safety. The home responded appropriately to both sets of requirements, the first were checked and found to be implemented when the inspectors returned to the home, and the home has confirmed that the second immediate requirements have also been implemented. What the service does well: Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 6 Residents said that care workers at the home are kind and caring. There is a new activities co-ordinator at the home who has already established positive relationships with residents and planned regular future activities based on their interests. The Proprietor is carrying out building works at the home that include new carpeting throughout; the building of a large conservatory which will give additional community, private and visiting space; refurbishment of all bedrooms to include en-suite facilities; a separate dining area; and further development of the rear garden. What has improved since the last inspection? 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. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 6 The information given to prospective residents does not reflect the current situation in the home and not all residents moving into the home have received a full, recorded, assessment. Residents cannot therefore be assured that their needs will be met. EVIDENCE: There is a well written and informative Statement of Purpose. However, the information about staffing is out of date, references to the frequency of Residents’ Association meetings and the local advocacy service have been left blank and some phraseology is misleading. For example, the Statement of Purpose refers to “The majority of lounges” although there are only two, and it states that there is “extensive investment in personal training and development” for which evidence of basic training only was found. There are also statements referring to systems at the home for which no evidence was found or for which the home could not provide the evidence. For example, it is stated that a full review of care profiles/plans will be carried out at least every three months but this was not evidenced in care plans seen. Evidence was not found of “risk of falling” being assessed “on admission and on an ongoing basis”, and the home could not provide evidence of a “Quality Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 9 Assurance Programme, including a, monthly audit programme”. Therefore, although the home’s aims and objectives are thorough and valid, evidence indicated that they are not currently being implemented so that prospective and current residents cannot be assured that their needs will be met. The Registered Provider must ensure that the Statement of Purpose is up to date, completed and accurately reflects the care standards at the home. In two of the four care files seen, the assessment by the home was incomplete with several sections that had not been filled in. This mitigates against the home being able to devise and implement care plans that meet the resident’s needs. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 standard(s) 7, 9 and 10 A care planning system is in place but is not being fully implemented resulting in some care needs not being documented. Similarly there is a suitable medication policy but it is not being adhered to, which potentially places residents at risk. Residents feel that care staff treat them with respect but there are aspects of the current running of the home that compromise their dignity and privacy. EVIDENCE: Four care plans were seen, two relating to residents who had been at the home for over 2 years and two relating to residents who had been admitted to the home within the last 6 months. Although the basic care plan format is very good, the older care plans had more plans than is necessary, some of which recorded personal care needs in detail that was not helpful and compromised the resident’s dignity. The newer care plans had very sparse personal information and did not, for example, state any preferences the resident had in regard to nutrition/activities/etc. None of the four care plans had been regularly reviewed, and none evidenced involvement of the resident or a representative in their compilation. This lack of a clear, consistent and regularly reviewed care planning system does not provide staff with the information they need to satisfactorily meet residents’ needs, nor does it evidence that this care is being provided and progressed. Requirements Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 11 relating to care planning reviews have been made following the three previous inspections, and continued failure to comply brings the competence of the running of the home into serious question. Care plans are now required to be brought up to required standard, including monthly reviews, by 31 October 2005, pending enforcement action. In regard to medication administration, the home has a policy covering all aspects of medication handling, all storage facilities are good and all receipts and returns are recorded accurately. However, several aspects of the medication policy are not being adhered to and this places residents at risk. Staff whose names do not appear on the authorised signature list have been administering medication and there was a high number of missing signatures on medication charts. Residents over the age of 75 who are taking 4 or more prescribed medications must have a medication review at least 6 monthly (annually for all others) but regular reviews have not been taking place and no reviews have been documented. Staff have received in-house training only and were not aware of the purpose of each medication nor the potential side effects. No residents self-administer. As only two residents have dementia, the home should carry out an assessment of whether any residents wish to and are able to self-administer their medication. All of these non-compliances are subject to requirement or recommendation and the requirements must be remedied as a matter of urgency to ensure the health and safety of residents. Residents spoken with commented that care staff were friendly and kind and a visiting relative said that she was very happy with the care given to her mother. One resident said that the food at the home had improved recently, and that his room was comfortable, clean and safe. One of the inspectors tested a call bell in a bedroom and a care staff came to the room in less than a minute, although both she and the resident whose room it was were both downstairs in the lounge when the bell was tested. This is a very good response and indicates excellent care and concern for residents’ needs. Similarly, one of the inspectors overheard another care staff supporting and encouraging a resident to come downstairs, in a very sensitive and caring manner. However, some residents commented that they felt there was not enough staff at the home and that management were not running the home well. These opinions were supported by the situation in regard to one of the stair lifts which had been out of order for several days. This had meant that some residents who were brought down using the stairs in the morning had to remain downstairs for the whole day, unable to access their rooms and bathrooms. This caused difficulties for incontinent clients who were having to be washed in a downstairs bathroom, were unable to return to their rooms to rest during the day, and had to queue up and wait to be assisted upstairs at the end of the day. The lift engineers only arrived to repair the lift at the end of the afternoon on the second day of the inspection, 8 days later. The proprietor said that this second chair lift often only worked intermittently and Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 12 that the cost of repair was very high. However, the lack of a working stair lift has a very detrimental effect on the privacy, dignity and choice for a large number of residents and so the home must ensure that an emergency contract is arranged to ensure the chair lifts are repaired in a timely manner. Other residents said that staff keep changing and there are never enough staff on duty, so they dont get tea or snacks after suppertime at 5.30pm and there is not enough staff for residents to get individual attention. Staffing numbers will be discussed later in the report. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 Not all daily living routines are currently sufficiently flexible and varied to suit some residents’ preferences and capacities, which can restrict their choice and fulfilment. Residents are able to have visitors at reasonable times but facilities for visiting are currently limited. Meals are adequate but the availability of snacks and drinks outside set hours is limited. EVIDENCE: On the first day of inspection, 13 residents were already up, dressed and sitting in the lounge at 8 a.m. and care plans evidenced that all but 4 of these residents had chosen to rise early (documentation was not available in the care plans for the other 4 residents). Five other residents were still in bed, through their own choice, and two were observed to emerge from their rooms later on after having chosen when to get up and when to get themselves dressed. During the day, mobile residents were observed to be moving about the home at will. Evidence from a night worker spoken with indicated that residents are able to chose when they wish to go to bed. However, as noted under Health and Personal Care above, the intermittent breakdown of one of the stair lifts was severely restricting the choice of less mobile residents to access their bedrooms and the upstairs facilities at choice. In addition, one resident commented that there was not enough staff for residents to receive sufficient individual attention, citing the need for an escort to enable individual trips out Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 14 of the home and the need for some residents to have their meals cut up by staff as examples. The issue of staffing levels and their impact on resident care and choice will be raised later in the report. Although the noticeboard in the hallway advertised the visit of a professional entertainer to the home at the time of the first inspection there was no evidence of a regular planned activities programme to interest and stimulate residents. However, a week later a permanent activities organiser had joined the home and had already spoken to all residents, held bingo sessions (as demanded by popular choice) and planned to hold regular hand massage, painting and reminiscence sessions as well as day trips out of the home. The inspectors spoke with the new activities organiser and felt that her enthusiasm, knowledge and experience would make a very positive contribution to the quality of life for residents at the home. In regard to visitors, the home’s policy is that visitors are welcome at any reasonable hour but there is no private visiting space apart from resident’s own bedrooms. However, a very large conservatory is currently being built in the back garden and the Registered Provider plans to incorporate private visiting space within this. Menus and observation at inspections evidenced that the meals provided are varied and nutritious, with the main meal and lunchtime and a light supper in the early evening (5.30 p.m.). However, comments were made by residents which indicated that choice may be limited, especially in regard to snacks and drinks. One resident commented that because there are not enough staff on duty there are no tea or snacks after suppertime, another said that it had only recently been possible to have an egg at breakfast and another said they could have a sandwich at night but that there was no filling available for it, just plain bread and butter. As some of the comments were contradictory it was difficult to establish whether these comments related to one-off situations or on-going situations. The cook mentioned that she cooked “5 eggs each morning”, which were not for named residents and therefore could restrict choice if more than five residents’ requested eggs, and on the afternoon inspection there was only cheese in the fridge for the evening supper (cheese on toast) and no other filings available for later in the evening or night. Both the daytime and weekend cooks had only just started at the home so this would be a good opportunity for the Registered Provider to conduct a review of the provision of food, drinks and snacks at the home to ensure that residents receive a varied, nutritious and healthy diet in sufficient quantity and with sufficient choice to meet their needs. This should include the availability of snacks and drinks outside of breakfast, lunch and supper. A trained nutritionist for elderly people should be involved in the review if necessary. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 Staff lack knowledge and understanding of Adult Protection issues. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. However, issues raised by residents should be captured more formally, including the action taken to address them. EVIDENCE: Residents said that they felt safe at the home and that staff were kind and caring. Staff had not received adult protection training, so were not aware of the different types of abuse apart from physical. This understanding is necessary to provide a safe environment to protect residents from abuse. There is a complaints book. However, staff mentioned that if any resident raised a complaint or issue, they would try to deal with it, rather than formally recording it. Two residents had raised issues recently, which had not been dealt with promptly or satisfactorily, and there was no record that these had been raised or what was being done about it. Formal recording of issues raised by residents is necessary to ensure that residents’ views are being considered. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 standard(s) 20, 21, 24, 25 and 26 Adequate and homely communal space is provided at the home. The home is generally clean and hygienic. There are problems with the physical standards in regard to insufficient toilet, bathroom and sluicing facilities, lack of furniture provision and maintenance in bedrooms and insufficiently guarded radiators and pipework. EVIDENCE: On the first day of inspection a full tour of the home was undertaken. Many resident bedrooms did not have all the basic furniture or fittings required, or that when some were present they were not in good working order. For example, not all bedrooms had bedside lamps, bedside cabinets, a shelf/storage for toiletries, adequate bedding (some duvets and pillows were very thin) or bulbs that were working, and some bedrooms had worn carpet, knobs missing on chest-of-drawers, flimsy curtain rails, and clocks that didn’t work or were not correctly set. However, a few bedrooms had been completely refurbished to a very high standard and it is understood that the Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 17 Registered Provider intends to refurbish all bedrooms to this standard during the forthcoming year. This will make a massive improvement to the quality of provision at the home but in the meantime the Registered Provider must ensure that all bedrooms have the required furniture and fittings, in good working order and of sufficient quality for residents to be safe, warm and comfortable. It is recommended that the maintenance worker undertake a complete audit of all bedrooms as soon as possible, making good as necessary, and that a system is put in place whereby keyworkers undertake a weekly check and report of any problems in resident bedrooms. These reports should be acted upon by the relevant staff and results monitored by management. The previous inspection report required that all radiators and pipe work were guarded or have low temperature surfaces and that pre-set valves were fitted to minimise the risk of scalding. At this inspection, radiators in lounges and some bedrooms had been guarded but the type of guards used did not give access to the thermostatic controls and therefore restricted choice. The Registered Proprietor said that she would plan for the radiator covers and thermostatic valves to be in place as part of the building works, including ensuring access to radiator thermostatic controls. The timetable for this requirement to be met was set at September 2005 and has not yet passed and the Proprietor must ensure that this requirement, which has serious implications for the health and safety of residents, is implemented on time. The home, which is registered for 27 residents, currently has only 2 bathrooms and 3 separate toilets, which is insufficient to ensure choice and dignity for residents. Furthermore, at the time of the inspection only the downstairs bathroom was in use as residents were unable to access the upstairs bathroom due to repairs (due to be completed in one week) and the breakdown of one of the stair lifts. The Proprietor intends that in a year’s time when the renovation works are complete, all bedrooms will have en-suite facilities. The latter consist of a washbasin, toilet and new-style walk in shower that is installed over the toilet, so that the user can sit on the toilet seat when showering. The completion of these plans, including a passenger lift for access, will ensure that the home has sufficient toilet and shower facilities, however the Proprietor must ensure that there are also sufficient assisted baths available to meet the needs and choices of residents. The Proprietor must consult with CSCI regarding the number and location of assisted bathrooms that are to be provided for general use. The home currently has two lounges, both with suitable furniture and fittings. The first lounge is the smaller lounge at the front of the building, which is also used for activities. It is suitably decorated, furnished and fitted and is homely in nature. The second, much larger lounge is at the rear of the building, has a hatch access to the kitchen and is also used as the dining room. It has double French doors which lead out to the back garden. Refurbishment has started on this lounge, with new carpet and radiator covers installed, and the Proprietor plans that two of the bedrooms that lead off from this lounge will be used to Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 18 expand the kitchen, a separate dining room will be created, and a large, new conservatory will provide new communal and private facilities. The problem of the new radiator covers preventing access to thermostatic controls has been discussed above. Kitchen and laundry facilities were adequate for the current size of the home but these are both planned to be expanded as they will be the two parts of this home that are shared with the planned new dementia unit. The kitchen was adequately clean and hygienic, despite the turnover of staff that had taken place recently. However it is recommended that a deep clean of the kitchen and larder room is carried out once the new permanent cook is in place. The previous report highlighted that facilities for washing commodes were inadequate as these were being washed in the communal bath. The Proprietor confirmed that this is still the case but that it is planned to install a sluice during the year as the building plans are implemented. The Proprietor also undertook to explore whether a temporary sink could be fitted in the meanwhile. On the days of inspection, apart from the issue of separate facilities for washing commodes, the home was found to be clean and hygienic and free from offensive odours. At the end of both days of the inspection, immediate requirements were made which related to health and safety at the home. For example in regard to frayed carpet on the stairs, an unsafe door mechanism, a metal grate protruding in a resident bedroom, fire hazards of pads and a wardrobe stored in the hallway. Some of these were corrected on the day they were noted and all were completed within the timescale specified on the immediate requirement notifications. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 The recent turnover of staff has lowered staff morale and had a detrimental effect on the consistency of care offered at the home and the time that staff can spend on individual resident support. Protection of residents is potentially compromised by the lack of completed recruitment procedures. EVIDENCE: The rotas submitted at the first inspection were incomplete and difficult to decipher but by the second unannounced visit the rotas had been redesigned and were clear, reflecting the situation found at the home on the day. Rotas showed that there are three care workers on duty for the early and late shifts with a fourth care worker on duty between 6 –9 p.m. to cover the peak period when many residents are preparing for bed. One of the three workers on each shift is a senior care worker. Whilst there is a manager in post and present at the home this staffing cover may be adequate, but at a time when there is no manager and therefore the senior care workers has to supervise the floor, the staffing cover may not be sufficient to meet residents’ needs and complete paperwork etc. Furthermore, as five care workers have left the home recently, the seniors also have to manage bank and agency staff. As several residents mentioned that there was not enough staff cover at the home, and as CSCI have received two anonymous complaints to this effect, the Registered Provider must review staffing levels according to the assessed needs of residents to ensure that there is at all times sufficient staffing to meet residents’ needs. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 20 All staff at the home had had Criminal Records Bureau checks, evidence of which was kept in a locked cabinet for safety and security. Two staff files were checked to ascertain whether all other appropriate documentation was in place. The care workers in question had begun employment in August 2004 and February 2005 respectively. The majority of the required documentation was present in both files but in one file the job offer letter was not dated, there were no induction sheets and there was only one reference. On the second file the interview form was not filled in, the induction form was not filled in, and there were no references (although two had been applied for). The lack of two written references on file does not fulfil the Regulations relating to the employment of staff at the home. The Registered Provider must ensure that all required employment information is obtained and kept on file. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 33 There has been a period of inadequate management cover, resulting in a lowering of staff morale. The quality of documentation and records at the home was generally poor and there was no evidence of an effective quality assurance system. EVIDENCE: There had been three different managers at the home within the past 18 months, with the last two staying for only one year and a few months respectively. At the time of the inspection there was no manager at the home and the proprietor and her administrator were managing the home. However, the administrator has no management or care experience and the proprietor necessarily spends a lot of time managing the building works and associated business. This has resulted in a lack of management presence on the floor and a lowering of staff morale. However, the Proprietor had advertised for a manager and at the time of writing the report a manager had started Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 22 employment. The Proprietor must now ensure that the new manager applies to be registered with CSCI. The general standard of documentation at the home was poor. Various sections of care files and plans were not filled in, care plans were not reviewed, medication records had many gaps, previous rota records were inadequate, employment records were not completed, and many records (monthly Registered Provider visits, resident meeting minutes,6 monthly feedback questionnaires) could not be found. It was therefore not possible to ascertain whether effective quality assurance and quality monitoring systems were operating at the home. The establishment of effective quality assurance systems was subject to previous requirement, the timescale for which has not yet expired. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 1 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 x 15 2 COMPLAINTS AND PROTECTION x 3 1 x x 1 1 2 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x 1 x x x x x Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 (1) Requirement The Registered Person must ensure that the Statement of Purpose is up to date, completed and accurately reflects the care standards at the home. (Previous timescale of 30/9/04 not met). The Registered Person must ensure that full assessments are completed for all residents entering the home. The Registered Person must ensure that all care plans are brought up to required standard, including regular reviews, as a matter of urgency.(Previous timescales of 16/6/03 and 31/10/04 not met). The Registered Person must ensure that there are no gaps in the recording of medication administration. The Registered Person must ensure that only trained and designated staff administer or handle medication. The Registerd Person must ensure that medication training for staff incorporates: 1. Basic knowledge of how medicines are used and how to recognise and deal with Timescale for action 31 October 2005 2. 3 14 (1) 24 June 2005 31 October 2005 3. 7 15 (1) & (2) 4. 9 17 Sch 3 3(i) 18(1)(i) 24 June 2005 24 June 2005 24 June 2005 5. 9 6. 9 18(1)(i) Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 25 7. 9 8. 10 9. 15 10. 24 11. 25 12. 21 problems in use and 2. The principles behind all aspects of the homes policy on medication handling and records. 14 (2)(a) The Registered Person must ensure that residents over the age of 75,who are taking 4 or more prescribed medications, have a medication review at least 6 monthly, annually for all others. 23 (2) ( c) The Registered Person must ensure that an emergency contract is in place to ensure that chair lifts are kept in working order. 16(2)(i) Registered Person must conduct a review of the provision of food, drinks and snacks at the home to ensure that residents receive a varied, nutritious and healthy diet in sufficient quantity and with sufficient choice to meet their needs. 16(2)( c) The Registered Person must ensure that all resident bedrooms have the required furniture and fittings, in good working order and of sufficient quality for residents to be safe, warm and comfortable. 13(4)(a) The Registered Person must ensure that all radiators and pipe work are guarded or have low temperature surfaces and that pre-set valves are fitted to ensure water is provided close to 43 degrees centigrade. Radiator guards must give access to the radiators thermostatic control. This requirement is brought forward from the previous report, including the timescale for action that was set. 23(2)(j) The Registered Person must ensure that there are sufficient bathroom facilities to meet G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc 24 June 2005 31 August 2005 30 September 2005 31 August 2005 30 September 2005 31 October 2005 Page 26 Penerley Lodge Version 1.30 residents needs. 13. 26 23(2)(k) The Registered Person must ensure that a sluicing facility is installed. The previous requirement of 31.7.05 was not met but plans are in place. the Registered Person must review staffing levels according to the assessed needs of residents to ensure that there is at all times sufficient staffing to meet residents’ needs. The Registered Person must ensure that all required employment information is obtained and kept on file. The Registered Person must ensure that the new manager applies to the CSCI to be registered. The Registered Person must ensure that there is an effective quality monitoring system and annual development plan in place. This requirement is brought forward from the previous report, including the timescale for action that was set. The Registered Person must ensure that staff are trained to recognised all forms of abuse. The Registered Person must ensure that all complaints/issues raised by residents are recorded and actioned. 31 March 06 14. 27 18(1)(a) 31 August 2005 15. 29 19 (1) 30 September 2005 31 August 2005 31 December 2005 16. 31 9 (1) 17. 33 24 18. 19. 16 18 13(6) 22 30 November 2005 24 June 2005 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 9 Good Practice Recommendations The Registered Person should carry out an assessment of whether any residents wish to and are able to selfG52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 27 Penerley Lodge 2. 9 3. 19 administer their medication. The Registered Person should ensure that a medication profile for each resident is completed, stating what each medication is for, potential side effects, and the consequences of missed doses. The Registered Person should ensure that the maintenance worker undertakes a complete audit of all bedrooms as soon as possible, making good as necessary. A system should be put in place whereby keyworkers undertake a weekly check and report of any problems in resident bedrooms. Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Sttreet Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI Penerley Lodge G52-G02 S25637 Penerley Ldge V234164 160605 Stage 4.doc Version 1.30 Page 29 - 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!