Inspection on 13/04/06 for Portland Lodge

This inspection was carried out on 13th April 2006.

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

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

Other inspections for this house

Portland Lodge 08/08/07

Portland Lodge 10/11/06

Portland Lodge 10/11/05

Portland Lodge 15/05/05

Portland Lodge 17/11/04

Portland Lodge 18/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Portland Lodge 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ Lead Inspector Mark Sims Unannounced Inspection 13th April 2006 10:30 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 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 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. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Portland Lodge Address 21 Landguard Manor Road Shanklin Isle Of Wight PO37 7HZ 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) 01983 862148 Isle of Wight Care Ltd Mrs Tina Sara Hughes-Thomas Care Home 19 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Old age, not falling within any other category (19) Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: Portland Lodge is registered to accommodate 19 service users, five of which are younger adults (under the age of 65), within 3 categories - DE(E), MD and OP. The property is a large period town house, which is situated along Landguard Manor Road, Shanklin. The amenities of the town are within walking distance for the younger clients and more able bodied, although are potentially too far away for older, less mobile service users to access directly. As the service does not include access to an in-house car or minibus, public transport becomes the most obvious route into town with regular bus services passing the home daily. The premises provides accommodation for service users across two floors, although the first floor is only accessible to fully ambulant individuals, as no passenger lift or stairlift is provided. The accommodation at the home is used mainly on a single room basis and communal facilities are open planned, with the dining room and lounge areas opening up onto one another in an L shaped configuration. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first Key inspection for Portland Lodge since the introduction of a new inspection process. As part of the new inspection programme, all core or key standards are to be reviewed and at this inspection all of those standards were considered. The fieldwork inspection, although initially planned over one day, ran into a second day, the second visit occurring on the 19th April 2006. The main reason for the second visit was the absence of the manager during the first inspection and the inability of the inspectors to access key information required for the report. At the time of the last inspection it was discovered that the manager had admitted service users outside of the home’s conditions of registration, a direct breach of the Care Standards Act 2000, which resulted in the manager accepting a Formal Caution. What the service does well: What has improved since the last inspection? Since the last inspection efforts to improve the environment, both internally and externally, with the front aspect of the property repainted, several bedrooms redecorated and new flooring fitted within bathrooms and toileting facilities. Work had also been carried out on updating key policies and procedures, such as the complaints procedure and adult protection policies. The service users’ guide and statement of purpose had been revised and reissued, although some work to ensure the accuracy of the primary document is still required. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 6 What they could do better: A lot of work is required to ensure the service complies with the majority of the core standards inspected, as failures to meet a number of the National Minimum Standards reviewed were documented: • • • • • • • • • Regulation 26 reports are still not being carried out. A number of accidents reportable under Regulation 37 were not reported to the Commission. Moving and Handling assessments were not available. Details of the Care Plans and Assessments carried out by care managers and hospital services were not being obtained. Records of the food provided to service users are not being accurately maintained. Current, ‘Control of Substances Hazardous to Health’ (COSHH), data sheets for chemicals used in-house were not available. The service lacks a quality assurance programme. Service users have no means (residents’ meetings) of providing feedback on the service provided. The medication system was noted to be flawed, with gaps in the medication administration records, medications not being appropriately returned to the pharmacist for disposal, staff involved in secondary dispensing, medications prescribed for service users (Paracetamol) being used by staff and medicine stored in the fridge without being properly secured. All or any service users involved in self-medication must first be assessed as competent and safe to carry out the procedure and must agree to maintaining their medication safely and securely to prevent access by less capable clients. The cleanliness of home was questioned when dirt and muck were discovered under bath hoists, carpets were stained, divans were stained and damaged and the toilets lacked bins. The environment was in need of further attention, bedrooms and lounges required redecorating, hot water supplies reviewing due to the temperature of the water at source being delivered too hot, vanity units – chairs – divans – carpets – wardrobes – lighting and walls damaged by doors, etc. repaired, replaced or renewed. The use of additional heaters, etc. by service users should be risk assessed on an individual as well as on an environmental level. The practice of allowing service users to smoke in the dining room should be reviewed, as this filters into the open plan lounge and affects nonsmoking clients. Staff should be discouraged from smoking in the laundry area, as this is located close to the kitchen. The door between the laundry and the kitchen should be kept shut to prevent any possible cross-contamination of infectious agents. Clients who are wheelchair users should not be admitted to rooms below 12m in size and therefore the client currently occupying a room below DS0000012525.V288201.R01.S.doc Version 5.1 Page 7 • • • • • • • • Portland Lodge • • • • • • • • • • • • • • • this square meterage should be offered a larger room when one become available. The pre-admission assessments should be comprehensively completed. Service users’ plans should have direct links to the pre-admission and ongoing assessments of their needs; all assessed needs should be included within the care plan. Gaps in the financial records of service users must be avoided. The home’s complaints process requires a system for logging complaints raised, investigations undertaken and resolutions or outcomes reached. Staff require structured, formal supervision on a regular scheduled basis. The activities for service users could be better organised, with a regular programme of entertainments, time set aside for staff to socialise and interact with service users and far greater emphasis placed on what the service users might like to do for entertainment (care plans, activities plans, records of activities, discussion at meetings, questionnaires around leisure pursuits, etc.) could be considered. The manager must enrol upon and complete a managerial qualification at NVQ level 4 or equivalent. A system for documenting and monitoring the training achievements of the staff must be introduced, as well as a process for ensuring ongoing training needs are identified and planned for. The recruitment and selection strategy of the home must be reviewed and renewed to ensure all relevant and required checks are completed prior to the person commencing employment. The contracts of the service users require attention to ensure both parties can sign to acknowledge receipt of their contract, terms and conditions. The home should review how its accident records are logged to ensure compliance with data protection requirements. Efforts to improve how and where details of medical, health and social care contacts for service users are kept and documents must be made. The structure of the home’s record keeping and the general neatness and accuracy of the records maintained should be improved. The home’s whistle-blowing policy should be reviewed to eliminate the possibility of staff not raising concerns for fear of blame and sanctions. The statement of purpose should be amended to ensure accurate details of the home’s categories of registration are documented. 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. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 8 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 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. Improvements have been made to both the statement of purpose and service users’ guide, although not all information contained within the statement of purpose is accurate. The contract for service users is erroneous as it possesses nowhere for the service user or home’s representative to sign. Service users’ pre-admission assessments are poorly maintained and often fail to link adequately into the home’s care planning process. The home does not provide an intermediate care service. EVIDENCE: At the time of the last inspection it was discovered that the manager had admitted service users outside of the home’s conditions of registration, a direct breach of the Care Standards Act 2000, this failure to comply with the law resulted in the manager accepting a Formal Caution. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 10 At the last inspection both the service users’ guide and statement of purpose documents were noted to be out of date and to possess inaccurate information. At this visit revised copies of these documents were provided to the inspectors, which evidenced that both had been revised and updated, although one error was noted in the Statement of Purpose were it describes the home’s categories of registration to be for 6 service users in the MD (mental disorder) category, whilst the home is actually registered in respect of 5 places under this category. The service users’ guide contains details of the terms and conditions of residency and is used to provide private service users with a contract, although as noted by the manager there is nowhere for either the service user or the company representative to sign their agreement/acceptance to the details of the contract. It would appear from the pre-admission assessments seen that the manager or senior staff members are available to meet with prospective service users prior to admission. However, it is also clear that the manager and the staff involved in carrying out the assessments are failing to complete the pre-admission documentation in any depth and that often large sections of the pre-admission assessment are left blank or partially completed. When records are being more comprehensively completed the care staff are failing to turn the identified care needs into working care plans and so evidence that they are meeting the needs of the service users are in short supply. When the placement of the service user is being arranged by the local authority or when the individual is being discharged from an NHS establishment their placement or discharge should be accompanied by a plan or summary of their care needs. However, many of the service users’ records inspected at this visit lacked this documentation, which would have supplemented the assessments undertaken by the staff and provided much needed additional information. In conversation with service users and visitors the lack of care planning or assessments seemed not to be of concern, with people more keen to stress how much they appreciate the care provided at the home and the dedication of the staff. The home does not provide an intermediate care facility and therefore this standard was not inspected. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. The care plans for service users are inadequate and lack direction for staff. The documenting of health and social care contacts lacks cohesion and structure, which leads to ad hoc documenting practices. The home’s medication system is inadequate and does not safeguard service users’ wellbeing. The service users feel well cared for, respected and happy with the service. EVIDENCE: The care of several service users was case tracked as part of the inspection process, which included a review of their care plans and associated documents. It was evident from reviewing these records, alongside the pre-admission assessments, running records and medical records, etc. that the home’s approach to care planning had faltered and that the care needs of people were not being adequately identified, monitored or planned out. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 12 Often people were noted to have only two or three care needs identified, whilst the inspectors could readily identify other issues that had been missed or ignored, plans for continence management, diabetic control/management, falls management, etc. It was also noticeable that no-one had been assessed with regards to their moving and handling needs, despite often possessing quite challenging handling problems, as highlighted by the staff, entries in their running records and accident reports. The art of any good care planning system is to ensure that all identified needs are covered by a plan and that good assessments, pre-admission, moving and handling, diet, etc. are employed to identify the full range of that person’s needs. It is also important to ensure that evidence is kept, in the form of a written running record, of the care delivered to the service users and that this document is accurate, clear and concise. However, the system used by the home at this time is disorganised and untidy, which can lead to recording errors or records being duplicated unnecessarily into two or more places. The staff’s approach to documenting the service users’ involvement with health and social care professionals, general practitioners, community nurses, consultants, care managers, etc. is also unstructured with some staff documenting the information in a file designated for the purpose of recording such data, whilst other staff appear to record the same type of information in the running record. The problems associated with such ad hoc arrangements should be quite clear to most managers, as the information can become easily lost and disjointed and can even lead to staff not documenting the outcomes of such interactions, as they are unsure of what is expected of them. A similar situation was noted with the accident and incident logging system, with some items noted to have been written down in the running record and others in the accident log, etc. It is important when monitoring trends of incidents, etc. to have the information readily and easily accessible, which is not the case if the recording practices of the staff differ. It was also noted that some incidents, classed as reportable under Regulation 37 of the Care Homes Regulations, had not been forwarded to the Commission and this practice should be reviewed, as the Commission also has a role in monitoring trends and accidents. However, despite the issues noted by the inspectors, the general impression of a community nurse visiting the service was that the home is very good at seeking medical and/or health care advice on behalf of the service users. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 13 Records also confirmed that staff often accompanied service users on hospital visits, even if only on the first visit to gauge their abilities to manage independently (younger service users) and that the manager always attended health care reviews when invited. The service users and their relatives also seemed happy with the support they received with this aspect of the care, one younger client discussing being accompanied on his first visit to St Mary’s Hospital. On previous inspections the lack of staff trained in the management of medications had been an issue; and whilst problems were encountered with the home’s medication management process, it was evident that steps have been taken to enable staff to undertake appropriate training, with five staff plus the manager having now completed a BTEC Award in Medication Management. However, as mentioned, some problems with the home’s approach to the management of service users’ medicines were still encountered: 1. Gaps were discovered in several ‘Medication Administration Records’ (MAR), which is concerning as it is imperative that a true and accurate account of the medications taken by a resident be maintained, in case of changes in health, repeated refusals to take a medication, to prevent overdosing, etc. 2. Medications were observed being stored in the fridge, which was not lockable and therefore not compliant with the guidance from the ‘Royal College of Pharmacists’ or ‘Safe Custody’ regulations. 3. Medications for return to the pharmacy were located in an unlocked filing cabinet, which again would breach the above guidance and regulations and is unsafe, as it does not inhibit access to confused clients. 4. Medicines (Paracetamol) prescribed for a service user was being used by staff to treat their own mild ailments, headaches, etc. This practice is illegal as any prescribed medication is the property of the person it is prescribed for and therefore once no longer required must be returned to the pharmacy for disposal. 5. Staff were involved in secondary dispensing – one member of the staff team dispensing the medication, whilst a second member of staff administers the medication (observed during the inspection) before the first staff member signs to confirm administration. This practice is dangerous, as mistakes can be made in communicating who the medication is for, or in the dispensing of the drug, etc., the result being that two staff are responsible for a medication error. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 14 This system can also encourage a laissez-faire approach to medication administration, as both parties rely on the other to ensure no mistakes occur instead of taking on the responsibility themselves. 6. The staff and management must remember, even when attempting to promote independence within the service user group, i.e. enabling a client to self-medicate, that an assessment of their ability to safely undertake the process is established: can they access the medication, do they appreciate the times the medication must be taken, do they appreciate that other medications might have to be avoided, will they agree to store their medication safely, etc. The home and/or staff actually received considerable praise from the service users and a visiting health care professional for their efforts to promote independence, dignity and respect within the resident group, the health professional discussing how people are always seen in the privacy of their own bedroom and how staff had been quick to establish boundaries for visiting one client, who is occasionally involved in private pursuits, which require interrupting. The staff were also noted to use specific terms of address when speaking to the residents, these preferred names, etc. clearly documented on the service user plan. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. There is a lack of social stimulation and entertainment available for service users. The arrangements for visiting meets both the needs of the service users and their relative / friends. There are boundaries or limiting factors to the autonomy that can be exercised by service users. The service continues to maintain incomplete or inaccurate records of the meals served to residents. EVIDENCE: From the evidence gathered during the inspection fieldwork visit it would appear as though the home and/or manager should undertake a review of the home’s programme of entertainment and how service users are supported during their leisure or social time. In conversation with service users it became apparent that some individuals felt the staff were often too busy to provide social support and stimulation, one Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 16 person commenting on how ‘they would like to go out more but staff are never available in sufficient numbers to assist’. This is, however, not a view shared with the manager, who stated that service users are supported when they wish to go out and maintained that additional staff are available in the form of domestic, catering and management staff whose contracted hours include additional time to support service users, although the duty roster seen did not include details of these hours. It was also clear that the staff felt they had insufficient time to socialise with the service users and mentioned how one client liked dominos but staff could not always spare time to play. There was also no formal activities programme scheduled, the manager stating that this was due to the fact that service users did not attend when entertainments were organised. However, as there are no residents’ meetings or evidence of the subject being discussed on admission or as part of the service users’ plans the inspectors must conclude that insufficient activities and entertainments are provided currently. On a more positive theme the inspectors did notice how regularly visitors arrive at the home, one client’s wife visiting daily and remaining with her husband for most of the day and other relative popping in as and when convenient. In discussion with the spouse of a service user it was established that the home imposes no direct limitations on her visits and that people are always welcoming on her arrival. She also discussed being provided with a meal during her visits and that the food was very nice. It was also established through conversation and observations of the younger adults that they are far more likely to be involved with the local community, as most are able to go out unaccompanied, although these outings should still have been thoroughly risk assessed, which on inspection of the records would appear not to have been the case. The promotion of autonomy or choice within the service user group appears to the inspectors to fluctuate wildly, with there being no evidence of any residents’ meetings, no evidence of a quality auditing system – where feedback from clients is sought, despite this being advertised within the statement of purpose and comments from clients about being unable to go out as there are insufficient staff available to support them. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 17 However, the home is prepared to support clients to self-administer their medication, although they had failed to undertake the necessary assessment; and do enable younger clients to go out shopping, etc., although again there is a failure to risk assess these activities. The inspectors also established that the home and/or staff are happy to, and do support, one client who likes to follow the horses and will even place small wagers for him. Another service user stated how he is supported in purchasing his own (additional) snacks and food items, which he likes. Generally the meals and menus met with positive comments from both service users and relatives, people describing the food served as ‘nice’, ‘good’ and confirm a choice of meals is provided. Observation undertaken over lunchtime established that people seemed to be enjoying the food served and that plates were being cleared. There also appeared to be sufficient staff available to support people who required assistance, although these individuals were being aided in the lounge, as the dining space is limited. The inspectors were also puzzled as to why the home should serve its teatime meals so soon after lunches had been finished, people observed to be commencing their evening meals around 16.00 hours, barely three and half to four hours past the main meal of the day. However, no service user or staff member spoken to specifically about meals raised this as an issue, which could indicate that either this is an accepted practice within the home or that it is a practice based on people’s own preferences, there is no evidence to support the latter possibility. On inspecting the home’s record of meals served to residents it was noted that several days worth of entries had been missed, which is an ongoing problem that must be addressed. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The home’s approach to managing complaints is reasonable, although still in need of development. The staff lack guidance and training in matters relating to adult protection. EVIDENCE: At the last inspection the home’s complaints procedure was found to require updating and revised details of the policy uplifted into the statement of purpose and service users’ guide documentation. At this visit it was established that these requirements had been met and that service users and visitors should now have access to current and accurate information relating to the home’s complaints process. However, whilst improvement had been made on how people are informed about the process for raising complaints, it became clear in conversation with staff that they did not appreciate how a complaint should be managed and could not locate the complaints logging book or forms; an important aspect of any procedure. Feedback from the service users would indicate that whilst they perhaps do not appreciate the finer points of the home’s complaints process they would be happy to raise concerns directly with the manager and/or staff, whom they described as approachable. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 19 Information relating to the promotion of adult protection was clearly accessible in-house and was located by staff within the home’s policy and procedures file, this file containing both details of the home’s own policy and the wider Isle of Wight protection strategy. However, training records and comment from staff indicate that they have not recently attended any adult protection training, although one of the senior staff attended an event hosted by the Local Authority and was supposed to cascade information down to her colleagues, it is understood, however, that this has not yet occurred. The inspectors also noted that the home’s whistle blowing policy, whilst generally well constructed, could lead to some staff fearing reprisals or disciplinary action if unsubstantiated. It was acknowledged by the manager that the intention was to ensure all legitimate concerns raised under this procedure would be handled accordingly but those of a more malicious intent would be addressed. However, the inspectors did feel that the manager should review this procedure to ensure that its primary message, one that should encourage people to come forward and raise concerns without fear of reprisals, etc. is set out clearly. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. The environment continues to be in need of attention as the décor, cleanliness and general ambiance could be improved. EVIDENCE: A tour of the premises was undertaken and whilst a number of improvements have been made to the home over recent months - newly decorated bedrooms, floors replaced in toilets and bathrooms, new moving and handling equipment purchased and the front aspects of the home repainted, other areas of the premises, however, have continued to degenerate. • • • Corridor carpets were noticed to be fraying where jointed and several stains were detected. Lighting is generally poor and several bedrooms had lights where the bulbs had blown. Items of furniture in people’s bedrooms required replacing, repairing or renewing: wardrobes, divans, vanity units, chairs, etc. DS0000012525.V288201.R01.S.doc Version 5.1 Page 21 Portland Lodge • • • • • • • • • • Several carpets in service users’ rooms were also noted to be stained Externally the side aspects of the home still require decorative attention, wall, gutter, window frames, etc., although the manager did state that arrangements for this to be addressed had been made. Furniture in the lounges requires replacing due to age or not being suitable for the people accommodated (moving and handling issues should be considered). The underneath of the bath hoists should be cleaned (regularly). General wear and tear to radiator covers in the hallway should be addressed. Bins should be brought and installed in the toilets. The lounge décor should be made brighter and lighter, as should the décor in the hallway off the kitchen, which is dark and has no natural light source (light is important to those with visual impairments). The smoking by service users in the dining room should be reviewed as the odour is detectable in the hallway and lounge and might be upsetting to non-smokers. Staff should stop smoking in the laundry, as odours could contaminate clean clothing. Free standing radiators should be risk assessed. The maintenance records were also inspected during the visit and would have seemed, on reading, to suggest that the identification of repairs and/or maintenance issues are left to the maintenance person, as all entries in the log were written by one individual. However, in conversation with the manager it was determined that staff and the manager herself record all maintenance concerns within a communications book and that the maintenance person then transfers this information into the logging book where he signs to confirm the job has been completed. On reading through the communication book a number of concerns or issues regards general repairs around the environment had been documented. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. Insufficient staff are available to meet the needs of the service users. Sufficient numbers of staff are accessing and/or possess National Vocational Qualification at level 2 or above. The home’s recruitment process is not being adequately operated to ensure the safety of service users. Staff have limited access to training and there is poor provision for identifying and planning how future training needs will be managed. EVIDENCE: The duty roster indicates that two care staff are available on each shift, morning, afternoon and night, with additional staff employed to undertake domestic, catering and maintenance duties. In conversation with the manager it was established that her role is supernumerary and that the domestic and catering staff are employed above the hours deemed necessary to perform their tasks, allowing them to support care staff in the delivery of care. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 23 However, conversations with care staff would tend to contradict this view, as carers were clearly of the opinion that they do not have time to undertake additional tasks i.e. socialising or participating in activities with service users. The views of the staff were also supported by comments from the service users, with at least two people stating that they would like to go out more often but that staff were often too busy to take residents out. It was also evident, during the review of the service users’ care plans, that generally people do not have their social or leisure needs considered as part of the care planning process and that the care plans lack any direction for staff as to how individuals might require entertaining. Staff were also asked about training, with the specific topic of National Vocational Qualifications (NVQ), highlighting that most senior or longstanding carers had completed either NVQ level 2 or an equivalent qualification. These statements were supported by information provided prior to the inspection, in the form of a list of employees and their qualifications and additional information collected on the day, copies of staff training records, which identify that 7 of the home’s 13 staff possess an NVQ at level 2 or above. Given the number of staff possessing an NVQ level 2 the home’s ratio for the number of staff trained to this level is 54 , which is above the recommended national minimum standard of 50 . However, whilst the home is performing well in respect of the number of staff possessing an NVQ, the evidence would suggest that the home is performing less well when it comes to its general training programme, the training records providing strong evidence that training opportunities are either limited or the staff lack motivation when it comes to taking up training opportunities. As it has already been established through conversation with the staff team that they feel stretched whilst at work, and given the simple fact that a newly purchased hoist cannot at this time be used as the staff have not received training around its operation, the inspectors are incline to believe the primary scenario. Additional factors which also have to be taken into consideration are the lack of any scheduled mandatory training events, the lack of any planned training and/or skills development opportunities for employees – above and beyond mandatory courses, the lack of supervision opportunities and the fact that when interviewed staff found it hard to recall the last training events they had attended or completed, other than the medications training course required by the Commission. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 24 The home was also found to be performing poorly in respect of its recruitment and selection strategy, the manager informing the inspectors of three cases where she had not obtained appropriate Criminal Record Bureau or Protection of Vulnerable Adults checks for staff she had commenced working in the home. It was also evident on reading through files that other information relating to Schedule 2 of the Care Homes Regulations 2001, was also missing, photo proof of ID, full and detailed employment histories, etc. As one of the staff employed at Portland Lodge was known to the Commission following the termination of their previous employment for matters reportedly constituting gross misconduct, it is important that a robust and thorough recruitment strategy be implemented and that this includes: full and detailed employment checks, thorough interrogation of applications - to ensure gaps in employment are explained, thorough inductions and supervised working arrangements and the collection of all documents specified under Schedule 2. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): St 31, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. The manager is experienced but lacks method and/or organisation in her approach to leadership. The home has no quality auditing programme and no clear means for identifying if service users are satisfied with the service provided. Where the home is involved in managing or supporting people to manage their monies, the record keeping by staff is poor and inadequate. The supervision process for staff is inadequate and does not provide staff with the opportunity to discuss training needs or seek managerial support and guidance. The home’s approach to record keeping is poor, as evidenced throughout the report. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 26 The manager does not provide staff with sufficient information in relation to health and safety and has no specific training objectives for staff. EVIDENCE: In discussion with the manager it was established that she has not yet enrolled on a managerial course, NVQ level 4 or equivalent, and whilst she has a professional qualification and over ten years experience she has little notion of how to manage records, plan and schedule training – meetings - supervision, etc. and generally has little concept of how to operate structured systems, which could improve the overall performance of the home. The evidence to support this judgement is clearly set out throughout the report and it is important that the manager begins to realise that good organisation and structured systems are often the bedrock of any successful service. It is also important for the manager to understand and appreciate the reason behind quality assessment and audit, processes that help to focus the service on areas that require improvement and/or, areas where the residents feel the direction of the service is not meeting their needs. During the visit the inspectors established through conversation with staff and the manager that service users are not afforded the opportunity through residents’ meetings to comment on the service provided. It was also confirmed by the manager that whilst she has in the past conducted satisfaction surveys, this has not recently occurred and that most evidence of people’s satisfaction with the service is provided either verbally or through thank you cards and letters. The statement regarding the use of satisfaction surveys was supported by comments made by staff, who prior to meeting with the manager had informed inspectors that a questionnaire had been sent to people previously but they were not sure if the manager still did this. Further evidence of the manager’s failure to monitor or audit even the most basic of systems was established whilst inspecting the complaints procedure, with staff firstly unable to locate the complaints log and secondly admitting that they were unaware if the system was still in operation. Staff meetings were noted to have commenced and occurred in January 2006, although a record indicates this meeting was not minuted. February 2006 minutes for this meeting were available. March 2006 - a meeting was scheduled but did not occur. No further evidence of meetings having been planned could be found. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 27 The accident logs were inappropriately completed, as each accident report lacked the inclusion of an identification code, as required by the health and safety executive, although the manager had not identified this, which indicates that reports are not being reviewed. Staff confirmed that they had not received any formal supervision this year and were unaware of any planned or scheduled supervision dates for later in the year. This coupled to the lack of training and development plans, which would normally link to appraisals and/or supervision sessions, suggests that staff are inappropriately being monitored and supported in the delivery of care. Service user plans were poorly maintained, as reflected earlier within the report, and were being inadequately reviewed and updated, etc. The above are just some of the issues identified during the visit, which a quality auditing system would have helped identify, monitor and improve. Whilst a manager should be capable of addressing these issues, if properly equipped for the role, the provider also has a responsibility for overseeing the operation of the service and should through the Regulation 26 process be monitoring the conduct of the home. However, despite being required to undertake Regulation 26 visits on a number of occasions, including the last inspection, the evidence is that these visits are not taking place, the manager confirming that the Responsible Individual, Mr Trott, has not visited to undertake this task, a statement supported by the Commission’s database, which documents the receipt of Regulation 26 notifications. There are also concerns over how the staff are supporting service users with their monies. Whilst it is acknowledged that the home has limited involvement with service users’ monies, collecting monies for people and passing this onto the individual as they request, the record keeping system put in place to safeguard those people’s money was found to be poorly maintained, with gaps of up to four or five lines appearing between entries. In discussion with the manager it was explained that this was due largely to the client refusing or forgetting to sign for their monies, however these lapses could easily be abused, as they provide people with the opportunity to add entries or leave entries out without having to account for the monies or their actions. It is also worth recalling that the individual clients are also vulnerable adults who have either mental health problems or dementia related conditions, which can lead to recall issues and therefore any systems set up to safeguard their wellbeing should robustly be managed and monitored. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 28 Health and safety within the home is again a concern for the inspectors, given the moving and handling issues faced by the staff, as discussed within Section 2 of this report and the lack of training (with only four training records indicating that staff have completed moving and handling courses within the last 12 months). It was also noted within daily running and accident records that staff were involved in manually lifting clients from the floor, staff stating that on occasions they are having to lift one client from the floor (manually) up to 20 times a day, a practice both potentially dangerous for the staff and service users alike. Other aspects of concern that directly link with health and safety are items such as the COSHH data sheets, which were out of date and no longer applied to chemicals used in house: Infection control, with a lack of bins in toilets and the underneath of the bath hoist requiring cleaning, etc. and environmental safety: the home’s electrical certificate being out of date, the ramp by the front door rotting and loose, corridors dark and poorly lit, water from taps still being delivered at a temperature that is considered unsafe and the use of freestanding heaters without being risk assessed, etc. Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 29 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 2 3 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 2 1 2 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 30 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 Requirement Timescale for action 19/05/06 2. OP7 3. OP8 Regulation All service users must undergo a 14 full and detailed pre-admission assessment prior to accommodation being offered; and where a professional assessment has be undertaken a copy must be obtained to support the decision-making process re the person’s suitability to be admitted. Regulation All service users must be 15 provided with comprehensive and informative care plans based on the information gathered during the assessment process and ongoing re-assessments and any changes in their needs. The manager must ensure that Reg 13 & 37 staff are aware of how and where information relating to the health care needs of the clients and visits from health and social care professionals is to be documented. Any accidents or concerns affecting the wellbeing of service users to be properly documented and reported. 19/05/06 19/05/06 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 31 4. OP9 Regulation The manager must ensure that 13 arrangements for the safekeeping, administration and recording of service users’ medications are made. This should include the cessation of secondary dispensing, the elimination of gaps in MAR sheets, the correct storage of medication for return to the pharmacy and those items kept in the home’s fridge, the completion of assessments for clients wishing to self-medicate and the cessation of staff using medications prescribed to residents for their own personal use. Regulation The manager must ensure that 12 the arrangements for entertainment are reviewed and that a structured approach is taken to the delivery of leisure activities for clients, including: documenting on assessments and care plans for people’s preferences for entertainment and hobbies, the production of an activities schedule, the provision of time within the staff team to support people in the pursuit of their leisure activities and running records to evidence that people’s needs are being met. Regulation The home must maintain 17, Sch 4 detailed evidence of the meals (food) provided to service users. This requirement has been previously raised. Regulation The manager must introduce a 22 system for documenting all complaints received and the measures taken to investigate and resolve the issues raised. 19/06/06 5. OP12 19/06/06 6. OP15 19/05/06 7. OP16 19/05/06 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 32 8. OP18 The manager must also ensure that staff are aware of this procedure and how to operate and use the complaints logging system effectively. Regulation The manager must ensure staff 13 receive training around the protection of vulnerable adults from abuse and that this is regularly updated. Regulation The manager must ensure that 23 the schedule for attending to the items list is forwarded to the Commission, the date for completion of all works to be no more than 6 months from the date of the inspection. • • Bedrooms and lounges required redecorating Hot water supplies reviewing - due to the temperature of the water at source being delivered too hot Vanity units – chairs – divans – carpets – wardrobes – lighting and walls damaged by doors, etc. repaired, replaced or renewed. Ramp to the front door repairing or replacing. External areas of the home redecorated. 19/06/06 9. OP19 19/10/06 • • • 10 OP26 Issues concerning the fabric of the premise have been previously raised. Regulation The manager must ensure issues 13 of infection control are addressed and monitored. • • Bins supplied in toilets. The underneath of bath hoists cleaned. 19/06/06 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 33 11 OP29 12 OP30 Stained and soiled divans replaced. • Stained or soiled carpets cleaned or replaced. Regulation The manager must ensure a 19 robust and comprehensive recruitment and selection process is developed and introduced, this to include all Schedule 2 information. Regulation The manager must develop a 18 training programme for staff based on their educational and skills development needs. This programme should include specialist training designed to ensure staff are able to meet the needs of the service users: dementia care, mental health training, medication, Parkinson’s, diabetes, etc. The training programme must also take into consideration annual courses, moving and handling, infection control, adult protection, food hygiene, fire safety, health and safety, etc. • 19/05/06 19/06/06 13 14 OP31 OP33 The manager must also devise a system for documenting and monitoring the staff’s training needs and achievements. Regulation The manager must enrol upon a 19/06/06 10 suitable managerial course at either NVQ level 4 or equivalent. 19/06/06 Regulation The home must introduce and 12 operate effective quality auditing systems, which provide service users with means to comment on the service provided, take into consideration training, development and support systems for staff, ensures all records are accurately and appropriately maintained and reviews/identifies environmental DS0000012525.V288201.R01.S.doc Version 5.1 Page 34 Portland Lodge issues to be addressed. The Responsible Person must arrange for Regulation 26 visits to be appropriately completed. This requirement has been previously raised. Regulation The manager must ensure that 17, Sch 4 all financial records maintained on behalf of service users are accurately and appropriately maintained. Regulation The manager must introduce a 18 system of supervision for staff that is both planned and scheduled on a regular basis, this should be a formal process and records of all sessions maintained. This requirement has been previously raised. Regulation The manager must address all 13 issues of health and safety, including: • • • • • • • Infection control concerns highlighted. The rotten and loose ramp by the front door. The temperature of water delivered at source. Moving and handling practices highlighted. The use of heaters without risk assessments. Dark corridors and passages. The lack of an electrical safety certificate. 15 OP35 19/05/06 16 OP36 19/06/06 17 OP38 19/06/06 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 35 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. 2 3 4. Refer to Standard OP1 OP2 OP18 OP26 Good Practice Recommendations Information contained within the statement of purpose should be amended to ensure it is accurate. All service users should have a signed and dated contract or terms and conditions of residency document available. The manager should review the home’s whistle blowing policy to ensure no element of blame could be placed on staff legitimately raising concerns. The practice of service users smoking in the dining room should be reviewed and an alternative location identified away from non-smokers. The staff should also stop smoking in the laundry and an alternative location for this designated. The manager should review how staff are deployed to ensure adequate numbers of staff are available to care for and support service users. The manager should ensure all accident records are appropriately completed (coded) and stored. Records are poorly maintained and haphazardly constructed, which should be addressed to give a more professional and organised feel to the service’s record keeping. 5. 6. 7. OP27 OP37 OP37 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 36 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Portland Lodge DS0000012525.V288201.R01.S.doc Version 5.1 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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