Inspection on 16/03/09 for Silversea Lodge Care Home

This inspection was carried out on 16th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Silversea Lodge Care Home 06/08/08

Silversea Lodge Care Home 26/02/08

Silversea Lodge Care Home 24/08/07

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Silversea Lodge Care Home 46 Silversea Drive Westcliff On Sea Essex SS0 9XE Lead Inspector Ann Davey Key Unannounced Inspection 16th March 2009 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 Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silversea Lodge Care Home Address 46 Silversea Drive Westcliff On Sea Essex SS0 9XE 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) 01702 480502 01702 710482 silversealodge@yahoo.co.uk Mr Pritesh Patel Manager post vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2008 Brief Description of the Service: Silversea Lodge provides care and accommodation for fifteen elderly people. The premises and facilities are provided on ground and first floor levels and have been suitably upgraded and adapted for the accommodation of elderly people. There is one main lounge and a separate dining room. There is single bedroom accommodation throughout, some of which have en-suite facilities. A passenger lift is provided for residents to gain access to the first floor. There is a medium size garden to the rear of the premises and limited parking available to the front. Silversea Lodge is located in a residential area of Westcliff on Sea. It is in close proximity to local shops, bus routes and other local community amenities including Chalkwell Park. There is a Statement of Purpose and Service User’s Guide available. A copy of the last inspection report was also available. The weekly charges range from £400.00 - £475.00. The exact fee depends on the type of accommodation requested/available, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key unannounced site visit that took place over two days. The first visit took place on 16th March 2009 and the second visit which was undertaken by the pharmacist inspector, took place on 8th April 2009. On both days, the provider and the provider’s consultant/representative were present. The last key inspection took place on 6th August 2008 and an additional unannounced inspection took place on 27th January 2009. The purpose of the January visit was to assess the progress the home had made on specific areas such as medicine administration practices, care plan documentation and staff training. We found significant improvements during that inspection. Nine residents were being cared for in the home at the time of this inspection. The reason for this has been explained the in ‘choice of home’ section of this report. The home’s Annual Quality Assurance Assessment (AQAA) had been completed and returned to us in September 2008. This document provided the home with the opportunity of recording what they did well, what they could do better, what had improved in the previous twelve months and their future plans for improving the service. We acknowledged that since this document had been completed significant changes that had taken place within the home. The next AQAA will hopefully provide a better overview of the home. We sent surveys to the provider asking that they be distributed and returned to us so that we could have an understanding of how residents, staff, relatives and health care professionals felt about the care provision within the home. We received two completed surveys from residents, three completed surveys from members of staff, four completed surveys from relatives and one completed survey from a health care professional. The majority of the surveys had been completed around the time of the August inspection when the outcome had been poor. We felt therefore that some of the comments within the August surveys reflected the situation within the home at that time and we have not therefore focused on them for the purpose of this report. Some surveys were sent to us in September 2008 (after the last key inspection) and were more positive. Comments from some of these surveys have been included within the report. Both days in the home were pleasant and all staff were co-operative and helpful. A tour of some areas of the home took place on 16th March 2009. Throughout the inspection, care practices were observed and a random selection of records viewed. We spoke with residents and staff. A notice was Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 6 displayed on 16th March 2009 advising any visitors to the home that an inspection was taking place. There were visitors in the home, but nobody asked to see us. Since the last key inspection, the consultant had introduced new polices and procedures, implemented improved staff training and supervision and had overseen the day-to-day management of the home. At this inspection we acknowledged the positive input of the consultant, but felt it was important to assess the competence of the staff employed in the home. The outcome of this has been reflected within this report and in the overall rating of the service. All matters relating to the outcome of the inspection were discussed with the provider and the consultant who took notes so that development work could be started immediately where necessary. What the service does well: What has improved since the last inspection? Following the previous key inspection, significant improvements were noted during this visit. Full details about them have been recorded within the report. These improvements had been as a direct result of the consultant’s input. The outcome of these improvements meant that staff were better trained and supervised, details in care plans and risk assessments were better, documentation and recording systems were more structured and current and the staffing establishment was stable and reliable. For residents, the outcome was that they had more confidence in the staff on duty, they knew that staff Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 7 had been trained to look after them, staff had more time to talk to them, the food was good and the home was a much happier place to be in. For staff, the outcome was that they were working in a structured way, they had been trained, they were receiving some supervision, they had direct access to the consultant who they felt was ‘in charge’ and generally were feeling much happier and fulfilled in their work. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 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 Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 (standard 6 was not assessed as intermediate care is not provided by the home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about what the home can provide was available. Systems were in place to ensure that no decision is made about any future admission to the home unless it was clear through a detailed assessment process that the proposed new resident’s care needs could be fully met. EVIDENCE: There had been no admissions to the home since the last key inspection. Following the outcome of the August 2008 key inspection, the local funding authority had suspended any future placements. Following the focused inspection in January, the local authority had written to the provider explaining that the suspension had been lifted but they would monitor practice in the home. The provider told us that no admissions would take place until they (the provider) was satisfied that care practice standards had been met and were being maintained. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 10 The consultant had put in place a detailed pre admission policy, procedure and a resident’s ‘dependency needs profile’. There was a format in place for an ‘interim care plan’ which the policy said would be completed within the first 48 hours of admission. At the next inspection we will assess this area of care further and look at completed documentation. The home’s Statement of Purpose and Service User’s Guide had been updated and was ready to be ‘approved’ by residents in their meeting which was due on 26th March 2009. Copies will then be made available within the home and further copies could be obtained upon request. The consultant told us that residents had been involved in the review of the documents. We asked two residents about this and they confirmed that this had taken place. One resident said ‘it was nice to be asked about what I thought…..I was asked what I would like to see written about the home and I told them I was happy here and liked the food’. At the last inspection it was noted that not all residents had contracts of residency/terms and conditions in place. We looked at three files at random and saw that these documents were now in place. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive care based on a sound intuitive understanding of their individual needs but may be at some risk because their recorded care needs were not always current. EVIDENCE: There was evidence that since the last key inspection, the consultant had completely reviewed the care plan documentation system used in the home. This included the care plans, health care records, medicine administration records and risk assessments. We could see that staff had undertaken ‘in house training’. The consultant had provided (and was containing to provide), significant input by way of implementing policies, procedures, overseeing and supervising practice. It was important for us to assess staff competence in these areas, otherwise, it would be the consultant’s work that would determine the overall outcome of this inspection. This view was discussed with the provider and consultant. It was agreed that the most senior member on duty would assist us in the assessing of documentation but would be supported by the consultant. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 12 The member of staff had an improved general understanding of care plans and risk assessments, but was not able to discuss the processes in any detail. For example, when asked about what aspects of care should be assessed and recorded on a care plan, the main focus of their response was on the physical aspect of care. We selected four care plans at random to look at. This also included the associated health care records, daily reports and risk assessment documentation. We acknowledged that recording was much clearer and easier to read and follow than at the last key inspection. The care plan format asked for the care need, expected outcome, goal, action plan, review date, date of implementation and staff signature. We saw that risk assessments had been reviewed. We acknowledged the significant improvement since the last inspection and discussed the areas that still required development. For example, on two care plans it was recorded that both residents were taking antibiotics. This was not accurate, as the medicines had finished some time previously. One care plan made no reference to the resident’s dietary needs and another made no reference to the additional care required by a resident following an infection. Two residents had received the attention of healthcare professionals, but this had not been record adequately on their respective care plans. The consultant agreed with the above findings. The consultant and the senior member of staff told us that the home has a good relationship with all healthcare professionals. We were told that residents have access to male and female doctors, the community nurse visits the home regularly and the funding local authority undertakes regular care package reviews on residents. One healthcare professional in the surveys commented ‘the care of patients is wonderful, referral to other agencies for further management is always prompt. When we leave any new care plans, care is followed as planned’. We received the following comment from a relative within their completed surveys about the care provided by the home ‘staff give good care and are all genuinely caring to all residents’. During our time in the home we received the following comments from the residents, ‘things have improved now’….’staff now have more time for us and we can understand what they say’…’I’m involved now in more things’….’the food is so much better and it’s a nicer atmosphere too’. Other residents told us ‘I’m happier now’…there’s enough staff around now’…’staff have time to talk to you’. A pharmacist inspector examined the practices and procedures for the safe handling, use and recording of medicines on 8th April 2009. This has improved over previous inspections. Facilities provided for the storage of medicines are secure and temperature controlled. This ensures that people receive medicines of good quality and prevents unauthorised access. We noticed, however, that there is no record of the temperature of the room used for Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 13 surplus medicines and dressings on the first floor. This was discussed with the acting manager and was to be remedied immediately after the inspection so we consider that the requirement made on the last inspection, that medicines must be stored under suitable environmental conditions and records kept, has been met. No medicines were found not locked away and so the previous requirement made that medicines must be locked away when not in use has been met. We looked at records kept of the receipt and disposal of medicines and the records made when medicines are given to people. These were in good order with no discrepancies. This demonstrates that people receive the medicines provided for them and special instructions for giving medicines to people e.g. before food, are followed. However, we saw that for two people the record made when medicines are given to people did not clearly record that date on which they were given. Also, hand-written medication record forms were not signed or dated by the person making the entry and they were not checked for accuracy by a second person. It is strongly recommended that such a procedure is implemented so that people are not put at risk of medication error. Where people regularly refuse to take their medication, there is no record that this has been discussed with their GP. It is important that prescriber’s are made aware of such an occurrence and that this is documented in the care records as this may influence future decisions about treatment. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a good nutritional diet and a developing activity/occupation/social programme. EVIDENCE: It was encouraging to note that following the last key inspection, there was evidence to demonstrate that the home’s activity/social programme had improved to some degree. On the care files we saw there was a questionnaire asking residents about what they would like to do. We saw that there was now a regular slot on the residents monthly meeting for activities to be discussed. There was an activities policy in place which we were told by the consultant is gradually being implemented. We saw a record of the activities that had taken place which included events such as nails painted, listening to music, skittles and ball games. The consultant assured us that other events had taken place, but unfortunately no record had been kept. In the activity record book, entries were inconsistent, for example in the past two months the following were the only entries recorded 2/2/09, 3/2/09, 16/2/09, 3/3/09 and 4/3/09. We were told that there had been a social event on Valentines Day and a recent fish and chip supper had taken place. These had not been recorded. The consultant told Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 15 us that the activity and social event programme was still being developed and acknowledged that although other events had taken place, they had not been recorded. One relative in their surveys commented ‘I would like to see the residents being taken out more, even just for a walk (or wheelchair ride) around the block and also some entertainment brought in more often’. One resident told us ‘I get bored sitting around, I know they are trying to do more things but I wish they’d hurry up’. Another resident told us ‘staff always talk to us but I want to do something like go out’. We did not see any residents isolated either in the bedrooms or in the lounge area. We noted that a member of staff was always in attendance or near by and responsive. As on the last key inspection, we noted that much of the interaction between staff and residents was task based, but there was a lot of good humour and pleasant, friendly dialogue. The senior member of staff told us that all current residents have regular visits from either their family or friends. During our time in the home a number of visitors were around. On this occasion the opportunity to speak with visitors did not present itself. We did speak to visitors at our last key inspection and since then we have received some of their views within completed surveys. The home does not have a designated area where residents can see their visitors in private if they so choose. The only choice available is their respective bedroom or one of the communal areas. The home’s office is too small for any private meetings and it leads directly to the staff cloakroom facilities, which understandably is in constant use. This area would not be conducive to any informal family/friends/resident gathering. On our arrival to the home, breakfast in the dining area was just finishing. Residents told us that ‘it was good’. We saw the table laid for lunch later in the morning. The menu was displayed on the table. During the course of the day we overheard staff asking individual residents about their preference for lunch and tea. Individual residents confirmed to us that they are given choice at every meal. We received no negative comments about food from any resident. Each resident had a record of what they had eaten for breakfast, lunch and tea. There was provision for any comments to be added and the signature of the member of staff making the entry. We could see from these records that residents are provided with a varied and nutritional diet. We asked residents about the level of choice and control they felt they had within the home. As on the previous inspection, all acknowledged that they understood that the home has routines, but within them there was a degree of personal choice. Two residents told us about their ‘getting up’ and ‘going to bed’ routines. When we asked if the home set these routines, we were told by one resident ‘certainly not, I go to bed when I want and get up when it suits Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 16 me’. Another resident told us ‘I can have a drink when I want, I just ask’. We received no negative comments from residents about any of the routines within the home. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their concerns will be managed appropriately and that staff understand how to protect them. EVIDENCE: Significant improvements have been made in this area of care for residents since the last key inspection. These improvements mean that complaints are managed well and staff know about the processes and procedures in place to protect and safeguarding residents wellbeing. The home’s complaints procedure was clearly displayed in the hallway. Residents we spoke with knew that had the right to raise any concern and said that they would speak with either Elaine (deputy manager) or Sara (consultant). Those spoke with said that they would be happy to do this and were confident that their concerns would be looked in to. One resident told us about a drink they were given and didn’t like. The resident said ‘I told them that I didn’t like it and they got another one for me’. Since the last key inspection the home’s records show that they had dealt with two complaints. We saw that that the matters had been properly recorded, how they had been investigated and the outcome. Both matters were in connection with care practices and had been resolved. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 18 Information about the local advocacy service had been displayed in the main entrance hallway. We spoke to three members of staff about their understanding of what the terms ‘safeguarding adults’ and ‘whistle blowing’ meant to them and we asked what they would do should they be concerned about a resident’s wellbeing. All told us that they had received training on these issues and were able to respond appropriately to our questions. We received the following comments from relatives within their completed surveys about the way in which the home had managed their concerns ‘I have raised several concerns about the home and have always found that if the issue is within the remit of the staff then it gets dealt with immediately, if it falls to the owner then it is either not done or takes a very long time’. We raised this comment with the provider who assured us that they had improved practice and matters would be addressed promptly now. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, comfortable and pleasant. EVIDENCE: Bedrooms viewed at random were clean and comfortable. Since the last inspection, the numbers on bedroom doors had been removed and all rooms had been named. For example, rose, tulip and peony. Residents told us that they had been allowed to choose the name for their room and were delighted with the result. All bedrooms seen contained personal items and were tastefully decorated and furnished. We noted that the member of staff who showed us around the home knocked on each bedroom door before entering. This demonstrated that staff respect resident’s privacy and dignity. The lounge was comfortable, light and airy. As on the previous inspection, residents told us they liked the lounge area because of the clear glass patio doors that overlook the patio and garden area. They could see the birds in the garden and Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 20 liked watching the effects of the changing seasons. One resident told us about a tree that they particularly liked looking at because of the variety of colours it had depending on the time of year. As noted in the previous inspection report, the current dining table remains too small for the number of residents the home is registered for. For example, the home is registered to accommodate fifteen residents, but the senior told us that the current table can only accommodate ten residents comfortably or twelve residents with a ‘squeeze’. We discussed this with the consultant who agreed to have further discussions with the provider, as the home must make suitable and appropriate provision. There remains insufficient designated storage space in the home for equipment. Wheelchairs and lifting apparatus were stored in corridor areas. We noted that some carpet areas were rucked up which meant that there was a potential hazard for residents tripping especially if they use walking aids or were unsteady on their feet. This was particularly evident in the corridor outside the dining area. This was discussed with the consultant who agreed to minimise the risk by making suitable arrangements. It was positive to note that the home now has a general maintenance and repair log book in place. The home‘s laundry and food storage facilities are housed in the rear garden area. In one of the food storage areas, we noted that one section of the floor covering was badly damaged. The senior member of staff agreed that this meant that the floor area could not be hygienically cleaned. In the other storage area, we noted a stack of old case records. We spoke to the consultant about this because to leave them there in a non-secure place, could pose a risk to resident’s confidentiality. The rear garden grassed area was well maintained and pleasant. As reported in the previous inspection report, the patio area was unkempt. The consultant told us that this will be attended to before the spring/summer season. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Current residents are cared for by a team of staff who have been trained, recruited well and are supervised. EVIDENCE: The home is registered to provide care for fifteen residents. On the day of the inspection, nine residents were accommodated. The outcome judgement for this section has been based on the staffing arrangements for nine residents. The senior member of staff told us that there were no less than three care staff on in the mornings (this number includes the deputy manager) and two care staff on duty in the afternoons/evenings. At night we were told that there is one ‘awake’ and one ‘asleep’ member of staff on duty. In addition, the home had a team of cooking and cleaning staff and a maintenance person. The rota was clear and reflected the staff that were on duty. A senior member of staff told us that there are now regular ‘handovers’ between each shift. They said that this had been a tremendous improvement and staff now had time to discuss individual residents care without being rushed. The home had not used any agency staff since the last inspection and has it’s own team of bank staff to cover holidays and training. The deputy manager told us that the consultant comes into the home three/four times a week and was available by telephone at other times. The deputy manager and care staff told us that they have a Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 22 very good relationship with the consultant and finds them ‘very helpful’, ‘friendly’ and ‘a good leader’. The consultant told us that since the last inspection no new staff had been recruited. We looked at two of the staff recruitment files that had been incomplete at the last inspection. Both had been updated. The consultant was putting the final staff supervision policies and procedures into place. We were shown various aspects of the proposed recording process. It was positive to see that the process also included a staff competency section. We discussed the staff supervision process with the deputy and the consultant. We understood that supervisor training is underway, but in the main, the consultant was undertaking a major role of overseeing all staff both in a personal ‘one to one’ meeting and also monitoring their individual practice. We will review the staff supervision practice again at the next inspection. It is important that robust supervision practices are put in place and maintained to ensure that staff are properly monitored in their delivery of care to residents. We saw evidence to demonstrate that regular staff meetings had taken place since the last inspection. This means that staff have the opportunity to meet together on a formal basis to discuss day to day issues and also to receive information and updates from the consultant or the provider. There was evidence to demonstrate that there had been a significant staff training drive since the last inspection. We saw records to demonstrate the training that had been achieved and what had been planed. We spoke to the consultant about the importance of not just having staff attending the various training courses, but of being more competent and confident in their respective practice as a result. With some training courses it was clear that a competence aspect was already built into the sessions, with others, the consultant had already seen the need to assess staff competence and this was being worked on. We discussed NQV training for staff. This too had improved since the last inspection. One member of staff has NVQ levels 2 and 3, another has NVQ level 2 and a further five members of staff had started their NVQ level 2. We will assess this further at the next inspection. Within the completed surveys, one relative commented ‘the carers in this small home are always friendly, cheerful and helpful’. Another relative commented ‘staff are patient and kind and always generate a cheerful atmosphere’. Whilst another relative commented ‘on the whole, I think staff do a superb job’. A healthcare professional in their surveys commented ‘staff are helpful, cheerful and caring’. Throughout the day, we spoke to many of the staff on duty. In the main, our conversations were in connection with the improvements that had taken place since the last inspection and we asked them for their views. We received the following comments ‘things are better now that Sara (consultant) is here as we Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 23 know what to do’….I’ve got a better understanding now of what I need to do’….there’s more order and structure’….’there’s been a big input of training and that’s helped’…’I would like things to stay this way, but Sara won’t always be here I know’….residents are getting much better care now’….everyone seems so much happier these days’. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home where the day-to-day management is overseen by an external consultant. EVIDENCE: Although the home is registered to provide care for fifteen residents, there were nine residents accommodated on the day of the inspection. There had been no manager in post for over a year. At the last key inspection, the outcome judgement for this section was rated as poor because the home was not being operated in a manner that safeguarded individual resident’s health, care or welfare. Following the last key inspection, the provider made arrangements for a consultant to oversee the day-to-day management of the home. The outcome of this inspection demonstrated the positive input the Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 25 consultant has had over the past six months. The consultant’s input and the positive manner in which the home had being operated on a day-to-day basis, meant that the quality of the care for the residents had improved significantly. The provider had no immediate plans to appointment a manager. The provider told us that they knew the input of the consultant remains crucial to the stability of the home and in providing quality and safe care for residents. The consultant visits the home three/four times a week and is available at all other times by telephone. The outcome judgement for this section has therefore been based on the above factors. Within the various completed surveys from staff and relatives we noted comments about their view of the provider’s lack of experience in running a care home and their lack of support to staff. These views were in the main reflected within the previous inspection report as they were completed and returned within the following month. Since then, as this report notes, a consultant now manages the home on a day-to-day basis. We understood from the consultant that their direct input was gradually being reduced and more responsibility given back to senior staff. The provider told us that they understand that the appointment of a suitable manager is vital. We will monitor the progress on this. The provider visits the home several times a week when they attend to shopping, some administration tasks and some maintenance tasks. The provider acknowledges that they have no experience of care management within a residential setting. The provider completes monthly Regulation 26 reports in conjunction with the consultant. This report is required by legislation to demonstrate that a provider knows what is happening and taking place in their home and is satisfied that all activity within it is compliant with statutory requirements. Since the last inspection, we have been kept informed about things that have happened in the home what we need to know about. For example, an error that had occurred in a medication practice and a reduction in staffing levels whilst there are only nine residents to care for. The consultant has brought about significant improvements in the quality assurance system within the home. Questionnaires to all stakeholders were sent out in September 2008 and we were told that there was a 51 return of completed surveys which was considered good by the provider. A Quality Assurance Report was produced in October 2008. On this occasion, we did not ask to see it. The consultant had reviewed and updated the home’s policies and procedures. Those we saw were well indexed, current and easy to follow. There was a ‘master copy’ folder of all policies, procedures, templates and formats in place. We spoke to three staff about these documents. All knew where they were and what they were used for. The consultant had also reviewed and updated the Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 26 system by which maintenance and safety certificates are audited, logged and filed. The home had an accident book to record any incidents that occur to residents. We were told that there had been no accidents since the last inspection. The home looks after residents’ personal monies if requested. The system used by the home had a good audit trail in place. We found that the general environmental and safe working risk assessments had been updated and were in place. There was evidence that all health and safety polices and procedures had been updated and these were displayed in appropriate places around the home. We saw records to demonstrate that regular checks had been carried out on the emergency lighting system, fire fighting equipment, firm alarms and automatic door closures (Dorgard) are in good working order. Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 3 3 3 Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? In part only 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 OP7 Regulation 15, Schedule 3 (2) Requirement Each resident must have a current plan of care in place which identifies every area of assessed care need, how the need is going to be met, who is going to meet the need and when. This plan of care must be kept under review at all times. This is to ensure that resident’s current care needs are known to staff and specifically relates to the those care plans seen where care plans had not been updated. 2. OP9 13(2) 17(1)(a) Records made when medicines are given to people must clearly record the date on which they were given. This will demonstrate that people receive the medicines prescribed for them. 3. OP9 12(1) 13(2) Where people regularly refuse to take their medicines, this must be reported to their GP and recorded in care notes. DS0000068495.V374541.R01.S.doc Timescale for action 31/05/09 30/04/09 30/05/09 Silversea Lodge Care Home Version 5.2 Page 29 This will protect people’s health and welfare. 4. OP31 10(1) Residents must benefit from a 30/06/09 leadership that has sufficient skills and expertise and is able to support staff in meeting the Statement of Purpose, protect residents’ wellbeing and understand how the service will achieve compliance with the Care Homes Regulations 2001. At the time of the inspection, the home was managed on a day-today basis by an external consultant. This requirement is in place to ensure that in the event of the consultant’s services being withdrawn, adequate arrangements are put in place by the provider for suitably qualified and experienced person to be in charge of the day-to-day management of the home. 5. OP32 10(1) Residents must benefit from leadership that has sufficient skills and is able to support staff in meeting the service’s Statement of Purpose, protect residents’ wellbeing and understand how the service will achieve compliance with the Care Homes Regulations 2001. At the time of the inspection, the home was managed on a day-today basis by an external consultant. This requirement is in place to ensure that in the event of the consultant’s services being withdrawn, adequate arrangements are put in place by the provider for suitably qualified and experienced person to be in Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 30 30/06/09 charge of the day-to-day management of the home. 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 OP9 Good Practice Recommendations Hand-written entries on medication record forms should be signed and dated by the person making the entry and checked for accuracy by a second person. The social activities/events programme should be developed in order to meet the needs and/or requirements of all residents. Staff should be suitably skilled and experienced to deliver the programme. The risk of residents or staff having an accident as a result of rucked carpets within the home should be addressed. The staff supervision programme should be developed to ensure that all staff are provided with regular individual sessions with a person who is suitable qualified and skilled to deliver the session. Previous residents care records that are currently in the outside rear food storage area should be removed and stored in a secure area to ensure that confidentiality is maintained. 2. OP12 3. 4. OP19 OP36 5. OP37 Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@cqc.org.uk Web: www.cqc.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 Silversea Lodge Care Home DS0000068495.V374541.R01.S.doc Version 5.2 Page 32 - 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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