Inspection on 26/02/08 for Silversea Lodge Care Home

This inspection was carried out on 26th February 2008.

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

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

Other inspections for this house

Silversea Lodge Care Home 16/03/09

Silversea Lodge Care Home 06/08/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Silversea Lodge Care Home 46 Silversea Drive Westcliff On Sea Essex SS0 9XE Lead Inspector Sara Naylor-Wild Unannounced Inspection 26th February 2008 10:50 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.V360529.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.V360529.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 Mr Pritesh Patel Mrs Shaila Rashid 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.V360529.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2007 Brief Description of the Service: Silversea Lodge provides care and accommodation for fifteen elderly people and is able to meet the needs of people requiring assistance and support with personal care and mobility. It is not registered to admit people with dementia. 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. The facilities provided have been maintained to a high standard. 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 and bus routes and other local amenities including Chalkwell Park. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced Key inspection was carried out on 26th February 2008 by Sara Naylor-Wild and Jane Offord. The term we (Commission for Social Care Inspection) is used throughout this report. The evidence contained in this report was gathered from discussions with the Manager, a visit to the home, discussions with people who use the service and their supporters. There was also information taken from the Annual Quality Assurance Assessment (AQAA) provided to the Commission for Social Care Inspection (CSCI). This form provides the home with an opportunity of recording what they do well, what they could do better, what has improved as well as future plans for improving the service. The manager assisted throughout the inspection visit. Feedback on the findings was given to them during the visit with opportunity for discussion or clarification. We would like to thank the manager, staff and people who use the service for their help throughout the inspection process. What the service does well: The residents enjoy their own rooms and are able to bring items of furnishings with them when they are admitted. Most residents spoken with made positive statements about the home, and were glad to be living there. Some activities are offered on a daily basis to residents. Relatives are made welcome in the home. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have some information about the home and an assessment of need prior to deciding to live there. EVIDENCE: The Commission for Social Care Inspection (CSCI) have been provided with a copy of the service’s statement of purpose that has been updated since the change of ownership and manager in 2007. There was not a copy of the document in evidence in the home for people to access on the day of inspection. Both the statement of purpose and the annual quality assurance assessment (AQAA) stated that the service assesses the needs of residents prior to offering them a placement. One resident spoken with said they had come to the home directly from hospital so there had been no opportunity to visit first but they remembered a visit in hospital from the manager. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 9 The files of three residents were seen and each one had a pre-admission assessment form. Two were completed before the resident was admitted to the home but the third one was dated on the day of admission, which indicates that this person was accepted in the home without information that would ensure that the service could meet their needs. The pre-admission assessment form was brief with headings covering personal hygiene, physical health, continence, diet, mobility and sight and hearing. There was also information about the person’s mental state and social situation. All the information recorded was sparse with little evidence of input about the resident’s specific preferences. There was also a ‘rough’ assessment in a tick box form that appeared to go with the pre-admission assessment but was not signed or dated so it was unclear when it was completed. The tick boxes covered mobility, ‘toileting’, continence, confusion and any aids used by the person. Under special diets there was a section for ‘likes and dislikes’ and for one resident dislikes of ‘beetroot, mixed vegetables and not keen on puddings’ had been recorded. A past medical history and very brief life history were recorded with some of the resident’s interests and any known allergies. The service does not offer intermediate care. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to be able to access professional health providers but cannot be assured that there will be a care plan in place to help staff support them as they would wish. People cannot be assured that they are protected by the present medication practice, storage and procedures. EVIDENCE: The files relating to three people living at the home were read during the inspection visit. These all had contact details of the person’s GP and other health professionals involved in the care of the resident such as chiropodist and optician. There was a multi-disciplinary sheet to record health professionals’ visits and the treatment or changes prescribed. In one file there was a note that the resident had refused chiropody treatment on one occasion. One resident who had been admitted directly from hospital had a discharge letter from the hospital stating that there was a laceration to one arm that Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 11 required input from the community nurses. There was documentary evidence that the community nurses were visiting regularly to renew the dressing and kept their own records within the file. The body map document in the file had no entry on it to show that the resident had any wounds or broken skin areas. The tissue viability assessment was blank. Each file contained risk assessment forms for moving and handling and falls but when the scores showed that a resident was potentially at risk there was no care plan to support any action required. One file had a falls risk assessment showing the resident was at high risk but no risk assessment for sustaining a fracture. The other two files contained a fracture risk assessment; one showed a moderate risk and the other was blank. There was a risk assessment in one file for the resident falling out of bed and the action taken to minimise the risk was to put bed rails in place. During the tour of the home with the manager this room was seen and there were bed rails in place but no protective bumpers. When asked the manager said there would be a risk assessment for the use of the bed rails in the resident’s file. There was no risk assessment found in the file although there were blank forms for the use of bed rails in both of the other files seen. There was a daily routine sheet in the files that covered residents’ preferences for waking and night needs, their personal hygiene routine and their diet. The information was sparse and in one case the form was blank. None of the files had care plans to support the expressed preferences. One resident was observed walking around the home with nothing on their feet. The manager said that the resident’s feet and legs had become very swollen and their shoes no longer fitted. The resident was on a respite stay and had brought limited clothing into the home with them. The resident’s file contained no care plan or reference to the problem of swollen feet and legs. There was a list of family and friends who could be contacted but the manager said they had not asked them if they could provide their relative with any slippers or shoes to fit nor had they taken any other action to resolve the problem. One resident spoken with said they had recently had a chest infection and had remained in their room while they had been unwell. They were due to go for a check x-ray the next day and would go to the hospital in a wheelchair taxi that they paid for themselves. They were asked why hospital transport was not being used and said that the home had not requested it. When asked if they would be accompanied they said they would not and hoped the taxi driver would take them into the hospital and there would be a nurse to help them undress as they had problems with arthritic joints. While going round the home with the manager they talked of one resident who had had an infected toe treated by the chiropodist a week ago and had a Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 12 dressing on their foot. The resident had diabetes, which means they require careful foot care to prevent complications. The manager said they had not notified the community nurses that the resident had a dressing that required changing. The resident’s file was one of the three files examined and there was no record that the chiropodist had seen the person since last year. A conversation was held with the resident and they said they had been seen by the chiropodist the previous week but they had nothing wrong with their feet and willingly took their socks off to show that. The information in some files was that residents had health care conditions that required monitoring such as diabetes and anti-coagulation therapy. There were no care plans in place to provide information and interventions for the management of the conditions. The manager said they had been finding the old care plan format difficult to complete and were in the process of preparing a new format but had not started to put them in files yet. They and the deputy manager had been on recent person centred care planning training. The lack of documentation does not support the service in monitoring the individuals health care needs and treatment, nor does it ensure that residents preferred plan of care is followed in meeting their assessed needs. During the tour of the home with the manager they did not knock on residents’ doors prior to entering rooms and in one case walked into a room where a resident was in bed. A psychiatrist visited for an assessment of one resident and the manager took them into the lounge and began discussing the resident’s symptoms in front of the resident and other people in the room. They were requested to take the resident and psychiatrist to the resident’s room for a private consultation. This was a serious failure to respect resident’s rights to privacy, dignity and confidentiality. It is of particular concern when these failures are carried out by the registered manager of the service, whose leadership sets example to the rest of the staff group in supporting the ethos of the service. In discussion with the manager about residents’ care they talked about a resident who had diabetes and suffered from cataracts. The manager said the person had recently seemed to lose interest in reading and watching the television. The resident has a degree of dementia and is unable to make decisions about their health care. The family had decided that they did not want their relative ‘put through’ an operation. The manager was asked if they had considered any action they could take to support the resident who could possibly benefit from the simple operation of cataract removal. They had not done anything further so the implications of the Mental Capacity Act 2005 were explained and how this resident could possibly access advocacy. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 13 The manager was notified that the administration of medication at lunchtime was to be observed but did not tell anyone when they actually dispensed the medicines. The manager was observed around midday signing the medication administration records (MAR sheets) for medication that they said had been dispensed at breakfast time. Inspection of the MAR sheets showed there were a number of signature gaps so it was not clear if medication had been given or not. There was no system for recording that prescribed topical preparations had been applied. On arrival at the home a large pile of plastic boxes were stacked in the entrance hall containing medication to be returned to the pharmacy. The manager said they had been due to be returned the previous day but the van driver had not taken them. When it was explained that they needed to be secured until they were taken the manager put them in the office and locked the door. The door to the office was later observed open with the medicines still stored inside. Since the last inspection the service has bought a purpose built medicine trolley but not yet obtained a controlled drugs cabinet although the deputy manager had said it was on order. Inspection of the storage of medicines showed a pot of skin cream with the label removed, a bottle of laxative medicine labelled for a resident who had died a month ago and some eye drops that had been issued on January 4th 2008 but no date of when they had been opened to ensure they were discarded after twenty-eight days following the manufacturers instructions. One resident has twice daily insulin injections given by the community nurses. The insulin is stored in an unsecured domestic refrigerator in the kitchen, kept in a plastic box. Also in the box were five sets of eye drops for one resident the earliest issued November 2007. Overall the procedures relating to the safe administration of medication were not present and the manager failed to demonstrate an understanding of the seriousness of the issue. Silversea Lodge Care Home DS0000068495.V360529.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 Poor. This judgement has been made using available evidence including a visit to this service. People who use this service cannot be assured that they will be offered meaningful pastimes or have a choice of menus at mealtimes. EVIDENCE: All the residents’ files seen contained contact details of the next of kin or the person’s representative. During the day a number of visitors were seen to come and go. They were welcomed by staff and were free to visit residents in the lounge or their own bedrooms. The home has limited space and no other room available for private meetings. The dining room is a through way for the kitchen and the small seating area in the entrance hall is not private. Neither of the small office spaces are suitable for either walking frames or wheelchair access. There was a weekly activities programme posted on the lounge door that showed a variety of pastimes offered and that should be organised by carers. They included playing cards, exercises, skittles, music session and on the morning of the inspection the hairdresser visit. Several residents had their Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 15 hair done during the day but no other activity was organised for the remaining people. The manager said they frequently encouraged carers to spend time with residents but they seemed reluctant and, when questioned, the manager agreed that they rarely sat with residents either. Residents that were spoken with said they did not often have activities to participate in and commented that the lounge was arranged in a way that made conversation with other residents difficult. Armchairs were not placed in social groups so anyone with difficulty hearing would be unable to have a private conversation with someone who did not raise their voice. Daily records looked at had limited information about activities undertaken by residents except to note that they had a rest in their room or watched some television. Two residents spoken with said they get bored regularly. Some residents said they join local church activities and pay for their own taxi to get there but there were no religious services held in the home. The dining room is dominated by a large oval dining table that will seat eleven of the residents. Other residents eat in their room. It was unclear if that was their choice or what the arrangements would be if they chose to eat in the dining room. The tablecloth was oilskin with coloured place mats that had wrinkled with the heat of plates and did not look entirely clean. The meal on the day of inspection was sausages, scrambled eggs and chips. Condiments and tomato ketchup were available. Dessert was jam tart and custard. There was no menu on display and residents spoken with said they did not know what they were to have each meal. Opinions on the quality of the food varied with some people saying they enjoyed the food and others saying it varied from day to day. One person said that if they did not like the main meal they could probably ask for an omelette. The food stores are in two outside rooms. There were four large chest freezers that were all partially full. There was a selection of fresh fruit and vegetables available and a varied store of dried goods. The kitchen was clean and tidy after the lunchtime meal was served. With the exception of some open boxes of cakes in the dining room all the food seen was correctly stored. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 16 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 and 17 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The residents cannot be confident that they will be listened to and that staff understand how to protect them. EVIDENCE: The complaints policy had been updated since the last inspection and a copy had been provided to the Commission. The copy did not contain essential details such as the name of the person to whom complaints should be addressed and the timescale for complaints to be responded to. People living at the home indicated that they did not complain. One person stated that they tended to “just nod and go along with things” The staff files did not all contain evidence of training in the safeguarding of vulnerable adults, and the manager stated that there was not a specific training programme in place to address these shortfalls. The actions of the manager in failing to recognise residents rights to dignity, respect and confidentiality as detailed in this report, give concerns as to their capacity to recognise abuse. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 17 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 Poor. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an environment that is suitable to meet their needs. However residents cannot be confident that the systems designed to protect them from harm are sufficiently maintained. EVIDENCE: The premises had been changed little since the previous inspection and issues raised in relation to the environment had largely not been addressed at this inspection. Specifically the arrangements for holding internal doors open had not been resolved, with some doors continuing to be ‘wedged’ open with devises such as wooden wedges. These doors form part of the services fire protection arrangements and as such should either be kept shut or close automatically Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 18 when a fire alarm is sounded, these create temporary barriers to the transition of a fire through the building and provides valuable time for the fire rescue services to attend and residents to be evacuated. By wedging the doors open fire would not be prevented from travelling throughout the home. The manager informed the Commission that the system had received maintenance checks following the last inspection visit, and copies of the work sheets for these were seen, but these had not resolved the issues with the system, and no further action had been taken to ensure that residents’ safety was not compromised. The services fire risk assessment was in place but did not reflect the accuracy of the situation with the ‘Dorgard’s or the wedging of doors, and there was no evidence of the manager’s considerations in relation to the increased risks and how these might be addressed in the short term. The manager advised that the proprietor intended to replace the ‘Dorgard’s system and quotes were being sought from companies for a magnetised door system linked to the fire alarm system. There were not copies of these available at the inspection. The refurbishment of the downstairs bathroom had not taken place and the badly stained carpet remained. There is not an annual maintenance plan for the service, although staff reported that they put minor repairs into a book, there is not a designated person to complete this work. An example of this was seen on the day of the inspection where a light on an upstairs landing had blown leaving the area in complete darkness. Staff said they had put it in the repair book the previous day but it had not had the bulb replaced despite the fact that the hairdresser was using the bathroom in this area and moving residents between that room and bedrooms along the corridor to dry their hair. Several issues relating to the storage and management of equipment were noted during the inspection. This included the upstairs bathroom was very cluttered with clothes on hangers drying, equipment such as surplus walking frames and wheelchairs stored in it and a night catheter bag in a bowl. There was a cupboard containing the hot water tank and hot pipes running from it. This was unsecured and a blanket was draped across the heater. There were not risk assessments relating to the hot water tank and the risk of burns. Several hand washbasins in toilets, bathrooms and en suites did not have paper towel dispensers available. Some paper towels were stacked on toilet cisterns and one basin had a cloth towel attached to the taps that was seen used by more than one member of staff. This is contrary to the best practice in infection control and overall these issues posed a potential risk to health and safety. In particular the risk of cross infection. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 19 The laundry was visited and found to have other equipment stored in it. The washing machine is domestic and does not have a sluicing programme. The manager said soiled linen is taken to the laundry, which is situated in an outside building, via the lounge patio doors before the residents use the lounge in the morning. The other way to the laundry involves going through the dining room and kitchen. In each case the way in which this action may detract from residents rights to treatment with dignity and any risk of infection was not considered via a risk assessment with suitable action taken to decrease the risks. Areas of the home did have an unpleasant odour; the manager stated that carpets are regularly washed but was not able to identify any other measures taken to manage issues with the management of odours. It was also of particular concern that the manager stated that a room with a noticeable stale odour of urine was not currently occupied by a resident who suffered any incontinence. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 20 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 Poor. This judgement has been made using available evidence including a visit to this service. The residents cannot be confident that the staff working at the home have sufficient skills to support their assessed needs EVIDENCE: The staff files for three individuals were sampled during the inspection. These contained the individuals’ application forms, two written references, and proof of identity. Staff who were employed as overseas workers also had proof of their right to work in the UK such as residency permits and grants of asylum. Subsequent to the inspection the proprietor informed the Commission that there were 5 staff working at the home whose documents were of questionable validity and therefore may have been illegally working at the home. The proprietor had contacted the Home Office immigration department and was working co-operatively with the agency in dealing with the matter. Staff rotas on display reflected that there were three staff on duty throughout the waking day of 08:00 to 21:00 with one awake and one sleep-in staff member at night. The manager stated at the beginning of the inspection visit that two staff members had not reported for duty that day and another staff member was working the first day of an induction. These details were not Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 21 present on the rota and no alterations had been made to previous days where staff had reported off sick. The manager stated that they had not calculated the numbers of staff required by the service in relation to the assessed needs of residents. The rota identified a cook throughout the week, but there was not a member of cleaning staff on duty. Staff spoken with reported that they were cleaning the home. On the day of the inspection visit a new staff member was reported to be undertaking their first day of employment at the service and shadowing a staff member in a supernumerary position as part of their induction. The observations of this staff member indicated that they were in fact working alone throughout the day. The manager reported that due to shortages caused by staff sickness the person was counted as part of the staff numbers. The member of staff was not aware of an induction process being undertaken. The manager reported that there was not a current staff training plan in place and instead staff took part in training as and when there was notification of a training course received at the home. The manager did not maintain an audit of the training staff had undertaken or training needs that were required. As a result there were gaps in staff skills and knowledge. One resident said they sometimes had problems understanding the accents of overseas staff but said they ‘just nod and agree with them’. People spoken with said staff were kind and willing but there were not enough of them. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. People living at the home cannot be confident that the service is operated competently and in a manner that safeguards their interests. EVIDENCE: Mrs Rashid has been in post for one year as the registered manager, and prior to this worked as the homes cook and deputy manager under the previous owner. During the inspection there were a number of occasions where the conduct of the manager was a matter of concern to the Commission. Specifically her inability to recognise infringements of resident’s rights to dignity, respect and Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 23 confidentiality were raised with her on two occasions during the inspection. In addition the managers failure to adherence to the homes written policy in the management and storage of medication was also discussed with her. On both occasions Mrs Rashid had been unaware of the conduct but acknowledged the poor practice. It is a requirement of the Care Standards Act 2000 Regulation 9 (1), that the person who is appointed to the post of registered manager is fit to do so and can demonstrate that they fulfil the role with sufficient care, competence and skill. The Commission had been provided with copies of the quality assurance survey format prior to the inspection visit, however the manager confirmed that there was not a quality assurance programme in operation at that time. Quality assurance systems support the service in listening to and understanding how residents experience the service and identify how this they could improve the ‘residents’ experiences of living in the home. The staff files examined at this inspection did not contain evidence of any supervision taking place, and the manager confirmed that this was the case. Staff supervision is an integral piece of the development of a skilled and competent staff team with a shared ethos. Without supervision managers are not able to work with individuals in identifying strengths and weaknesses in their practice and how training might support their development. The security of resident’s monies had been considered since the previous inspection with storage being kept in a locked cupboard. The system for recording had also been reviewed and with the residents and a staff member both signing for any monies withdrawn. The issue in respect of payment for items such as flannels had not been clarified since the last inspection and a full statement of the items covered in resident’s fees is required in the services statement of purpose and the terms and conditions residents sign. The documents relating to annual maintenance and safety checks of equipment in the home were checked for compliance at this visit. The certificates for gas and electrical equipment were present and in date. Insurance certificates were posted in the home. Fire safety equipment had received an annual service and the manager and deputy had undertaken regular checks. However the continued failure of the ‘Dorgard’ system was not noted in any of these checks and calls into question the quality of the staff’s competence in undertaking such checks and therefore the validity of the document. Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 24 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 X X X X X 1 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 2 1 X 2 Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 25 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 OP2 Regulation 5(1)(b), Schedule 4(8) 14, Schedule 3(1) Requirement Residents must be provided with a clear definition of what elements of the care provision is included in their fees. The service must be clear that it understands the needs of proposed residents prior to their admission by carrying out a needs assessment. This should identify the levels of support they will require and the resources required to meet this. Timescale for action 31/03/08 2. OP3 30/04/08 3. OP7 15, Schedule 3 (2) Residents needs, strengths and 30/04/08 aspirations must be discussed with them and documented in care plans to support the consistent delivery of person centred support to each resident. Residents health and welfare must be supported by the documentation of health advice the use of monitoring records to assist staff in supporting identified health issues. 31/03/08 4. OP8 12(1), Schedule 3 (3) (m) Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 26 5. 6. OP9 OP10 13(2) 12(4)(a) Medication must be stored in a safe and secure manner. Resident’s rights to be treated with respect of their privacy and dignity must be upheld. Residents must be consulted as to their preference in relation to aspects of daily living such as meals and activities. This demonstrates a respect for their individuality and independence. Residents must be able to raise concerns and be assured that these will be responded to appropriately within a timescale. Staff must understand how to recognise and take steps to protect residents from abuse. Residents must be able to use facilities that are kept in good repair and do not present a hazard. Residents must be protected from the risk of fire by the homes fire safety systems and these must be maintained in good working order. Fire doors must not be obstructed in any way. 31/03/08 31/03/08 7. OP12 OP14 OP15 12(2)(3)1 6(m)(n) 30/04/08 8. OP16 22(4)(5), Schedule 4(11) 13(6) 31/03/08 9. OP18 31/03/08 10. OP19 23(2)(b) (o) 31/03/08 11. OP20 23(4), Schedule 4 (14) 31/03/08 12. OP26 13(3) 13. OP27 OP28 OP30 18 (c) The service is operated in a 31/03/08 manner that protects residents from risk of infection. Specifically this refers to the transport of soiled linen, and effective hand washing facilities. Residents must be supported by 30/04/08 a staff group who are provided with sufficient training to gain skills to meet the assessed needs of those residents they support. DS0000068495.V360529.R01.S.doc Version 5.2 Page 27 Silversea Lodge Care Home 14. OP29 19(1)(b)(c Residents must be protected by )(5)(d) the services recruitment checks. Specifically this refers to the confirmation of legal documents permitting immigrant’s leave to take up employment. 18 (a), Schedule 4 10(1) Duty rosters must contain accurate information in respect of who is actually working. The service 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. 31/03/08 15. OP27 31/03/08 16. OP31 OP32 31/03/08 17. OP33 24 Residents and other stakeholders 31/05/08 must be consulted about how the service delivery matches the Statement of Purpose and individuals’ expectations. Staff must receive regular and consistent supervision from their line manager that supports their development and provides them with feedback on their practice. Records relating to the prescribed safe maintenance of equipment used in the home must be kept. 30/04/08 18. OP36 18(2) 19. OP37 OP38 12(1)(a), 17 (2)(3)23( 2) 31/03/08 Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Silversea Lodge Care Home DS0000068495.V360529.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection 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@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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