CARE HOMES FOR OLDER PEOPLE
Stanley Lodge Residential Home School Lane Bay Horse Lancaster Lancashire LA2 0HE Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 10th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stanley Lodge Residential Home DS0000067072.V366371.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. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stanley Lodge Residential Home Address School Lane Bay Horse Lancaster Lancashire LA2 0HE 01524 791904 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) Unlimitedcare Limited Manager post vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 Date of last inspection 31st July 2007 Brief Description of the Service: Stanley Lodge is registered with the Commission for Social Care Inspection to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster. Stanley Lodge is a detached property set in landscaped gardens and has uninterrupted views of the surrounding countryside. The majority of the residents have been admitted from the surrounding area. There are strong community links, which the management and staff endeavour to maintain. The accommodation comprises 23 single rooms, 20 of which have en-suite facilities. There are two conservatories, a lounge, and a dining room; these communal areas provide residents with a choice of where to sit and who to sit with. All the personal needs of the residents are catered for by care staff. The residents’ general practitioners and district nursing staff manage any medical needs. Chiropodist, dental and optical treatment is arranged for residents. At the time of the visit the information given to the Commission showed that the fees for care at the home are from £360 to £415 per week, with added expenses for hairdressing, private chiropody and newspapers. Stanley Lodge Residential Home DS0000067072.V366371.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 0 star. This means that people using this service experience poor quality outcomes.
The inspection of this home included a site visit which was carried out over one day. This visit was unannounced meaning that the manager, staff and residents did not know it would be taking place until the inspectors arrived. During the visit we spent time talking with and observing residents, staff and the acting manager, we were joined by the owner of the home later on in the visit. We viewed a selection of paperwork including a sample of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. A specialist pharmacy inspector carried out a full medication inspection which included examination of the home’s procedures, stock of medicines and all records relating to residents’ medication. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point that they moved into the home. Prior to our visit, we wrote to the acting manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. A number of completed surveys were returned to us. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 6 What the service does well:
People we consulted both in writing and during our visit spoke very highly of staff at the home. When responding to our written survey one resident wrote ‘The staff work really hard to maintain good standards.’ Other comments included; ‘A pleasant, caring environment.’ ‘The staff are really committed and care for the residents well.’ During our visit we observed staff going about their duties in a pleasant and professional manner. Carers addressed residents in a kind and respectful manner and there was pleasant and lively interaction between carers and residents throughout the day. The residents we met appeared content and relaxed in their surroundings. One resident told us ‘’We are all well cared for, the staff here are very good.’’ Stanley Lodge is a well maintained, spacious home with all accommodation being offered on a single room basis, so no residents have to share bedrooms. Out of the 23 rooms, 20 have ensuite facilities and plans are in place to provide en suites to the remaining three rooms. There are a variety of communal areas for people to use including attractive, well maintained gardens. At the time of our visit we found all areas of the home to be clean, warm and comfortable. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
Since the last inspection a number of environmental improvements have been made including the provision of additional en suite facilities in a number of bedrooms. Some areas of the home have been redecorated and new carpets have been provided. The emergency call system has been updated and cordless call bells are now provided throughout the home. There have been no significant improvements in the handling of medication since the last pharmacy inspection on 17th April 2008. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 8 What they could do better:
A number of residents and their relatives who responded to our written survey told us that they had not received a contract from the home. During our visit the acting manager was unable to confirm that contracts had been provided to all residents. It is a legal requirement that people be supplied with a personalised set of terms and conditions, ideally prior to their admission but no later than the day they move into the home. A requirement has been made in relation to this matter. When admitting new residents, it is important that a pre admission assessment has taken place. This is so the person can be assured that their needs will be met at the home and that it is the right place for them, and also ensures that carers have an understanding of people’s needs from the point that they move into the home. We found evidence that two residents had been admitted to the home without a pre admission assessment being carried out in respect of their care needs. This means that the residents were at risk of not receiving the care and support they needed. A requirement has been made in relation to this matter. Care planning is an important tool that enables people to have some say about how they want their care needs to be met. In addition, written care plans provide guidance to carers about residents’ daily care needs and the help and support they require. Some care plans we viewed contained out of date information which was no longer relevant and gave an inaccurate picture of the residents’ circumstances. Others failed to address very important areas such as pressure care and people’s dementia related needs. We also found that two residents who had lived at the home for several weeks did not have care plans in place. A requirement has been made in relation to this matter. Some residents have limited mobility and need assistance to transfer and move safely. We viewed care plans of some of these residents and found that there were no moving and handling plans in place. In addition, several staff members we consulted told us that they did not feel they had the correct equipment to assist people in this area such as hoists, which are used to transfer people. A requirement has been made in relation to this matter. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 9 The service must make sure that all records and care plans relating to medication are complete and accurate, and are followed to protect the health and well-being of the people who live there. Ordering procedures must be reviewed to ensure that medicines never run out. The storage and recording of medicines liable misuse, called Controlled Drugs, must comply with the law to show that they are handled correctly. Staff who administer medication must be trained in the task and assessed as competent. Regular checks, or audits, of medication must take place to make sure that medicines are handled properly and errors are identified and dealt with promptly. Several requirements have been made in relation to this matter. People we consulted said that the home did not provide enough activities for residents on a regular basis. There had been a failure in a number of cases to assess people’s social needs and preferences. Several people told us that staffing levels at the home did not provide carers with enough time to spend with residents to carry out activities. It is important that residents are provided with regular oporunities to engage in enjoyable and fulfilling activities that are in keeping with their individual needs and preferences. A requirement has been made in relation to this matter. We received positive feedback about the quality of food provided at the home. One resident we talked with said ‘’The food is always very nice, I have never had cause for complaint.’’ Menus showed that an appealing and nutritious diet is provided to residents. However we did note that an alternative choice of main meal is not generally provided although we were advised that an alternative meal can be provided should a resident specifically request it. We discussed this with the acting manager and made a recommendation that residents be provided with a choice of main meal on a daily basis. Whilst the home has safeguarding and whistle blowing procedures in place, not all staff we talked with were aware of them. It is essential that all staff members are made aware of safeguarding and whistleblowing procedures as part of their induction and receive ongoing training in this area. A requirement has been made in relation to this matter. The home’s recruitment practices were found to be very poor. We found evidence of a number of staff members being employed at the home without the necessary background checks such as references and Criminal Records Bureau disclosures. The failure to carry out such checks has resulted in a the safety and wellbeing of residents being compromised. We discussed this with the owner and acting manager who were advised they were in breach of the Care Homes Regulations, 2001. Several requirements have been made in relation to this matter. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 10 When viewing records relating to several staff members who had all worked at the home for a number of months, we were unable to find evidence that they had been provided with induction training, any ongoing training or formal supervision. A number of staff members we spoke with confirmed a lack of induction, training and support. Our findings were discussed with the acting manager and owner and several requirements have been made in relation these matters. A number of people we consulted expressed concern about staffing levels at the home. We were advised that there were generally two staff on duty throughout the day and that staff did not have the time to spend with residents as a result. One person wrote ‘There is a real shortage of staffing, there are only two staff in the day and they are rushed off their feet.’ We were also concerned to find that night staffing levels had recently been reduced to one waking watch and a sleep in member of staff, despite the fact that there were two residents in the home who required two staff to assist them to move safely. Our concerns were discussed with the owner and acting manager and a requirement has been made in relation to staffing levels. The home has been without a registered manager for a significant period of time. During this inspection a number of serious concerns were identified. The home was found to be in breach of a number of regulations and we found that people who use the service are at risk of poor outcomes in several areas. The fact that standards within this home have deteriorated to such an extent is a reflection of current management arrangements. These must be reviewed immediately to ensure that the necessary improvements are achieved without delay. 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. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 11 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 Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 12 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 & 3. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have been admitted to the home without their needs being properly assessed. This means they have been at risk of not getting the care they need. EVIDENCE: A Service User Guide is provided to people at the point that they express an interest in moving to the home. This document includes various information such as the facilities and services provided and information about staffing and daily routines such as meal times and activities. We were advised that this document is currently only available in a standard written format. We made a recommendation that the document be made available in a variety of formats such as large print and audio so that everyone has equal access to the information.
Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 13 A large number of people who responded to our written survey told us that they didn’t have written contracts in place with the home. This was an issue that was also raised following the home’s last inspection in July 2007. We discussed the matter with the acting manager who was advised that it is a legal requirement for care homes to supply all residents with personalised terms and conditions, which include details of fees payable and services provided, by no later that the day they move into the home. Processes should be in place to ensure that a thorough pre admission assessment is carried out with any person prior to them moving into the home. This is so that it can be determined that the home is right for them and will meet their needs, and also so that staff can plan people’s care and provide the support they need from the point they move into the home. However, during this inspection we confirmed that there were two residents who had lived at the home for several weeks that had been admitted without any such assessment being carried out. As such, carers were not fully aware of the residents’ needs and were unable to plan their care in an effective manner. This means that the residents were at risk of not receiving the help they needed. This matter was raised with the owner and acting manager during our visit. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 14 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are at risk of not receiving the help they need because their care is not properly planned. People’s health and wellbeing is at risk because medication is poorly managed. EVIDENCE: Written plans of care must be in place for all residents which outline their needs and state how carers should go about providing support. We viewed a number of residents’ care plans and found that they did not consistently reflect people’s needs or the service provided. For example, we viewed the care plan of one resident which had not been updated for some time. The information contained within it was out of date and no longer relevant as the resident’s needs had changed significantly. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 15 We were also advised that there were two residents who had lived at the home for several weeks, who had no care plans in place at all. This means that because carers didn’t have sufficient, relevant information about the residents, the residents were at risk of not receiving the help they needed. We were able to determine through our case tracking exercise that one resident was at high risk of developing pressure sores. However, a pressure sore risk assessment had not been carried out and there was no preventative pressure care plan in place. We were however able to establish that staff were providing preventative pressure care for the resident as general good practice. There were no moving and handling plans in place for some residents. For others we viewed plans that were out of date and did not accurately reflect their current needs. In addition, we were advised by some staff that the home lacked the equipment needed to move people safely, for example, hoists. This was discussed with the acting manager and owner who were advised that arrangements must be put in place to ensure the safe moving and handling of residents. Overall, records for receipt, administration and disposal of medication had not shown great improvement and it was not possible to check that medicines were always handled properly. Although records of receipt of medication were better, the service had not started to record disposal of medication. Records of administration were sometimes inaccurate so that it was not always clear what medicines were given or why they had been omitted. We saw records for a pain-killer signed in error on the wrong day and this could cause harm from medication being missed or duplicated. One person did not get their diabetic medication for three days and no reasons were given. This could lead to a worsening of diabetes. We saw that medicines had run out for six days for another person so that they were not able to have the treatment they needed. Care plans for managing medical conditions and medication were poor or not followed properly and this could affect the health of people who may not be managed or monitored properly. The care plans for a person who looked after and took their own medicines did not fully assess the risks involved. The person also had recent worsening of their condition requiring a doctor’s visit, but there was no information in the care plans or other records to show that this was being monitored, the latest entry in the daily records being three weeks old. Another care plan for a diabetic required weekly blood sugar level checks. The latest check was recorded more than two months previously. Discussions with doctors were not always recorded and it was not possible to tell why changes to medication were made. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 16 Medicines liable to misuse, called Controlled Drugs, were poorly managed. Despite being raised at the last pharmacy inspection the storage and recording of these medicines still did not comply with the law. Staff who administered medicines had not been adequately trained or assessed as competent though some training was planned. On occasions staff who do not regularly perform the task administer medication to the people who live there. For example, one staff member gave medication only once in three weeks. Extra care must be taken to ensure that staff who only occasionally administer medication are, and remain, competent. There have been no internal checks, or audits, of medication since the last pharmacy inspection despite a number of issues being raised that could affect the health and safety of the people who live there. There must be a system of regularly assessing the handling of medicines to make sure that the people who live there are protected. During the inspection we found that personal information about residents had been written in the home’s general communication book. This is poor practice that compromises residents’ privacy and dignity. We discussed this matter with the acting manager and advised her to ensure that the practice ceased. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 17 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 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff understand that residents benefit from the chance to take part in enjoyable and stimulating activities. However, due to low staffing levels they are not always able to provide them. People are provided with nutritious and appealing meals but would benefit from increased choice. EVIDENCE: A number of people who responded to our written survey told us that they didn’t think there were enough activities arranged for residents at the home. One person wrote ‘Too many days go by with nothing to do,’ and another stated ‘Staff simply don’t have the opportunity to carry out activities.’ One resident we talked with during our visit said that they would like the chance to go out sometimes but that there was never staff available to provide support for this purpose. We viewed the resident’s care plan and found that
Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 18 there was no information about their individual needs or preferences in relation to activities. Another person we spoke to told us that whilst there was very well maintained and attractive gardens at the home, some residents rarely got the opportunity to enjoy them if they needed staff support to do so. This area was discussed with the acting manager who advised us that a review of the activities programme had recently been carried out and that plans were in place to implement a number of new ideas such as a garden area for residents to maintain. However, staffing levels need to be adequate to enable staff to support residents in such activities. We received positive comments about the food, the majority of people who responded to our survey told us that they liked the meals at the home. One resident we talked with during our visit said ‘’The food is always very nice, I have never had cause for complaint.’’ We observed a mealtime and noted this to be a relaxed and social occasion. Residents who required assistance with eating were provided with help in a dignified and discrete manner. Menus demonstrated that people are offered an appealing and well balanced diet, however we did note that only one option is prepared for the main meal each day. When we queried this we were advised that alternatives could be provided should a resident request this, but that a choice was not offered as standard. We made a recommendation that menus be reviewed so that resident are provided with a choice of main meal on a daily basis. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are processes in place that enable people to raise concerns but residents are not always aware of them. EVIDENCE: The home has a complaints procedure in place which is written in a clear and easy to understand way. However, the procedure is currently only available in a standard written format. The procedure must be made available in a variety of formats for example, large print and audio, so everyone has equal access to the information. The complaints procedure is included in the Service User Guide and is posted on several areas around the home. Despite this, a number of people who responded to our written survey told us that they did not know how to make a complaint. This was discussed with the acting manager and owner who were advised to discuss the procedures with residents and their relatives to ensure they are all aware of it. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 20 All homes are required to have written guidelines in place that staff should follow if it is alleged or suspected that an incident of abuse has occurred. These guidelines are generally referred to as safeguarding procedures. Whilst we were able to establish that the home did have these in place, a number of staff members we spoke to were not aware of them. In addition, a number of staff members we spoke to were not aware of the home’s whistleblowing procedures which are in place to encourage people to report poor practice. We were advised by the acting manager that around half the staff team had completed training in safeguarding and that the remaining staff members were due to complete the training. However, staff members we spoke to and those whose personnel files we viewed had not completed the training. It is essential that all staff members are made aware of safeguarding and whistleblowing procedures as part of their induction and receive ongoing training in this area. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at this home are provided with safe, comfortable accommodation which is maintained to a good standard. EVIDENCE: Stanley Lodge is a spacious home and all accommodation is provided on a single room basis. 20 out of the 23 bedrooms have en suite facilities and plans are in place to provide ensuites to the remaining three bedrooms in the near future. There are ample numbers of bathrooms and toilets located around the home, these include a set of three communal, cubicle type toilets. We discussed these
Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 22 facilities with the acting manager and made a recommendation that consideration be given to replacing them with more private, single facilities. There are a variety of communal areas for residents to spend their time in, including a pleasant conservatory with a safe accessible patio area, two lounges and two dining rooms. In addition the home benefits from well maintained gardens. There have been a number of improvements made at the home since the last inspection including general redecoration and the provision of new carpets. During our visit we found all areas of the home to be warm, clean and comfortable. It was confirmed that the home has infection control procedures in place. We made a recommendation that the acting manager obtain the Department of Health infection control guidance for care homes, ‘Essential Steps’ to ensure that the home’s procedures are in line with this guidance. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 23 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s failure to follow robust recruitment procedures means that residents’ safety and wellbeing has been compromised. EVIDENCE: Residents and relatives that we consulted spoke very highly of staff at the home. One relative who took part in our survey wrote ‘The carers are absolutely wonderful, nothing is too much trouble.’ Throughout our visit we observed staff going about their duties in a pleasant, professional manner. We also noted that staff were kind and respectful in their dealings with residents. However, several people who responded to our written survey and people we spoke with during our visit told us that staffing levels at the home were not adequate to meet the needs of residents. Comments included; ‘There is a real shortage of staffing, there are only two staff in the day and they are rushed off their feet.’ Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 24 ‘The service needs more carers, it is very difficult to meet residents needs when there are not enough carers.’ ‘There are not enough staff on duty to do activities. Sometimes staff come in on their day off to take residents out.’ One resident we spoke with on the day of our visit said ‘’The girls are all lovely but there isn’t enough of them. They are always very busy.’’ We viewed staffing rotas that confirmed there were generally two carers on throughout the day in addition to the acting manager. We were concerned to note that night staffing levels had recently been reduced to one waking watch carer and a sleep in shift, despite the fact that there were two residents at the home who needed two carers to give them assistance in the night. During out visit we examined recruitment processes and looked at records relating to four staff members who had all worked at the home for several months. None of the staff members had been asked to complete an application form prior to their recruitment and there was no evidence that interviews had been carried out. It was confirmed that the acting manager had failed to obtain references for any of the staff members and there was no Criminal Records Bureau clearances on file for two of the four carers. The acting manager and owner were advised that this was a serious breach of the Care Homes Regulations, 2001 and requested to rectify the matter immediately. Some staff who took part in our written survey told us that they had not received any induction training at the start of their employment. This was confirmed when we looked at the four most recent starters. Two of these staff members had been in post for 8 months and there was no record of induction, ongoing training or supervision being provided to them at any point during their employment. We discussed our concerns in relation to the above findings with the acting manager and owner. Several requirements have been made in relation to these matters. Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is currently a lack of effective management at the home which has resulted in residents being at risk of experiencing poor outcomes. EVIDENCE: There is a health and safety policy in place that is supported by a number of procedures in areas such as fire safety and infection control. However, as a number of staff currently working at the home have not being provided with induction we were unable to confirm that all staff were aware of the home’s health and safety procedures.
Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 26 A number of staff who responded to our survey told us that they had not carried out training in the key health and safety areas such as moving and handling. This was verified by the personnel files we viewed. The home has been without a registered manager for a significant period of time. During the last inspection of the home which was carried in July 2007 we were advised that the acting manager would be making application to the Commission for registration in the near future. However, this application has not yet been made. During this inspection a number of serious concerns were identified. The home was found to be in breach of a number of regulations and we found that people who use the service are at risk of poor outcomes in several areas. The fact that standards within this home have deteriorated to such an extent is a reflection of current management arrangements. These must be reviewed immediately to ensure that the necessary improvements are achieved without delay. In addition, the home’s internal quality assurance processes need to be reviewed so as to identify why the issues we have raised in this report have not been identified by the acting manager and owner previously. Stanley Lodge Residential Home DS0000067072.V366371.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 1 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 2 Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) (c ) Requirement All residents must be provided with a personalised set of terms and conditions which include details of fees and services to be provided. It must be ensured that no person is admitted to the home unless the needs of the person have been assessed by a suitably trained person, so that people can be assured their needs will be met. A written care plan must be in place for every resident that outlines their needs and provides staff with guidance in how to meet these needs. Suitable arrangements for the safe moving and handling of residents must be put in place to assist staff in supporting residents in a safe manner. Records for receipt, administration and disposal of medicines must be accurate to protect people from errors. Previous timescale of 01/06/08 not met. Timescale for action 30/06/08 2. OP3 14 (1) (a) 30/06/08 3. OP7 15 (1) 30/06/08 4. OP8 13 (5) 17/06/08 5. OP9 17(1) 15/07/08 Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 29 6. OP9 13(2) Controlled Drugs must be stored and recorded according to the Misuse of Drugs regulations. Previous timescale of 01/06/08 not met. Staff must be regularly assessed as competent in medicines handling and must receive training if necessary to ensure that medication is administered to residents safely. 15/07/08 7. OP9 18(1) 01/08/08 8. OP9 24(1) 9. OP9 15 The quality of medicines 15/07/08 handling must be reviewed, or audited, regularly to protect people from errors. Care plans for managing medical 15/07/08 conditions and medication must be improved and followed so that people receive good care and are monitored properly. Ordering procedures must be reviewed so that medicines do not run out. The practice of recording personal information about residents in general communication books must cease so as to protect people’s privacy and dignity. All residents should be offered regular opportunity to take part in activities both inside and outside of the home. It must be ensured that all staff are fully aware and have a full understanding of the home’s safeguarding and whistleblowing procedures. It must be ensured that the complaints procedure is provided in formats appropriate to the needs of all residents. It must be ensured that there
DS0000067072.V366371.R01.S.doc 10. OP9 13(2) 15/07/08 11. OP10 12 (4) (a) 10/06/08 12. OP12 16(2)(m) 31/07/08 13. OP18 13 (6) 30/06/08 14. OP16 22 (2) 31/07/08 15. OP27 18 (1) (a) 17/06/08
Page 30 Stanley Lodge Residential Home Version 5.2 16. OP28 17. OP29 18. OP30 19. OP31 20 OP36 are appropriate number of staff on duty at all times to meet the needs of residents. 18 (1) (a) It must be ensured that at least 50 of carers at the home hold National Vocational Qualifications in care at level 2 or above. 19 (1) (a) It must be ensured that people (b) (i) & are not employed to work at the (c ) home until the appropriate information as specified in paragraph 1 to 7 of Schedule 2 of The Care Homes Regulations, 2001 has been obtained. 18 (1) (c ) People employed at the home (i) must be given appropriate training to enable them to carry out their duties. 8(1)(b)(iii An application for the registration of manager in respect of this home must be submitted to the Commission. Previous timescale of 30/09/07 not met. 18 (2) All staff must be provided with regular supervision. Previous timescale of 30/09/07 not met. 30/04/09 17/06/08 30/09/08 10/07/08 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Where medication is crushed there should be clear documentation to show that this is done in the best interests of the person and after discussion with people involved in their care including the pharmacist. Where people look after and take their own medicines risk
DS0000067072.V366371.R01.S.doc Version 5.2 Page 31 2. OP9 Stanley Lodge Residential Home assessments should be done regularly and the level of support should be documented. 3. OP9 The practice of packing down medicines from original containers to compliance aids should be reviewed to prevent errors that could affect health. Medicines with limited expiry after opening should be marked with the date they are opened so that they are not used after their expiry date. It is recommended that the pharmacy be requested to label eye drops on both the bottle and the outer carton. People should be provided with a choice of main meal on a daily basis. All staff should be provided with training in Safeguarding. The home’s Service User Guide should be provided in a variety of formats so that everyone has equal access to the information. Consideration should be given to the removal of the communal, cubicle toilets and provision of a more private facility. The home’s infection control procedures should be reviewed in line with the Department Of Health guidance Essential Steps. Personal Development plans should be put in place for all staff that record induction and ongoing training. A training matrix should be in place at the home so the manager can monitor training and allocate resources for training effectively. The home’s quality assurance procedures need to be reviewed to ensure that they are effective. Results for satisfaction surveys and other quality assurance processes should be published in the Service User Guide. 4. OP9 5. 6. 7. 8. 9. 10 11. 12. 13. 14. OP9 OP15 OP18 OP1 OP19 OP26 OP30 OP30 OP33 OP33 Stanley Lodge Residential Home DS0000067072.V366371.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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
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