CARE HOMES FOR OLDER PEOPLE
Stanley Lodge Residential Home School Lane Bay Horse Lancaster Lancashire LA2 0HE Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 16th October 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.V370038.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.V370038.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.V370038.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 10th June 2008 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.V370038.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 and staff, 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. 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.V370038.R01.S.doc Version 5.2 Page 6 What the service does well:
We wrote to residents before we visited the home and asked them to take part in a survey by completing a questionnaire. People who returned questionnaires to us made some positive comments about the home and in particular expressed satisfaction about the approach and attitude of carers. One person wrote, The staff are very caring, and another stated Staff are very kind and helpful. These opinions were reflected in our discussions with residents during our visit. People told us that carers treated them with dignity and respect and always tried to provide assistance if requested. One resident told us The girls do their very best for us, I have no complaints about them at all. During our visit we spent time observing staff as they went about their duties. They did so in a pleasant and professional manner and residents appeared to be comfortable and relaxed. Stanley Lodge is a 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. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection?
We made a number of requirements following our last key inspection in June 2008. During this inspection we found that some action had been taken to address some of the requirements. However, we did not find that improvements were significant enough to fully meet the majority of requirements we made. We were able to confirm that pre-admission assessments had been carried out for all the people that had been admitted to the home since the last inspection. This is important as it means that carers have some understanding of peoples needs and can plan their care from the point that they arrive at the home. However, we have made some recommendations as to how the quality of assessments can be further improved. During the last inspection of the home we found that there were a number of residents who did not have any care plans in place. We made a requirement in relation to this and during this visit found that there was a care plan in place for every resident. However, we also found that some peoples care plans failed to address important areas of need. We have made a further requirement in relation to this matter. We found that there had been no significant improvements in the handling of medication since the last pharmacy inspection on 10th June 2008 despite several requirements in relation to this area. We made a requirement during our last inspection that peoples mobility needs be properly risk assessed and clear guidance for staff on the safe moving and handling of residents be put into place. We tracked the care of a number of residents with mobility needs and found current risk assessments and guidance in place. We found during this inspection that some improvements had been made to the homes recruitment procedures. However, these were still inconsistent and not sufficiently robust to safeguard people living at the home. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 8 What they could do better:
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. Whilst we were able to confirm that pre admission assessments had been carried out for all the residents living at the home, those we viewed were very basic. They lacked information about the individuals social needs and didnt explore the individuals own views and opinions about their daily preferences or the care they would want to receive. 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. Whilst we were able to confirm that there was a care plan in place for every resident, we found that some peoples care plans failed to address important areas of need in areas such as pressure care or mental health for example. The service must ensure that all medicines, including Controlled Drugs, are handled safely and records for receipt, administration and disposal are accurate and to protect people from errors. Medicines must be accounted for at all times. Medicines must be administered as prescribed and risk assessments with management plans must be in place for people who selfmedicate so they receive safe and effective treatment. Regular audits of medication should be done to monitor the management of medicines and staff must be regularly assessed as competent in the handling of medication to keep people safe. 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 opportunities to engage in enjoyable and fulfilling activities that are in keeping with their individual needs and preferences. Despite requirements made following our last inspection, we found that the homes recruitment procedures were still inconsistent and not robust enough to safeguard people living at the home. Records of induction, training and supervision were disorganised and it was extremely difficult to assess the support individual staff members had received in this area. Evidence was not available to demonstrate the home are meeting standards in this area.
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 9 A number of residents and staff members we consulted expressed concern about the staffing levels at the home. We found that staffing levels had been reduced since our last inspection and people told us that there were not enough staff on duty to meet peoples needs. One resident who took part in our written survey wrote The home is short staffed and therefore care has deteriorated. A staff member we received comments from told us There is just not enough of us on duty and we are struggling to meet just basic needs. This area was discussed with the registered provider during our visit. Following our last inspection the management of this home was rated poor. Since then the acting manager has resigned and the home has been without a full time manager for several months. We were advised during our visit that some staff were acting up as shift leaders to ensure that there was an identified senior on duty at all times. However, we found that there was confusion with staff and residents as to what the shift leaders duties entailed. A number of people who responded to our written survey expressed concern about the lack of management within the home and several commented that they didnt really know who to speak to if they had a concern or complaint. 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.V370038.R01.S.doc Version 5.2 Page 10 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.V370038.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are routinely carried out but dont provide enough information for carers to plan peoples support in a person centred manner. 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 viewed the Service User Guide and found that there was some information contained within it that was out of date. In addition, we found that the document is still only available in a standard written format despite a previous recommendation that the document be made available in a variety of formats
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 12 such as large print and audio. This is so that everyone has equal access to the information. The home has improved pre admission procedures so that a care needs assessment is carried out for each person before they move into the home. This is important because it means that carers will have information about new residents and as such can plan their care from the point that they move into the home. It also means that new residents can be assured that the home can meet their needs and is suitable for them. We viewed a selection of pre admission assessments and found that whilst they covered residents basic care needs, they were very brief and didn’t provide a great deal of information about the individuals social history or preferences in relation to daily living. This sort of information is important because it helps staff to plan peoples care in line with their personal wishes. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 13 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. Peoples health and general wellbeing is at risk because their health care and medication is not managed effectively. EVIDENCE: Each resident has a care plan in place that details the support they need and how this should be provided. However, we found some examples where important aspects of peoples care needs had not been documented. For example, when examining the daily records of one resident we noted that they had become increasingly depressed and anxious over recent months. When we viewed the residents care plan we found that this issue had not been addressed and there had been no action taken to plan support. We viewed the care plan of another person who was at high risk of developing pressure sores. We found that advice given by the district nurse in relation to preventative pressure care had not been detailed in the care plan although we
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 14 were able to determine that carers were providing preventative pressure care for the resident as general good practice. We found evidence that residents health related problems are not always addressed properly. For example, we viewed the care plan of one resident who had been assessed as being at high risk of becoming under nourished. We found that there had been no referral made to a dietician for the resident. In addition, we found that the resident had not been weighed for several months. Overall we found no significant improvements in the way that medicines were handled since the last pharmacist inspections in June and April this year. Records for the receipt, administration and disposal of medicines continued to be poor. This meant that medicines could not be accounted for and people are at risk of errors in the administration of medicines that could affect their health. On many occasions it was not possible to tell why medicines had been omitted. Some tablets had recently been lost and the home was investigating their disappearance. The home assumed responsibility for the storage and administration of most medicines on behalf of the people who lived there. However on occasions people were able to look after and take their own medicines if they wanted. Care plans for these people were checked but did not contain any evidence that risks had been assessed or managed properly to keep people safe. On occasions people conditions for which they were self-treating worsened but records failed to show that they were being monitored and that they were taking their medication correctly. Sometimes records did not indicate that there were problems and these were only obvious when medication such as antibiotics were prescribed. Changes to medication and contact with health care professionals were not consistently recorded or were sometimes recorded in different places so that it was difficult to track changes to peoples treatment. Medication following hospital discharge was poorly managed. We saw medication in the trolley from the home’s pharmacy and from the hospital. Some was duplicated but some medicines were different, for example different doses or discontinued, and it was not possible to tell if people had received the right treatment. We also saw antibiotics that were not given in the correct dosage and this could lead to infections not being treated properly. Medicines liable to misuse, called Controlled Drugs, were handled poorly. Homes are required to keep a register of receipt, administration and disposal of medicines but for one Controlled Drug there were no records in the register for over two months even though there was other evidence of receipt and administration. Storage should be reviewed as we saw sloppy practice that resulted in loose, unlabelled medication in the medicines trolley and this places people at risk
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 15 from getting inappropriate treatment. The home should also make sure that the fridge is suitable for the storage of medicines. An audit had been done in July that also highlighted problems with medication. However, the home must do medicines checks more regularly so that problems and errors can be put right promptly. This should include regular assessments of staff to show that they are, and continue to be, competent and follow good practice at all times when handling medicines to protect the health and wellbeing of the people who live in the home. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 16 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. EVIDENCE: During our case tracking exercise we found that there was very little information in peoples care plans about their individual preferences and preferred daily routines. There was also very little information about peoples hobbies and interests. We talked with a number of residents about the activities provided. Most of the people we talked with told us that activities were not regularly provided and in general, people felt that this was because staff didnt have enough time. One resident said The girls dont have time to chat or do little things with us. Another person told us The staff dont have time to do anything like that with us, but I am sure they would if they could.
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 17 We viewed individual records of activities that people had taken part in. We found that there were long gaps, in some cases several weeks, between activities provided for these residents. People we talked with and those who responded to our written survey said that they were satisfied with the quality and variety of meals provided. 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 residents are provided with a choice of main meal on a daily basis. In addition, it should be ensured that residents are given information about the choices available to them each day. A number of residents we spoke to during our visit said they did not know what was for lunch that day. One resident said that staff sometimes wrote it on the notice board but that she could not see it. Another resident told us We dont usually know what is being served until its put in front of us! Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are procedures in place to enable people to raise concerns but people are not always aware of them and some people are unsure who to raise concerns with. EVIDENCE: The home has a complaints procedure in place which is written in a clear and easy to understand way. However, despite a requirement made following the homes last key inspection, the procedure is still 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. We also noted that there was some out of date information on the complaints procedure in relation to other agencies and their contact details. Several people who responded to our written survey expressed concern that they didnt know who they would talk to if they had any complaints. One person wrote There is no manager on site so I wouldnt know how to make a complaint.
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 19 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. We were able to confirm that the home has these procedures in place although the procedures had not been reviewed for several years. 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. We made a requirement following the homes last inspection that it must be ensured that all staff are aware of the homes safeguarding and whistleblowing procedures. We were unable to find any evidence that this had been addressed when we viewed staff training files. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with comfortable accommodation but issues that require attention around the home are not always dealt with promptly. 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 en suites 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 on the ground floor.
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 21 We made a recommendation following the homes last inspection that consideration be given to replacing them with more private, single facilities and have repeated the recommendation in this report. 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 and spacious gardens. During a tour of the home we noted some issues that required attention. These included a broken toilet roll holder and missing light bulbs. These were pointed out at the time of our visit and we have made a recommendation that a system be introduced whereby such problems are reported and dealt with quickly. We also noted during our tour of the home that not all residents bedroom doors were lockable. We discussed this during our visit and were advised that all residents who wished so, would be provided with locks on their doors as soon as possible. The home has infection control procedures in place to help safeguard residents. However, records showed that not all staff had completed training in this area. During our case tracking exercise we also noted that there was a resident at the home who had been diagnosed with a condition that would require special measures to reduce the risk of infection of other people. However, there were no guidelines in the residents care plan about the condition or how it should be managed. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. Peoples health and wellbeing could be at risk because there are not always adequate numbers of staff on duty. EVIDENCE: A number of people we consulted both in writing and during our visit told us that they did not feel staffing levels at the home were adequate. People told us that staffing levels rarely allowed for activities or for the staff to spend time chatting with the residents. One person who returned a questionnaire to us wrote The home is short staffed, therefore care has deteriorated. A resident that we spoke with during our visit said The girls do their best but they are so busy all the time because there isn’t enough of them on duty. We looked at rotas that confirmed that there were often only two carers on duty throughout the day. We were also advised by one staff member that a number of residents at the home needed the assistance of two carers, at times. We discussed the issue of staffing levels with the registered provider who advised us that staff had not made her aware of the problem. We explained
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 23 that it was her responsibility to ensure that there are adequate numbers of staff to meet residents needs on duty at all times. Recruitment procedures have been improved since the last key inspection but are still inconsistent. We viewed a number of staff personnel files which were not well organised and did not provide evidence that appropriate documentation had been received, such as references and completed application forms, in all cases. Records of induction, training and ongoing supervision for staff were incomplete in some cases and as such it was not possible to confirm that all staff members had received induction or regular supervision. We saw evidence that some training had been provided including courses in the safe handling of medication and safeguarding adults. However, we found that important training in area such as moving and handling had still not been provided to all staff. Stanley Lodge Residential Home DS0000067072.V370038.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, 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: The home has now been without a registered manager for over a year and at the time of our visit, there had not been an acting manager in place for several months. We were advised by the registered provider that an acting manager had been appointed and was due to commence her employment in the very near future.
Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 25 As an interim measure a system had been implemented whereby a number of carers had been asked to take up team leader duties. However there appeared to be some confusion with residents and staff as to what the team leader duties involved. A number of people who responded to our written survey expressed concern about the lack of management within the home. In particular people commented that they would not know who to approach in the event that they had a concern or complaint. The home has policies and procedures in place that cover all aspects of the homes management. However, we found evidence that these are not always followed, for example in respect of recruitment. In addition, we noted that policies and procedures had not been reviewed for several years. We were unable to find evidence that there are effective quality assurance systems in place. We found that residents meetings were not held on a regular basis and satisfaction surveys had not been issued to residents, their representatives or other stakeholders for over two years. There is a health and safety policy in place and a number of individual procedures in areas such as fire safety and COSHH (control of substances hazardous to health). However, due to missing documentation, for example, in relation to fire safety, we were unable to confirm that health and safety procedures are always followed. Staff training records confirmed that some carers had not been provided with training in important health and safety areas such as moving and handling. During our tour of the building we noted some potential hazards which included some windows of upper floors of the home without restrictors and a laundry area which was accessible to residents. We discussed these with the registered provider and advised her to carry out risk assessments and take any necessary action to safeguard residents as soon as possible. Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 26 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 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 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 2 Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 5 (1) Requirement Timescale for action 31/12/08 2. OP7 15 (1) & (2) 3. OP9 15 A Service User Guide that contains current and accurate information must be provided to all residents so that they have adequate information about the home. Residents’ care plans must 30/11/08 contain all the relevant information about their individual needs so that staff are aware of the support they should provide. Care plans for managing medical 16/11/08 conditions and medication must be improved and followed so that people receive good care and are monitored properly. (Previous timescale of 15/07/08 not fully met). Records for receipt, administration and disposal of medicines must be accurate to protect people from errors. (Previous timescales of 01/06/08 and 15/07/08 not met). 17/11/08 4. OP9 17(1) Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 28 5. OP9 13(2) Controlled Drugs must be stored and recorded according to the Misuse of Drugs regulations. (Previous timescales of 01/06/08 and 15/07/08 not met). The quality of medicines handling must be reviewed, or audited, regularly to protect people from errors. (Previous timescale of 15/07/08 not met). Staff must be regularly assessed as competent in medicines handling to ensure that medication is administered to residents safely. People who look after and take their own medicines must be assessed for risks and monitored to keep them safe and well. All residents should be offered regular opportunity to take part in activities both inside and outside of the home. (Previous timescale of 31/07/08 not met). It must be ensured that all staff are fully aware and have a full understanding of the home’s safeguarding and whistleblowing procedures. (Previous timescale of 30/06/08 not met). It must be ensured that the complaints procedure is provided in formats appropriate to the 17/11/08 6. OP9 24(1) 17/11/08 7. OP9 18(1) 17/11/08 8. OP9 13 (4) 17/11/08 9. OP12 16(2)(m) 30/11/08 10. OP18 13 (6) 31/10/08 11. OP16 22 (2) 16/11/08 Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 29 needs of all residents. (Previous timescale of 30/06/08 not met). 12. OP26 13 In the event that a resident has a relevant condition, staff must be provided with individual infection control guidelines in relation to that person so that the risk of spread of infectious diseases is reduced. 31/10/08 13. OP27 18 (1) (a) 14. OP28 18 (1) (a) 15. OP29 19 (1) (a) (b) (i) & (c ) It must be ensured that there 31/10/08 are appropriate numbers of staff on duty at all times to meet the needs of residents. (Previous timescale of 31/07/08 not met). It must be ensured that at least 30/04/09 50 of carers at the home hold National Vocational Qualifications in care at level 2 or above. It must be ensured that people 31/10/08 are not employed to work at the home until the appropriate information as specified in paragraph 1 to 7 of Schedule 2 of The Care Homes Regulations, 2001 has been obtained. 31/12/08 16. OP30 18 (1) (c ) People employed at the home (i) must be given appropriate training to enable them to carry out their duties. (Previous timescale of 30/09/08 not met). 8(1)(b)(iii An application for the registration of a suitably qualified and experienced manager in respect of this home must be submitted to the Commission. (Previous timescale of 30/09/07 & 10/07/08 not met). 17. OP31 31/12/08 Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 30 18. OP31 8 The registered provider must ensure that the home has adequate management at all times to help ensure the safety and wellbeing of residents. 23/10/08 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 OP1 Good Practice Recommendations The home’s Service User Guide should be provided in a variety of formats so that everyone has equal access to the information. Pre admission assessments should contain greater information so that carers have a better understanding of individual residents. Residents or where appropriate, their representatives should be invited to sign their care plans to demonstrate that they have had some involvement in their development. It is recommended that the pharmacy be requested to label eye drops on both the bottle and the outer carton. The practice of packing down medicines from original containers to compliance aids should be reviewed to prevent errors that could affect health. 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 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. 2. OP3 3. OP7 4. 5. OP9 OP9 6. OP9 7. OP9 Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 31 8. OP15 People should be provided with a choice of main meal on a daily basis and menus provided for residents so that they are fully aware of the choices available to them. All staff should be provided with training in Safeguarding. Consideration should be given to the removal of the communal, cubicle toilets and provision of a more private facility. All residents bedrooms should be lockable and all residents who wish so, should be provided with a key. 9. 10. OP18 OP19 11. OP19 12. OP19 A system should be implemented for the reporting and addressing of repairs around the building so that they are dealt with promptly. 13. OP26 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. Risk assessments should be carried out in relation to residents access to the laundry and windows on the upper floors of the home to help ensure residents safety. 14. 15. OP30 OP30 16. 17. OP33 OP33 18. OP38 Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection NW Regional Office 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Stanley Lodge Residential Home DS0000067072.V370038.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
