Inspection on 10/06/09 for Stanton Lodge Nursing & Residential Home

This inspection was carried out on 10th June 2009.

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

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

Other inspections for this house

Stanton Lodge Nursing &... 21/04/10

Stanton Lodge Nursing &... 26/01/10

Stanton Lodge Nursing &... 06/08/08

Stanton Lodge Nursing &... 04/06/07

Stanton Lodge Nursing &... 13/06/06

Stanton Lodge Nursing &... 14/11/05

Stanton Lodge Nursing &... 02/06/05

Stanton Lodge Nursing &... 07/12/04

Stanton Lodge Nursing &... 26/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Stanton Lodge Nursing & Residential Home Millfield Avenue Shiremoor Tyne & Wear NE27 0LE Lead Inspector Mary Blake Key Unannounced Inspection 09:00 10 & 17th June 2009 th DS0000029001.V376120.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stanton Lodge Nursing & Residential Home Address Millfield Avenue Shiremoor Tyne & Wear NE27 0LE 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) 0191 2522919 0191 2535017 stanton.lodge@fshc.co.uk www.fshc.co.uk Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Veronica Bernadette Cairns Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (21) of places Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2008 Brief Description of the Service: Stanton Lodge is a purpose built 72 bed care home. All the accommodation is on ground floor level and all the bedrooms have en-suite facilities. The home is situated in a residential area and is close to local amenities and public transport. There are two units within the home each offering a different category of care, one provides for older people requiring personal care or personal care with nursing and the other provides care for 21 younger physically disabled people. There are lounges and dining rooms on each unit and there is a smoking lounge. All units have specialist baths, showers and disabled toilets. There are enclosed garden areas, which are wheelchair accessible, and there are car-parking facilities. Fee rates vary on an individual basis and are available from the home. This fee includes the nursing care element without specialist equipment. Further information about the home is available in the service user guide, which contains the statement of purpose and previous inspection reports. This is kept in the reception area of the home. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. An unannounced visit was made on the 10th June 2009 with a further announced visit on 17th June 2009. A CQC pharmacy inspector also visited on 10th June 2009. The Registered Manager was present throughout the inspection. Before the visit: We looked at: • Information we have received since the last inspection in August 2008. • How the service dealt with any complaints and concerns. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff and other professionals, including surveys. • The Annual Quality Assurance Assessment (AQAA), which is a selfassessment document, was sent to the home for their completion and was returned to CQC. “Have your say” questionnaires were sent out to people who have used or had interest in the home, none of which were returned to us. During the visits we: • Talked with people who use the service, relatives, staff and the manager. • Looked at information about the people who use the service and how well their needs are met. • Looked at other records which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around parts of the building to make sure it was clean, safe and comfortable. • Checked what improvements had been made since the last visit. We told the manager and provider representative what we found. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 6 What the service does well: Residents said, and it was seen, that staff were kind, considerate and supportive. What has improved since the last inspection? What they could do better: Ensure that all pre-admission information is developed into a care plan that will support staff to meet the individual needs of residents. Ensure residents receive good personal care, including bathing and mouth care. This will reduce the risk of illness and infection. Ensuring care plans are person centred and up to date. This will enable staff to provide more individualised care. Ensure residents receive adequate fluids and diet and that they are weighed. Ensure that nutritional risk assessments are undertaken and that fluid and nutritional records are kept for those assessed as being at nutritional risk. All of this will help reduce the risk of weight loss, illness and infection. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 7 Medication administration and recording practices in the home must be robust enough to ensure that residents will always receive their medicines accurately as prescribed. Ensure that all residents are given the opportunity for meaningful social activities and choice in their daily routines and are treated with respect and dignity. This will improve their health and wellbeing. Ensure that the premises and residents’ bedrooms are kept clean and free from odours and clutter and that smoke from the smoking room does not impede on the health and welfare of other residents. Ensure that there are sufficient staff, on a consistent basis, to meet the dependency needs of the residents. Ensure that staff are suitably qualified and competent to meet the healthcare needs of residents and promote their welfare. That training is provided for people employed to work at the home to enable them to develop their skills and knowledge and therefore improve the quality of the care provided. To reintroduce relatives and staff meetings to provide management with an overview and for people to have their say on how the home is operated. Ensure that all staff undertake fire drills at three monthly intervals for night staff and six monthly for day staff. This will help improve the safety for residents, staff and visitors. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 3 Residents have their needs assessed by care staff and have opportunities to visit before admission to the home but this information is not always developed into the care plan. EVIDENCE: Pre-admission assessments are undertaken and reflect the needs of the residents. The manager is involved in the decisions and in the majority of instances visits the residents herself prior to their admission. Residents and relatives spoke of visiting the home prior to admission and that this was useful to reduce anxiety and make the settling in process easier. A Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 10 number of the residents relied upon their relatives to go to the home and advise them if it was suitable for them. The pre-admission information had not been transferred into the care plans which in turn did not contain sufficient information to ensure that the home can meet the overall needs of the resident. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 7,8,9 & 10 People receive basic care and support but this does not take into account their diverse needs or promote their privacy and dignity. The residents’ health, personal and social care needs are not set out in their individual plan of care and their individual health needs are not fully met. There are poor systems for the accurate administration, recording and storage of medicines. This puts people at risk of not receiving their medication safely and as prescribed. EVIDENCE: Four care plans were examined and case tracked. This means that we spoke to the individual residents or observed their care and then matched our observations to what was written in the care plan. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 12 There has been deterioration in the consistency and amount of information which is recorded. There were a number of assessment tools in place such as nutrition, pressure sore risk, moving and handling and dependency. However these had not been consistently completed, reviewed or updated. The care plans had not been updated since April 2009, risk assessments had not been completed or actions recorded to help reduce risk such as weight loss. The preadmission information for the last two admissions had not been transferred into the care plan. Nutritional assessments were undertaken for some residents and risks identified but action has been inconsistent, for example one resident identified as at risk did not have her weight loss evaluated for six months and it was unclear if any weights had been recorded during this time, another shows a significant weight loss but no evidence of actions since March 2009. Staff could not find fluid or food recording charts. When we arrived at the home there was concern that there were only two permanent qualified nurses for day shift at the home. The nurse and staff on duty reported that they were under pressure and that staff morale was poor. Throughout the inspection, staff talked to us about lack of consistent leadership on the floor and the affect on the health and welfare of residents. We noticed that residents’ call bells were not answered promptly and that staff were not always directed to work. The individual health needs of people who use the service are not consistently met. Whilst staff were kind and caring they were not always giving the residents the support and care they needed. For example at 1.30pm many residents were not out of bed and staff reported that many only got up on alternative day. The reason for this was not clear from the care plans and staff thought it was due to staff shortages. The manager stated that it was part of some residents plan but acknowledged that staff might not be clear without the leadership of the nurse. Residents told us they were well looked after though some said that they were not bathed often enough. Staff were concerned that they were unable to give the support to bath or shower people on a regular basis and did not have the time to carry out personal tasks properly. Not all of the residents who were in bed had access to a nurse call or drinks. Some residents did not appear clean or well dressed with items of clothing missing or soiled and dirty nails and mouths. Despite our immediate concerns we found that inappropriate and loud music was playing in a bedroom where a gentleman was in bed on both days of the visit. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 13 The pharmacist inspector made the following observations in relation to medication arrangements: The home has a comprehensive set of Four Season policy documents. Records of medicines supplied and destroyed by the home are kept and the home has a contract with a waste contractor for the disposal of medicines. Some residents who self-medicate medicines or inhalers did not have a completed risk assessment in their care plan. The room used to store medication is of a good size, however there was no record of room temperature and there was inconsistent recording of fridge temperatures. The maximum fridge temperature, which should be between 2-8 degrees centigrade, had been recorded as 21 degrees for a period of 23 days. Staff did not know how to reset the minimum/maximum thermometer and no action had been taken to investigate this matter. Some items which do not require cool storage were inappropriately stored in the fridge for example glycerol suppositories, glyceryl trinitrate spray, hydroxycobalamin injection and gel packs. The areas used to store medicinal oxygen were appropriately marked. No dates of opening were recorded on liquids or eye preparations within the medicines trolley on the residential unit. The cupboard used to store controlled drugs appears to meet regulations. Neat records were kept. However, not all stock balanced on the day as some controlled drugs record books were unavailable. On two occasions morphine sulphate tablets had been transferred from one pharmacy box to another. There was a record of staff authorised to administer medicines, however, none of the staff giving medicines on the day of the inspection had signed this list which was laminated making it difficult for any temporary staff to sign. Most residents had a divider in the Medication Administration Records (MARs) charts with a good photograph and allergies recorded. There is inconsistency in the recording of the quantity of medication from one monthly cycle to another and the date received into the home. Handwritten entries are not always checked or signed and on some occasions were incorrect. MARs were incomplete with gaps and some entries were difficult to read. An audit of current stock and records showed that some medication had been signed for but not given. Records of the use of creams were poor. Medication required for some people was unavailable on the day of the visit. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 14 The medication for the neuro-disablity unit was observed on the day of the visit. There were insufficient pots and cups at the start of the round and on several occasions the nurse had to return to the medicines room to obtain medication which was not on the trolley. Liquid medication was measured using a graduated pot rather than a 5ml spoon or oral dose syringe. There was a tablet crusher on the trolley containing white powder with no name marked on it and no record of any person who had had medication crushed before administration. There was a large quantity of nutritional supplements in the home mainly stored in the dining rooms. When checked many of these were out of date and some were unlabelled. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 12,13, 14 & 15 Residents are not satisfied with the flexibility of their routines for daily living and there were insufficient activities to meet their social needs. They can maintain contact with family, friends and the local community. Residents are not always supported to receive wholesome diet or sufficient fluids. EVIDENCE: An activities coordinator is employed in the home but has been absent from the home for some time. A limited range of activities is available. Residents’ social needs are not assessed or recorded within the care plan. There are more activities and individualised social support on the neurodisabiity unit. Residents and relatives spoke of the lack of things to do “I am stuck in bed” “the days are long” “it is ok if you can do you own thing but not if you need support”. Arrangements for residents to maintain contact with their family and friends are supported and family are encouraged to take residents out and about. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 16 Residents told us that they could have visitors at any reasonable time. We noticed visitors in the home coming and going freely. Residents said they had, at times, limited choice about their day, “takes forever for staff to come” “buzz for a long time before anyone comes” “I get up when they have time, I would like to get up earlier” “I never get to go the toilet on time” “staff are always pleasant but so busy I don’t like to bother them” “I am ok as I can manage myself but difficult for others who need more help”. This problem was observed during the inspection and confirmed by residents, relatives and staff. Several staff told us that residents were not always offered enough to eat and that the menu was not followed. In particularly the evening meal where comments included ‘they have to halve the fritters as not enough’ ‘not enough éclairs only fifteen for twenty one people so we to have cut them up’. Staff said this had been raised with the cook and manager of the home, however the manager said that she was not aware of this. The lunchtime was observed. Staff managed the dining room and serving of food well, portions sizes were observed to be small, although there was ample food on the second inspection visit. It took over an hour to complete this meal and staff advised us there were fourteen residents who needed support with feeding. Staff said they felt very rushed “if someone stops I don’t have time to encourage them to eat more as I am worried about X getting food”. Residents themselves did not actually complain about the food. We observed that they did appear to enjoy the food and the atmosphere in the dining rooms was pleasant and relaxed. Residents were offered hot drinks with the meal but residents and staff stated that they often did not get a drink outside of mealtimes. Staff stated that they are often too busy to go around with the tea/drinks trolley. The tea trolley was not evident on the first day of inspection and morning coffee was still being served at 11.50 on the second day. The manager was not aware that the tea trolley was not going out on a regular basis. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 16 & 18 There are procedures in place to make sure that complaints are dealt with satisfactorily and that residents are safeguarded from harm. EVIDENCE: The complaints procedure is displayed in the home and available to each resident. Residents and relatives said that they knew problems were dealt with and how this would be done. Six complaints had been investigated by the provider and upheld. The manager stated that staff were aware of the whistle blowing policy and informing the manager of any incidents or issues of concern. Staff confirmed this during discussion. A number of staff had received safeguarding of vulnerable adults training with further training planned. Safeguarding issues had been appropriately managed. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 19 & 26 The home offers accommodation that is basically clean and maintained and has design features to help people of this client group, this promotes their dignity, comfort and welfare. EVIDENCE: The home is a single storey purpose build care home. The home has undergone an extensive refurbishment and redecoration programme, which is almost complete. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 19 Each unit has access to enclosed courtyards and garden areas. The areas are pleasant and residents said they enjoyed being able to use these areas. Bedrooms have been refurbished and redecorated and offer people living in the home pleasant, comfortable personnel space. However some of these were very messy and cluttered, shelves and ornaments were very dusty, bins were turned over, creams and lotions were around the rooms and catheter equipment scattered around. Again some of the residents have taken personal items into the home making the bedrooms personalised but some others were very stark. The home was basically clean with some odours in the home on the day of inspection, communal areas appeared satisfactory, but some bedrooms had odours and were untidy. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 27, 28, 29 & 30 The manager ensures there are adequate numbers of staff on duty to care for the residents but there is not consistent leadership from qualified staff because the majority are agency. Staff training is provided and the recruitment processes in place protect residents. EVIDENCE: The manager reported to us that the home had been short of consistent qualified staff since November 2008 and this was confirmed from staffing rotas. She said that recruitment campaigns had failed and that she and the deputy were the only permanent qualified nurses for day duty. This leaves a seventy five per cent shortage and the home has to rely on bank or agency staff to provide the number of staff necessary. Night staffing arrangements are currently unaffected. The provider and manager have tried to ensure consistency by the use of the same bank/agency staff but this had not always been possible. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 21 Staff said that they are undertaking or had completed National Vocational Qualifications in Care (NVQ) level 2 or over, but the number with an actual qualification falls well short of the fifty percent target. A staff training programme is now available and includes the dates of completion for mandatory, safeguarding, NVQ and other training. This confirms that the staff team are developing the skills and training which is required to meet the needs of residents but there remain shortfalls in areas such as health and safety, basic food hygiene and health related training. The home has an induction and training programme for all staff working in the home. Staff spoke knowledgably about the individual needs of residents. Staff recruitment files were examined and were satisfactory. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 31,33 & 38 There are systems in place to organise the home taking into account the needs and wishes of the residents. Quality systems have been established and are being developed but the health, safety and welfare of residents and staff are not protected. EVIDENCE: The residents and staff made positive comment about the manager and staff team. The manager had made steps to address the two previous requirements from the last inspection but due to the lack of consistent staff these were no Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 23 longer met. The manager stated that staff supervisions are being undertaken but not frequently enough and that she has not received supervision. Regular meetings had not been held for residents, relatives and staff. Accidents are well recorded with accident analyses being completed and risk preventions being undertaken to safeguard residents. System testing had been undertaken and maintenance certificates were available. There was evidence of management planning within the home but this was not evident from the leadership on the floor where the atmosphere was confused and staff lacked direction. It was evident from the views of manager, staff, relatives and residents that the lack of consistent leadership of the floor was resulting in deterioration in the provision of consistent quality care. This shortage has resulted in the manager and deputy working on the floor and at times not being able to have a management overview. Staff were very supportive of the management but morale was low and staff were tired. Staff felt they were under a lot of pressure to support agency staff. Care staff said that they had lacked leadership and often senior care staff had to support agency staff who were unfamiliar with the residents and routines. It was also appear that the dependency levels of the current residents groups are quite high and this had not been reviewed. Staff and residents meetings are not being held. Quality assurance systems are in place with audits for a range of areas and remedial actions plans in place. Regulation visits by the provider had confirmed the staffing issues and the concerns of the manager/deputy manager. The provider and manager had been working together to plan further recruitment drives for example competitive rates and links with further education establishments but this does not resolve the current situation. The health and safety checks carried out by the handyman were mostly up to date. The fire drills had not been carried out at the timescales of six per year of night staff and two per year for day staff. An immediate requirement notice was issued to address this health and safety matter. It was noted and residents complained that smoke was coming out of the smoking room into individual bedrooms. We concluded that the home was not running in the best interests of residents. Issues raised in every section of this report have an impact on residents’ lives and potentially serious implications for their health, welfare and safety. Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 24 Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 25 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 X X 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 2 Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 (2)(b) Requirement The care plan documentation must be regularly reviewed and updated Outstanding from 01/01/09 Make arrangements to ensure that residents have all their hygiene, cleanliness and personal grooming on a daily basis and after meals. Ensure residents are weighed, nutritional risk assessments are undertaken, fluid and nutritional records are kept for those at risk Ensure that all residents have access to their call bells when in bed or unattended Arrangements must be in place to ensure that medication records are accurately maintained; that the reason for non-administration of medication are recorded by the timely entry of an appropriate code or entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication DS0000029001.V376120.R01.S.doc Timescale for action 01/08/09 2 OP8 OP10 12 (4) 01/08/09 3 OP8 12 (1) 01/08/09 4 OP9 13 (2) 01/08/09 Stanton Lodge Nursing & Residential Home Version 5.2 Page 27 Administration Record in respect of each individual service user at the time of administration. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. Medication must only be administered from the containers supplied by the pharmacy. This will reduce the risk of mistakes 5 OP9 12 (1) (b) Arrangements must be made to ensure that an effective system is in place to request, obtain and retain adequate supplies of prescribed medicines for people living in the home so that they can be given to them when prescribed. Ensure that all residents are given the opportunity for meaningful social activities. Ensure that all residents are given the opportunity for choice in their daily routine such as bathing and when they get up. Ensure residents receive adequate fluids and diet which is suited to their individually assessed and recorded requirements. Ensure that the premises and residents bedrooms are kept clean and free from odours and clutter Ensure that at all times there are sufficient numbers of suitable qualified nurses working in the care home to meet residents nursing care needs and provide full support and supervision of the carers. Ensure that all staff undertake DS0000029001.V376120.R01.S.doc 01/08/09 6 7 OP12 OP14 16 (m) (n) 12 (3) 01/09/09 01/08/09 8 OP15 12 (1) (a) 01/08/09 9 OP26 23 (2) (d) 01/08/09 10 OP27 18 (1) (a) 01/08/09 11 OP38 13 (4) (c) 02/07/09 Page 28 Stanton Lodge Nursing & Residential Home Version 5.2 fire drills at the intervals of three monthly for night staff and six monthly for day staff. Immediate requirement notice issued. 12 OP38 13 (4) Prevent smoke from the smoking 01/08/09 room impeding on the health and welfare of other residents. 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 Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The temperature of the medication room and fridge should be regularly monitored and recorded. This makes sure that medicines are being stored at the temperatures recommended by the manufacturer More than fifty percent of staff should complete National Vocational Training in Care level 2 or above 2 OP9 3 OP28 Stanton Lodge Nursing & Residential Home DS0000029001.V376120.R01.S.doc Version 5.2 Page 29 Care Quality Commission National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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