Inspection on 22/09/05 for Stanway Green Lodge

This inspection was carried out on 22nd September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Stanway Green Lodge 17/10/07

Stanway Green Lodge 28/11/06

Stanway Green Lodge 31/01/06

Stanway Green Lodge 21/06/05

Stanway Green Lodge 19/10/04

Stanway Green Lodge 15/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Stanway Green Lodge Stanway Green Stanway Colchester Essex CO3 0RA Lead Inspector Tim Thornton-Jones Final Unannounced Inspection 22nd September 10:00 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 Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Stanway Green Lodge Address Stanway Green Stanway Colchester Essex CO3 0RA 01206 330780 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) Mrs Laura Kanitkar Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 27 persons) Mrs Kanitkar must propose a manager for registration to the Commission for Social Care Inspection, under the Care Standards Act 2000, by 31st July 2005 21st June 2005 Date of last inspection Brief Description of the Service: The care home provides personal care and accommodation to people over the age of 65 who require such care by way of their older age and the conditions associated with aging. This does not include care for any specific category of service such as dementia or any other condition excluded from the current registration category for the home. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to review the progress of standards that had not been met at the time of the last inspection. There has been a relatively short time span between inspections due to the extent to which the service has not achieved adequate ratings against National Minimum Standards. This inspection concluded that the considerable majority of the standards not met at the previous inspection remain unmet and whilst the Registered Person had submitted an action plan following the previous inspection and it is accepted that the time scales for some improvements had not yet been reached, nevertheless a greater proportion of improvements were expected than have been achieved. Previous inspections, including the one to which this report refers, conclude that the home is not being adequately managed. There is a lack of experienced, skilled and competent workers, although some are clearly attempting to provide the best possible care that they are able. Care management continues to be poor and care workers rely heavily on their own intuitive practice rather than following an agreed, assessed and planned approach to meeting care outcomes. The workforce is not appropriately recruited, inducted, trained or supervised and this is a major factor in the quality of the care experience for service users. The service has no operational approach to quality monitoring, although this is being developed. Whilst some practices were observed to be caring, respectful and supportive, others were undignified, inappropriate and institutional in origin. This tends to support the view that the care process is left to individual care workers rather than as a result of well managed, clear, procedure led practice. The service outcomes must improve. This is a matter that will continue to be addressed by CSCI with the Registered Person, who has been advised that failure to make significant and speedy improvements will inevitably lead to serious enforcement action to safeguard the safety and wellbeing of service users. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 6 What the service does well: • • • The service maintains a quiet and spacious environment. The gardens and grounds are well maintained* Some examples of good practice are being maintained by some care workers. * Notwithstanding requirements and recommendations set out within this report. What has improved since the last inspection? What they could do better: The areas that need to be improved have been reviewed from the previous inspection. Those that remain valid have been reiterated below. • • • • • • • • • Some maintenance and decoration. Care workers recruitment, training and supervision. Application of good care practice within the revised and improved care plan structure. Recording of care practice in an objective and reflective style in accordance with agreed and planned care documentation. Maintenance of care related records and practice procedures. Develop principal documentation such as Statement of Purpose and Service User Guide. Management of prescribed medicine administration. Quality Assurance systems. Develop care practices that are consultative in nature and protect service users. DS0000053190.V254259.R01.S.doc Version 5.0 Page 7 Stanway Green Lodge • • • • • Bathing and washing facilities. Buildings maintenance. Health and safety issues. Strategic and day-to-day management of the service. Understanding, knowledge and application of practice reflected by current industry standards. 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. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 & 6 • • • Service users do not yet benefit from the information they need to make an informed choice about the service. Contractual arrangements remain inadequate to meet National Minimum Standards. Service users and their representatives are not adequately informed about the homes ability to meet their needs or to assess the services suitability. EVIDENCE: The Statement of Purpose and Service Users Guide were confirmed by the Registered Person as not having been updated since the previous inspection and therefore remains in need of improvement to meet with Regulatory requirements and National Minimum Standards. The Registered Person has previously submitted and action plan in response to the previous inspection report, detailing actions that will be taken to improve Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 10 the home and services. The action plan indicated that the documents referred to would be completed by the end of September 2005. The Registered Person confirmed that this remained ‘on line’ to be achieved. There is an expectation that the revised documents, setting out the service objectives and standards to be achieved, will be forwarded to CSCI by the due date. A case tracking approach was used to ascertain whether service users and their representatives were confident and fully aware of whether, at the time they started to live at the home, the service would have the capacity to meet their needs. The inspection concluded that the information available did not demonstrate that the home’s care practice was based upon current good practice and reflected relevant professional guidance. This was the position noted at the previous inspection and therefore no improvement had been evidenced. There was information available to indicate that a representative from the service either visited the prospective service user and/or pre-commencement information had been gathered. An assessment of needs was in place within care plans sampled, but was unclear in some cases as to when the assessment was undertaken. The assessment document was in a ‘closed question’ format and the assessment findings were brief. It was not evident that the assessor in these examples had appropriate skills to carry out the assessment and identify how, for example, an identified need might impact on another. For instance, it was noted under a heading ‘Communication’, “no problems” and under a heading ‘Hearing’, it stated “deaf”. Another assessment stated, “Needs glasses”, but did not give further detail. An optician report for this individual was consulted as part of the case tracking approach, which clarified that the person was partially sighted and had a deteriorating eyesight condition, it was also noted the person had fallen quite frequently. None of this information had been adequately collated and planned for. Service users spoken with expressed that relative’s choice, location and availability were strong reasons for their choice of the service and did not recall receiving any written information regarding the home. The statement of terms and conditions were examined. The sample lacked clarity about fees charged, stating only that fees were reviewed annually and if a service user required additional care it may be necessary to increase fees. The documents did not include the level of care and support already agreed and the amount of fees payable was blank and undated. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 • • • Service users do not fully benefit from having a detailed personal plan. Service users do not benefit from fully adequate practices of healthcare matters. The service has not yet developed a policy and procedure to address the capacity of service users to make decisions. The absence of this approach detracts from service users rights’ and dignity. Service users did not benefit from practice that promoted their privacy and dignity at all times. • EVIDENCE: Service user care planning documents and associated information was examined as part of a case tracking approach. The care planning sampled was not adequately comprehensive to enable care workers to be clear about individual care requirements and methods to be used in order to deliver consistent and planned care. The sample indicated that no discernable improvement had been achieved to care management practices since the Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 12 previous inspection and, whilst remaining adequate in general structure, was inadequate in terms of good professional practice. There was little evidence available to demonstrate that care management arrangements at the home operated a key worker or similar arrangement. Care workers spoken with commented that the key worker system had ‘broken down’, and was under review. Each care plan seen showed that daily notes were being written. These varied in quality and objectivity. The majority of entries were not directly linked to care plan objectives or decisions taken, where present. Care workers spoken with were unable to demonstrate a clear understanding of care planning and did not contribute to the process. One recently recruited carer had not been shown a care plan. None of the care plans sampled gave a clear indication that the service user was integral to the decision making and monitoring process. This approach contributes, in part, to a lack of dignity and empowerment for those receiving the service. All of the care plans sampled were unable to provide evidence of individual consultation or planned arrangements for illness and/or ‘end of life’ choices or preferences. The overall practice of care workers was, again, similar to that noted at the previous inspection where examples of good practice were observed when service users were spoken with in a suitable tone and volume, and service users appeared to acknowledge they had been listened too and supported by carers. Care workers were also observed to knock on doors before entering a service user’s room. Contrary to this were several examples of service users either having their requests ignored or not responded to appropriately. One such example observed involved a carer assisting two service users. One was assisted to the toilet and told to ”sit there and don’t move”. The carer then hastily left this person in order to catch up with the second service user who was walking down the corridor with a frame for support. The carer left the toilet door half open, leaving the service user visible to those walking past. It is unclear from this observed example whether the individual practice was at fault, there was lack of appropriate training, the flustered carer was unable to control the workload presented as a consequence of inadequate care worker levels or this incident occurred as a result of poor supervisory support. A combination of all these factors may well be responsible for this outcome. Care workers indicated that service users normally had a bath at times when there were enough care workers on duty. (See Staffing section.) Observation of practice and documentation highlighted that practice was not reflective of appropriate continence management. Service users were being Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 13 taken to the toilet at set times, i.e. before and after meals. One service user was observed to ask a carer where she was being taken, having been woken up and placed in a wheelchair, to be told she was ‘going to the toilet’. The sampled care plans did not provide suitable evidence of relevant healthcare screening and other healthcare related practices that promote the monitoring and wellbeing of service users, including regular monitoring via primary healthcare services. The service should utilise appropriate risk assessment, undertaken by a competent person, regarding pressure sore prevention and management, nutrition, continence and mobility. Existing care planning did not demonstrate an adequate approach in this regard. A care plan for a service user who had suffered a stroke did not reflect an agreed management plan for the condition relating to communication, mobility, exercise and nutrition. A pre-printed exercise programme dated 2003 was located in the file, but no evidence was apparent as to whether this had been implemented. The sampled care plans did not evidence that ‘mental capacity’ issues had been assessed or considered in appropriate instances regarding decision making and consent issues, for example self-administration of medicines. The management of prescribed medicines was reviewed in terms of practice and security. The policy and procedure documentation was not reviewed on this occasion but will be examined at the next inspection. The security arrangements and general administration was satisfactory, with the exception of prescribed topical treatments. These were maintained in service users rooms but no records were being maintained regarding their use and frequency of administering. Other observed practice was satisfactory in that care workers did consult with service users regarding ‘as and when required’ medicines. The practice of receiving a verbal change in prescription for medicines such as Warfarin is not considered safe practice. The Registered Person is advised to ensure that a suitable procedure is agreed with the relevant GP surgery for signed notification of advised dosage/frequency changes to medicines and that, in the use of Warfarin, monitoring blood test results are maintained. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 • • • Service users do not fully benefit from the underdeveloped culture, quality monitoring and capacity assessment issues of the home. Service users benefit from flexible arrangements regarding visitors, although access to the local community is less comprehensive. Service users benefit from an approach to choice to a certain degree, although service users have limited choice in some aspects of the service delivery. Records were too limited regarding food served to make an accurate judgement as to the variety and amount of food served. • EVIDENCE: The daily routines of the home were observed to be variable in terms of flexibility, preferences and choice. Some daily matters were properly addressed by some care workers that were observed to present real choices, whilst some examples of an institutionalised approach were observed. Service users do not benefit from a wide range and choice of activities suited to their assessed needs. This is an aspect of the home would benefit from Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 15 development since it is likely to have an immediate impact on the quality of life for service users. The policy and procedure towards the encouragement of visitors was positive, although there were no opportunities to speak with relatives at the time of inspection. The relatively low level of care worker deployment impacts on virtually all aspects of the provision. Activities provided are not as comprehensive as it might be, especially regarding assisting service users to access the community. Activities are provided via visiting entertainers, however, no activities were observed during the inspection resulting from carer involvement. A number of service users were observed during the inspection to be disengaged from their surroundings and demotivated. Eight service users were observed throughout the morning to be sleeping in their chairs within a lounge. Several service users spoken with commented that they did not do anything during the day and tended to fall asleep. Some service users chose to sit in the corridor outside the office area. They expressed that this location was “busy”, and there was more to see and interact with. From discussions with service users, and as a result of case tracking, it was apparent that several service users were disoriented at times with short term memory loss and other associated conditions. Care workers spoken with were unsure about how to engage service users with these presenting needs. Care workers tended to associate activities with ‘group’ sessions of games, music or trips out and this was rarely possible due to care worker shortage. The Registered Person will need to ensure that appropriate care worker/service user assessment is undertaken and that care workers’ training and development addresses the practice issues regarding meeting the social, emotional and related needs of service users, in particular those who require a greater degree of support due to age related cognitive difficulties. The lunchtime meal was substantial and appeared hot and well presented. Assistance was provided to service users during the meal in a dignified and appropriate manner, although it was disappointing to note that every person on each table had a plastic beaker to drink from rather than a suitable shatterproof glass. It was noted that service users were not routinely provided with cold drinks outside of mealtimes. A senior care worker advised that this was not current practice. It was disappointing to note that, even following advice regarding this, no drinks were observed to be offered for the remainder of the inspection. A menu is produced on a four-week revolving basis. There was no information maintained concerning the seasonal changes, nor was there information held on whether service users ate the meal, although there was an ‘alternatives’ Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 16 book. This recorded the food served to service users if they request something different from that served as part of the menu. A record of food served was being maintained on a daily basis, although it was noted that some meals had been written in advance of having been served. The records also showed that gaps were present where meals had been previously served. These tended to occur at weekends. In discussion regarding this, there was clearly some confusion around who was responsible for maintaining this record and no person spoken with was aware of the requirements for or the purpose of maintaining the record. There was no adequate explanation of why meals purportedly served to service users had been written in advance. It does, however, demonstrate that the records in question are not being routinely checked. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 18 • • Service users who may lack capacity to express their informed choice were not protected in terms of their legal rights. The arrangements in place did not fully protect service users from abuse. EVIDENCE: The inspection concluded that a proportion of service users accommodated presented as possibly lacking capacity to make informed choices and decisions, however, no assessment procedures were in place regarding this. Based upon the sample of care planning arrangements, there was inadequate evidence to show that equal opportunities had been sufficiently considered. There were examples of practice seen that were variable in terms of dignity and appropriateness. Examples of poor practice were observed. Whilst these examples did not suggest a specific abuse, it was nevertheless consistent with institutionalised practice and undignified care. This must be improved by appropriate deployment of informed, experienced, well-supervised and trained carers. In contrast, it should be reiterated that some positive examples of practice were observed. (See Staffing section of this report.) Procedures for the protection from abuse were in place but, as noted at the previous inspection, in practice the principles and outcomes of the procedure were not clearly demonstrated by all care workers. The whistle blowing procedure would benefit from updating to meet the practice suggested within current guidance available. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 25 & 26 • • • • • • • The building and grounds meet with service notwithstanding the matters highlighted below. users’ needs, Service users do not benefit from an environment that has been risk assessed to help ensure their safety. The bathing and WC facilities do not meet with service users’ needs. Individual bedrooms were well decorated, furnished and comfortable. The communal areas were less well maintained. The health and safety of service users were not being adequately maintained. The rooms used by service users presented as not having any obvious hazards to their safety and wellbeing. Service users benefit from a clean and hygienic environment, for the most part, with the exception of one bathroom. DS0000053190.V254259.R01.S.doc Version 5.0 Page 19 Stanway Green Lodge EVIDENCE: The building is adequately proportioned, private, quiet with the grounds well maintained. The inspection of the home included a tour of the building where all communal rooms and several of the bedrooms were visited. There were a number of decoration improvements still to be made, such as to repair cracks in walls and other marks as noted at the time of the previous inspection. Toilets visited continue to not have adequate facilities, as stated within the previous inspection report. The carpet in one bathroom was in need of cleaning and repair or replacement. Again, this was a matter raised at the time of the last inspection. The home pre-existed the current legislation of the Care Standards Act 2000 and, under arrangements, the bathing and WC facilities specified as compliant as at March 31st 2002 must be maintained providing this level meets with the needs of service users. This inspection found that service users did not use one bathroom as it could not be used in conjunction with mobility equipment. On this basis the homes facilities continue to not meet requirements. Access and exit doors are required to be risk assessed as some had a step down immediately after the doorstep. There was an entry in the accident book showing that one service user had fallen having attempted to leave the building by this exit. Entry and exit doors are required to be suitable for use by service users, therefore, all should be made safe by ensuring they are ground level equivalent or appropriately ramped. This is a matter that was raised at the previous inspection. The laundry was visited and noted to have been improved since the previous inspection. The area has revised equipment and was well organised and clean. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 • • • • Service users do not benefit from adequate numbers of care workers who are appropriately trained and who have appropriate skills. Service users do not always benefit from a cohesive, well trained and experienced care team. Service users are not fully protected from the recruitment practices of the service. The service was unable to evidence that all care workers are adequately trained and competent to do their jobs. EVIDENCE: The service had used an assessment recommended by the Department of Health (Residential Forum) to calculate the number of care worker hours required to meet service users’ needs. The current assessment document was seen and indicated that of the 23 service users assessed, 19 were considered ‘low’ needs, 3 were ‘medium’ needs and 1 was ‘high’ needs. Based upon the information gathered at this inspection, through discussion with service users and from observation and examination of various records, inspectors consider that this category division requires review on the basis that some service users may have been mis-categorised in terms of the care and support they require. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 21 Based upon the figures used by the home, however, a total of 515.31 hours were assessed as being needed to care for service users. The care workers deployment record, sampled for week commencing 19th September and the previous weekend of 17th/18th September 2005, confirmed that a total of 454.50 care hours were deployed, indicating an approximate shortfall of 60 hours per week. The roster indicated that care workers were undertaking ‘double’ shifts of approximately 13 hours, further indicating a shortage of care workers. Inspectors found that this was the second successive occasion where care workers were observed to undertake duties and tasks in a way that was inconsistent with good practice and variable to their colleagues who, by contrast, were observed to demonstrate sound practice. This would indicate that an inconsistent approach is probably frequent. This is a matter that must be addressed by the Registered Person. The care workers training and development profiles were underdeveloped and similar to that noted at the previous inspection. Supervisory management is also under developed. The Registered Person must ensure that care workers are appropriately informed and associated systems are fully developed and operational. It is important that a skills audit is undertaken and deficits identified and planned for. The CSCI will be expecting progress to be made on these matters in view of the ongoing failure to meet National Minimum Standards. The recruitment of care workers did not meet with National Minimum Standards or regulatory requirements at the previous inspection and little progress had been made on this occasion. From a sample of four care workers, none had all of the information required by regulation. Two did not have a current Criminal Records Bureau (CRB) check certificate in place. None of the care workers sampled had evidence of relevant qualifications. Two had inadequate references. This practice is not acceptable to maintain appropriate levels of safety for service users and must improve to avoid enforcement action. Care workers spoken with stated they felt the induction process was rushed and that they had been ‘left to get on with it’. Care workers spoken with expressed that the only training being accessed was being advertised as no cost. None of the care workers spoken with were aware of their training and development plan. Some care workers had completed NVQ level 2. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 & 38 • • • • • • Service users do not benefit from a service managed by a person who is registered and has satisfied the CSCI that they are fit to be in charge. Service users do not benefit from sound leadership and management approach. Service users do not benefit from a service that is quality assured and quality monitored. Care workers are not adequately supervised. Not all records, policies and procedures are being maintained to help safeguard service users best interests. Aspects of the home’s external environment presented as a potential risk to service users. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 23 EVIDENCE: Whilst senior care workers are employed, the service has not benefited from demonstrable competent management. This is a matter that has been a long standing issue and the Commission placed a condition on the registration of the service that a manager must be registered. At the time of this inspection no application to register a manager had been received. The Care Standards Act requires that the manager of the service be appropriately experienced, qualified and competent to undertake the day-today management of the home. It was noticed that during the previous three inspections the acting manager, or the person in charge in the absence of the manager, spent a high proportion of their time working within the office. This might indicate that tasks associated with the administration of the service are taking up a high proportion of time. The Registered Person may need to consider a supernumerary status of the manager. In the opinion of the inspectors, the manager should be enabled to spend a higher proportion of time within the wider home, assessing care workers working, undertaking supervisory duties, quality monitoring, consulting with service users and similar associated tasks. It may, therefore, require a review of the manager’s administrative duties. The quality assurance and quality monitoring remains in need of development to ensure that an operational approach is adopted based upon consultation with service users of their experiences of the service. The systematic collection of valid data should then be analysed and used as a basis to inform the direction of the service and to review the Statement of Purpose and associated policies and procedures. The supervisory structure of the home is not adequately developed. The quality and frequency with which care workers, senior care workers and manager are supported, with their competence assessed, does not meet with good practice. The variability of practice within the home, observed by inspectors, is likely evidence of a lack of supervision, procedure and training. Those care workers whose role it is to supervise others have not received appropriate training and in these circumstances it is not uncommon for the quality of support to be below that required. Not all records required to be maintained were examined. However, of those sampled, there was little or no evidence to support the view that service users had either access to them or were integral to their upkeep. Care plans and assessment documents were an example. Several records examined were not adequately maintained, for example records of food served, care workers roster and other records mentioned within this report. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 24 The external premises remain in need of assessment to help ensure that all risks associated with level surfaces, steps and gradients are safe to use. Other safety procedures require improved monitoring. Bath temperatures had previously been recorded. It was noted, however, that at some point care workers had stopped recording temperatures in favour of a description of the temperature, for example various care workers had written the word ‘warm’ consecutively. One currently disused bath was being used to soak commode bowls in a bleach solution. This arrangement was unsuitable since the bowls were either submerged or partly submerged. There was no protective wear evident. This was also noted within the kitchen area where no protective wear was being worn. The Registered Person must ensure that procedures are followed to ensure the safety of carers and that the service is in accordance with both food hygiene and COSHH requirements. Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 1 1 X 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 2 18 2 2 2 2 2 3 X 3 2 CARE WORKERSING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 X X 1 2 2 Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 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 OP1 Regulation 4,5, & 6 Timescale for action The Registered Person must 30/11/05 develop a Statement of Purpose and Service Users Guide that meets the requirements of Regulation. This is a repeat requirement. The Registered Person must set 30/11/05 out the terms and conditions as require by regulation. The Registered Person must 30/11/05 ensure that the service is able to demonstrate the capacity to meet the needs of service users. This is a repeat requirement. The Registered Person must 30/11/05 ensure that service users’ health, personal and social care needs and aspirations are set out in an individual plan of care. This is a repeat requirement. The Registered Person must 30/11/05 ensure that service users’ health is promoted. The Registered Person must 30/11/05 ensure that the system for maintaining prescribed medicines is managed in a way that meets service users known and expressed needs. This is a repeat requirement. Requirement 2 3 OP2 OP4 5(1b) & 6 4-6,89,1219,23,24 15 4 OP7 5 6 OP8 OP9 12,13 12,13 Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 27 6 OP10 12,13 7 OP11 12,13 8 OP12 12,15,16 9 OP14 12,15,16 10 OP15 17 11 OP17 15 12 OP18 13 13 OP19 23,24 14 OP20 23,24 The Registered Person must ensure that the conduct of the home reflects practice that preserves the dignity and privacy of service users. This is a repeat requirement. The Registered Person must ensure that care planning arrangements take account of service users wishes and feelings regarding illness, dying and death. This is a repeat requirement. The Registered Person must ensure that the lifestyle experienced within the home matches their expectations and preferences. This is a repeat requirement. The Registered Person must enable service users to exercise choice and control over their lives. The Registered Person must ensure that the home can demonstrate that wholesome nutritious food in adequate quantities is provided at all times. This is a repeat requirement. The Registered Person must ensure that service users legal rights are protected by ensuring they facilitate advocacy services where the person lacks capacity. The Registered Person must ensure that service users are protected from abuse. This is a repeat requirement. The Registered Person must ensure that service users live in a safe, well-maintained environment. This is a repeat requirement. The Registered Person must ensure that service users have access to safe communal outdoor facilities. DS0000053190.V254259.R01.S.doc 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 Stanway Green Lodge Version 5.0 Page 28 15 OP21 15,23,24 16 OP22 23,24 17 OP26 23,24 18 OP27 18,19,24 19 OP29 18,19,24 20 OP30 18,19,24 21 OP31 8 22 OP32 8 23 OP33 24 The Registered Person must ensure that service users have sufficient and suitable washing facilities. This is a repeat requirement. The Registered Person must ensure that service users have the specialist equipment they require to maximise their independence. The Registered Person must ensure that all parts of the home are clean, pleasant and hygienic. This is a repeat requirement. The Registered Person must ensure that the numbers and skill mix of staff meets service users needs. This is a repeat requirement. The Registered Person must ensure that Service Users are protected by the home’s recruitment policy and practices. This is a repeat requirement. The Registered Person must ensure that staff are trained and competent to do their jobs. This is a repeat requirement. The Registered Person must ensure that service users live in a home which is run and managed by a person who is fit to be in charge and able to discharge their responsibilities fully. This is a repeat requirement. The Registered Person must ensure that service users benefit from the ethos, leadership and management approach of the home. The Registered Person must ensure that the home is run in the best interest of service users. This is a repeat requirement. 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 29 24 OP36 18 25 OP37 17 26 OP38 13,16,23, 24 The Registered Person must 30/11/05 ensure that care workers are appropriately supervised. This is a repeat requirement. The Registered Person must 30/11/05 ensure that records required by regulation are appropriately maintained. This is a repeat requirement. The Registered Person must 30/11/05 ensure that the health, safety and welfare of service users and staff are promoted and protected. This is a repeat requirement. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stanway Green Lodge DS0000053190.V254259.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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