Inspection on 08/04/09 for The Dene Lodge

This inspection was carried out on 8th April 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

The Dene Lodge 06/10/09

The Dene Lodge 17/08/07

The Dene Lodge 05/07/06

The Dene Lodge 02/12/05

The Dene Lodge 19/01/05

The Dene Lodge 01/07/04

The Dene Lodge 24/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Dene Lodge Bircham Road Alcombe Minehead Somerset TA24 6BQ Lead Inspector Alison Philpott Key Unannounced Inspection 8th April 2009 10:00 DS0000016025.V373710.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. The Dene Lodge DS0000016025.V373710.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 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Dene Lodge Address Bircham Road Alcombe Minehead Somerset TA24 6BQ 01643 703584 01643 708550 info@thedenelodge.co.uk 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) Hazelgate Ltd Mr Richard Mackie Care Home 33 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (27) of places The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 33 including a maximum of 6 service users with a dementia care need. 17th August 2007 2. Date of last inspection Brief Description of the Service: The Dene Lodge is a care home proving care and support for up to 33 people over the age of 65 years, with a wide range of support needs. There is a selfcontained unit for six people with a primary diagnosis of dementia. The home is located in Alcombe on the outskirts of Minehead. It is close to local shops and services and public transport links. The service users accommodation is arranged on three floors with the communal areas located on the ground floor. The home has a through floor passenger lift and a range of adaptations have been made to the home to ensure it is accessible for those who live there. The home is set back from the road and has attractive garden areas. Richard Mackie is the Registered Manager. The current fee range is £550 to £570 per week. The Dene Lodge DS0000016025.V373710.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 home is zero star poor service. A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. This was an unannounced inspection which as carried out on 8th April 2009, over a total of 14 hours by Regulation Inspectors Alison Philpott and Jane Poole. Whilst there were two inspectors throughout the report the term we will be used as it is written on behalf of the Commission. The Dene Lodge is an older building which has been extended. The home has 33 beds available. The home provides care for people over the age of 65 and has 6 beds for people with dementia care needs. On the day of inspection, 23 people were living in the home. We carried out a random inspection on 3rd March 2009, which raised 2 immediate requirements, 10 requirements and 3 recommendations. As part of this inspection we spoke with people who live at the home, management and staff. We viewed the accommodation. We looked at five individual care plans, and looked at records relating to medication, staff, finance and health & safety. We also spent time observing and recording the experiences of people using the service. The focus of this inspection visit was to inspect the relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focusses on outcomes for people living at the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 6 The basic care plans are person centred and detailed. The newer bedrooms provide a high standard of decoration and furnishing. Bedrooms are personalised with peoples’ belongings. People living at the home told us “the staff are kind”, “it’s a nice place” and “the food is lovely”. What has improved since the last inspection? What they could do better: The registered manager must ensure that people who live at the home are assessed and reviewed to ensure that specialist health needs can be met and the category of registration of the home is maintained. The registered manager must ensure that care plans reflect all areas of assessed need to ensure that all staff are aware of the needs of the individual and the actions needed to meet those needs. Arrangements must be made to ensure that the home accesses health professionals so that peoples’ health care needs are met. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 7 The registered manager is required to ensure that the Medication Administration Records are maintained in a clear manner. This is required to ensure a clear audit trail of medications administered for the safety of people using the service. The registered manager is required to ensure that social interaction and activity is provided and available for all people living at the home to enable social interaction for each person. The registered manager must ensure that people living at the home are supported to exercise choice and control over their lives. This is with reference to when people ask for assistance and help, that they receive that assistance promptly. The registered manager must ensure that all complaints are dealt with using the homes complaints policy. This is required to ensure that people are protected from any risks and that the home is proactive in addressing any issues raised. The home must undertake an audit of all wardrobes in bedrooms. Where a person may be placed at risk, the wardrobe must be secured to protect people from risk of harm. An Immediate Requirement was issued at the inspection. The home must ensure that there are sufficient staff on duty at all times to meet the dependency needs of the people living at the home. This requirement was made at a previous inspection and has not been met. There must be a recruitment system in place that ensures two references are received prior to commencement of work with people. This is to protect people from risk of harm. This requirement was made at a previous inspection and has not been met. There was evidence that a number of staff have not undertaken training. This means that staff are not trained to meet the needs of people who live at the home and are not up-to-date with current good practice. This may place people who live at the home and staff at risk of harm. Records relating to training were seized at this inspection. We are considering issuing a Statutory Requirement Notice in relation to the lack of staff training at the home. The registered manager is required to ensure that care provided at the home is monitored and audited to ensure good practice is maintained. This is required for the health, safety and well being of people using the service. The provider must ensure that monthly visits are undertaken and recorded to monitor the quality of the service. This requirement was made at a previous inspection and has not been met. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 8 The bedroom doors that do not close to properly must be repaired so that residents are protected in the event of a fire. This requirement was made at a previous inspection and has not been met. The home must ensure that cleaning products are locked securely when not in use in line with the Control of Substances Hazardous to Health (COSHH) guidance. This is to protect people who have specialist dementia care needs as there is a risk of accidental ingestion of these solutions. The home must record any accidents that occur in the home. This is so that the home can monitor accidents, promote accident prevention and prevent the risk of injury to people using the service. The Registered Manager is required to inform the Commission by Regulation 37 notifications any occurrences which are outlined in the scope of the notification. Six good practice recommendations were also made at this inspection. These are included in the report. 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. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 9 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 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 10 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): 3, 4 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. The home undertakes a pre-admission assessment for people who may move into the home. The home is not able to meet the needs of all the people living at the home. People with specialist needs may receive poor quality of care through lack of trained, knowledgeable staff. EVIDENCE: Since the last inspection, one person has moved into the home. The home had undertaken a detailed pre-admission assessment. The person has dementia The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 11 care needs and should not have been admitted as the home had already reached its maximum number of registered beds. The home is registered for six people with dementia care needs. We viewed a list of people living at the home that indicates that eight people with dementia care needs were living at the home on the day of the inspection. Seven staff at the home who work with people with dementia care needs have not completed appropriate training in dementia care. Further to review and assessment, some people who live at the home have been identified as needing nursing care. The home is not registered with the Commission to provide nursing care. Some people are in the process of moving to another home. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10. 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. Basic care needs are contained within care plans. For people with complex care needs not all care plans seen reflect the needs of the person and action is not always taken in response to the changes noted. The system for management of medicines in the home does not protect people receiving medicines from risk of harm. The home does not fully respect people and their dignity. EVIDENCE: We looked at three care plans at the random inspection on 3rd March 2009. We looked at four other care plans at this key inspection. The care plans are now more person centred. They contain detailed information for staff to follow so that they know how to assist people with basic care needs. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 13 Care plans for a number of health needs and complex needs are not clear. At the Random Inspection on 03/03/09, we viewed a care plan for a person who has a food and fluid record. This had not been completed since 25/02/09, and had been completed at intervals prior to this. There was no clear plan on how to manage and meet the residents’ nutritional needs. At the Key Inspection, we found nutritional assessments with a score that indicated a need for encouraging a healthy varied diet and supplementary drinks. There was no evidence that the supplementary drinks were being administered for the identified people. One care plan highlighted that a person who lives at the home was at risk of choking and needs supervision when eating. We observed lunch in the dining room. Staff were not available to supervise the person at all times. We observed staff standing in the doorway to the dining room. Staff were not able to see the person from this position. We spoke with one member of staff who was not aware that the person was at risk of choking. We found that a person had recently been through a significant life changing event. No reference was made to this within the care plan despite a review taking place on 28/03/09. This means that staff had no guidance on how to best support the person and does not promote their dignity. At the random inspection on 03/03/09, we viewed a care plan for a person living at the home who had a mattress in place to relieve pressure. The person had an old wound that had reopened. There was no detailed information relating to how staff should prevent pressure damage. A second person was receiving visits from the District Nurse for a pressure sore. The nurse attends three times a week. The record viewed did not show that the nurse attends all of these visits. The home confirmed that the nurse does attend. Another person had a mattress to relieve pressure in place. The mattress had been placed on top of another mattress meaning that the bed rails would not prevent them from rolling over the top of the bed. Instructions said that the person must be turned two hourly as pressure sores were apparent on the skin. The home had not recorded that the person had been turned at these intervals. We spoke with staff who told us that they do not record when they turn people. We viewed an entry in the daily records that stated that hot tea was spilt over the person’s hip and leg. A Blister appeared and a dressing was applied. The medical attention records told us that the nurse did not see them until twelve days after the incident. The home had not completed an accident record and a Regulation 37 report had not been submitted to the Commission. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 14 One person had a falls risk assessment in place that states on 19/12/08 that they had fallen in the last three months. The moving and handling assessment states there is no history of falls. Records state that the person is becoming increasingly more aggressive. On 19/03/09 it was noted that they can become verbally and physically abusive towards any member of staff or people living at the home. The Community Psychiatric Nurse has carried out a review. There is no care plan for staff to follow in relation to the aggression being displayed and how to manage it. Incidents are not documented or detailed. We spoke with staff who told us the person had punched them in the stomach. This was not reported or documented. At lunchtime, one person called out that they needed the toilet. Staff did not respond to this. Staff carried on assisting residents to leave the dining room. The person again asked for the toilet and continued to be ignored. Staff were observed clearing tables and ignored the resident. Five minutes later, we observed staff assisting them to the lounge. We looked at the home’s medication and medication records. The Medication Administration Record Sheets (MAR) contained photographs of people using the service to help staff confirm identity. The MAR Sheets were not fully completed. There were a number of gaps. There was no explanation as to why medication had not been administered or signed for. One person is prescribed an inhaler to relieve symptoms such as coughing, wheezing and shortness of breath. The instruction stated that the inhaler needs to be administered four times a day. Since 27/03/09, there were 24 occasions where the inhaler had not been signed for as administered. No reason for non-administration was given. Where ‘as required’ medication had been prescribed, the home had not recorded when a variable dose had been administered. The home had amended a number of instructions for prescribed medicines on the MAR Sheets. The home was not able to show us documentation to evidence that the doctor had changed the prescription. The dose and frequency of the administration of one medicine had been changed by hand. The new instruction was to administer each morning. The home had not signed that the medicine had been administered since 30/03/09. Where staff had written a MAR Sheet by hand, they had not obtained a second signature to evidence that a second person had checked the entry. This means that it was not possible to determine if these medicines were being used as prescribed. We found loose blisters of Paracetamol in the bottom of the medication trolley. The home told us that these had been found in a bedroom and were not prescribed medicines. The home told us they do not keep homely remedies. We checked the balance of two controlled drugs and these were found to be correct. We viewed medicinal creams in bedrooms that were not dated on opening. This means that the home will not know when the cream needs to be disposed of. The home has a fridge to store medication. The temperature of the fridge is not being recorded consistently. This means it The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 15 is not possible to ensure that medicines are being stored at a safe temperature (between 2 and 8 degrees). We observed some staff being kind and caring towards people living at the home. At lunchtime, one person was falling asleep at the dinner table. We observed staff say “come on sleepyhead, pudding will be up in a minute”. The Dene Lodge DS0000016025.V373710.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. 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. There are currently limited opportunities for people living at the home to take part in activities. Menus are not available for people who live at the home. Mealtimes are not considered to be an enjoyable event for people. EVIDENCE: The home is currently interviewing for an Activities Worker. This means that there are currently limited opportunities for people to take part in any activities. We observed limited interaction between staff and people living at the home during the inspection. A number of people were sitting dozing in the lounge. Other people were sitting in the dining room. One person told us that they like to read their newspaper. One person told us “I don’t go out and I should be able to”. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 17 We observed staff place chocolate and an Easter card in front of a person. They did not say anything to them and walked away. The person appeared confused and asked us what had been placed in front of them. Communion was being held in the home for those who wished to attend. In the Exmoor Wing, the television was on. Floor skittles was laid out but no one was observed to take part. The home doesn’t have a menu on display and it was not clear how people choose what they would like to eat. One person told us “the food is lovely” and “don’t know what’s for lunch”. Lunch was lasagne or corned beef salad. We observed the meal being served in the Exmoor Wing. There was little interaction between the four people eating there. One person was falling asleep at the table. We observed staff trying to wake them up. We also observed lunch being served in the dining room. Staff offered people bread and butter. Staff were observed pouring cold drinks for people. Jugs were not available on the tables. Food had been cut up for one person and appropriate cutlery had been provided. We observed that the dining room was not staffed at times. People asked us for a drink and the salt. One person was not eating their food. A member of staff encourages them and then leaves the room. The person still has food in front of them twenty six minutes later. Staff place pudding on table for them whilst they are still eating the main course. Staff leave the room and the person tries to move their plate to get their pudding. We observe another person who lives at the home assisting them to do this. Thirty three minutes after we observed the person not eating their food, a member of staff asked if the person was able to reach their dinner. Another person was dozing and no real encouragement was given. On one of the occasions where no staff were in the dining room, one person started to talk loudly calling out for the manager, other people were getting annoyed. One person started to tap their spoon. Most people had finished their main course and there was no sign of pudding. We observed people getting restless. Staff came in to the dining room to serve pudding which was apple crumble and custard. No one is offered a choice of custard or an alternative. There was no music, little interaction with staff and the experience did not appear to be a pleasant dining experience for people. Nutritional intake is not recorded consistently or monitored. Nutritional assessments indicated a need for encouraging a healthy varied diet and The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 18 supplementary drinks. There is no evidence that information is reviewed or prompts further action. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. 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. The home has a complaints procedure. This procedure is not always followed. The home does not follow its written policies relating to abuse, to protect people from risk of harm. EVIDENCE: We viewed the complaints the home had received at the Random Inspection on 03/03/09. The home had received one complaint since the random inspection. The complainant stated that when visits were made to their relative, they found that on four occasions within six weeks, the person was in their bedroom in the afternoon with their lunch that had gone cold and was untouched. The home responded to the complaint within the agreed timescale. The home’s complaints policy includes a complaints form with description of action taken and follow up to ensure that the complainant is happy that the complaint has been resolved. We were unable to evidence that this form had been completed and follow up action had been taken for any of the complaints. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 20 At the Random Inspection, we found that a person had been working at the home without the required recruitment checks including a Criminal Record Disclosure. We issued a requirement in relation to this. Staff told us that when concerns are raised within the home, these are not always followed up. This means the home is not safeguarding people in accordance with their written policies and places people at risk of abuse. A number of staff have not received any training in abuse awareness. Concerns and safeguarding issues raised at the Random Inspection and this inspection are being investigated currently with the Local Authority who have the responsibility for contracting/funding provision from the service. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. 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. The home provides some areas of good quality accommodation but some areas of the home require attention. EVIDENCE: We viewed the home. Peoples’ bedrooms are personalised with their own possessions. The newer bedrooms in the extension are decorated and furnished to a high standard. The new bathrooms and en-suites are finished to a high standard and lights come on automatically when entering them. A hairdressing room has The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 22 been provided for people who live at the home. All areas of the home were cleaned to a good standard. Six bedrooms within the Exmoor Wing are registered for people with dementia care needs. The Exmoor Wing consists of a communal lounge and dining area, and bedrooms. Access to a garden area is via a lift. Access to the specialist bathing facilities is via a lift or via a locked door into the main part of the home. It is not clear how people will be supported to access these areas if there is only one designated member of staff on duty in the Wing during the day. There are no facilities for people to make drinks or snacks in the Wing. Three of the bedrooms in the Exmoor Wing did not have a call bell lead. The home told us that the people who occupy these rooms would not be able to use the call bell. This means that people may not be able to summon assistance in an emergency. If the lounge/dining room doors are closed in the Exmoor Wing, people who live there can not access this area as the doors are locked and operate on an electronic card system which is for staff use only. Some of the older bedrooms would benefit from redecoration. We observed stains where there had been a leak from the roof. Carpets viewed in one bedroom were badly stained and there was a malodour. We viewed two bedrooms where the wardrobes were not secured to the wall. This may place people at risk of harm if the wardrobe was to fall on them. An Immediate Requirement was issued at the inspection. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. 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. Staffing levels may not meet the needs of the people living at the home, with their health and welfare being adversely affected. Staff are appointed and start working without references being received. The home does not support or encourage the development of a competent staff team. Training provided is limited and much of the training is out of date. Staff do not have the necessary skills to meet the assessed needs of people who live at the home. EVIDENCE: There appeared to be sufficient staff on duty at the inspection to meet residents’ needs. At the random inspection on 03/03/09, we viewed the rotas and found that some shifts had not been covered. One person who lives at the home told us “I sometimes have to wait and I don’t ring for staff until really necessary”. Staff who completed surveys and spoke with us told us that there aren’t always enough staff on duty. At this inspection, people told us that staffing levels had been better recently. The Commission has told the home The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 24 that they need to use a dependency tool to ensure that there are sufficient staff on duty at all times to meet the dependency needs of people living at the home. The home was extended in 2007 to provide dementia care within the Exmoor Wing. When the home was registered for this provision, a Registration Report was produced (27/03/07). The report states “Six residents are proposed with a dementia care need to live on the second floor with access to the secure garden area via a lift. It was agreed that a designated staff team (trained in dementia care) will be rostered to this floor – for example: 2 care staff from 08:00 -20:00 and 1 care staff overnight”. We found that five day staff who are rostered to the unit have not completed training in dementia care. Two out of the six night staff have completed training in dementia care. At night, the home employs two waking staff. The home confirmed that the night staff base themselves in the main lounge in the home and carry out two hourly checks. These checks are not documented. The home told us that some of the people with dementia care needs who live in the Exmoor Wing would not be able to use a call bell to summon assistance. This means if there was an emergency during the night, staff are not based in the Exmoor Wing and may not identify this until they carry out their check. This potentially places people at risk of harm. We viewed four staff recruitment files. These contained most of the information required. One member of staff had commenced work prior to two references being received. The home must ensure that references are received prior to staff commencing work in the home to protect people from risk of harm. The home employs twenty two care staff. The Registered Manager confirmed that eleven of the care staff have completed an NVQ at Level 2 or above. We viewed records that indicate that eleven staff have not completed induction training. We viewed care plans that state that a hoist needs to be used to move residents. The home has a manual handling policy that states “each staff member should be given such information, instruction and training as is necessary to enable safe manual handling”. We viewed minutes of a staff meeting dated 29/01/09 that state moving and handling training to commence as soon as possible. The staff training records show that none of the twenty eight staff have received up-to-date moving and handling training. We spoke with staff who told us they don’t feel confident using the hoist. This potentially places residents and staff at risk of harm. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 25 Staff have been given instruction on how to use fire extinguishers. Staff have not received any other fire training or instruction. This places people at risk of harm in the event of a fire. Seven staff have up-to-date first aid training. Two of these staff work together part time on nights in the home. This means that three nights per week, the home does not have staff on duty who have completed first aid training. Due to the needs of the people living at the home, this places people at risk of harm, if they need assistance in an emergency. Records relating to training were seized at this inspection. We are considering issuing a Statutory Requirement Notice in relation to the lack of staff training at the home. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35, 38 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. The home lacks direction and leadership leading to inconsistent practice and recording. Some areas of health and safety management must be reviewed to ensure that people using the service and staff are safe. EVIDENCE: The Registered Manager is Richard Mackie. Richard has worked in care for over eleven years. He has been employed at The Dene Lodge since March 2008. He has completed NVQ 4 and the Registered Managers Award. He is The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 27 supported by a deputy manager. Staff told us that they find the management at the home very approachable. The home sent out surveys to relatives in September 2008. The home had collated the responses into a graph and formed an action plan to make improvements. The home has not given surveys to people who live at the home, staff, healthcare professionals or other interested parties. This means that the home is not gaining a full insight into the quality of the service. We completed an Annual Service Review in September 2008, we asked the provider to send us a monthly report. We have not received any reports. Further to this, reports were not available to us at the random inspection on 03/03/09. At this inspection, the home told us that there were no reports available. The home keeps small amounts of monies for some people who live at the home. We viewed the records relating to this. These were found to be correct. One person controls the monies and the records. The home has recently had a visit from the Environmental Health Officer. The kitchen was awarded a three star rating. The home has received a report that details the action it needs to take to comply with The Food Hygiene Regulations and Health & Safety at Work Act. The home told us that they are currently introducing the ‘Safer Food, Better Business’ pack. At the Random Inspection on 03/03/09, we had concerns around fire safety. Further to this inspection, the Devon & Somerset Fire Service have visited the home. A letter of non compliance was issued. Since the visit, the home has removed a padlock from a gate which had been installed across an escape route. Combustible material that was being stored under the staircase has been removed. Items that were being stored on escape routes have been removed. A company visited the home on 07/04/09 to review and update its fire risk assessment. At the random inspection and on the day of this inspection, we viewed doors that would not close properly when released. This places people at risk in the event of a fire. We viewed cleaning products had been left in a bedroom in the Exmoor Wing. Staff were not in attendance and left the products unattended for at least ten minutes. This may place people who have specialist dementia care needs at risk of accidental ingestion of these solutions. We viewed the health and safety records. The home had up-to-date servicing records for gas safety; electrical installation; Portable appliance testing; fire alarms; fire extinguishers. We found that one of the home’s passenger lifts had not been serviced since 04/09/08. The lifting equipment is not being serviced in accordance with LOLER Regulations. The home told us that hoists had been serviced in November 2008. We did not view these records and this will be followed up at the next inspection. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 28 The Commission met with the provider and manager after the random inspection to emphasise the seriousness of our findings. Our concerns about the home were discussed with the registered manager during and after the key inspection. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 29 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X 1 X 1 X 2 STAFFING 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 2 X 1 X 2 X X 1 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 18 (1) a Requirement Timescale for action 08/06/09 2. OP4 14(2) 12 15 3. OP7 There must be a comprehensive training programme for staff who are to work in the dementia care area. This training should include care planning and practical care of people with dementia. The manager must ensure that key staff are trained prior to the admission of people. (This requirement was made at the previous key inspection and the timescale of 01/10/07 has not been met). The Registered Manager must 08/06/09 ensure that the category of registration of the home is maintained. 08/06/09 Care plans must be audited to ensure they are regularly reviewed and contain evidence of peoples’ involvement. It must be clear from the plans how short term health needs have been addressed. (This requirement was made at the previous key inspection and the timescale of 01/10/07 has not been met) The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 31 4. OP7 15 5. OP8 12 6. OP8 12 The registered manager must ensure that they develop a care plan in relation to one identified person’s aggression so that staff know how to manage incidents effectively. This is to protect people from risk of harm. The registered manager must ensure that specialist equipment (such as pressure mattresses) is used correctly and in accordance with manufacturer’s guidelines, to protect people from the risk of harm. The registered manager must ensure that; they seek medical advice promptly after an accident or incident to protect peoples’ health and wellbeing. that there is a detailed plan with action to prevent damage developing as far as possible, when people are at risk of pressure damage. records of health professional visits and any advice given are kept so that staff know how to support people. that they seek appropriate advice from healthcare professionals and have a clear plan on how to manage and meet peoples’ nutritional needs. 08/05/09 15/04/09 15/05/09 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 32 7. OP9 13 (2) The home must ensure that people receive their medicine as prescribed to protect their wellbeing. Arrangements must be made to record actual dose administered for medicines prescribed to be administered with a variable dose. This is to ensure that people’s response to medicines can be effectively monitored and fed back to the prescriber, also preventing the risk of either under or over dosing. Arrangements must be made to ensure that when entries are hand written on the MAR Sheet a safe system is used. This is to ensure that the records of administration are accurate. The home must ensure that medicines are correctly disposed of and not available for use. This is to ensure that inappropriate stock is not used for people living there. The home must consistently date creams on opening to ensure they are used when at their best. The home must ensure that when medicine is stored in the fridge, the temperature is checked on a daily basis. This is to ensure that medicines are stored at a safe temperature (between 2 and 8 degrees). 15/05/09 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 33 8. OP12 16 (2)(n) 9. OP14 12 10. OP16 22 11. OP24 13 (4) 12. OP27 18 (1)a The registered manager is required to ensure that social interaction and activity is provided and available for all people using the service. Activity should be provided with regard to the needs of the people using the service to provide social interaction for each person. The registered manager must ensure that people are supported to exercise choice and control over their lives. This is with reference to when people ask for assistance and help , that they receive that assistance promptly. The registered manager must ensure that all complaints are dealt with using the homes complaints policy. This is required to ensure that people are protected from any risks and that the home is proactive in addressing any issues raised. The home must undertake an audit of all wardrobes in bedrooms. Where a person may be placed at risk, the wardrobe must be secured to protect people from risk of harm. An Immediate Requirement was issued at the inspection. The home must ensure that there are sufficient staff on duty at all times to meet the dependency needs of the people living at the home. (This requirement was made at the previous random inspection and the timescale of 05/03/09 has not been met). DS0000016025.V373710.R01.S.doc 08/06/09 08/06/09 08/06/09 10/04/09 08/06/09 The Dene Lodge Version 5.2 Page 34 13. OP29 19 14. OP30 18 (1)(C) 12 (1)(a) 15. OP31 12 16. OP33 26 17. OP38 13 (4) There must be a recruitment system in place that ensures two references are received prior to commencement of work with people. (This requirement was made at the previous key inspection and the timescale of 01/09/07 has not been met). The home must ensure that all staff receive training in moving and handling to protect residents and staff and to keep staff up-todate with current good practice. (This requirement was made at the random inspection on 03/03/09). The registered manager is required to ensure that care provided at the home is monitored and audited to ensure good practice is maintained. This is required for the health, safety and well being of people using the service. The provider must ensure that monthly visits are undertaken and recorded to monitor the quality of the service. (This requirement was made at the previous random inspection and the timescale of 03/04/09 has not been met). The bedroom doors that do not close to properly must be repaired so that residents are protected in the event of a fire. (This requirement was made at the previous random inspection and the timescale of 17/03/09 has not been met). 09/04/09 03/06/09 08/06/09 08/05/09 08/05/09 The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 35 18. OP38 13 (4) 19. OP38 17 Schedule 4 20. OP38 37 The home must ensure that cleaning products are locked securely when not in use in line with the Control of Substances Hazardous to Health (COSHH) guidance. This is to protect people who have specialist dementia care needs as there is a risk of accidental ingestion of these solutions. The home must record any accidents that occur in the home. This is so that the home can monitor accidents, promote accident prevention and prevent the risk of injury to people using the service. The Registered Manager is required to inform the Commission by Regulation 37 notifications any occurrences which are outlined in the scope of the notification. 09/04/09 09/04/09 08/05/09 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. 2. 3. Refer to Standard OP10 OP19 OP22 Good Practice Recommendations The home should ensure that staff use people’s preferred term of address, as terms such as ‘sleepyhead’ do not show respect for the person. The home should consider re-decorating the older bedrooms and replace one identified carpet. The home should review the call bell system, undertake a risk assessment for each person and provide a suitable means for people to call for assistance, when needed. The home should review the access to the lounge/dining room in the Exmoor Wing for people who live there. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 36 4. OP33 5. 6. OP35 OP38 The home should seek the views of residents and other stakeholders, so that it can monitor the quality of the service provided and make improvements where necessary. The home should ensure that someone else audits the monies on a regular basis to protect the person controlling the monies and peoples’ monies. The home should ensure that lifting equipment is serviced in accordance with LOLER Regulations. The Dene Lodge DS0000016025.V373710.R01.S.doc Version 5.2 Page 37 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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). 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. 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