Inspection on 08/05/07 for The Lodge

This inspection was carried out on 8th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

The Lodge 09/10/08

The Lodge 18/10/07

The Lodge 12/07/06

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Lodge 29 Bargate Grimsby North East Lincs. DN34 4SN Lead Inspector Theresa Bryson Key Unannounced Inspection 8th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge Address 29 Bargate Grimsby North East Lincs. DN34 4SN 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) 01472 357774 Ramesh Dalton Murugupillai Rabindranath Rommel Selliah Position Vacant Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29) of places The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2006 Brief Description of the Service: The Lodge is a 29-bedded care home set near the centre of the town of Grimsby. The building is Victorian in style and retains many of its original features, but has a modern extension and large gardens. The home is equipped to provide care for those with dementia and problems of old age. It will also take up to 4-day care places. The home has a variety of sitting rooms and a dining area. The residents, who are able, can wander freely in the home as there is a digital locking system, for which the code is available, to ensure those less able do not leave the building unescorted, due to the very busy main road, through to Grimsby town centre. The home has bathroom and toilets on all floors and also a shower. The first floor is reached via a chair lift. The current scale of charges is £367 per week. Additional charges include hairdressing and chiropody. A statement of purpose and services users guide is available on request to ensure prospective service users are aware of the services the home can provide. Copies of the last inspection reports can be obtained from the manager on request and is available at all times in the main office. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 2 days in May 2007. There were 22 people resident in the home and 3 people receiving day care. Prior to the visit survey sheets were sent out to 11 relatives of which 8 were returned. 4 people were visited in their own homes and 5 contacted by telephone. Also prior to this site visit members of a local social services team were contacted and a team of district nurses. During the site visit 1 member of a social services team was spoken to, 5 relatives and 8 members of staff. This home has also received 2 random inspection visits and a follow up visit to an immediate requirements visit, since the last inspection. There is an on going safeguarding adults’ investigation currently in progress at the home. The health and safety officer and fire officer were also contacted before the site visit. Also the event history for the home was tracked at CSCI prior to the visit. The Acting manager was on site for the whole of the visit and feed back was given to her in person and the following day feedback was given to one of the owners of the home by telephone. What the service does well: What has improved since the last inspection? Since the last inspection staff have been made aware of a whistle blowing policy, which enables them to freely discuss any issue they feel they may need to ensure all the correct care is given to individual people and all staff are doing their jobs correctly. Any staff who are not doing their jobs correctly have this recorded accurately on their personal files. This enables the management team to track their The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 6 progress and see whether they have learnt from their errors and are still safe to work with the people who live there. There is more fresh fruit available for people who live there to eat and this has also been included on a more regular basis on the menu plans. This helps people to maintain a balanced diet. What they could do better: Information given to prospective people who have approached the home to stay must be accurate. There was detail seen in the present documentation, which did not reflect the services on offer. This could give people a false impression as to what is on offer. The staff need to ensure that the care recorded in the case notes of each person living in the home is accurate and up to date, as there could be a risk of unmet needs not being addressed. These need auditing by the management team to ensure that the detail of the delivery of care is correct for each person and that people living in the home and their relatives are happy with the service provided. The choice of social activities in the home is poor and there was little variety in the recording of events. More links could be made with the local community and people close to the people living there approached as to their interests and expectations prior to coming to stay. The management team need to ensure that all staff administering medication do so correctly and that the records are accurate. During the course of this visit inaccurate recording was seen on the controlled drug register and the manager asked to look into this as a matter of urgency. This could result in people living there being put at risk from incorrect medication being given. There was insufficient evidence to show that the building was being properly maintained. Areas looked tired and there needs to be a structured programme of maintenance in place to ensure the redecoration of the home is up to date. This will ensure that people living there are in a safe, comfortable and pleasant environment. The owners are aware that urgent work needs to be completed on making the radiators safe, which is being monitored by the local health and safety officer and the fire risk assessment reviewed, which is being monitored by the local fire brigade safety officer. There was no robust system in place to ensure staff are safe to work with the people who live there prior to employment, at all levels. There must be more accurate recording to ensure the necessary safety checks have been made prior to a person commencing work and that the personal records are kept up The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 7 to date. This will ensure the people are not put at risk from unsuitable staff being employed at the home. After employment there must be a more structured programme of training in place to ensure staff can do their jobs and that there is recorded evidence to ensure the management team are checking their work progress. Although The Company has a policy manual to show staff what to do on a variety of topics this is not exhaustive and needs up dated to ensure staff are working with the latest knowledge base to enable them to give the correct care to people living in the home. There was some dissatisfaction with relatives, health professionals and staff that issues with the people living at the home had not been addressed. There was no accurate recording of complaints and staff had not recently followed correct procedures in a safe guarding adults’ issue. This could result in unmet needs not being addressed and people living there at risk. A quality assurance system also needs to be in place to ensure that all aspects of running the home are being monitored and that people using the home, their relatives and others visiting, including health care professionals are surveyed for their opinions and are included in the planning of the home. This is currently not done and all parties spoken to felt they are not approached correctly and included in decision-making. This has made them feel very hurt and saddened. In the absence of a Registered Manager with the CSCI the owners must ensure that they are closely monitoring the running of the home and when delegating tasks to staff they are capable and trained to complete those tasks. This will ensure that any issues are dealt with promptly and that the CSCI is also aware if problems when they have access to the site visit reports. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users looking for a home are provided with misleading information. This could lead to people choosing the wrong home for them and being dissatisfied with the service. EVIDENCE: During the course of this inspection Standards 1,2,3 and 6 were checked. Since the last random inspection there have been no new admissions so the documentation seen previously on admission processes remains unchanged. The acting manager at the moment is using the previous documentation, when required. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 10 Copies of the Service Users Guide and Statement of Purpose were given to the inspector during the site visit. On reading these documents it was found that certain parts do not reflect the current service that the home is providing. Items such as how often there is a change of menu, what type of staff are employed and what can be provided for day care admissions are some of the items needing review. Failure to have written accurate details of the service provided could result in prospective service users from having an inaccurate picture of what services the home provides and be wrongly placed in the home. The documentation needs to reflect the actual type of service, which can be provided, and be available in different formats for example audio and large print to ensure diverse needs of service users can understand the information available. On tracking the care plans there was very little evidence to support that every person resident in the home had a valid contract. Some contracts had been signed by a representative of the home but not the service user or their next of kin, some had no contracts at all. The contract format included all the necessary information to ensure service users were aware of what the fees consisted of and also what was not included in the basic fee level, but few relatives remembered signing any document. Each person needs to be aware of what they are paying for and why so they can check any invoices received and know they are an accurate record of the care delivered, which they can refer back to the original contract. The home does not provide intermediate care and therefore Standard 6 is not applicable. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users at the home receive an inadequate level of care, which places them at risk. Documentation in the home does not promote the needs of service users. Medication is not managed in a way, which makes sure service users healthcare is a priority. EVIDENCE: During the course of this inspection Standards 7,8,9 and 10 were checked. Prior to the visit 50 (11) of the service users families were sent survey forms of which 8 were returned. 3 relatives were spoken to by telephone and 4 visited for face to face interviews. 5 relatives were also spoken to during the course of the site visit and one member of a social services team. 1 social worker and 1 district nursing team were also spoken to over the course of the last few weeks. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 12 During the course of the site visit 5 service users care plans were tracked and a copy of the recent relatives meeting minutes given to the inspector. There were no service users at the time of the site visit that could make enough informed decision to answer questions of the inspector. 10 members of staff were also spoken with during the site visit. Issues raised at the relatives meeting such as inappropriate clothing being worn, unclean nails of service users and poor communication between the staff group and relatives were also stated in interview and survey sheets sent in to The Commission. Although some issues could be found documented in the care notes there was a lot of dissatisfaction amongst the relatives group to prove that issues had not been addressed to their satisfaction. Relatives stated issues such as “staff say they cannot bath my loved one because it is too difficult” and “I don’t see mum in her own clothes very much” and “staff just don’t pass on information” and “laundry is often damaged or missing” were common statements given to the inspector. There were a few positive comments, but they tended to be very general comments such as “they generally do a good job” and “the room is clean”. The outstanding requirements concerning the auditing of care plans and ensuring there is accurate recording still remain from the last random inspection, after a further 5 care plans were tracked at this site visit and on speaking to staff. The care plan documentation used prior to this visit is quite comprehensive and if used correctly will give a good holistic view of the needs of individuals. This could assist the staff to ensure that individualised care is given to each person and will prevent comments from relatives and health professionals such as “ everyone is treated the same” and “I get the same comments about every one I see here”. Most had evaluations recorded on a monthly basis, but the overall current needs were not accurate in some cases. Staff were stating higher dependence needs, which were not well documented and when health professionals had recommended a different approach this was not always followed through. The inspector was quite concerned about the delivery of care to one service user and made enquiries herself of the local authority funding this person’s care, who agreed to look into the care as a matter of urgency. The acting manager was also asked to look into the care of one service user, as the documentation appeared to reflect that not adequate consultation had taken place between the home, the relatives and health care professionals to ensure that all needs were being correctly addressed. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 13 On the site visit date the home was still in the process of assisting the safe guarding adults team in an enquiry started in January 2007. This involves the delivery of care to service users and work processes of staff. Since January 2 random inspections had taken place and a follow up visit after an immediate requirements notice had been issued. Since the last key inspection in July 2006 1 other complaint concerning care issues had been considered by the CSCI. Requirements had been outstanding since the complaint, which have still not been fulfilled and a shorter timescale will now be given to ensure service users are protected and all their current needs are being met. During the course of the site visit the administration of drugs records were checked. There was insufficient evidence recorded that there had been the correct procedures followed for the administration of controlled drugs. The detail was passed to the manager and she was asked to contact the police. The drug administration sheets were tracked and there appeared to be some inconsistencies in recording, which could result in service users being at risk from unsafe administration. Staff were observed over a 2 day period in assisting service users in a variety of tasks such as toileting needs, assisting at meals, walking and sitting with the service users. Generally in the presence of the inspector they appeared calm and caring and gave time to each person to achieve a task. Some staff appeared to be inexperienced in dealing with the service users showing more aggressive tendencies, which could put them and others at risk from sometimes volatile situations. The staff records did not show that any observational supervision had taken place, so issues had not been addressed with staff members on an individual basis. This could assist staff to identify training needs and ensure service users were being cared for appropriately. There are still outstanding requirements from a previous random inspection detailing the need for more training and supervision of staff, for which new time scales will be set. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient activities provided to ensure that the social, cultural and religious needs of each individual service user are being met. Meals are cooked in a clean environment, with an adequate choice of menus. EVIDENCE: During the course of the inspection Standards 12,13,14 and 15 were checked. Since the last random inspection no progress had been made in the provision of activities. There was insufficient documented evidence to show that each person’s needs were being individually addressed. Relatives spoken to also made comments such as “staff appear to do the same activities all the time” and “everyone is treated the same” and “even when there is appropriate music on staff talk above it”. The home has an appropriately qualified staff member, as part of the care staff team who is trained to facilitate activities, but these skills are not being used The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 15 to the full, as this is not part of this person’s job description/role within the home. Some work needs to take place in the home to ensure that in discussion with relatives and input by service users that appropriate activities are provided and each person’s involvement is documented. This will ensure all expectations are being met and service users are living a full and varied life. There was no evidence to support that contact is made with the local community to access recreational activities. There are known organisations in the local town which provide for people suffering from dementia, including support groups for staff and relatives, but there was no evidence to support that the home had accessed any outside resources. Relatives spoken to also stated such comments as that they did not know “the last time mother went out”. This has prevented the expectations being met that service users and families have of the continued integration that they can make in the local community. The environmental health officer has recently been involved with the home on health and safety matters which has included the kitchen, so an in depth inspection of this part of the home was not made. There are outstanding requirements, which were made concerning safety in the kitchen, which the health and safety is yet to check to ensure compliance. On two brief visits over two days the surface areas, equipment and floor areas appeared clean and there was only one piece of broken machinery, the dishwasher, which was being attended by the home’s staff. The home operates a 4-week cycle of menus, which the manger has chosen to review. The present ones appear to give a varied diet and no issues were raised by the recent inspection by environmental health. Some positive comments from relatives included “my mother has put on weight” and “each meal I’ve seen looks appetizing”. There is now more fresh fruit on the menu and a bowl of fresh fruit always in the main sitting area and items seen to be offered throughout the day. Care is taken by the cook to ensure that those requiring a more soft diet have this prepared and presented in an appetizing way. Staff were seen to assist service users at different meal times in a calm and relaxed manner. They gave encouragement at all times and also recorded in the care notes when a lack of diet had been taken. Concerns were raised by staff that as the kitchen staff hours have recently been reduced this may result in some cleaning not being able to be completed and other events such as future menu planning, training and talking to service users’ families about their choices. The manager was asked to monitor this situation to ensure the smooth running of the kitchen area and that all meals continue to be varied and cooked in a clean and safe environment. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. There is an inadequate process in place to ensure that concerns are dealt with promptly and that outcomes are recorded. The training of staff in safe guarding adults is also inadequate and could result in service users being put at risk from an inefficient process being in place. EVIDENCE: During the course of this inspection Standards 16 and 18 were checked. A variety of concerns were stated to the inspector by relatives and health care professionals, which appeared to have not been addressed over a long period of time. Although some of these had been documented for example unclean nails, damaged clothing and a failure to pass on information. As they were stated to the inspector there had not been a clear outcome for relatives of service users and a number of unanswered concerns were still evident. There was a lack of written information to evidence that issues had been discussed and the complaints log seen only detailed one concern in two years. This information was not accurate as there had been two concerns in the last six months brought to the notice of CSCI. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 17 Failure to deal with concerns and complaints could result in the unease of relatives during visits to service users. And not allow a relaxed atmosphere to occur and cause friction between all parties. Some training has taken place since the last random inspection on safe guarding adults and some more was seen to be planned for the end of May 2007. During the start of the current safe guarding adults investigation in the home the incorrect process of suspending and interviewing a member of staff was not followed. even though the records show that senior members of staff had received appropriate training at that time. Failure to follow the correct process and staff not trained to understand how to recognise abuse could result in service users being in an unsafe situation and at risk. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Areas of the home are unsafe due to unprotected radiators and the home although clean was shabby in some areas and results in service users living in an environment which is pleasurable. EVIDENCE: During the course if this inspection Standards 19 and 26 were checked. Before the commencement of the site visit the events history for the home shows that there is still an ongoing investigation into the possible unsafe practise of unprotected radiators, which has resulted in one person having a severe injury. Work on the covering of the radiators has still not been completed and the health and safety officer, who is working with the local fire brigade officer, had set revised timescales. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 19 The local authority safe guarding adults’ team and the health and safety officer are leading this investigation. The investigation is on going. The inspector was in the home for two days and toured around the home unescorted and on the second day was accompanied by the Acting manager where all bathroom areas, toilets, communal areas and a selection of rooms were checked. Although the cleanliness was of an adequate standard areas of the home were looking very tired and shabby. Relatives had used such expressions as “mother is living in a shabby building” and “the chairs are grubby and seen better days”. Some relatives were very emotional with the inspector and felt “saddened” that their loved ones were living in what appeared an uncared for environment. Staff who had been at the home a long time also expressed grave concern and were visibly upset when speaking how the home is “being allowed to go down hill”. Little consideration had been given to the needs of those suffering from dementia. There were no visible aids to orientate them to time and place. Special equipment such as beds and chairs for those unable to move around easily was very limited. Televisons and radios were constantly on stations not appropriate to their needs such as children’s’ programmes and very modern music – when no recording in care plans and on talking to staff and relatives indicated service users liked this form of entertainment. Layouts of rooms appeared to suit the needs of staff as most furniture was pushed to the sides of rooms, giving little thought to service users being able to talk in groups, where they are able or to even see each other easily, when some had very limited body movement. The lack of a maintenance and renewal programme has not helped the staff to keep control of the redecoration in the home. This requirement has been outstanding for sometime and will now be given a shorter timescale. The Acting manager was asked to monitor particularly the cleanliness and maintenance of bath hoists, extraction fans and toilet areas. There was recorded evidence that items such as wheelchairs, bed safety rails and manual handling equipment was being checked ensuring that they are safe to use all the time. Permissions are entered on each individuals care plans for such items as use of bed rails and consent forms on those tracked were in place. This ensures that all parties are aware of the risks in using equipment and are happy to give their consent to aid the delivery of care to service users. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 20 There was little evidence to support that service users in this home are living in a safe and welcoming environment, which needs to be addressed as a priority issue by the owners. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are insufficient staff on duty to ensure that all the needs of service users are maintained and they have not received enough service specific training to ensure they can look after the diverse needs of the service users they care for. EVIDENCE: During the course of this inspection Standards 27,28,29 and 30 were checked. The inspector checked the rotas of all staff groups within the home and the dependency levels of service users, and found that on the care staff rota there was insufficient evidence to show that there were enough staff on duty to meet the needs of service users. The Acting manager did not know what dependency tool was in place to check the dependency of service users and this information was taken from verbal statements given by staff to the inspector at the last 2 random inspections and also on this site visit. They had stated that the dependency of some service users has increased and that not all tasks can be completed. Relatives also stated how staff had told them they are constantly short staffed and stated “ some times they go around like headless chickens” and “they The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 22 always appear rushed and don’t have enough time to speak to relatives properly”. On tracking some care plan documentation it was seen that one service user had been recently reassessed by a health care professional and was requiring one to one care, this was not in place and the inspector witnessed a volatile situation between this person, a member of the care staff and two other service users. Had the appropriate levels of care been in place for this person, then this situation may not have arisen. Staff did not appear to know how to handle the displayed challenging behaviour in an effective way to safe guard that person and those around them. The inspector felt it necessary to contact the funding authority for this person and was assured an urgent further review would take place. The home also currently has 3 service users who receive day care in the home. There was no documented evidence to support that staff are identified to care for these persons, over and above the required permanent staffing needs for service users. There was also no staff identified to facilitate social activities in the home and despite requests at recent random inspections there are still insufficient staff on duty to deal with laundry and domestic duties at weekends, and care staff are taken away from their caring role to do these tasks. Kitchen staff hours have been cut and the Acting Manager was asked to monitor this closely as staff expressed to the inspector they feel they can not complete all tasks allocated to them and feel the service provided by the kitchen will suffer, for example concerning enough time to deep clean, talk to relatives and update training. This has put an extra strain on the care staff and some were visibly upset at the pressure they are being subjected to and appeared to want to complete their tasks well but felt constrained by the hours provided by The Company. The outstanding requirement remains, but a shorter timescale will be set to ensure The company complies with this Regulation to ensure there are sufficient staff on duty to meet all the needs of service users at all times. Failure to do so could put service users at risk from needs being unmet. There has been little progress made since the last random inspection on the training programme for all staff. The Acting manager was in the process of having the training schedule revised and this will be submitted at a later date. Not all staff have received training in mandatory subjects and no training has occurred in service specific training. Requirements for these subjects remain from the last inspection and will now be given shorter timescales. Staff on NVQ training informed the inspector that the training provider for their course has ceased business, but they are keen to complete their course and hope another one will be found. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 23 Failure to have incorrectly trained staff to assist service users could result in them not using the most up to date methods to deliver care to service users. There have been no staff employed, except the Acting manager since the last random inspection. A number of staff personal files had been tracked at the last random inspection and the requirement still remains that all staff should have valid contracts in place. The Acting manager was also asked to audit all personal files to ensure that all the correct information was there and track what was not, to ensure all staff currently employed are safe to work with service users. At a recent meeting with the owners of the home assurances were made that adequate checks were in place before the Acting manager was allowed to work at the home. During this site visit the inspector was informed that despite very clear guidance given to the owners, in the presence of other health care professionals, that this was not followed and they allowed the Acting manager to work with out sufficient safety checks being in place and that person allowed themselves to work in the building and be privy to confidential information without a POVA check being completed. There was also no accurate record of how the accuracy of the information supplied by the Acting Manager had been tested and the inspector found discrepancies in the addresses given by the person on their curriculum vitae and CRB disclosure form. There had also been insufficient supervision in place for that person, with only a part-time administrator monitoring the person, again, despite clear guidance being available for the owners to access. The CSCI is considering the action, which will result from this failure to comply with this Regulation, at the time of writing this report. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is being inadequately managed by all parties and consequently places service users at risk. EVIDENCE: During the course of this inspection Standards 31,33,35,36 and 38 were checked. There was written evidence to support that some supervision had taken place with staff, but only at a discussion level. The documentation provided did not detail all the requirements set at Standard 36 and there was no evidence to support that any observational supervision and taken place. This could result in staff not being monitored correctly and gaps in their knowledge base not being The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 25 identified so further training can take place and they are capable of looking after the service users and have the skills to deal with their needs. During the course of the site visit the inspector witnessed one incident where staff were dealing with a volatile situation and staff did not have the skills to ensure a safe environment for all service users, visitors and other staff. This was reported back to the manager. The role of the manager has been documented in another part of this report, but all documentation concerning the Acting manager has now been forwarded to the CSCI local office. The inspector has been in correspondence with the owners since the last inspection and they had been prompt in their replies for requests for information. Written documentation was seen to show that the majority of certificates were in place to monitor the use of most equipment in the home. There is still an outstanding requirement from the last random inspection that a complete fire risk assessment be in place and the inspector is working alongside the fire officer on this part of the legislation. The first draft of this assessment was given to the inspector and was also to be sent to the fire officer. There was no evidence produced to support that an annual development plan is in place using a verifiable quality assurance tool and that relatives and others having access to the service are adequately consulted. Many relatives stated they do not know what happens regarding the running of the home and stated several times where there had been a breakdown in communication with the home and individuals. Some relatives were very emotional and there were several unresolved issues, which were feed back to the manager. The owners have not demonstrated their understanding of their responsibilities in running this home. There appears to be a lack of understanding of this particular complex client group, service users needs, staff training needs and maintaining and providing a suitable environment. This lack of leadership in the home has resulted in the potential for service users being put at considerable risk. The owners must ensure that all measures are taken to ensure the home is run for the service users, it is safe to live and work in, that staff are safe to work with service users and are trained to do their job and that all needs can be met within the categories of registration the home has on their certificate. There was insufficient evidence recorded that all of these items take place and that there are sufficient polices in place to ensure staff are aware of what to do. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X 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 1 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 1 X X X X X X 1 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4.1a-c and 4.5c Requirement The statement of purpose and service users guide must reflect the services provided in the home and be available in different formats. Contracts must be in place for each person resident in the home and those receiving day care. These must be signed by the service user or their advocate and show they understand the document. The registered person must ensure that all care plans are up to date and reflect the needs of the service users. (Previous time scale of 08/03/07 and 10/4/07 not met). The registered person must ensure that all care plans have been audited and there is written evidence that this has occurred. (Previous timescale of 08/03/07 and 10/04/07 not met). A named services user’s care plan must be reviewed to reflect current needs. DS0000067509.V339436.R01.S.doc Timescale for action 30/06/07 2 OP2 14.1.d. 30/06/07 3 OP7 15.2.b. 20/06/07 4 OP7 15.2.b. 30/06/07 5 OP7 15.2.b and c. 20/06/07 The Lodge Version 5.2 Page 28 6 OP8 15.2.c. and 13.1.b. 7 OP9 13.2. 8 OP10 13.1.b. 9 OP12 16.2.m 10 OP13 16.2.m. 11 OP15 16.2.g. 12 13 OP16 OP18 23.3,4 and 8 13.6. 14 OP19 23.2.b. A named services user’s care plan must be reviewed to ensure all parties are aware of this person’s behavioural needs and suitable medical advice be sought. The recording of controlled drug medication must be accurate and any misdemeanours reported to the appropriate legislative body. Staff must ensure that appropriate action and advice is sought immediately a need is identified from other health care professionals. Appropriate activities to suit the needs of service users must be provided. (Previous timescales of 14/08/06,31/12/06 and 30/04/07 not met). Appropriate links must be made with the local community to ensure service users expectations of being part of an integrated community are fulfilled. The owners must ensure that the advice of the health and safety officer regarding safety in the kitchen area is adhered to, to ensure food is prepared in a safe environment. All complaints must be accurately recorded and the action taken to address issues. The registered person must ensure that all staff are aware of the Protection of Vulnerable Adults policy and all training is up to date. (Previous timescale of 30/04/07 not met). The registered person must ensure that all radiators in the building are safe and do not poise a hazard for service users, visitors and staff. DS0000067509.V339436.R01.S.doc 20/06/07 20/06/07 30/06/07 30/06/07 30/07/07 30/06/07 30/07/07 30/06/07 30/06/07 The Lodge Version 5.2 Page 29 15 OP19 23.2.b. 16 OP19 23.2.b. 17 OP19 23.2.b. 18 OP19 23.1.a. 19 OP27 18.1.a. 20 OP27 18.1.a. (Previous time scale has been revised due to health and safety officer rescheduling improvement notice). The registered person must ensure that a maintenance and renewal plan is in place for the whole building inside and outside and this is open for inspection. (Previous timescale of 12/03/07 not been met). The registered person must ensure that the refurbishment programme has commenced by the action date given to ensure service users are living in a safe and comfortable environment. The registered person must ensure that all planned work has actually taken place and adjust the programme where necessary and clear records are kept of any work completed and changes necessary. The registered person must ensure that any work carried out meets the diverse needs of the categories of registration the home has with CSCI. The registered person must ensure that there are sufficient staff on duty through a 24-hour period to ensure that all the needs of all service users can be met after using a valid dependency tool. (Previous time scale of 02/03/07 and 10/04/07 not met). The registered person must ensure that adequate staff are on duty at all times for the named service user who’s’ assessment showed required one to one care from staff. Rotas, with designated staff must be submitted on a weekly basis until DS0000067509.V339436.R01.S.doc 30/05/07 20/06/07 20/06/07 30/06/07 20/06/07 20/06/07 The Lodge Version 5.2 Page 30 21 OP29 18.1.a. 22 OP29 18.1.a. 23 OP29 18.1.a. 24 OP30 13.5. 25 OP30 18.1.c.i. 26 OP30 9.2.a, b ii and ii, c. 30/06/07, when the situation will be reviewed. The registered person must ensure that all staff have valid contracts and evidence can be seen on each file. (Previous time scale of 12/03/07 not met). All staff personal files must be audited to ensure they have sufficient information within them to ensure they are safe to work with service users. The registered person must ensure that the recruitment practises in the home are robust, staff are safe to work with service users prior to employment and all evidence to support adequate checks have been made is open for inspection. The registered person must ensure that all staff have received updated training in manual handling and this is tested as observational supervision and recorded on their files. (Previous timescale of 30/04/07 not met). The registered person must ensure that all staff have received updated training in service specific subjects such as challenging behaviour, dementia, care of the person requiring wound management and aggression management. (Previous timescale of 23/05/07 not met). The registered person must ensure that the appointed manager has had sufficient checks made to ensure that person is competent, has the skills and experience to be in charge of the home. DS0000067509.V339436.R01.S.doc 30/05/07 30/07/07 30/06/07 30/07/07 30/07/07 30/06/07 The Lodge Version 5.2 Page 31 27 OP33 24.1.a, b. 28 OP36 18.2. 29 OP38 23.4.c.v. 30 OP38 26.1,2,4 and 5. 31 OP38 17.3.a.b. There must be a quality assurance system using a verifiable tool in place to ensure all aspects of the home are monitored and the views of service users are taken into account when decisions are being made. The registered person must ensure that all staff have received supervision and this is a balance between discussion and observational supervision and these records are open for inspection. The first round of supervision must be completed by the date stated. (Previous time scale of 12/03/07 not met). The registered person must ensure that all fire risk assessments are updated and adequate checks are made on a regular basis of all fire equipment, exits, emergency lighting, nurse call systems and drills by staff. These to be open for inspection at any time. (Previous time scale of 30/04/07 not met). There must be evidence open for inspection that the Registered Providers are visiting the home, assessing the action and writing about the site visit. There must be a review of all policies and procedures in the home to ensure there are sufficient in place to meet all needs of running the home and staff have signed to say they have read and understood them. 30/08/07 30/06/07 30/05/07 30/05/07 30/07/07 The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 32 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 Refer to Standard OP15 OP28 Good Practice Recommendations The manager needs to monitor the recent changes in the kitchen area and ensure that food continues to be prepared in a safe and clean environment. 50 of staff should be trained to NVQ level 2. The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lodge DS0000067509.V339436.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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