Inspection on 25/10/06 for Thistleton Lodge Care Home

This inspection was carried out on 25th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Thistleton Lodge Care Home 19/04/07

Thistleton Lodge Care Home 14/10/05

Thistleton Lodge Care Home 26/04/05

Thistleton Lodge Care Home 01/02/05

Thistleton Lodge Care Home 02/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Thistleton Lodge Care Home Fleetwood Road Thistleton Nr Kirkham Lancashire PR4 3YA Lead Inspector Mrs Felicity Lacey Unannounced Inspection 25 October & 3 November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thistleton Lodge Care Home DS0000006089.V314919.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. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thistleton Lodge Care Home Address Fleetwood Road Thistleton Nr Kirkham Lancashire PR4 3YA 01995 671088 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) Thistleton Lodge Limited Sally Clarke Care Home 57 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (38) of places Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home may accommodate 38 service users in the category of old age (OP) and 19 service users in the dementia (DE) catergory. The maximum number of service users who can be accommodated at any one time must not exceed 57. 14th October 2005 Date of last inspection Brief Description of the Service: Thistleton Lodge Care Home is a very large detached property in its own grounds situated on the main Fleetwood road near to Kirkham. It is easily accessible and there is ample car parking space for visitors. The home provides care for up to 58 service users incorporating residential, respite and dementia care on the ground and first floors. Accommodation is in single and double rooms; each bedroom complies with minimum space requirements. There are four lounge areas and a conservatory. The lounge areas incorporate dining space and there is a separate dining room on the ground floor. There is a passenger lift and access for wheelchairs throughout. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two site visits that were unannounced. Two inspectors visited the home. A range of comments were received from residents and relatives through the completion of comment cards and discussion. 11 comment cards were completed by residents and 2 comment cards were received from relatives. The acting manager, registered manager and staff members were also spoken with during the site visit. Care plans and documents were looked at. The premises were toured. Information was provided by a Pre Inspection Questionnaire that was completed by the acting manager. What the service does well: What has improved since the last inspection? The exterior appearance of the home has improved with the replacement of window frames. Internally carpets have been replaced and rooms refurbished. More staff have achieved a recommended qualification in care and the home is continuing to provide training opportunities for all staff. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 7 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 Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 8 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): 3,4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Preadmission assessment information is not consistently transferred to the residents care plan and this means some needs go unmet. The staff lack the knowledge and skill to provide specialist dementia care based on current good practice, the health and welfare of the people on this unit is not promoted because of this lack of understanding. EVIDENCE: The care files contained initial assessments of needs, completed by health or social services personal. This information is transferred on to a cardex. In some cases the information contained did not appear to be consistently acted upon, for example mobility difficulties were highlighted on an initial assessment, however a risk assessment had not been completed, on another initial assessment it was noted that the person wore glasses, however the staff were unable to explain why the resident was not wearing these or where the Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 9 glasses were. Not all service users had an up to date care plan, and in some cases needs identified on the care plan were not being met, for example weight charts were being maintained for residents, however where losses have occurred it is not clear what action has been taken by staff to address significant weight loss. It is important that all information gathered at the pre admission assessment is transferred to the individual care plan, and risk assessments completed when necessary. This ensures that residents receive consistent support to help meet their identified needs. The home is registered to provide care for people with dementia, however the support provided did not appear to be based on an understanding of the needs of people with dementia. The unit does not operate in a person centred way. Decisions appear to have been taken with little regard to individual abilities and needs, for example alarm call bells where tied out of reach as a member of staff said that no one would no how to use them appropriately, this type of generalisation demonstrates a lack of appreciation of individual needs. The environment of the dementia unit is dealt with in a later section of the report, but again the decoration and organisation of this showed no understanding of current good practice guidelines that identify ways in which to provide a safe and homely environment for people with dementia. It is important that staff are equipped with the skills and understanding of the needs of people with Dementia through appropriate training and management. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans do not accurately reflect the needs of residents and this means that health and welfare is not consistently promoted. The medication procedures at the home are not consistently followed and this may affect the wellbeing of service users. EVIDENCE: On the older persons unit and the dementia unit care plans were in place, however these were not always accurate reflections of a persons needs, or supported by relevant risk assessments. Care plans were in some cases signed by a relative, however this was not a consistent practice. Care plans are reviewed monthly by care staff and amendments made. The care plans for some people contain a number of amendments and it is advisable that all care plans are reviewed and where there have been significant changes a new plan should be produced. Care plans must clearly details the action that needs to be taken by staff to ensure that all aspects of health, personal and social care needs are met. For example, where mobility issues are identified at the time of admission a risk Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 11 assessment should be completed, and kept under review. If mobility difficulties develop a risk assessment should be devised, and when appropriate, advice should be sought from the falls prevention service to determine the reason for the increased number of falls. The home has regular visit by a GP and there is a system to ensure that residents are seen with continuing health problems. The choice of GP services is restricted by the homes location and the majority of residents are registered with the same surgery. This restriction is made clear to all residents at the time of admission. Residents spoken with felt that their medical needs were met and that health advise was sought when necessary. However in the case of two instances of significant weight loss the acting manager was unable to say what action had been taken, other than the staff of the unit had not identified this as a problem with her. An initial assessment seen on the older persons unit highlighted the need for pressure area care, however this was not included in the care plan. There is a need to develop systems that ensure the health needs of residents are consistently monitored and met. Opportunities for physical exercise appear limited in the Dementia Unit, there was a lack of structured activity or staff to support residents to go out of the building. There is an enclosed courtyard which has to be accessed by going downstairs, and it was not clear that staffing levels would allow for this to happen regularly. Medication storage, administration and recording systems are in place at Thistleton Lodge, however the operation of these should be monitored by the manager. All medication administered should be recorded accurately, for example currently some creams and dietary supplements are prescribed and administered but are not recorded when administered. It was not possible to tell if dietary supplements had been provided as prescribed or whether creams had been applied as prescribed. The timing of medication given should also be recorded accurately, currently the medication administration recording sheet (MARS), gives the times as ‘breakfast, dinner, tea, supper’ however as some residents are given tea at 4 o’clock this means that medication is being given over an 8 hour period and then not administered for another 16 hours. It is important that the manager and staff are aware of the correct practices when administrating medication and the need to follow prescribing guidelines must be understood. Some medication operates on a time release basis and the effect of other medications may be time limited. It is important that the home discuss these issues with the pharmacist and ensures that all prescription medication is administered correctly. With regard to controlled drugs the receipt and administration of these should be recorded accurately, at the time of the inspection the MARS did not accurately reflect the date of receipt of the drugs into the home. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 12 The residents of the older peoples unit felt that their privacy was respected and staff were responsive to their opinions and respected their choices. At the time of the initial site visit the privacy of residents on the Dementia Unit was being compromised by staff recording information, for example, dietary needs and medical conditions, on a large white board in the dining area. The explanation for this was to need to ensure that all staff knew this information, however if staff were accessing care records and plans as they should do they would be aware of these needs. If this information is needed as staff who are unfamiliar with residents are providing care it could be stored discretely. Also the condition of the toilets and bathrooms of the Dementia Unit showed little regard for treating residents with dignity, the bathrooms were unattractive and unclean. There was no usable soap or means to dry hands available, following the issue of an immediate requirement notice steps had been taken to rectify these issues, it is important that standards are maintained that recognise the need to treat all residents at the home with dignity and respect. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The level and type of activities on offer vary between different parts of the home, this means that some people are able to have their social and recreational interests met. EVIDENCE: The level of activity on offer at the home varies between the older peoples unit and the dementia unit. At the time of the initial visit there was no organised activity going on in the Dementia Unit. The only forms of entertainment were music in the dining area, which one resident said just washed over her, she said it was always on and she didn’t notice it anymore and the TV was on in the Video lounge. The manager explained that residents of the Dementia unit went downstairs for the hairdresser and beauty treatments. A group of residents like to sit outside the lift and watch people coming and going, it was suggested by a relative that this might be popular due to the lack of other social activity on offer. Staff spoken with explained that most activities go on in the afternoon, as staff time was filled with personal care tasks during the morning, the impact of this is that many residents are passing the morning sitting in chairs with no interaction or occupation, until lunch time. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 14 Staff spoken with were keen to offer activities such as art and crafts however take up was limited, it is important that when providing care for people with dementia that activities which are suited to the individual are offered. The home has a member of staff who previously organised regular activities for the residents with dementia, but this member of staff has moved on to the older persons unit whilst the registered manager is on maternity leave. A social history of the person can often give an insight into their previous lifestyle and interests and this can form a basis of activities. It is important that staff are supported by the management to access training and advise about providing stimulating and meaningful activities for residents with dementia. In the older persons unit there was a full programme of activities, including excursions. At the time of the visit a group of people were taking part in dominos. There is a range of places to sit and spend time, the garden is easily accessible. Residents who wished to spend time in their own rooms did so. A diversional therapist was employed 3 days a week who provided a range of activities and organised outings. Community activity is limited by the location of the home. However there are links with the mobile library service and pet therapy. Residents are able to receive visitors when they wish and can see them in private. There were isolated examples of personal choice found on the Dementia Unit where a resident had her own pet. Her preferences for caring for the pet were known and respected. On the older persons unit residents felt that their opinions and choices were sought and respected. Residents were comfortable in their surroundings and were supported by staff in their interests. Residents were able to choose whether to spend time alone or with others. The meals served were enjoyed by the residents. The majority of residents who commented thought that the meals were well cooked and tasty. The menu allows for choice, staff from the dementia unit help residents decide what meals they would like, and bear in mind the likes and dislikes of the residents. The dining room of the dementia unit is not pleasant. There was a collection of different types of chairs at the dining tables, some of which had dried food and marks on them. The floor covering is dark and unattractive, and could pose difficulties for people with dementia who may find it disorientating. Consideration should be given to improving the standard and appearance of this room including the flooring and furnishings. This room is in frequent use and also acts as a sitting room for some residents. The dining room of the older peoples unit is pleasantly decorated and arranged. There is a fish tank which residents like. The dining room provides a social space for some residents who may meet there to play dominos and other games. Dietary intake is not recorded in sufficient detail to allow for monitoring of nutritional intake, for some residents the importance of monitoring diet and weight was highlighted in the care plan, however this was not being followed in Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 15 practice. The implications for the health and welfare of older people of the failure to provide a regular and nutritious diet for any older person must be appreciate by staff at the home. The system of recording must be reviewed to ensure that all residents receive a wholesome and nutritious diet. Thistleton Lodge Care Home DS0000006089.V314919.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): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The home has a complaints policy and residents know who to raise concerns with. There is no record of complaints maintained and therefore it is hard to decide if appropriate action is taken. EVIDENCE: Two complaints have been investigated since the last inspection, one, which was made to CSCI and passed to the provider for investigation, and one, which was made directly to the home. The record of complaints held at the home was not available for inspection. The manager must maintain a record of complaints made and the action taken to resolve issues raised. The complaint procedure was on view in the hall. Residents who were spoken with and who completed questionnaires indicated that they knew how to raised any concerns they may have. The manager of the home has demonstrated her knowledge of adult protection protocols and has instigated these when required. Staff receive training through National Vocational Qualifications, other training opportunities and the homes policies and procedures that ensures that they understand the importance of adult protection procedures. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 17 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. There is a noticeable difference between the décor and furnishings of the two parts of the home that demonstrates a lack of respect and understanding of the needs of people with dementia. There is a need to ensure infection control measures are understood and consistently followed by all staff at the home promote and safeguard the wellbeing of residents. EVIDENCE: At the last inspection the need to improve the external appearance of the building was highlighted. Work has been carried out to replace rotten window frames and to clear the entrance to the home. The need to improve the environment in the Dementia Unit was also highlighted. At the time of the initial site visit the unit was found to be unclean. There is a marked contrast between the standards of furnishing and decoration on the dementia unit and the unit for older people. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 18 On the dementia unit the bathrooms and toilets were dirty, dried faeces could be seen on toilet seats and walls. Baths were not properly cleaned. An Immediate Requirement was made at the first site visit, that the whole unit be cleaned to an acceptable standard and a cleaning schedule put in place. The manager of the home responded to this requirement. It is important that standards of cleanliness are maintained. As previously noted the dining room of the Dementia Unit has black flooring and looks unappealing, at the time of the initial site visit there was food and dust in the corners of the room despite the floor having been mopped. There was lock on the outside of the dining room, the inspectors were told differing reasons for this lock, however there appeared to be no need to have a lock in place and this was removed. The flooring appeared to be sticky. There was a collection of chairs, which were marked and stained, at the time of the second visit some chairs had been sent to be cleaned. The carpet in the Dementia Unit had been replaced following the previous inspection, however at the time of the initial site visit it was marked and contained food debris, and did not appear to have been hoovered for some time. The furnishings were worn and needed replacement, for example in the TV lounge there was a dresser which a large burn mark on it and a coffee table which was damaged. The smoking lounge had a fly strip hung in the centre of the room, which was covered in flies. When the inspectors asked about this the acting manager said it was a local problem, however ways in which to deal with this problem do not appear to have been explored. It is important that the manager seek advise about the cause and control of the problem of flies at the home. At the initial site visit bins containing used incontinence pads were found, the pads had been placed directly into bins, two of which had no lids. Effective infection controls did not appear to be in place. The soap in dispensers in both units of the home was found to be rancid. Staff were seen to be wearing protective aprons and gloves, but were seen wandering from resident to resident without removing these. Gloves and aprons were thrown in open bins. The staff appeared to lack an understanding of the principles of infection control. Alcohol wash was only present in open bathroom of the unit, despite personal care being provided in a number of toilets, bathrooms and bedrooms. Two immediate requirement notices were issued requiring the safe and hygienic disposal of continence pads and the provision of suitable hand washing products. These were acted upon and bins had been replaced, and infection control products provided, by the time of the second visit. It is important that infection control training is provided as a matter of priority for all staff working at Thistleton Lodge. The standards of furnishing and decoration in the older persons unit are noticeably higher. The unit is well decorated and has flowers and pictures on Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 19 display, giving a welcoming and homely appearance. There is a range of communal rooms and spaces that residents can make us of. The individual bedrooms are large and decorated to the tastes of the individual resident. The residents spoken with were satisfied with the standard of cleanliness at the home. The laundry system at the home is efficient and residents were very pleased with the service provided. The infection control procedures required for laundering soiled articles were understood and followed by the staff member responsible for the laundry. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty are not able to consistently meet the needs of the residents this place residents at risk. Training opportunities should be focused on identified training needs, dementia care and infection control should be given priority, to ensure that staff are competent. EVIDENCE: The rota shows that at times there is a shortage of staff at the home. The manager is currently advertising to recruit more staff. The staffing compliment has been calculated using the Care Staffing Forum, however the levels of staffing do not appear to be adequate to meet the needs of the residents consistently and safely. This conclusion was supported by considering the staff rota, discussions with staff members and was commented on consistently by the residents of the older persons in conversation and was evident in a satisfaction survey completed by the manager of the home in May 2006. Currently after 5 pm there are 2 members of staff on duty on the dementia unit providing oversight for 19 residents, some residents require 2 carers to assist with personal care and therefore 18 people are left unattended during these times. A relative commented that she often struggles to locate a member of staff and that staff have to do many jobs as well as support the residents, such as collect laundry and serve food. During the morning and afternoon 3 staff are rotaed on in the Dementia Unit and 5 in the older persons Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 21 unit. These staffing levels are the minimum required and the manager should review the evening staffing in accordance with the needs of the residents. Out of 11 questionnaires returned none indicated that there was always enough staff on duty, 11 out of 19 of the homes own quality assurance questionnaires indicated that staffing levels were poor or less than adequate, and that call bells were not always answered. The home operates a recruitment procedure that ensures that checks are completed prior to employment being offered. The staff files seen contained completed application forms, references and POVA first checks. Criminal Record Bureau disclosure checks are obtained and there is a process in place to address any issues which may arise. A checklist should be used to ensure that all relevant checks are completed and containing key information such as the date employment commenced. The staff rota showed that staff who were awaiting full CRB clearance were working supernumerary. Some staff training records demonstrated that an induction training programme had been completed, however for some staff there is no record of this or any other training being provided. The manager is to compile a training matrix which will show which staff have completed which courses and enable an accurate assessment of current skills and training needs. An audit of staff training records for those staff employed in the Dementia Unit, showed that staff had very little if any training relating to the care of people with dementia. It is of concern that the 2 senior staff on the dementia unit have no significant training in the care of people with dementia. A sampling of the whole staff groups training records showed that some staff had relevant training in dementia, however they were employed in the older persons unit. Staff members have received training in moving and handling, care of the dying and other topics. Infection control training should be organised without delay. The home continues to progress towards meeting the ratios of staff who hold a National Vocational Qualification in care at level 2 or above. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The acting manager is seen as approachable and responsive, however the lack of management processes to monitor the care practice and records maintained at the home has impacted on the quality of care received by residents. EVIDENCE: The current registered manager is on maternity leave however she continues to be involved in the running of the home. The acting manager is working hard to fulfil the responsibilities of the management role. The residents spoken with felt that the manager and staff were approachable and provided a good service, within the limits of the time they had available. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 23 The home has achieved Investors in People quality award. The home also conducts its own quality survey. The most recent resident survey was conducted in May 2006, however the results of this have not been collated or feedback given to residents about the improvements that may be made in response to the survey. The results were positive regarding cleanliness, attitude of staff and food at the home, and negative regarding staffing levels. The Care Homes Regulations 2001 require that were a company owns a care home that a representative of the registered provider must conduct a monthly visit in accordance with regulation 26. During this visit, which should be unannounced, the views of residents, representatives and staff regarding the standard of care at the home should be gathered. The premises should be inspected, its record of events and complaints should be inspected and a report complied which is then made available to the manager and the CSCI. To date these reports have not been submitted. In providing the reports the registered provider demonstrates that they are aware of the conduct and standards at the home and are ensuring that these are maintained. Regulation 26 visit must be conducted and the result reports provided. The home does not retain any accounts on behalf of residents. The resident, their family or an appointee administers their finances. The home has accounting and invoicing procedures. The accident record was looked at as part of this inspection. It was of concern that in the past 2 months there have been 24 falls at the home. These records should contain a reference number, and should be analysed for any trends or identifiable hazards. The number of staff available to assist and oversee residents can also impact on the number of falls in a care home. One lady on the Dementia Unit had tripped over another resident who was sat in the corridor opposite the lift, the continued use of this seating area should be risk assessed considering that the hand rail ends where the chairs begin, and a decision made regarding the safety of current arrangements. Infection control measures in place appeared to be inadequate. There was no demonstrable understanding and practice of measures to prevent the spread of infection. For example soap dispensers contained rancid soap, there were no paper towels, areas of the home were dirty, the method of disposal of continence pads and protective clothing was unhygienic. Where infection had been identified, for example it was recorded on an initial assessment was written ‘MRSA awaiting 3rd negative swab results’, the care plan contained no further reference to this and the staff could not definitively explain if this test had occurred and what the outcome was. The registered person must ensure that measures, including training, are implemented to ensure that staff carry out their duties in a way that promotes infection control. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 24 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 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 25 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 OP19 Regulation 23(1)(a) & (2)(a) Requirement The registered provider must ensure the dementia unit is decorated and furnished to meet the needs of the residents. Previous time scale not met. 2 OP4 12(1) The care home must be conducted to promote and provide for the health and welfare of residents with dementia. The care plan must reflect the identified needs of the resident and how these will be met, it must be kept under review and be drawn up in consultation with the resident or their representative. The plan should pay particular attention to prevention of falls. The registered person must ensure that health needs are met. The registered person must make arrangements for the recording, handling, safekeeping, safe administration of medicines received into the care home. DS0000006089.V314919.R01.S.doc Timescale for action 03/01/07 03/01/07 3 OP7 15 03/01/07 4 5 OP8 OP9 12(1) 13(2) 03/12/06 03/12/06 Thistleton Lodge Care Home Version 5.2 Page 26 6 7 OP10 OP12 12(4)(1) 16(2)(m) (n) 8 OP16 17(2) Schedule 4 16(2)(j) 9 OP26 The registered person must ensure that all residents must be treated with dignity and respect. The registered person must consult with residents and make arrangements to provide social opportunities and appropriate activities. A record of complaints and action taken by the registered person must be kept at the home. The registered person must make satisfactory arrangements for maintaining satisfactory standards of hygiene. Immediate requirement notice issued. The registered person must make suitable arrangements for the prevention of the spread of infection at the home. Immediate requirement notice issued. The registered person must ensure that at all times suitably qualified, competent and experienced staff are employed in such numbers as are appropriate for the health and welfare of service users. The responsible individual must conduct monthly visits to the home in line with the requirements of regulation 26. The registered person must ensure that unnecessary risks to health and safety are identified and so far as possible eliminated. 03/12/06 03/01/07 03/12/06 25/10/06 10 OP26 13(3) 25/10/06 11 OP27 18(1)(a) 03/12/06 12 OP33 26 03/12/06 13 OP38 13(4) 03/12/06 Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 27 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 4 Refer to Standard OP28 OP3 OP15 OP33 Good Practice Recommendations The registered provider must ensure that at least 50 of care staff are trained to NVQ2. The preadmission assessment should inform the plan of care and identifies needs should be consistently met. Individual assessed dietary needs should be provided for. Meals should be served in a congenial setting. Effective quality monitoring is in place that informs planning and review of services. Thistleton Lodge Care Home DS0000006089.V314919.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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