Inspection on 01/02/06 for Valentine Lodge

This inspection was carried out on 1st February 2006.

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

Valentine Lodge 02/10/08

Valentine Lodge 08/10/07

Valentine Lodge 14/05/07

Valentine Lodge 29/01/07

Valentine Lodge 14/06/06

Valentine Lodge 26/04/05

Valentine Lodge 22/11/04

Valentine Lodge 29/06/04

Valentine Lodge 18/02/04

Valentine Lodge 15/10/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Valentine Lodge 28 Edith Road Canvey Island Essex SS8 0LP Lead Inspector Mrs Bernadette Little Unannounced Inspection 1st February 2006 08:00 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 Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 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. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Valentine Lodge Address 28 Edith Road Canvey Island Essex SS8 0LP 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) 01268 696955 01268 696955 Valentine Lodge Limited Mrs Valerie Sheila Matthews Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing and personal care to be provided for up to 20 people over the age of 65 years. Maximum number to be cared for shall not exceed 20. Date of last inspection 26th April 2005 Brief Description of the Service: Valentine Lodge offered accommodation with nursing care for twenty older people. The home was situated near to local amenities and transport on Canvey Island. There were six shared bedrooms on the ground floor, all with a toilet, wash basin and shower, and eight single bedrooms on the first floor with hand washing facilities. There were two lounges and a dining room downstairs and there was a passenger lift. There was limited parking to the front and side of the home and a very small garden to the rear. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second routine unannounced inspection of Valentine Lodge in this inspection year. It was done on a Wednesday by two inspectors, Bernadette Little and Michelle Love, over an eight-hour period, starting at 8am. Much of the time was spent sitting in the lounges, looking at the everyday things that happen in the home and talking with residents and visitors and staff. Records and documents were looked at and there was a tour of the premises. The Commission has concerns about this home and its continued failure to meet Regulation and National Minimum Standards, its failure to record complaints, and the two recent referrals of issues under the Protection of Vulnerable Adults protocol. An additional visit had been undertaken to the home on the 24th of October 2005 to look at whether the Immediate Action Requirement Notices, issued at the home at the previous inspection on 26th of April 2005, had been addressed. After this additional visit, Enforcement Notices were issued to the registered provider in December 2005. These related to staff training, safe staff recruitment procedures/staff records and residents care plans. These issues were again found on this inspection not to meet regulatory requirements and the Commission is taking legal advice about further action in respect of this home. The registered manager was on annual leave at the time of this inspection. The senior nurse on duty assisted with the inspection, as did the five residents, two visitors and five staff spoken with. Their help and hospitality was appreciated. There were 15 residents living at Valentine Lodge at the time of this inspection. What the service does well: Many of the staff who work at Valentine Lodge had been there for some years. This gave them the chance to get to know the residents well and residents also knew the people who were caring for them. Residents talked to said that they liked the food. Visitors said that they were always made welcome. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 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 Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 The provision of written information for prospective uses of the service was poor, and did not support them to make an informed decision about moving into the home. The home’s actions to assess residents prior to admission was poor, and did not reassure that the home could meet the needs of residents. EVIDENCE: The statement of purpose was reviewed in July 2005. It could be written in a way that made it easier for residents to see and understand. Areas of the document that did not comply with, and provide adequate information as required by, Schedule 1 of the Care Homes Regulations included the organisational structure of the home, the arrangements made for consultation with service users about the operation of the care home, specific details of fire precautions and associated emergency procedures in the care home, lack of clear information about the home’s visiting policy, the number and size of the rooms in the care home, and details of any specific therapeutic techniques used in the home and arrangements for their supervision. The statement of purpose and service user guide were available in the home. A copy of the service users guide was said to be put in each resident’s bedroom. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 9 This was not observed in the rooms sampled. Staff confirmed that the documents are not provided to prospective service users or their relatives, prior to admission, so they would have sufficient information to feel sure that the home was right for them. The files for two recently admitted residents did not evidence that any preadmission assessment had been undertaken by Valentine Lodge. One file did not identify the date of admission but this was later dated from other documents. One file showed an assessment of nursing needs undertaken by the hospital some six weeks prior to admission to Valentine Lodge. There was no written evidence that the home had confirmed in writing to the residents or other relevant person, as required by Regulation, that they had obtained an appropriate pre-admission assessment, and based on it, could meet all the resident’s needs. The section later in this report on staff training indicates that staff have had limited training in some areas, including on conditions associated with older people. Of the seven qualified nurse files sampled only one showed evidence of training on dementia, continence management, Parkinsons disease, or diabetes management, and two on catheter care and tissue viability. Some of the seven care staff files sampled showed that they had attended an information session on dementia but no other recorded training on conditions associated with older people. A relative spoken with said that they had been able to visit the home prior to making a decision on taking up the place, but that they had not been provided with any written information regarding the home. Copies of contracts, or statement and of terms and conditions, for residents were again not available for inspection. Valentine Lodge does not offer intermediate care. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10 While care plans had some minor improvements, they, and risk assessments, continued to provide poor levels of information of all the resident’s individual assessed needs and details for staff on how these were to be met for the individual person. EVIDENCE: Valentine Lodge undertook a plan of care assessment for one of the recently admitted residents, eight days after their admission to the home, which was eight weeks prior to this inspection. The hospital discharge sheet identified that the person had poor vision but were self caring of their stoma. This was not identified in the plan of care assessment/care plan. While considered able, there was no evidence of resident input to this document. This care file identified that the resident was unable to mobilise and had not attempted to do so. The hospital discharge sheet provided on the day prior to admission to Valentine Lodge stated that the person walked short distances with their Zimmer frame, with supervision. The moving and handling risk assessment undertaken by Valentine Lodge the day after admission did not provide an accurate score, as the resident’s weight was not included, but did Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 11 identify that the resident could walk a few steps with the frame and could transfer with the assistance of two staff and their frame. The only care plan in place contained some information regarding stoma care, and additional information on health care issues, for example contact with the GP. The plan of care assessment for the second recently admitted resident had been undertaken five days after their admission. While a high risk in relation to pressure area care was identified, there was no care plan in place relating to this. This risk assessment identified that the resident was on a pressure relieving Airways mattress. Documents also indicated that the resident had bed rails in place, although the risk assessment relating to these did not provide adequate assessment or detail. However, the homes own assessment tool stated clearly that bed rails should not be used when an air mattress was in place. The was no clarity within this plan of care assessment whether the person was cared for in bed on a 24-hour basis or whether they spent any time out of bed. One area of the assessment stated that they were unable to weigh the resident, as the person was unable to sit in a chair. However in another section, the same assessment stated that the resident was to be showered and have a hair wash on a weekly basis. The moving and handling assessment stated that the resident was unable to stand. This assessment did not follow through and identify what equipment was to be used for this resident who was unable to stand or walk when, for example, they were going to have a bath, where it identified that the resident needed the assistance of one carer, and needed two carers for movement in bed. The assessment of nursing needs undertaken in relation to this resident prior to admission clearly states that the resident needed a qualified nurse to feed and supervise them for a specific time after food, due to the risk of aspiration. A risk assessment was in place relating to this care need, which is positive. It identified that the person needed to be supervised after meals, but not by whom or for how long. This was the only area of need where a care plan was in place for this person. Medication Administration Records (MAR) were inspected for fifteen residents for the month of January. Omissions were noted on some occasions. The controlled drugs tallied with the register, which was appropriately maintained. A sample of the initialled signature of three staff, recorded as designated to administer medication, was not recorded. Better evidence was seen on this occasion of staff showing respect for residents’ dignity. A staff member spoke to a resident, and escorted him from the lounge to have a shave in the privacy of the bathroom. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 Opportunity for stimulation and meaningful activity was limited, particularly for higher dependency residents. Residents were provided with a satisfactory diet. EVIDENCE: Some residents went out with their relatives. A member of staff was observed to enthusiastically undertake a ball game in the lounge with the residents. It was particularly clear that one more able resident really enjoyed this. Staff deployment in the lounge was notably improved in the afternoon and the staff member talked about current events while sitting with a couple of more able residents. No specific, considered activity or interaction was observed to be provided for the majority of individual residents, who were unable to join in with group activities undertaken. The menu did not demonstrate an active choice of meals. One resident was noted to have a different meal at lunchtime and staff confirmed that this was because they did not like the meal that was on offer. The meal seen was well presented and residents spoken with said the food was generally satisfactory. It was noted positively that when the drinks trolley was brought to the lounge during the morning, residents were offered a choice of tea or coffee. One resident asked for a different drink, which they had had yesterday and enjoyed and this was provided. The member of staff took time to chat with the Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 13 residents while offering them their drinks. Adequate food supplies were observed to be available. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home’s complaints process and their approach to the protection of vulnerable adults did not safeguard residents. EVIDENCE: Information on the homes complaints procedure was displayed in the area near to the lounge and office. Staff advised that no complaints had been received by the home since the last inspection. The comments and suggestions book, seen to be available in the entrance hallway was provided as the record of complaints and compliments. A compliment noted since the last routine inspection was not signed and dated but recorded “ staff excellent”. A resident spoken with said that they would feel able to raise any concerns or worries that they had with staff. In a subsequent conversation with visitors and residents it was identified that a formal complaint had been made to the home. This related to the rudeness of a member of staff to a relative who approached senior staff to ensure good communication of an issue relating to their relative’s health and medication. The relative advised that they had not had a formal written response. No formal outcome was recorded. A more accurate method of recording complaints needs to be implemented, which also identifies outcomes. The report of the last routine inspection also identified that the home had not recorded a complaint and the decisions taken from its investigation. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 15 Since the last inspection two concerns have been reported and investigated under Protection of Vulnerable Adults [POVA] guidelines. One issue alleged poor care and inappropriate restraint of a resident. The other issue alleged that a resident had been slapped by a senior member of staff. Both complainants clearly identified that concerns had been raised with the home previously but these had not been recorded formally as complaints, or investigated appropriately. While formal outcomes are awaited from the local social services team, it is considered that the outcomes are not possible to determine due to the dependency levels/needs of the individual residents concerned. When requested, the homes policy and procedure on protecting vulnerable adults, as well as a copy of the local POVA guidelines were not available within the home. The last inspection report identified that both of these documents were not available in the home. A copy of the whistleblowing policy was available. There was no evidence that staff had seen or read this and it was not signed and dated by the registered manager. Evidence was not available on individual training files sampled that the registered manager and three of the other six qualified nurses had had training on the protection of vulnerable adults. Records indicated that none of the ancillary staff in the home had been given training on this issue. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26 Aspects of the premises were not safe for residents and did not provide appropriate facilities. Levels of cleanliness, decor and maintenance did not provide residents with the best possible living environment. EVIDENCE: The lounge carpet was split and rucked and presented a clear tripping hazard. The carpet in the long passageway also had an area where the carpet was lifting. An immediate action requirement notice was again issued in relation to the carpet. Staff advised that the registered owner was aware and had plans in place to have it made safe soon. The self closures on the fire doors of some bedrooms were not effective and the doors were not closing properly. Staff were made aware of this and an immediate action requirement notice was issued. Hot water temperatures in some areas were again noted to be a potential hazard to residents and also a hazard in the laundry in relation to the control Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 17 of infection. This issue was included in an immediate action requirement notice. Exit doors from the premises, for example from both lounges and from a corridor were fitted with sensor alarms, which would identify if a resident was leaving the premises unsupervised. These were again noted at this inspection not to be switched on. Staff advised that it was only for a short time while the cleaner was going in and out. It was noted throughout the inspection that the alarms were not switched on and there were long periods where these areas were not supervised by staff. There continues to be a lack of storage for equipment, for example wheelchairs and hoists, which had been noted at previous inspections. The décor are in many areas of the home is tired and needed attention. The main bathroom floor looks in poor condition and the legs of the assisting seat in the toilet in this room were rusted. The legs on the over bed tables did not present as clean and several were rusted. These issues had been raised in previous inspection reports. The flooring in the kitchen was highly textured and difficult to clean. A recent Environmental Health Officer report noted trapped grease and dirt around the raised areas that must be brought to a clean condition. It strongly recommended replacement with an easy to clean surface covering. This had not been undertaken and dirt and grease was noted around the raised areas. The laundry was clean and tidy. The hot water in the hand washing sink was tested as being at 65.5°C and steaming. The laundry person advised that they did not know what temperature soiled clothes/linen should be washed at and had not had any infection control training. Artificial lighting levels in bedrooms was quite low and consideration should be given to this to ensure it meets resident need and assist with safety in the prevention of trips and falls. One bedroom currently in use had no light shade. It was noted positively that all bathroom and toilet wash hand basins had access to liquid soap and paper towels. Bins were fitted with lids. Disposable protective clothing for example gloves and aprons were seen to be available to staff. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Staffing levels/deployment continued not to best meet residents’ needs. Staff recruitment procedures do not safeguard residents. Staff training remains inadequate in some cases to meet residents’ needs and provide good care outcomes. EVIDENCE: The minimum staffing level at Valentine Lodge is one qualified nurse and four care staff in the morning, one qualified nurse and three care staff in the afternoon and one qualified nurse and one care staff at night. Rosters for a four-week period were inspected. These indicated occasions where minimum day staffing levels had not been met. Staff and residents spoken with confirmed that there had been occasions recently where they were short staffed. The activities coordinator was not included on the staff rota. Rosters indicated that some staff work long shifts of 12 or 13 hours. As noted at the last routine inspection, staff needed breaks during long day shifts. At times this effectively meant that staffing levels were reduced for those periods, which limited the staff available for the care of residents. At times, staff deployment, for example staff being present in the lounge with residents, was noted to have improved. However even with their full staffing level and reduced resident numbers at the time of this inspection, there were periods of time were staff were not supervising residents in the main lounge. During the first 2 hour period in the morning there was no member of staff supervising the residents in the lounge, although staff did come in and out Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 19 when bringing another resident in. Staff supervision of residents in the main lounge was notably improved in the afternoon. Staff recruitment files were better organised which is a positive development. It was also noted positively that for two recently appointed staff, the registered provider had ensured that appropriate Criminal Record Bureau checks were in place prior to employment commencing. The remainder of the recruitment of these two new staff was disappointing and again did not meet regulatory requirements. Inadequate references, or no new application or references in the case of a member of staff had worked at home some time previously, had been taken up. There were no photographs of the staff, no records of induction, no declaration of health, and on one file, no proof of identity. Inspection of an additional 16 staff files did show some improvements following the issue of Enforcement Notices to the registered provider in December 2005. It remains of concern that while not requiring retrospective references, none of the files contained all of the required records. Training records were inspected for seven qualified nurses, seven care staff and five ancillary staff. There was no evidence that any member of staff in the home had a current first aid certificate. Several files had no record of moving and handling or fire training. Others recorded that some staff had watched a video on these and other basic mandatory training issues. This is not considered adequate training to comply for example with the 1990 Manual Handling Regulations and 2002 Amendments. A member of the care staff stated that she had been managing this video training for staff. She was advised that as she was not trained to be a trainer, for example in moving and handling both she, the staff she was training, and the residents receiving the manual handling, were being put at potential risk. Evidence was available that only two of the qualified nurses/care staff and one cleaner had had training in infection control. The laundress confirmed that she had not had any training on infection control or health and safety/COSHH. Apart from their Pin number identifying that they were currently registered nurses, files for three of the seven qualified nurses inspected did not evidence that they had undertaken any additional or recent training. The above does not comply with the homes of the statement of purpose which states that they will “provide at all times an appropriate number of staff with qualifications in health and social care and observe recruitment policies and Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 20 practices which both respect equal opportunities and protect residents safety and welfare”. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 The repeated issuing of immediate action requirement notices, the issuing of enforcement notices and the homes continued failure to meet regulatory and national minimum standards shows poor discharge by the responsible persons of their duty to ensure that the home is run in the residents’ best interests. EVIDENCE: The registered manager was an annual leave at the time of this inspection. The rotas demonstrate that the registered manager had had supernumerary shifts to allow her to undertake management tasks. As she was not present during this inspection, it was not possible to ascertain why there were so many outstanding unmet requirements and to demonstrate her fitness to manage the home effectively. At the time of the additional visit in October, it was noted that the registered person had admitted a resident with a clear diagnosis of dementia. This was in Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 22 breach of the home’s registration and a prosecutable offence. However, in the best interests of the resident who was at that time already living at the home, the Commission agreed to vary the registration of Valentine Lodge to allow this one named resident to remain. The registered provider and registered manager must ensure that they comply with the conditions of the registration. Staff advised that there is no quality monitoring system in place. Regulation 26 notices have begun to be sent to the Commission. This is positive, but they are basic in detail and in light of the number of breaches of Regulation and failures to meet National Minimum Standards noted in this report, can not be done in such a manner by the person registered as to reassured himself fully that the conduct and running of the home is appropriate. Staff advised that no money is looked after on behalf of residents, but that families are invoiced for here and chiropody etc. However it was additionally stated that the relative of one resident does provide a cheque to the home, which is cashed and looked after by the registered manager. Access to the money or any records relating to it were not available as staff advised that the registered manager has the only key. Information on this was not included in the statement of purpose or service user guide. At the last routine inspection in April 2005 staff advised that regular supervision was to be implemented. At this inspection and a record of one supervision session was available in relation to one member of staff. Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 23 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 1 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 2 X X X X 2 2 STAFFING Standard No Score 27 2 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X 3 1 X X Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 24 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 Requirement The Statement of Purpose must include all the required information. (Previous timescales from 18.02.04, i.e four inspections, not met). A copy that meets regulation to be sent to the Commission. The Service User Guide must include all the required information. A copy to be sent to the Commission. (Previous timescales from 18.02.04 not met) A contract or statement of terms and conditions that includes all relevant information to be available to all residents. (Previous timescales from 18.02.04 not met). The person registered must show that the home can meet the assessed needs of residents and ensure that staff are provided with training to enable them to meet these needs.(Previous timescales from 22.11.04 not met). A written care plan must be prepared for each resident, DS0000015564.V282876.R01.S.doc Timescale for action 01/03/06 2. OP1 5 01/03/06 3. OP2 14(1) 01/03/06 4. OP4 18(1) 01/04/06 5. OP7 15 01/04/06 Valentine Lodge Version 5.1 Page 25 6. OP8 13 (1)b 7. OP9 13 (2) 8. OP12 16(2)m 9. OP16 22 10. OP18 13(6) 11. OP18 13(6) based on their assessment, that identifies how the residents needs in all aspects of their health and welfare are to be met. This includes detailed risk assessments. (Previous timescales from 22.11.04 not met). The person registered must make arrangements for the resident to receive any treatment necessary from their GP or other healthcare professional. (Not inspected on this occasion, carried to a future inspection). The person registered must ensure safe recording of medication. (Previous timescale of 26/04/05 not met). Residents must be consulted about their social interests, facilities, staff and training must be provided to meet them and care plans must include details of how they are to be met. (Previous timescales from 18.02.04 not met). Complaints must be fully investigated and records available to evidence this. (Previous timescale of 22.11.04 not met). The person registered must ensure the safety of residents by providing staff with clear and relevant procedures on Protecting Vulnerable Adults and ensure that staff are aware of this. (Previous timescales from 18.02.04 not met). Arrangements to be made by the person registered to provide staff with training on Protection of Vulnerable Adults and management of behaviour that challenges.( Previous timescales from 18.02.04 not met). DS0000015564.V282876.R01.S.doc 01/02/06 01/02/06 01/04/06 01/02/06 01/02/06 01/02/06 Valentine Lodge Version 5.1 Page 26 12. OP19 23(2)b 13. OP19 23(4)c(i) 14. OP19 23(2)c & d 15. OP20 23(2)o 16. OP21 23(2)j 17. OP22 23(2)l 18. OP26 13(3) The person registered must ensure that the care home is kept safe and well maintained. This refers to the carpets and the hot water.(Previous timescale regarding the carpets from 18.02.04 and 26.04.05 regarding the hot water not met). The person registered must ensure that firer safety equipment is maintained at all times. This refers to self-closures on the fire doors. The person registered must ensure that the home is kept clean, reasonably decorated and equipment is well maintained.(Previous timescales from 29.06.04 not met). Additionally this also refers to the cleanliness of the kitchen flooring. The person registered must ensure that the external grounds are suitable and safe for residents and appropriately maintained.(Previous timescales from 31.08.04 not met). Not inspected on this occasion, carried to a future inspection. All residents to be provided with safe hot and cold water in their ensuites.(Previous timescale of 23/05/05 not met). The person registered must ensure that there is adequate storage for equipment such as wheelchairs and hoists to avoid storage in residents bathrooms and bedrooms.(Previous timescales from 31.08.04 not met). The person registered must ensure appropriate infection control measures in the home. This refers to the availability of hot water at a safe temperature in the laundry for hand washing DS0000015564.V282876.R01.S.doc 01/02/06 01/02/06 01/04/06 01/02/06 01/02/06 01/04/06 01/02/06 Valentine Lodge Version 5.1 Page 27 19. OP27 18(1)a 20. OP27 18(1)a Sch4 (7) 21. OP29 19, 17(2) Sch 2 & 4 22. OP30 18(1)c 13(5) 23. 23. OP30 OP31 13(4) 9(2)(b)i 25. OP31 10(1) & 2(a) and ensuring that staff are provided with appropriate training. The person registered must ensure that at all times there are enough suitably qualified and competent staff on duty to meet residents needs. This refers to staff deployment and the number of hours they work each shift. (Previous timescale of 23/05/05 not met). It also refers to ensuring that agreed minimum staffing levels are met at all times. The duty roster must include all persons working at the home and a record must be kept as to whether the roster was actually worked. The person registered must evidence robust and safe recruitment procedures and have all the required records and documents available at all times.(Previous timescales from 18.02.04 not met). The person registered must ensure that all staff receive training to the work they are to perform. (Previous timescales from 18.02.04 not met) This refers to induction training, basic mandatory training such as moving and handling, fire etc and resident specific training. The person registered must make arrangements for staff to be trained in first aid. The registered manager must demonstrate that they have the skills and training to manage the home effectively. (Previous timescale of 22.11.04 not met). The registered provider must demonstrate that they are carrying on the home with sufficient care, competence and DS0000015564.V282876.R01.S.doc 01/02/06 01/02/06 01/02/06 01/04/06 01/04/06 01/02/06 01/02/06 Valentine Lodge Version 5.1 Page 28 26. OP33 24 27. OP35 17(2) Sch 4(9) 18(2) 26 28. 29. OP36 OP37 30. OP38 23(4)d 31. OP38 23(4)e 32. OP38 13(3) skill and undertake any necessary training to ensure this. The registered person must ensure systems are in place for monitoring and improving the quality of the care services provided by the home. ( Previous timescales from 18.02.04 not met). A record of all monies and valuables received on behalf of residents must be available in the care home for inspection. Staff must be appropriately supervised. (Previous timescales from 29.06.04 not met.) Monthly reports must be undertaken by the registered provider to a degree that allows him to form an opinion of the standard of care provided in the home and other matters as required by Regulation. The person registered must ensure that staff working at the care home receive suitable training in fire prevention. (Previous timescale of 22.11.04 not met). The person registered must ensure that staff working at the home participate in regular fire drills. (Previous timescale of 22.11.04 not met). Not inspected on this occasion, carried to a future inspection. The person registered must ensure the safety of the water storage system and undertake appropriate risk assessment and actions. Not inspected on this occasion, carried to a future inspection. 01/04/06 01/02/06 01/03/06 01/03/06 01/03/06 01/02/06 01/02/06 Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 29 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 OP1 OP3 Good Practice Recommendations The Service User Guide and Statement of Purpose should be made available prior to admission to the home. The home should have a dependency rating assessment tool, to be used regularly to assist with monitoring staff training and staffing levels. (Outstanding from the last inspection). Risk assessment should be undertaken to determine if any resident could self medicate.(Not inspected on this occasion, carried forward to a future inspection). The complaints procedure could be written in bigger print and be in a suitable format for residents A written programme of maintenance, decoration and renewal should be available. A review of the lighting levels in residents bedrooms should be undertaken. 50 of care staff should achieve NVQ Level 2 The registered manager should achieve NVQ Level 4 in Management and Care 3. 4. 5. 6. 7. 8. OP9 OP16 OP19 OP25 OP28 OP31 Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Valentine Lodge DS0000015564.V282876.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!