Inspection on 14/06/06 for Valentine Lodge

This inspection was carried out on 14th June 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 01/02/06

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 Key Unannounced Inspection 14th June 2006 08:15 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.V298385.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. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 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.V298385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing care to be offered to no more than 20 older people. Accommodation and nursing care to be provided for one person whose name is known to the Commission who is diagnosed with vascular dementia. 26th April 2006 Date of last inspection 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. The weekly fee range is £470 to £500 per week. Additional charges/costs are incurred by residents relating to chiropody, purchase of some personal toiletries and hairdressing. This information was detailed in the pre-inspection questionnaire. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken as part of a key inspection of Valentine Lodge by two inspectors, Bernadette Little and Michelle Love, who together spent 18 hours at the home that day. 5 residents, 2 visitors, 4 staff, the registered manager and the registered provider were spoken with. A tour of the premises was undertaken and records, policies and procedures were sampled. Case tracking was undertaken in relation to three of the thirteen residents living at the home at that time. A pre-inspection questionnaire was received from the home prior to the site visit and information from this document was also used to inform this report. Discussion of the inspection findings took place with the registered manager throughout the inspection and guidance and advice was given. Survey forms were sent to five funding authorities with a request for comments and information regarding Valentine Lodge. No responses were received. Responses to survey forms were received from each of five GPs contacted and information is contained in the body of the report. Completed questionnaires were received from five users of the service and from four relatives. No additional comments were included and the information received from the tick boxes is reflected throughout the report. The Commission has had ongoing concerns about this home and the continued failure to meet Regulation and National Minimum Standards. As part of the Commissions monitoring of the home a random inspection was undertaken on 26th April 2006. The registered manager and the registered provider have not, to date, demonstrated effective management of the service/business. There was some evidence at the site visit of 26th April and also in this inspection that some action had been taken to address the number of outstanding requirements and recommendations from previous inspections. This however was limited and National Minimum Standard and Regulation were again not met in the majority of cases, with Immediate Requirement Notices being issued again regarding the safety of the fire doors. The registered person must demonstrate a pro-active approach to meeting Regulation and National Minimum Standards and provide a detailed and time specific Action Plan to the Commission in response and to this report. The Commission will continue to monitor Valentine Lodge. The assistance of all at Valentine Lodge during this site visit is appreciated. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 6 What the service does well: 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.V298385.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 Valentine Lodge DS0000015564.V298385.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Interested parties were provided with information and opportunity to visit to allow them to make an informed choice. The accuracy of the information was not always clear. Residents had been assessed prior to admission, but this was not followed through by the home confirming that they could meet the identified needs. EVIDENCE: Since the last inspection, the home has provided the Commission with an appropriate Service User Guide and Statement of Purpose. A copy of the Service User Guide and the most recent inspection report was clearly accessible in the entrance hall near to the visitors signing in book. Contracts were not available for inspection for any of the four residents files sampled. The registered manager stated that she insists that the service user or their family visits the home initially and they will be given a brochure. Following this she will undertake an assessment prior to admission, and once agreement Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 9 is reached to admit, a copy of the Service User Guide and Statement of Purpose will be sent to the family. Pre admission assessments were in place on two recently admitted resident files sampled. Both contained a copy of the COM 5 (the funding authoritys assessment) one of which was particularly well detailed. The files contained an NHS assessment of nursing needs. Both files also showed a preadmission assessment undertaken by the registered manager at Valentine Lodge. While these were noted positively to contain more detail than previously, they still did not contain confirmation that the home had considered all areas of the residents needs. The preadmission assessment contained a tick box so that the assessor could identify if the home could meet the needs of the resident. There was no evidence on the file that the home had written to the prospective resident, confirming, that based on the preadmission assessment, the home could meet their needs, as required by Regulation. The family of a prospective service user were being shown around the home by a senior care staff. When asked by the family if staffing levels reduced at other times of the day, the senior carer did not inform the family that the afternoon staffing level is lower, and that the home have regularly reduced the staffing levels with the explanation that they have had fewer residents accommodated. It was also of concern that the senior carer informed the family that all residents are put to bed before the day staff go off duty at 8pm. Valentine Lodge does not offer Intermediate Care. Valentine Lodge DS0000015564.V298385.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care management documentation does not identify all aspects of the person’s individual needs and does not contain an accurate and sufficiently detailed plan to ensure that these can be met for each person. EVIDENCE: Care plans were in place on all resident files requested for sampling. Photographs were not available on two of the three files sampled. As identified to the registered manager at the random inspection in April 2006, the home’s documentation is titled Care Plan, Plan of Care Plan - Assessment, a title that could be confusing. The registered manager stated that this is done on the resident’s admission, and if there were any changes these would be recorded in the Nursing Care Plan document for their nursing needs, but it does not lead to a fuller plan of the person’s care. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 11 The Care Plan Assessment sampled covered the main areas, but provided limited instruction in some areas in the actual plan of care to be delivered and how it was to be achieved. An example of this was noted where a resident was stated as catheterised, unable to give themselves drink or food and the assessment indicates they are to be encouraged to take fluids to help prevent urine infection. The care plan does identify a preference for cold drinks but gives no clear instructions for staff on when and how drinks are to be offered and supported. No fluid monitoring chart was being maintained. The nursing care plan one month later identifies that the resident has been prescribed antibiotics as they have a urine infection. This residents documentation states that they are unable to communicate verbally. While not completely clear in speech, the resident verbally informed the inspector that they did not like the food at Valentine Lodge, was able to say what food they would like, that they are comfortable in the home and that one carer hurts them on their right side. This residents relative stated that this was probably due to their arthritis and that they would follow this up with the staff. There was no reference on the residents file of them having arthritis. One resident file showed that they were at very high risk in relation to developing pressure sores. A risk assessment was in place that advised four hourly turns and the use of appropriate creams. No care plan was in place that identified how and when the creams were to be used. No record of turns was maintained in the care notes and no turning chart was available in the resident’s room. Relatives’ signatures were seen on the care plans, which is positive. Care notes are not always written regularly and there were no night care notes in some cases. A resident’s care notes identified that they seemed unwell and possibly had had a CVA and were to be monitored. There were no more entries in the care notes for five days, although a record of GP visits identifies that the resident was seen on the fourth day. It was noted positively that residents had been registered with and seen by a GP as part of their admission. In the survey responses from GPs, some stated that they had limited comment to make due to limited contact with the home but, for example, they had no cause for concern expressed to them by the patients or family regarding the residents’ care in the home. Two confirmed that the home communicate clearly and work with them, that staff demonstrated clear understanding of the care needs of residents, that medication is appropriately managed in the home and that they are satisfied with the overall care provided to residents. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 12 A resident care plan said they are to see the chiropodist 6-8 weekly. A senior nurse stated that a communal record was maintained of this and was advised that communal records are not appropriate. On inspection of this record it was determined that there was a separate page for each resident but entries had stopped in September 2005, and senior staff were not aware of this. It was noted that some staff hoisted an individual resident from their armchair but other staff did not and lifted this resident under the arms, which is inappropriate practice. It was noted positively that there were no omissions on the Medication Administration Records {MAR}. It was noted however that for one resident, a medication was already signed for, for the following day. The homes list of staff signatures/initials for those able to administer medication had been updated. There was a clear records depicting medication received and returned. The dedicated fridge was observed not be locked but fridge temperatures were recorded and observed to be appropriate. Controlled drugs were maintained for two residents. Records and actual medication tallied and were stored appropriately. Medication administration was observed and noted to be satisfactory. The home has its own medication policy and procedures. There was no homely remedy policy available. The home did not have a copy of the Royal Pharmaceutical Society Guidelines for the Administration and Control of Medication in Care Homes. ‘Medical Usage’ as a heading in the care plan/assessment for residents identified only for example “all medication to be administered by staff”. Protocols had not been devised for ‘as required’ {PRN} medications. An incident was noted where a member of staff approached a resident and help them to rearrange their clothes so that they looked better. This was done with consideration. Other incidents were noted where some staff more than others paid attention to the residents dignity when hoisting them. Comment cards indicated that residents felt that staff respected their privacy. Information on the care plan in relation to ‘Death and Dying {Optional}’ for the resident for whom their religion is recorded as being very important to them showed no reference to the residents wishes being sought or to end of life religious care being considered with the resident or their family. Valentine Lodge DS0000015564.V298385.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident preferences and wishes were not clearly shown to be sought and there was no plan of how they were to be met. Valentine Lodge did support residents to maintain contact with family and friends. Residents’ views on the food were varied. EVIDENCE: Staff advised that an activities coordinator is employed three hours twice each week. There is no evidence on the staff roster of an activities person or of any staff being designated to this role. On the day of the site inspection no activities were observed to be undertaken with residents in the main lounge. The majority of residents in this lounge sat in their chairs around the room with a television on. Some residents did watch the programmes and one had a visitor. Staff interaction with residents was limited. Some more able residents in the other lounge were involved in some of their own activities for example puzzle books and reading. With regard to offering choices to residents in any other way, a member of staff advised that they try to rotate which residents they get up first in the morning to be fair. A staff members comment that all residents are put to bed before day staff go off duty at eight oclock in the evening, should be reviewed Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 14 with staff by the person registered. However, a resident spoken with advised that they go to bed later in the evening and at a time that suits them. Records identified that relatives regularly take residents out into the community. There was no evidence that demonstrated that staff regularly offer residents the choice of outings to the local community shops etc. A topic of social interest, hobbies, religious and cultural needs on a care plan identified that the resident used to attend their local church, that their religion was very important to them and that the church has been contacted to request they visit the resident. This was written five weeks prior to this site inspection. There was no plan to determine whether the resident could be taken to the local church, whether their wishes had been sought as to whether they wanted to be taken there, or whether anyone from the church had actually visited the person. The other information on this subject identified that the resident appeared to enjoy visits from a relative and liked having the TV on in their bedroom. Inspection of the visitors’ book and resident care notes as well, as discussion with residents and visitors, confirmed that visitors are welcomed and encouraged to come to Valentine Lodge. Of the five resident comment cards received, four said they like the food and one said they liked it sometimes. A detailed pre-admission provided by a social worker identifies that nutrition is an area that needs monitoring and dietary supplements are required. No nutritional risk assessment was available and there was no information in the care plan regarding supplements. This indicated that the resident could choose their own soft diet. Valentine Lodge uses a four-week rotating menu. This does not indicate any choice at mealtimes. A resident spoken with advised that they do not like the food and are not offered a choice. Two residents confirmed that lunch had been okay and one said it was a nice. A mid-morning drinks trolley routine was observed. Residents were not offered a choice of drinks. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most interested parties were aware of the complaints procedure and felt confident to raise concerns. The homes approach to the protection of vulnerable adults continues not to best safeguard residents. EVIDENCE: Information on the homes complaints procedure was displayed in the area near to the lounge and office. The Pre inspection questionnaire states that one complaint had been received by the home in the past 12 months and had been partly substantiated. Staff advised that no complaints had been received by the home since the last inspection. A comments and suggestions book is available in the entrance hallway. The Commission for Social Care Inspection have received no complaints regarding Valentine Lodge since the last inspection. Following previous instances where concerns and complaints were not recorded by the home, they have now recorded issues raised by residents, including informal concerns/incidents, which is positive. Comment cards from five residents stated that they would know who to speak to if they were unhappy with their care. Comment cards from four relatives indicated that three of the four were aware of the homes complaints procedure. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 16 Most of the staff have received training on abuse awareness and the protection of vulnerable adults. The inspection of Valentine Lodge in February 2006 identified that two concerns had been referred under Protection of Vulnerable Adults guidance {POVA} and were being investigated. No clear outcome had been achieved by the time of the random inspection in April 2006. Formal outcomes have since been reached and the Commission and the home have been informed by Social Services, who co-ordinated the investigation. It was found that the outcomes were not possible to determine as to whether or not the events had occurred, as the residents themselves were unable to give a clear view due to their particular needs/abilities. A senior care assistant spoken with, and who has received the recent training, was clear as to the action to take within the home to protect a resident in such an instance, but was unsure as to who to contact/inform for example social services and/or police or the Commission for Social Care Inspection. Another senior carer confirmed that they had not received POVA training although they have worked in the home for a number of years. This staff member was unsure of the correct procedures and could not demonstrate a basic understanding of appropriate practice. Discussion with another carer confirmed that they had recently undertaken POVA training. They had not read the policy and procedure on whistleblowing. They said they may have seen a policy and procedure on protection of vulnerable adults, but not recently and when shown the current booklets on guidance for staff issued by Essex County Council, they confirmed they had not seen them. The registered manager was advised to ensure that all other staff receive training as soon as possible. They were also recommended to devise a simple guide for the home depicting clear steps to be taken and linked to appropriate guidelines. Valentine Lodge DS0000015564.V298385.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home continues to provide concerns in relation to fire safety, which does not best protect residents. The tired décor, high level of shared rooms, and poor maintenance do not best provide residents with a pleasant and homely environment. EVIDENCE: All areas of the premises were looked at. Several fire doors were seen to be wedged open. These were not fitted with automatic self closures in the event of fire. The fire alarm activated twice during this site visit. Two of the main fire exit doors were found by the inspectors to be extremely difficult to open. The registered provider attempted to fix the fire exit doors with a screwdriver. Some internal fire doors did not close properly and therefore did not provide appropriate protection. An immediate requirement notice was again issued to the registered provider to address this matter effectively and without delay. In a written response to the Commission regarding previous concerns with the fire doors, the registered provider advised that a procedure had been put in Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 18 place to check fire doors weekly and that immediate action would be taken where necessary. This had clearly not occurred in an effective manner. A fire exit door from the first floor was not alarmed. This could present a risk and advice was provided to the registered provider and the registered manager. All but one of the eight single bedrooms on the first floor were vacant. All six of the double rooms on the ground floor were occupied. Some of the bedrooms inspected on the ground floor had peeling wallpaper and damaged paintwork. None of the residents bedroom doors were fitted with locks. The viewing window in the doors presents an institutional appearance and does not support an ethos of giving regard to residents’ privacy and dignity. Privacy curtaining was fitted in the rooms. The main bathroom floor continues to look to be 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. A previous Environmental Health Officer report noted the flooring in the kitchen was highly textured and difficult to clean and trapped grease and dirt around the raised areas, and that this must be brought to a clean condition. It strongly recommended replacement with an easy to clean surface covering. This had not been undertaken and although the floor had clearly been washed, dirt and grease was noted around the raised areas. The registered provider’s previous written response to this issue is that complete redecoration will take place as finances allow. The laundry was again noted to be clean and tidy. The hot water in the hand washing sink was tested at the last inspection as being at 65.5°C and steaming hot. This continued to be too hot to touch at this site visit. The registered providers previous written response to this issue is that the laundry sink is only used by staff members. This demonstrates a lack of understanding of appropriate measures to manage cross infection that would allow staff to wash their hands after handling dirty/soiled laundry. The registered provider has not identified a specific date by which time an appropriate and safe outside area will be available to residents. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate staffing levels and staff deployment have not always been maintained. Staff recruitment files continue not to evidence appropriate records. There is a positive approach to NVQ training. There are gaps in basic staff training. EVIDENCE: The agreed staffing levels at Valentine Lodge are one qualified nurse and four care staff on the morning shift, one qualified nurse and three care staff on the afternoon shift and one qualified staff and one carer on the night shift, both awake. Rosters were sampled for a four-week period. These demonstrated regular occasions where staffing levels were reduced to one nurse and three care staff of the morning shift and an occasion where there was one nurse and two care staff on shift. While there have been reduced numbers of residents at the home, the home need to inform the Commission at anytime when staffing levels are reduced. The home must ensure that there are adequate staffing levels at all times to meet residents needs, rather than just basing it on the number of residents in the home. The homes pre inspection questionnaire identified that there are five residents who required two or more staff to undertake their care during Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 20 the day and seven residents who required two or more staff to undertake their care at night. Staff deployment around the home is also an issue. Again, there was limited staff presence in the main lounge for long periods of the day. The ancillary roster for the kitchen records on occasion relief. The roster must identify the name of the person and the hours each person works at the home in each role. The roster also indicated on some occasions that staff are working double/long day shifts. The registered manager stated that this was to provide cover rather than use agency staff. The practice of staff working planned long day shifts is not considered good practice and could put both staff and residents at risk. Each of the four resident comment cards received confirmed that residents felt that staff treated well. A resident spoken to said that staff were alright and a visitor said that the staff were very nice and friendly. Three of the six files sampled evidenced that the staff had achieved NVQ level 2, which is positive. The homes administrator advised that six care staff have completed NVQ level 2 training, two care staff are not currently attending the training and one expects to start an NVQ course on the day following this site visit. The Pre Inspection Questionnaire advised that no new members of staff had been recruited since the last random inspection and this was confirmed as accurate on the day of this site visit. None of the six staff files sampled contained a photograph, as required by Regulation, and as identified as a requirement in previous inspection reports. None of the six files sampled contained evidence of the health declaration. Four of the six files sampled did not contain evidence/proof of identity. While it is understood that most staff have been in post for some time, there is no reason why current photographs, evidence of identity and health declarations have not been included on the files. This information has been made known to the registered person on several occasions, and it continues to be of concern to the Commission that the registered person continues to ignore it and to remain in breach of Regulation. In relation to the basic mandatory topics, records indicated that four of the current staff have not had moving and handling training, two have not had fire Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 21 training, five have not received protection of vulnerable adults training and three have not attended training on food hygiene. The majority of mandatory training at Valentine Lodge has been through staff watching videos. The home were previously advised that this did not provide adequate practical opportunity or adequate assessment of competence to ensure a satisfactory level of staff skill and expertise to care for residents. It was noted positively that outside training for several staff has been arranged recently in moving and handling and dementia awareness. Information on the four hour dementia course and three hour practical client handling technique course content was provided. Staff spoken with advised that they were given practical instruction in the use of equipment and demonstrations. The course instructor subsequently confirmed that he was a qualified person to instruct in client handling, did not rely on video training, had been employed to provide part of his usual course content, and that staff had had practical instruction and competence assessment. At the random inspection of Valentine Lodge in April 2006 it was recorded that training was planned for a number of staff in issues such as managing aggression, risk assessments, promotion of continence and nutrition/PEG feeds and assessment. There was no evidence that this had occurred. Valentine Lodge DS0000015564.V298385.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management team have not evidenced the understanding of, or ability to, plan the business activity and manage the home effectively. EVIDENCE: The registered manager is a qualified nurse, but does not have any management training/qualification. The registered manager advised that while she had started the NVQ level 4/ Registered Managers Award, this was no longer the case as she had inadequate time while she was trying to sort everything out at the home and she cant use a computer, which made it difficult for her. In discussion, the registered provider stated that the Commission could not expect him to comply with Regulation and National Minimum Standard when Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 23 the home was struggling financially, having had so many vacant beds for so long. The registered provider was advised that it is his responsibility to manage the home effectively so that it remained financially viable. He was also reminded that the concerns regarding Valentine Lodge have been ongoing for some years and that Regulation and NMS had not been complied with during times when the majority of the homes beds were full. Minutes indicated that residents meetings took place approximately twice a year. The registered manager advised that a service user satisfaction questionnaire has been devised and is being given to newly admitted residents. It is envisaged that this will be conducted annually. Once the outcomes are collated and analysed and an action plan devised, a copy must be sent to the Commission. As required under Regulation 26, monthly reports have been completed by the registered provider. The registered provider was again advised that the information is limited, for example there is no evidence of follow up to actions taken from previous reports. Additionally there is no evidence that he looks at records such as care plans, medication records or staff files, and so cannot be discharging his duty of ensuring the management of the home and the care of residents is satisfactory and effective. The registered manager confirmed that Valentine Lodge does not look after money for any resident. No evidence of supervision was found on four of the six files sampled. A record of supervision was found for one occasion on each of the two other files sampled, both of which contained records of disciplinary action undertaken by the home regarding both members of staff. Current safety inspection certificates were available in relation to gas, hoists, passenger lift, fire equipment and the fire alarm system. The most recent electrical fixed wiring safety certificate was dated 2001. This recommended that the installation be further inspected and tested after an interval of not more than one year. The most recent portable appliance testing had been completed some 14 months ago. Records indicated that emergency lighting and fire alarm system are tested monthly. A fire assessment questionnaire had recently been completed. A record of fire drills indicated that these had been undertaken monthly. A record of the name of staff involved and the time was maintained in a separate book. Valentine Lodge DS0000015564.V298385.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 3 1 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 1 X X X 2 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 X 1 X 2 Valentine Lodge DS0000015564.V298385.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 OP2 Regulation 5(1) Sch 4(8) Requirement 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 and 26/04/06 not met). The person registered must ensure that a full assessment of the residents needs undertaken prior to admission by a person qualified to do so and the resident assured in writing that, based on the assessment, the home will meet these needs. Timescale for action 14/06/06 2. OP3 14(1) 14/06/06 3. OP4 18(1) The person registered must show 14/06/06 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). Not inspected on this occasion, carried forward. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 26 4. OP7 15(1) & 15(2)b 5. OP8 12 The care plan must contain 14/06/06 sufficient information to show how the residents’ needs are to be met, supported by appropriate risk assessment, and they must be kept reviewed and updated The person registered must show 14/06/06 that residents’ needs in terms of their health and welfare are identified and met. This refers to pressure area care and to care recordings demonstrating appropriate monitoring of residents’ health and welfare. 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 to 26/04/6 not met). The registered person must consult with residents and ensure they are provided with opportunities to develop and maintain links with the local community The registered person must ensure that residents are offered variety and choice of meals and drinks. The person registered must ensure the safety of residents by providing staff with clear and relevant procedures on Protecting Vulnerable Adults, including the Whistleblowing procedure and ensure that staff are aware of this. (Previous timescales from 18.02.04 to 26/04/06 not met). Arrangements to be made by the DS0000015564.V298385.R01.S.doc 6 OP12 16(2)m 14/06/06 7. OP13 12(2) 16(2)m 14/06/06 7. OP15 12(3) 16(2)j 13(6) 14/06/06 8. OP18 14/06/06 9. OP18 13(6) 14/06/06 Page 27 Valentine Lodge Version 5.2 10. OP19 23(2)c & d person registered to provide staff with training on Protection of Vulnerable Adults and management of behaviour that challenges. (Previous timescales from 18.02.04 to 26/04/06 not met). The person registered must 14/06/06 ensure that the home is kept clean, reasonably decorated and equipment is well maintained. This also refers to the cleanliness of the kitchen flooring. (Previous timescales from 29.06.04 to date not met) The person registered must ensure that fire safety equipment is maintained at all times. This refers to fire doors being wedged open, ensuring that fire doors close properly and fire exit doors being able to be opened easily in an emergency. The person registered must ensure that the external grounds are suitable and safe for residents and appropriately maintained. (Previous timescales from 31.08.04 to date not met). The person registered must ensure that there is adequate storage for equipment such as wheelchairs and hoists to avoid storage in resident’s bathrooms and bedrooms.(Previous timescales from 31.08.04 not met). Not inspected on this occasion, carried forward. 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.V298385.R01.S.doc 11. OP19 23(4)c(i) 14/06/06 12. OP20 23(2)o 14/06/06 13. OP22 23(2)l 14/06/06 14. OP26 13(3) 14/06/06 Valentine Lodge Version 5.2 Page 28 (Previous timescale of 26/04/06 not met). 15. OP27 18(1)a 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 and 26/04/06 not met). It also refers to ensuring that agreed minimum staffing levels are met. The duty roster must include the names of all persons working at the home, and a record must be kept as to whether the hours were 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 to date not met). The person registered must ensure that all staff receive training to the work they are to perform. This refers to induction training, basic mandatory training for all staff such as moving and handling, fire etc and resident specific training. Previous timescales from 18.02.04 to date not met) The registered manager must demonstrate that they have the skills and training to manage the home effectively. (Previous timescale of 22.11.04 to date not met). DS0000015564.V298385.R01.S.doc 14/06/06 16. OP27 18(1)a Sch4(7) 14/06/06 17. OP29 19, 17(2) Sch 2 & 4 14/06/06 18. OP30 18(1)c 13(5) 14/06/06 19. OP31 9(2)(b)i 14/06/06 Valentine Lodge Version 5.2 Page 29 20. OP31 10(1) & 2(a) The registered provider must demonstrate that they are carrying on the home with sufficient care, competence and skill and undertake any necessary training to ensure this. (Previous timescales of 01/02/06 and 26/04/06 not met). 14/06/06 21. OP33 24 The registered person must 14/06/06 continue to develop systems for monitoring and improving the quality of the care services provided by the home. (Previous timescales from 18.02.04 to date 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. Not inspected on this occasion, carried forward. Staff must be appropriately supervised. (Previous timescales from 29.06.04 to date not met). A photograph must be kept in the home of each service user The person registered must ensure that staff working at the care home receive suitable training in fire prevention. (Previous timescales from 22.11.04 to date not met). The person registered must ensure the safety of the water storage system and undertake appropriate risk assessment and actions. (Previous timescales from 26/04/05 to date not met). DS0000015564.V298385.R01.S.doc 22. OP33 26 14/06/06 23. OP36 18(2) 14/06/06 24. 25. OP37 OP38 17(1)a 23(4)d 14/06/06 14/06/06 26. OP38 13(3) 14/06/06 Valentine Lodge Version 5.2 Page 30 27. OP30 13(4) The person registered must make arrangements for staff to be trained in first aid. Not inspected on this occasion, carried forward. Additional information being sought. 14/06/06 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 Refer to Standard OP3 Good Practice Recommendations 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). Medication should not be signed for in advance of administration. The home should maintain a policy on homely remedies. The home should obtain a copy of the Royal Pharmaceutical Society Guidelines on the Control and Administration of Medication in Care Homes. Protocols should be in place for as required medications. The home should reconsider the use of glass viewing windows in residents bedroom doors. Residents’ wishes in relation to end of life care and practices should be ascertained and recorded in the care plan. The complaints procedure could be written in bigger print and be in a suitable format for residents. The registered person should ensure that the complaints procedure is made known to all interested parties. The doors of residents’ bedrooms should be fitted with safe and appropriate locks. Residents should be offered keys to their rooms unless risk assessment indicates otherwise. 50 of care staff should achieve NVQ Level 2 2. 3. 4. 5. 6. 7. 8. 9. 10. OP9 OP9 OP9 OP9 OP10 OP11 OP16 OP16 OP24 11. OP28 Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 31 12. OP31 The registered manager should achieve NVQ Level 4 in Management and Care. Valentine Lodge DS0000015564.V298385.R01.S.doc Version 5.2 Page 32 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.V298385.R01.S.doc Version 5.2 Page 33 - 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!