Inspection on 14/05/07 for Valentine Lodge

This inspection was carried out on 14th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Valentine Lodge 02/10/08

Valentine Lodge 08/10/07

Valentine Lodge 29/01/07

Valentine Lodge 14/06/06

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 Unannounced Inspection 14th May 2007 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.V338410.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.V338410.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 valentinelodge@hotmail.co.uk Valentine Lodge Limited Manager post vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Valentine Lodge DS0000015564.V338410.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. 29th January 2007 Date of last inspection Brief Description of the Service: Valentine Lodge is registered to offer accommodation with nursing care for twenty older people, including one resident who has dementia and whose name is known to the Commission. 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 £457 to £525 per week. Additional charges/costs are incurred by residents relating to chiropody, purchase of some personal toiletries and hairdressing. This information was provided by the acting manager. Valentine Lodge DS0000015564.V338410.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. Five residents, four visitors, three staff and the acting manager 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 fourteen residents living at the home at that time and additional records were sampled for specific issues. Information was subsequently requested from care managers/social workers and healthcare professionals regarding Valentine Lodge. Comments from residents and relatives, including from completed questionnaires and telephone conversations are also reflected throughout the report. This is the first key inspection of this home this year. The Commission has had ongoing concerns about this home and the continued failure to meet Regulation and National Minimum Standards. An immediate requirement form was left with the home at this site visit relating to concerns regarding medication management. Additionally, the home was subsequently served with a Statutory Enforcement Notice because of the concerns regarding poor recruitment practices. Discussion of this inspection site visit findings took place with the acting manager during the site visit. Full feedback was provided to the acting manager, and to the registered provider who was present for part of this time, and guidance and advice was given. The further improvements made by the acting manager are noted positively and some requirements and recommendations from the last inspection report have been met (several others have been combined into each of the requirements contained in this report). However, the improvements made have not been adequate to demonstrate effective management of the home or change the homes’ assessed rating level. The registered provider has not, to date, demonstrated effective management of the service/business. The Commission will continue to monitor Valentine Lodge. The inspectors would like to thank the acting manager, staff team, residents, relatives and professionals who participated for their help throughout the inspection process. What the service does well: The entrance area is bright and provided useful information for residents and visitors. Residents can have visitors at any time, and those visitors are always made welcome. If residents or relatives have any concerns, worries or opinions they can raise these with staff at the home and will be listened to. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 6 Staff at the home were welcoming and helpful. Comments included “ the staff care for mum as if she was one of their own family”, “ the staff look after mum and she do given the care and respect that she deserves”, “it is with good humour and great affection. They try to create a very happy atmosphere which is important”. 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. The summary of this inspection report can be made available in other formats on request. Valentine Lodge DS0000015564.V338410.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.V338410.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 Quality in this outcome area is adequate. Prospective users of the service had some information to help them make choices. People can be sure that their needs will be assessed before they move into the home. These would be better met by additional specialist and training for staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service user guide were available in the entrance hallway. A recent letter on file from a relative confirmed receipt of both documents. Discussion with relatives confirmed that they felt that they had access to enough information about the home. The statement of purpose stated that the person officially registered to manage the care home is Mrs Jill Slater. This is inaccurate as Mrs Slater is not registered to manage the home and currently there is no registered manager at Valentine Lodge. It describes her qualifications and experience as being “Enrolled RMA”, which could be misleading in a nursing home as it simply refers to the fact that she has enrolled on the registered managers award course and has no relation to the qualification of Enrolled nurse. Additionally Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 9 the current service user guide refers to the registered acting manager, which is again inaccurate. Files for the new residents sampled contained a statement of terms and conditions that contained information on the fees and who was responsible for payment. Additionally confirmation of funding was on file where appropriate, including which room was involved, the weekly cost and that this was for a single occupancy. Files sampled for more recently admitted residents contained a pre-admission assessment document. This contained basic information and was signed and dated. It led to a tick box sheet considering whether or not the home could meet their needs. A letter was also on file to the person that confirmed that based on the assessment undertaken the home could meet their needs. These are positive developments. The sections on staffing, on premises and management later in this report give information on some limitations on the homes ability to meet the needs of residents. Visitors/relatives spoken with confirmed that they were able to visit the home prior to their relative being admitted. Valentine Lodge does not offer intermediate care. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. Residents’ care and health needs were not always clearly detailed to support staff to provide residents with consistent and individual care. Residents are not safeguarded by medication practices at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for three recently admitted residents were tracked and others sampled. The new residents’ files contained photographs of the residents. The persons likes and dislikes were recorded and incorporated into the care plan, which demonstrates respect for the person, for example in relation to food and drinks or times for getting up and going to bed. The care plan covered some areas of the resident’s assessed needs with clear instructions for staff to follow on how to meet these for each person. They included reminders for staff to offer support without infringing a resident’s rights, or to allow the person to do what they still could for themselves or identified parts of their personal care that were particularly on important to that persons dignity. Some sections of the care plan were supported by other records, for example foot care was followed by a record of chiropody visits. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 11 It was disappointing to note that residents who were able had not been offered the opportunity to sign their care plans to confirm that it had been read to them and they had agreed it. There was no signature from a relative that they had acted for the resident where appropriate. A sheet at the end of the care plan was signed as the overall review of the care plan by the acting manager. Advice was provided on ensuring that residents, or relatives where the resident is unable, have opportunity to read and sign each part of the care plan, and a recommendation made that each part of the care plan is shown to be considered and reviewed. Two staff were observed to provide care for a resident that followed the instructions identified in the care plan, providing encouragement and clear instruction to the person, and addressing them by name. Positive interaction was noted between staff and residents on several occasions throughout the day. Risk assessments regarding pressure areas were in place on the three files tracked, which is good preventative practice. It was disappointing that, where all of these indicated that the residents were ‘at risk’ or ‘high risk’, no care plan was in place on any to support good care management. One resident had a pressure sore that was acquired before coming to Valentine Lodge. It was noted that the home had accessed the support of the tissue viability specialist nurse who had provided advice and recommendations. The acting manager was advised that this information should have been used to support an individual plan of care. Where the resident was advised as having two hourly turns, the records in the resident’s room showed gaps, in one case of almost ten hours during the day, where this was not recorded as having occurred. This information has been explained to the acting manager previously and was identified in the last inspection report. Risk assessments regarding falls were in place, which is good practice. Where this indicated a score of zero for one person, bed rails were in place. There was no risk assessment to indicate why these were considered appropriate, the involvement of a multidisciplinary team, whether they themselves presented a risk to the person in relation to their size, weight, any other equipment being used etc, and no care plan was in place relating to their use for this individual person or their maintenance and monitoring. This information has been explained to the acting manager previously and was identified in the last inspection report. An agreement for the use of bed rails was on file and signed by the acting manager. There was no signature by the resident or their relative to show that agreement was sought and that the issues relating to bed rails had been explained to them and accepted. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 12 The care plan for an additional resident was sampled following observations. Care notes sampled indicated increasing anxiety and changes in behaviour for this person including the fact that they had hit out at a member of staff, and on occasions were not able to eat or sleep properly because of their anxiety. It was noted positively that the acting manager had requested a medication review. Notes were recording whether or not the resident was eating or drinking well. The resident’s weight was being monitored regularly and shows the loss of approximately one stone in weight in four months. No care plan had been written to instruct staff on how to manage the situation effectively for the resident’s well-being. One resident was identified as having diabetes. While some reference was made to this in other aspects of the care plan, there was no actual care plan in place on how to manage this aspect of the residents’ health care needs. There was limited evidence of any staff training in relation to this specific health care need. Moving and handling assessments were noted to have better information, for example most explained which hoist or sling was to be used for individual residents. Two of the three new resident file samples confirmed that the person had had an initial checkup with a GP. A relative advised that the home had monitored a resident’s well-being, noted they seemed to be unwell and took appropriate action. Care plans included medication/medical usage, which is positive. Records evidence the names, initials and signatures of the six qualified nursing staff identified by Valentine Lodge as those competent to administer medication. There was no evidence of staff training regarding medication administration, which would be expected as there have been concerns noted on several occasions regarding the management of medication. Medication Administration Records (MAR) were inspected and these are now pre-printed at the pharmacy. It was noted that these were not signed and dated by staff at Valentine Lodge to record the medication received for each person and that the quantity was correct. The MAR indicated occasions where information on the administration of medication to residents were scribbled out, with no written information as required on the back of the sheets to explain this and whether the medication was given or omitted. A medication for another resident was stopped but there was no explanation of who instructed this and the rationale behind it. Information on medications were handwritten on some MAR sheets, with no signatures to confirm the accuracy of this. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 13 No protocol was available in relation to a resident’s medication that was administered ‘ as required’ (PRN). For another resident who was regularly refusing their medication there was no risk assessments available on the care plan. The acting manager stated that while no protocols could be located at the site visits for PRN medications, they had been devised. She also advised that the home would not have a homely remedies policy as recommended at the last inspection, as they have decided not to accept any homely remedies for residents. Omissions were noted on some MAR records, and it was unclear whether the residents had been given their medications on these occasions or not. The acting manager confirmed that she had met with all the qualified carers following the last inspection to discuss the legal requirements in relation to medication practices and the other concerns raised in that report, which included the issuing of an Immediate Requirement Notice. Inspection of the Controlled Drugs were appropriate for one resident. Concerns were noted in relation to the Controlled Drugs for another resident, where liquid temazepam was not recorded or signed when the bottle was opened and commenced. While difficult to measure accurately, the acting manager agreed that the amount of medication remaining in the bottle did not tally with the amount in the register. Additionally a second bottle was also found in the cupboard for the same resident, with no date recorded as to when this was opened/started and no record on the MAR that it had been brought into the home. It was unclear as to whether this had been used as well as the previous bottle or not. It was noted that while no entry was recorded for a specific date for this resident’s temazepam, the tally of medication administration continued. These concerns led to a further immediate requirement notice being issued to the home in relation to Controlled Drugs Medication procedures/records. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. Residents were supported to participate in some social and leisure activities at times and could make some choices about their daily lives. Residents know that their visitors will be made welcome. Food at the home was varied and enjoyed by residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities co-ordinator had recently been appointed and confirmed that she works three hours a day, five days a week. A file of information was available which she explained was gathered from sitting with residents to ascertain their likes and interests. This was contained on an individual sheet and a record maintained of their choice of involvement or not, in each day’s activities. Activities seen during the site visit included reading, discussion on current topics, music, and ball games, and occurred in both lounges. Assessments/care plans also contained better information on resident’s interests that the activity coordinator was clearly aware of, for example in relation to the preference for a daily newspaper, a particular author or a favourite football team. It was noted positively that a hand massage was offered to a resident who was not easily able to participate in the other activities or communicate verbally. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 15 Some residents went out regularly with family and friends. Records sampled also showed that another resident had been out with staff to the seafront at Canvey and to get an ice cream. Residents and visitors spoken with at the site visit or subsequently confirmed that they were free to visit regularly and were always welcome. A record of visitors was maintained. Some residents also have visitors from the church. Discussion with residents and relatives indicated that residents do exercise some choices and control over their lives, for example whether or not to join in activities, or stay up late to watch the sports programs on television in the lounge. Please also see the information in the section on complaints, which indicates that not all staff respected residents’ rights in this way. Inspection of the food monitoring charts for residents showed variety with an alternative meal available. The meal on the day of the site visit was ham, eggs and chips, which the cook advised was one of their favourites. Residents’ comments regarding the food were positive with comments such as “ I like egg and chips” and “ I look forward to this every week”. Residents had a choice of meals at teatime for example sandwiches or something hot like jacket potatoes. Tables were pleasantly set with condiments. A small chalk board advised residents of what was to be served at the next meal. It was suggested that this information could be displayed for residents in a way that would make it easier to see. Residents who required specific assistant with feeding were provided with appropriate support, and all but one staff member sat down rather than standing over the resident. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. Residents feel able to express any concerns and have their views listened to. Residents were adequately safeguard it by staff knowledge on protection but would be better served by better management and knowledge of behaviour that challenges. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information on the complaints procedure was displayed in the hall. It was in a sized print that enabled it to be read more easily and referred to contacting the social worker or funding authority as another avenue to raise concerns. The acting manager had maintained records of complaints received, which is positive. One of these was made by a resident relating to poor care where they had not been got up when they asked us to be. The member of staff was spoken to by the acting manager and advised it was not acceptable to ignore a resident’s request simply because they were busy. Action recorded as taken by the acting manager was for the member of staff to be given monthly supervision by a qualified number of staff. A second complaint of poor care was made by the same resident shortly afterwards regarding as a member of staff and the same issue. Records indicated that a meeting with the acting manager determines that no protection of vulnerable adult issues were raised but that training on this issue was to be attended by the staff member the following month. The staff member’s name no longer appears on the rota. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 17 The staff training list for 2007/08 indicates that a 13 staff have undertaken training on protecting vulnerable adults very recently, which is positive. A random sample of files provided certificates that evidenced this training. None of the files sampled evidenced any training for staff in relation to managing aggression or positive responses to behaviour that challenges. This was also identified in the last key inspection report of January 2007. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. Residents are offered an improving environment that was clean and brightly decorated. Residents may face some limitations in relation to preferences for privacy, This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements are noted to the premises. This includes completion of the decoration program that incorporated lightening the colour schemes in the corridors and bedrooms. A garden area has been sectioned off and provided with a security gate. A small storage room has been built, as has a small garden room. The manager advised of plans to provide some plants and flower baskets in this area so that it will become a pleasant area for residents to sit in. The large window in the smaller lounge has been replaced, which increased the natural light for residents and also provides opportunity to see out over the new garden area. The acting manager advised that new carpet has been Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 19 quoted for but not yet ordered for this room, which has been identified in previous inspection reports as a potential tripping hazard. The glass viewing panels in bedroom doors have been permanently covered providing more privacy and dignity for residents. Bedroom doors were still not fitted with appropriate locks, which does not promote privacy and dignity. Furniture in some bedrooms remains shabby and damaged. The acting manager advised that new furniture has been ordered for five bedrooms. Some bedrooms were pleasantly personalised. Valentine Lodge has a large number of double rooms on the ground floor. One resident would have liked a single room and is happy to wait for this to be available on the ground floor, while, as there are a number single rooms empty upstairs, the lift is unable to accommodate the wheelchair. Staff spoken with confirmed that the lift is limited in space to accommodate residents’ wheelchairs. A strong odour was noted in one bedroom. The acting manager later reported that a catheter bag had been inappropriately connected and it had leaked all over the floor during the night, but staff had not communicated this to the day shift so that it could be actioned. Fire doors in corridors are now fitted with automatic door closures that remove the need for them to be wedged open. There is an entry keypad system on the door to the kitchen and also the laundry to protect residents. The acting manager advised that there has also been a thermostatic control valve placed on hot water tap in the laundry. The downstairs bathroom was cleaner and tidier with all the clutter having been removed. A blind and pictures had been fitted to make it more homely. The flooring remains tired and needs to be placed into the homes maintenance/ improvement plan, along with the kitchen flooring which, while cleaned regularly does not present the best surface in relation to infection control. The upstairs bathroom was also tidier and no longer had an unpleasant odour. Bath chairs were seen to have labels confirming that they had recently been inspected. Residents and relatives is spoken with expressed views that perhaps the premises is not the best decorated or furnished, and that they have made suggestions in residents meeting, that changes are occurring and therefore they find the situation acceptable, particularly balanced against what they view as a homely and friendly atmosphere. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. Residents and relatives were offered positive relationships by staff. Residents were not well protected by the homes recruitment procedures, staff monitoring and some aspects of staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff interaction with residents was seen to be friendly and kind. Comments from residents and relatives were particularly complimentary regarding the staff. Comments included “ they are very friendly and helpful” “ the staff do everything possible for mum and more”, “ are always cheerful and try their best to cater to everyone”. Records showed that three of the ten car staff have achieved NVQ Level 2. As additional residents have been admitted, the home had increased their staffing levels, which is positive. Staffing levels were advised as one qualified senior and three care staff during the day and two waking night staff including a qualified nurse. Several occasions during the day were again observed at this site visit were staff were not monitoring lounges for periods of time. A relative spoken with advised that they had raised concerns that at times when staff are very busy, their relative gets forgotten and may sit alone waiting for assistance for up to forty minutes, which caused some distress. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 21 Rosters sampled showed occasions when there was only one member of night staff recorded as on duty, with the addition of the word agency but no name of the person who was providing care to residents that night. The current weeks rota did not record the acting manager hours. It also needs to clarify that she is not registered in any capacity to manage the home. Rosters show some staff working double shifts and on occasion staff working excessive hours for example 63.5 or 67.5 hours per week. A person seen to be working at the home was confirmed as employed there but was not detailed on the rota. Staff recruitment files now contain a recruitment checklist, which is positive. Job descriptions were noted on the files sampled for the care assistant and qualified staff but not for the activity coordinator or ancillary staff. Inspection of one file showed that employment history or the reason for leaving current employment had not been explored, there were no written references, no induction and only a standard level of record bureau check. Another file sampled showed gaps in employment history not explored, only one written reference on file, no evidence of induction and only a standard level criminal record bureau check. Additional files sampled for recently recruited staff also showed poor recruitment practice. Files were sampled for long serving staff and from this it was noted that some staff still did not have an appropriate criminal records bureau check relevant to this employment. This had been raised in inspection reports previously. Due to the continuing failure to meet registration requirements, a Statutory Enforcement Notice was served on the home subsequent to the inspection, requiring them to undertake appropriate references and checks on all staff to safeguard residents. A training plan for 2007/08 was provided. It was noted positively that it records that 18 staff have undertaken health and safety training, 13 staff have undertaken food hygiene training, 13 staff have undertaken training on protecting vulnerable adults, 14 staff have undertaken training on infection control and 16 staff of undertaken training in first aid in recent months. The administrator/carer also advised that 10 staff had received training relating to Tracheostomy very recently. It is known that several staff had attended training on dementia and moving and handling last year and that the latter would be due for update in the near future. This was not indicated on the training plan. The acting manager advised at the last inspection of plans to arrange proper fire training for staff, there was no evidence of this had been arranged. Training files were sampled for seven care staff, two senior care staff, four qualified staff and one domestic staff, and a range of certificates were noted on files including those identified in the training list above. The files showed that most staff now had training in basic issues, with the exception of fire and Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 22 medication. However, there was no evidence of recent training in moving and handling on the files for one care assistant, one senior carer, two qualified nurses and one domestic staff. Additionally there was limited evidence of recent training on clinical issues for some of the qualified nursing staff. As noted there was no evidence of induction training for the recently recruited staff. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is poor. Residents live in a home that is not effectively managed in all aspects and so raises some concerns regarding their well-being and safety. They will have the opportunity to express their views about the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has had an updated job description relevant to her new role. She expects to begin the Registered Managers’ Award training this month. There were clear improvements noted in some areas since the last inspection, while other basic aspects were clearly not addressed. One example is that the format, detail and organisation of the care plans were notably improved in some areas, yet clearly missing some important issues including safety aspects, that had been clearly explained and advised previously. It was indicated that the acting manager has instigated improvements in the areas within her skills and expertise, but these were not fully evidenced in areas outside her expertise such as clinical matters. Healthcare professionals spoken Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 24 with indicated that clinical support caused some unease as the acting manager is not a nurse and has no clinical knowledge, clinical support was advised to them as being provided by a person other than the person agreed by the commission and that some nursing staff did not have the up-to-date training and skills necessary to meet particular residents’ needs. Other areas demonstrated at this site visit as again not effectively managed related to medication, which is administered only by qualified nurses, and staff recruitment records. One relative commented that the manager was very approachable. Another stated that the home gives a high degree of care to each person under the excellent supervision of the acting manager. The acting manager confirmed that she had not fully understood quality monitoring and that there should have been outcomes drawn from the surveys and analysed into a report, that should have been used in the development plan that she had produced. Regulation 26 reports were not on site initially but brought personally by the registered provider, who advised that no one had written to tell him he was no longer required to send them to the commission but must keep them at the home for inspection. He was advised that it was his duty to keep himself aware of current regulations. The information on their availability was also clearly stated in the Requirements section of the last inspection report. The acting manager confirmed that the home does not look after any money for residents. Two of the staff files sampled showed that they had been offered supervision once this year. For others the date of the last recorded supervision was over a year ago and others had no recorded supervision. This included three of the four qualified nurses. Clinical supervision is the responsibility of the person identified to the commission is having the supporting role on this area. This clearly is not being effectively managed. Management of health and safety aspects were sampled. A current certificate of thorough inspection of the lift was again not available at this inspection. A current certificate in relation to the safety of the fixed electrical wiring was again not available at this inspection. These were clearly advised as required in the detailed requirements section of the report of the last inspection. Checks of the hot water temperatures of all rooms in use were being done weekly which is positive and if any were high, a temporary risk assessment was put in place and a plumber on site within 48-hours. No checks of the cold water temperatures were being undertaken as part of the management of the risk of legionella. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 25 The portable appliance testing was out of date. Weekly checks of the fire alarm, fire doors, fire equipment in emergency lighting were not being undertaken regularly, with three entries for February, two in April and one in May. Records of fire drills shows three occurred in March, three occurred in April and one in May. The time of these should be recorded and varied to allow all staff to participate. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 1 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X N/a 1 X 1 Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 OP22 Regulation 4&5 Requirement Residents must be provided with detailed and accurate information within the statement of purpose and service user guide. This includes information on any limitations with the premises in this case access for some residents to the upper floor due to the size of the lift. Copies of the amended documents must be sent to the commission. 2. OP4 OP9 OP18 OP30 18(1)c 13(5) 23(4) Residents must be cared for by competent staff who are adequately trained in all areas of the residents’ assessed needs and safety requirements. This includes providing staff with an induction to a recognised standard, all basic training including moving and handling and fire, and specialist/ updated training as required for both care staff and qualified nursing staff (Previous timescales from 22/11/04 not met). Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 28 Timescale for action 15/07/07 15/07/07 3. OP7 OP8 15 So that residents are cared for safely, individual care plans must identify all their assessed needs. Care plans and associated health documentation must be kept up to date and provide staff with sufficient information to enable them to offer residents proper and consistent care and assistance. This includes preventative pressure area care management and management of behaviour that challenges. (Previous timescales from 22/11/04 to date not met) 01/07/07 4. OP8 13(4)a !2(1) So that residents are cared for safely, individual risk assessments must be in place that identify all assessed risks for the residents including refusal of medication, nutrition and bed rails. (Previous timescales from 22/11/04 to date not met) 01/07/07 5. OP9 13(2) So that residents are safeguarded medication must be safely managed, for example medication received at the home must be recorded, accurate records must be kept relating to administration of medication, and tallies of controlled drugs, protocols must be kept for drugs taken on an ‘as required’ basis . (Previous timescales of 29/01/07 not met) 14/05/07 6. OP19 23(2)c & d Residents must have a pleasant and safe place to live. The person registered must ensure that furniture is well maintained and that the carpet in the smaller lounge does not present DS0000015564.V338410.R01.S.doc 15/07/07 Valentine Lodge Version 5.2 Page 29 a tripping hazard to residents. (Previous timescales from 29.06.04 to date not met) 7. OP27 18(1)a Sch 4 (7) To safeguard residents, enough suitably qualified and competent staff must be on duty to meet residents needs. This refers to ensuring that staff are deployed in a way that ensures that residents are monitored, particularly for those who may not be so able to use a call bell, that minimum staffing levels are evidenced on the rota with the name of all staff on duty and that staff do not work excessive hours that may affect their competence. These are outstanding from previous inspection reports. 8. OP29 19, 17(2) Sch 2 & 4 So that residents are safeguarded the home must evidence robust and safe recruitment procedures and have all the required records and documents available at all times. This includes having current and appropriate Criminal Record Bureau checks available on file for all staff that work at the home. (Previous timescales from 18.02.04 to date not met). 9. OP31 9(2)(b)i 10(1) & 2(a) So that residents live in a home that is effectively and safely managed, the registered person must show that they have employed a person/people who are skilled, knowledgeable and able to discharge fully the responsibility of meeting DS0000015564.V338410.R01.S.doc 01/07/07 14/05/07 01/07/07 Valentine Lodge Version 5.2 Page 30 Regulations and National Minimum Standards Previous timescale of 22.11.04 not met. 10. OP33 24 26 So that the views of residents can be obtained routinely to influence the care provided, the registered person must continue to develop systems for monitoring and improving the quality of the care services provided by the home and reports from the monthly regulation 26 visits must be kept at the home. (Previous timescales from 18.02.04 to date not met). To support staff to provide quality care for residents, staff must be offered regular supervision. This includes clinical supervision for the qualified nurses and also support for the acting manager. Previous timescales from 29.06.04 to date not met. 12. OP38 13(3) 23(2)c To ensure residents and staff live and work in a safe environment regular health and safety checks/audits must be undertaken. These would include checks of the cold water temperatures, fire equipment and opportunity for all staff to participate in fire drills. The safety of the lift, the fixed electrical wiring and portable appliances must be inspected. Copies of certificates in relation to these must be sent to the commission and is outstanding from the last inspection in Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 31 01/07/07 11. OP36 18(2) 01/07/07 01/07/07 relation to the fixed electrical wiring and the lift. 13. OP38 23(2)c To ensure residents and staff live and work in a safe environment risk assessments in relation to safe working practices must be carried out. Not fully inspected on this occasion, carried to a future inspection. 14/05/07 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 OP9 Good Practice Recommendations The registered person should consider that hand-written changes or additions to instructions for prescribed medicines are signed and dated by the person making the entry. Residents’ wishes in relation to end of life care and practices should be ascertained and recorded in the care plan. Not inspected on this occasion, carried to a future inspection. The home should continue to develop the program of social and leisure activities for residents. Residents should be enabled to make decisions and choices for example, what time to get up and this should be respected by all staff. Residents should be given clearer information about the days menu. Staff should sit down with residents when offering support with feeding. DS0000015564.V338410.R01.S.doc Version 5.2 Page 32 2. OP11 3. 4. OP12 OP14 5. OP15 Valentine Lodge 6. 7. 8. OP21 OP28 OP31 The programme of maintenance should include the flooring in the bathroom and kitchen and the development of the garden area. 50 of care staff should achieve NVQ Level 2 The registered manager should achieve NVQ Level 4, Registered Managers Award. Valentine Lodge DS0000015564.V338410.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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