Inspection on 29/01/07 for Valentine Lodge

This inspection was carried out on 29th January 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 14/05/07

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 29th January 2007 08:05 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.V328192.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.V328192.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 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.V328192.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. 14th June 2006 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 £427 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 and confirmed at this site visit by the acting manager. Valentine Lodge DS0000015564.V328192.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 16 hours at the home that day. Four residents, five 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 two of the eleven residents living at the home at that time. A survey form was sent to a funding authority with a request for comments and information regarding Valentine Lodge. No responses were received. A survey form was completed by telephone by a placing social worker. Completed questionnaires were completed on site or received from six relatives and a resident, and the information received is reflected throughout the report. This was the second key inspection of Valentine Lodge this inspection year, the first having been undertaken on 14th June 2006. 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 during the inspection year, two random inspections also took place in April and October 2006. Reports from these inspections are not public documents but relevant information is reflected in the key inspection reports. While some improvements were noted, they were limited in some cases or not sustained. A meeting took place between the Commission for Social Care Inspection and the registered provider of Valentine Lodge in November 2006 to discuss the Commissions concerns regarding the continued failure of Valentine Lodge to comply with Regulation and to meet National Minimum Standards. It was advised at this meeting that the registered manager had resigned and a proposal made to appoint an acting manager, supported by an acting clinical nurse manager. This second key inspection was agreed as an opportunity for the home to demonstrate their clear understanding of the need to demonstrate rapid movement towards complete compliance and a significant improvement to the service offered. Discussion of this inspection site visit findings took place with the acting manager and the acting clinical nurse manager during the inspection, and guidance and advice was given. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 6 An Immediate Requirement form was issued at this inspection relating to concerns about the recording and administration of medication. The actions taken by the acting manager and the developments achieved in the limited time she has been in post are noted positively. However, they have not been adequate to 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 while considering what appropriate action will be taken. The assistance of all at Valentine Lodge during this site visit is appreciated. What the service does well: What has improved since the last inspection? What they could do better: There are a lot of things that Valentine Lodge needs to do better to improve their services to residents and to meet Regulation and National Minimum Standards. These are shown at the end of this report in the section on Requirements and Recommendations. All of them have been raised as concerns in previous reports and so the registered owner was aware of them. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 7 The Commission will consider what steps it will take to ensure that these are now complied with. This includes ensuring that the home undertakes a proper assessment of people before admitting them to make sure that the home can meet their needs, and that they do not admit any residents that they are not registered to care for. All staff need to have training, including in conditions that affect older people like those who live at the home. There also needs to be a plan of care for each of the residents that tells staff how each person is to be cared for in a way that meet their particular needs. The medication system needs to be better organised and managed to ensure that it is safe for residents. Residents need to have more opportunities for a meaningful and stimulating activities and interactions, and there needs to be enough staff for this to be achieved. More attention is needed to the premises to make it a pleasant and safe living environment for residents both inside and out. The records taken up when staff are employed must be in place to protect residents. There needs to be more effective management and supervision of staff to make sure that they are supervising and monitoring residents at all times to keep them safe. 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.V328192.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst readily available, the statement of purpose and service user guide did not provide adequate and accurate information to those who want to know about the home. Residents had some information about their rights and responsibilities. Since the last inspection the home had not undertaken full pre-admission assessment and had again admitted a resident outside of their registration category. Staff have limited training in the conditions of their residents and associated with older people. Prospective users of the service were welcomed to visit as part of their decision-making process. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 10 EVIDENCE: A statement of purpose was displayed in the entrance hall. This needed to be updated to reflect the changes in the management at Valentine Lodge. It was noted positively that the inspection report of June 2006 was also clearly available. A service user guide was seen on the file for the most recently admitted resident. This document was also in need of review to accurately reflect the current management situation at Valentine Lodge and to include the information on fees and charges required by the changes to regulation in September 2006. A contract was noted on the file for one of the residents files tracked. This is a noted improvement. While recently issued, it was disappointing to note that it did not been signed by the resident or their advocate. A statement of terms and conditions were seen on the second resident file tracked. This did not include any information regarding fees. The report of the unannounced inspection of Valentine Lodge for the 12th of October 2006 identified that the home had admitted a resident outside the category of registration (the resident had sadly passed away). A requirement was made in that report that the admission of residents outside of the homes registered category was not to be repeated. One of the case files tracked showed that a pre-admission assessment had been undertaken in late October 2006 by the registered manager of Valentine Lodge, prior to her resignation. Information provided by the hospital prior to admission identifies that the principal reason for admission related to dementia. Valentine Lodge is not registered to admit people who have a diagnosis of dementia and an application for this category of registration had been refused because of the Commissions concerns as to whether the home could meet their needs. The previous registered manager had written to the prospective resident confirming that the home could meet their needs. Subsequent discussion with the admitting social worker from the hospital indicated that they had not known that the home was not registered to provide dementia care. An interim action plan was received from the acting manager on 9th January 2007. This advised that new pre-admission assessment forms were available and were to be used on any new potential residents and as a tool to help to make a decision in regard to Valentine Lodge being an appropriate placement for that person. The second resident file tracked (admitted late January) demonstrated that the current management at Valentine Lodge had not undertaken their own preValentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 11 admission assessment of the residents needs, or had not written to the resident as required to confirm that they could meet the resident’s assessed needs. The acting manager advised that she had relied on the faxed information provided by the admitting social worker. This information identifies that the resident will need specialist support to deal with their lack of sight to minimise the risk to their safety. None of the staff files indicate that they have had any training in relation for example to sensory needs. It was observed that, while speaking kindly to the newly admitted resident who had no sight, they walked away without letting the person know they were leaving the room, and the resident was observed to show some distress when they continued to speak to the staff and receive no answer. Some staff had had basic training on dementia. Valentine Lodge does not offer intermediate care. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 12 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, 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A care plan was not available for a recently admitted resident, and staff did not have adequate information to be able to meet that persons needs fully. Appropriate risk assessment and detailed safe working practice plans were not in place to safeguard the health and well-being of residents and staff. Monitoring of general health care for residents was demonstrated. Medication systems did not protect residents and an immediate requirement form was issued to effect compliance. EVIDENCE: No care plan was in place for the recently admitted resident, for whom the home had not undertaken their own pre-admission assessment. There was limited information available on how staff were to care for this resident. This was based on an overview assessment/care plan undertaken in a different Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 13 environment, which while detailed, did not provide all the necessary information to ensure appropriate and consistent care. It was discerned by observation and confirmation with staff that this resident smoked. Staff advised that they had now taken away the resident’s lighters and cigarettes and were looking after them. There was no care plan, risk assessment or record infringement of rights regarding this issue. There was no care plan relating for example to sight impairment (registered blind), medication, pain management, pressure area care, use of oxygen, social and emotional needs, finance, bathing, oral care, and no indication of the residents likes and dislikes, for example regarding food or times for going to bed and getting up. The resident was seen to sleep for periods of time leaning over the arm of the armchair and was also advising of feeling pain. Staff were attentive and kind but clearly stated they did not know whether this was unusual practice for the resident or whether they were used to doing this or had a particular type of armchair etc. A falls risk assessment had been undertaken on the day following admission. This and previous information provided to the home indicated that the resident must never be left unattended and must be observed by care staff at all times. While the resident was provided with direct access to a call bell, there were long periods of time noted during the day when there were no staff supervising the lounge where this resident was sitting. A moving and handling risk identification assessment showed a moderate risk with a score of 10. The home’s own scoring system indicated that this score requires assistance from two staff according to the task or use of mechanical aids and equipment. However the document stated that the resident needed one carer for assistance with bathing, standing and walking, and transfers. No care plan or safe working practice plan was available that specified the actions for care staff to follow and what this equipment would be. A care plan was in place for the other resident case tracked. There was evidence of family involvement, which is positive. A life history was recorded as well as a list of likes and dislikes. The initial care plan provided some information on a number of areas of care needs. However, there was no plan relating to dementia care needs in aspects of daily living, bathing, medication management, the section on end of life care/wishes was blank, a ‘regular’ toileting programme was not defined, bedrails were stated as required although there was no history of falls. A pressure area care risk assessment stated that the resident still had a large sacral sore (acquired prior to admission to Valentine Lodge). Staff advised that Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 14 that was now healed but the assessment and a subsequent care plan had not been updated. A wound assessment chart had been maintained. It is to be noted positively that the pressure sore had healed while the resident was cared for at Valentine Lodge. It was also noted that the resident was sitting on their pressure relieving cushion, had a pressure relieving cushion on their named wheelchair, a pressure relieving mattress on their bed and had a maintained fluid chart. The assessment stated a requirement for four to six hourly changes of position. The acting manager confirmed that no moving/turning chart was maintained. No record of moving/turning was noted in the care records. As a clearly identified risk for this resident, a preventative care plan was not in place. The accident records indicated that this resident had two falls from their bed in the three months they had been living at Valentine Lodge. A more recent falls risk assessment resulted in the recent introduction of bed rails, with no evidence of the involvement of a multidisciplinary team. While the assessment referred to the risk of the resident climbing over these bed rails, no further risk assessment of this hazard was included. There was no reference to how the bed rails were to be identified, whether the resident’s size and weight had been assessed as appropriate to the bed rails and the mattress used, or what specific checks and maintenance of the bed rails was to be undertaken. The moving and handling risk assessment form did not lead to a safe working practice plan and contained no instruction as to which hoist or sling was to be used for this resident. This resident was hoisted into a wheelchair at lunchtime. It was noted positively that staff spoke to the resident about having their hair done, addressed them by their name, and asked them where they would like to sit in the dining room. When asked, a member of the care staff was able to identify which residents were currently on fluid and transfer charts, as part of their care management. On inspecting one of these with her, it was identified that the movement chart on the day prior to the inspection had not been recorded after 2:30pm, and that the fluid monitoring chart had not been recorded after 5pm. Six comment cards completed by residents and relatives (including relatives of both of these residents) stated they were satisfied with the overall care provided at Valentine Lodge. A different type of survey form was completed by another relative that confirmed that the resident always received the medical support they needed. Care management records demonstrated the resident had received a routine admission visit from the GP soon after admission. The resident had two further GP visits, which indicated that staff were monitoring the resident’s health care needs. Chiropody treatment is also recorded as having occurred. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 15 A list of staff initials/names and signatures was available for those stated as competent to administer medication, noted positively to have been reviewed and updated since the last inspection. The acting manager provided information on the six named qualified staff who are responsible for the administration of medication. It was advised that only two of the staff attended recent training provided by the local pharmacist. A copy of the Royal Pharmaceutical Society Guidelines for the Control and Administration of Medication in Care Homes was available. Inspection of the Medication Administration Recording (MAR) sheets showed a number of omissions, where staff had not signed the records to confirm that the medication had been administered to the resident. An Immediate Requirement form was issued that required immediate compliance with Regulation 13(2) of the Care Standards Act, and that the recording of medication was conducted in line with the code of conduct of the Nursing and Midwifery Council and with the Royal Pharmaceutical Society Guidelines for the Control and Administration of Medication in Care Homes. On inspecting controlled drugs, the dispensing label details that one tablet was to be taken every 12 hours, however the book details that two tablets were administered to the resident. The patient medication and monitoring card from Southend PCT evidences that two tablets being given for some considerable time. The qualified nurses on duty were informed that written evidence of a detailed discussion with the GP on this matter was required and must be recorded. A qualified staff member advised that the pharmacy will commence printing the MAR sheets in the near future. A qualified member of staff was observed to cut a tablet with a knife on a table in the lounge, rather than with a tablet cutter. This is both an inaccurate judgment for half a tablet and is unhygienic and introduces a risk of cross infection. Protocols continue not to be available relating to ‘as required’ (PRN) medications. Advice was provided that where packets/bottles of medication are used, they should be signed and dated when opened/commenced. The domestic medicines policy (homely remedies) continues not to detail the specific types of homely remedies that can be used. The MAR sheet is currently used as the homes record of medication received into the home. A returns folder and drug ordering folder were available. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. Limited information and planning was in place to evidence residents’ needs and preferences, and so to support staff to achieve these. Residents were provided with limited opportunities for stimulating and meaningful recreational activities and for making choices in everyday life. Visitors were encouraged and welcomed. Residents were satisfied with the food provided and were offered some choices. EVIDENCE: The acting manager advised that the home have a new hairdresser, who now comes in the afternoon and that this works better for residents. The initial care plan for a resident (admitted late October 2006) on ‘Interests/Hobbies/Religious and Cultural Needs’ states that the resident “ has so far had not said anything on these subjects, will liaise with family to devise a care plan”. No care plan/information was in place relating to these issues. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 17 Records indicated that activities over Christmas included a party, a sherry and mince pie afternoon, writing Christmas cards and watching a film. The activities record also includes reference to a bean bag game, watching DVDs, reading, reminiscence cards, listening to music, foot massage and quiz. Some life histories were also noted positively within the activities folder. A yesteryear file was available as well as a touch and feel folder. The activities coordinator was on duty and did read to the residents in the main lounge. This was not particularly appropriate to the needs of the residents there and later she read to the individual residents in the smaller lounge. A few residents, particularly in the smaller lounge, were able to undertake their own activities such as reading and quizzes, but generally it was observed that residents in the main lounge ‘ watched’ the television. Care staff did speak to residents, but this was often task orientated. Inspection of the current and previous five weeks rotas shows that for two weeks there was no activity co-ordinator hours allocated, and for two weeks the activity of coordinator was on duty three hours each week. The previous week and day of the inspection the activity coordinator was on duty from 10am until 4pm on one day each week, whilst staff training was also taking place. The acting manager advised that she is hoping to recruit a new activities person as the current person is normally only able to offer the home approximately 3 hours per week. This clearly limited the opportunities for residents, particularly those who are not so able, but whose needs are equally as great. Visitors were clearly welcomed at Valentine Lodge and this was confirmed with those spoken with. The six comment cards received also confirmed that visitors were welcomed in the home at any time and could visit with their friend/ relative in private. Both the lunchtime and teatime meals were observed at this site visit. For lunch residents had ham, egg and chips, and those who needed a soft diet were given scrambled egg, tinned tomatoes and mashed potato. Desert was iced sponge and custard. At teatime, residents had the choice of a hamburger, salad or assorted sandwiches. Residents’ comments relating to the food were noted to be positive. Beakers of cold drinks were available to residents throughout the day. Residents were given a hot drink from the trolley both in the morning and afternoon, only some were offered choices. It was disappointing to see that staff still continued to physically handle biscuits to give to residents rather than let them make a choice, for example, from a couple of types of biscuits on a plate. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 18 A five week written menu was available. It was noted positively that this shows a choice of breakfast, which included cereals or a cooked meal. The lunchtime meal offered one meal or an alternative and no choice of putting. The teatime meal offered a selection of items including hot snacks or sandwiches. The cook advised that there is now a daily choice sheet as they have to give people the choice of meal and record it. These sheets show the residents name and also include information on specific dietary needs for example liquidised, soft, normal or PEG feed. Inspection of the food stocks showed a high proportion of ‘ value’ brand foods. There were several home-made cakes in the freezer. Food stocks in the fridge and freezers were appropriately date labelled. Storage of some dried goods was not so well managed, for example open packets of cereals and containers of cereals with open and dirty lids were seen on a low shelf under a table unit in the kitchen. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on the complaints procedure was readily available, provided accurate information and was in a format that was easier to see/read. The management of the complaints system needed to be better evidenced to protect residents and other stakeholders. Staff training in the protection of vulnerable adults had been provided for the majority of staff to safeguard residents, and further training was planned to include all staff. EVIDENCE: A comment and complaints book was available in the entrance hall. No complaints were recorded here. One recent comment was recorded “ Everyone in this home are helpful. Also residents get looked after well, keep it up. Well done.” Information on the complaints procedure was clearly displayed in the main corridor. This was accurate in its information that complaints can be raised directly with the home and provided information on the opportunity also to contact the funding authority where this is appropriate. The print was large and so easier to read. Two comment cards stated that the authors were not aware of the homes complaints procedure. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 20 The acting manager initially advised that one complaint had been received about a member of staff but the family did not wish it to be taken up formally. Inspection of the complaint information retained in the office showed that both the staff and the resident had been interviewed and a meeting had taken place. No outcome had been recorded as reached. Another complaint was noted where there was no hot water for the hairdresser to use to wash residents’ hair. No outcome was found/recorded. However the acting manager confirmed that this was accurate as a hot water element had ‘gone’ but had now been replaced. A third complaint was recorded from a resident who stated they never went out any more. An outcome was recorded relating to this, which advised that it had been explained to the resident that they did not wish to go out any more. Detailed advice was provided to the acting manager on maintaining a log of complaints, while recording investigations and outcomes confidentially. Other issues were recorded in the complaints book, which were not actual complaints but which the acting manager confirmed indicated problems/issues between particular staff members. Since the last inspection, the acting manager has sent a copy of the whistleblowing policy to the Commission. This document was written in plain language. As a response to a Requirement in the last inspection the registered provider confirmed that staff had been reminded on the procedures for protecting vulnerable adults, including the whistleblowing procedure, and that all staff had completed training on the protection of vulnerable adults and management of behaviour that challenges. This was not evidenced as factually correct in the staff files sampled. Some of the staff files sample indicated that staff had attended training on the protection of vulnerable adults in 2005. Others, who did not attend this training course, are recorded as having watched a video on the subject. Three staff files sampled, (including senior staff) indicated that the staff had not attended training or watched a video on the issue of protecting vulnerable adults. None of the 16 files sampled showed the staff had had any training on management of behaviour that challenges. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 21 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): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements were noted to some aspects of the decor in an effort to provide a more pleasant environment for residents. Aspects of the premises did not protect residents and presented potential risks. EVIDENCE: The acting manager advised that since taking over her new role, several bedrooms and the dining room have had a coat of paint to brighten them up and this was seen. A resident advised that they had been consulted and given a choice about the colour scheme for their room, which is positive. Some bedrooms had some nice personal touches. One bedroom remains with torn wallpaper. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 22 Corridors are painted in darker colours but the acting manager advised that these are to be painted in lighter colours, and the entrance hallway was being painted at the time of the site inspection. A letter had been sent to the commission advising that this work had already been completed. The carpet in the small lounge remains as previously with some rucking. The registered provider has been made aware in previous reports that this could present a potential tripping hazard. The window in this lounge is partly opaque and does not allow full natural light or vision to the outside area for residents. This room smelt of cigarette smoke, as the staff room leads directly off it. There were plenty of individual side tables for residents and drinks were available. The outside area has not yet been made safe and available for residents although the registered provider has given two dates in the past by which this was supposed to have been completed. The acting manager advised that a quote has been obtained. Additional discussion took place regarding the size and security of the area and advice given that Essex Fire and Rescue Service should be consulted. Only bedrooms on the ground floor were currently being used. The doors to these bedrooms continue to have glass viewing panels which, while covered with a small piece of material, do not present as homely and do not evidence an underlying philosophy of respect for residents’ privacy. Fire doors in corridors continued to be wedged open and although the home has been issued previously with immediate requirement notices to cease this practice. Fire doors in some of the rooms were not closing properly. The carpenter was on site assessing the doors and advised that they needed adjusting. This has also been a concern previously where the home were issued with immediate requirement notices. Oxygen was stored in a shared bedroom. There was no signage on the door advising of the additional fire risk. The furniture in some of the rooms, including the over bed tables, continues to be shabby. Privacy curtaining was available in the double rooms. However, when in use, some residents did not have any natural light or view from the window in their area of the room. Many rooms had only one central light and some residents had no access to a light switch from their bed. The recently admitted resident who had a sight impairment did not have a cabinet or other surface close to their bed where they could leave things that they may wish to reach, for example their mobile phone or a drink. At 1pm a resident was in bed in their room, apparently sleeping, where there was a smell of faeces. Bedrails fitted with protective covers were in place and the resident was on an airflow mattress. A fluid chart showed the last entry at Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 23 11:30am. The television was on in this room although it was not possible for the resident to see it from where and how they were laying. It was later mentioned to the acting manager that should the resident be calling out for assistance it would be unlikely to be heard because of the volume of the TV. Not all rooms had a lockable facility and none of the rooms were fitted with a door lock to and does not demonstrate an active underlying philosophy of respecting residents’ dignity and privacy. The hot tap in room six was loose and swivelled round. The hot water in room 8 was very hot to the touch and the acting manager was advised to address this immediately. Water temperatures tested in other bedrooms and bathrooms were satisfactory. The unlocked laundry room was clean and tidy and had adequate equipment. The water in the large sink was again extremely hot. The risk assessment relating to this was not appropriately detailed or adequate and sensible action needs to be taken to make the room inaccessible and protect residents. The downstairs toilet had been made more homely with the addition of a shelf and plant. However the yellow bin for hazardous/incontinence waste was so full that the lid could not close. This presents an infection control risk as well as an unpleasant environment for residents. The downstairs bathroom, including the floor, continues to look tired, and the room was cluttered. This is the main bathroom used for residents. There was no room thermometer. The seated weighing scale was so dusty it was possible to ‘write’ on it. The room was also used to store the electric hoist, the manual hoist, a commode chair, slings, an over bed table and a broken and dirty hairdressing trolley. There was thick dust on the pipes and other low surfaces. The yellow bins were fitted with bags, the lids were closed and there was no odour. The bath hoist, the manual hoist and the electric hoist contained labels that indicated inspection within the last six months. The upstairs bathroom, which is currently not being used by residents, was storing lots of equipment and also had a most unpleasant odour. The kitchen floor had clearly been deep cleaned, but the raised surfaces continue to present difficulties with cleaning and therefore a continuing infection control risk. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence including a visit to this service. Staff interactions with residents were positive and caring. Staffing numbers and deployment did not always offer the best care outcomes to residents. Safe staff recruitment has not yet been evidenced to show that residents are protected. Staff training, whilst improving, demonstrates gaps in basic issues relating to resident care and safety. EVIDENCE: Staff were seen to speak to residents in a kind and friendly manner. Comments from relatives/visitors cards received included “ I find the staff seem genuinely to care for the patients”, and “ we have found the staff very helpful and friendly”. The five visitor/relative comment cards received indicated that they felt there was always enough staff on duty at the home. One resident survey shows that staff were usually (not always) available when they need them and that they usually (not always) receive the care and support they need. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 25 The senior nurse in charge of the shift confirmed that the home continues to run operate a staffing level of one qualified person plus three care staff on duty each day. This is considered appropriate in number taking into account for example, the number and dependency needs of the residents and the layout of the premises etc, with the exception of sufficient staffing to ensure adequate hours available to meet the social and emotional needs of residents, including those with the highest dependencies and least abilities/independence The deployment of staff however was not considered appropriate and as indicated in various sections in this report this was not managed effectively to ensure that staff will readily available to monitor and supervise the well-being of residents at all times. As indicated previously in this report, there were periods of time throughout the day when no staff were observed to be monitoring the lounges to ensure resident well-being and safety. Inspection of the current and three previous week rotas indicate occasions where this minimum staffing level was nit met and there were one qualified and two care staff on duty. Rosters showed that staff were working long days, i.e. from 8am to 8pm. It was of concern that staff were again working excessive hours for example four x 12 hour shifts plus two x 6 hour shifts (60 hours per week), our x 12 hour shifts (60 hours per week) or four x 12 hour shifts plus two x 6¼ hour shifts (60.5 hours per week). The register person had previously informed the Commission that this practice had ceased at the home and was now better managed. It was noted positively that the rosters for a three week period showed that a cook was on duty each day, and also that a domestic was on duty for some hours almost every day with few exceptions. The acting manager advised that the home were advertising for an activity coordinator, a part-time relief cook and two qualified nurses. It was observed that there was no communication between the qualified staff going off duty and the qualified staff coming on duty on the morning of the site visit. This not only included not hand over, but qualified staff going off duty left the home without even informing their replacement that they had gone. This lack of communication cannot be in the residents’ best interests and needs to be managed. Recruitment records of 16 staff were sampled at this site visit. Several of these have been sampled previously. While basic requirements in relation for example to evidence of identity and photographs were now in place on these files, it was noted that there was no Criminal Record Bureau (CRB) check was available on one file and that on four other files the CRB check was not Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 26 appropriate as it did not relate to Valentine Lodge. All but one of the staff are currently working regularly at Valentine Lodge. The Commission had previously made the registered person aware of their concern on this issue on numerous occasions. Nine of the files sampled at this site visit were of care staff. Two of these contained evidence of completion of NVQ level 2. It is noted positively that the majority of staff attended training in dementia care and appropriate moving and handling in May 2006. Until this time much of the staff training relied only on videos. The acting manager stated that she is arranging for all staff to receive up to date mandatory training as soon as possible and was advised to consider the inclusion of training on supervision and care planning. She advised that it is planned that the local will conduct fire awareness training, although no date for this was provided. An external trainer was on-site at the time of the inspection site visit. He confirmed that training has recently also been provided on basic first aid, food hygiene and infection control, and is planned in the near future for health and safety and protection of vulnerable adults, all of which is positive progress. Some staff files sampled demonstrated very limited training had occurred. However, on at least two files sampled for night carers, they had recently failed to attend a training course on nutrition. One care assistant had had training in falls prevention, and another had failed to show up for the course. None of the files showed any evidence of training on nutrition, continence management (with the exception of one staff who attended bowel management training in 1999), diabetes, Parkinsons disease, medication or that relating to preventing pressure sores. The files for other care assistants indicated that they had attended training as offered. It has previously been stated in this report that of the six qualified staff who have responsibility for administering medication, only two attended the medication training offered. There is a clear need for updated training for these staff. Evidence of relevant and up-to-date training for the nursing staff varied from one file that showed evidence of regular ongoing training in issues such as Parkinsons disease, wound assessment, principles of palliative care, moving and handling, food hygiene, principles of phlebotomy and record-keeping, to another file that showed an undated training certificate relating to infection control and a record that the person had watched a video on fire prevention. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. While effort has been made to provide management of the home, it has not been sufficiently timely or effective to demonstrate adequate development. The registered person has not demonstrated the level of appropriate action and support needed to ensure that the home is effectively managed in the best interests of the residents. The views of residents and other stakeholders was stated to have been gathered and was awaiting collation. All staff were not appropriate to supervised. Records that protected residents need to be maintained to a better standard. The safety of those at Valentine Lodge was not best protected. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 28 EVIDENCE: The acting manager had been in charge of the home for almost 2 months prior to this site visit. She is not a qualified nurse and does not have any management training or experience. She has worked at the home for several years, more lately as a senior carer, and the Commission agreed to her being given opportunity to manage the home, with the support of a qualified nurse for clinical supervision and management. The acting manager advised that arrangements have been made for her to commence NVQ level 4 in caring management later this year. The roster was not clear in its demonstration of whether the acting manager was part of the care roster and what hours she was acting as in a managerial role as supernumerary to the care staffing level. The acting managers job description continued to be that of a senior care assistant, and was not appropriate to her current role, which needs clarification. The acting manager was able to show that some things had changed. The work she has undertaken in the timeframe available to her is acknowledged. However, the home has struggled to meet a large number of regulations for a long period of time and intensive intervention in terms of hours, skills and other support is required. Since taking up her new post the acting manager advises that she has written to GPs, chiropodist, hairdresser, all 10 residents with the help of family, to relatives and friends individually and also surveyed all staff as part of the introduction of a quality monitoring system. She advised that she is now awaiting an opportunity to collate information and produce a report and action plan from it. The reports required by Regulation 26 to be undertaken by the registered provider were not available in the home. These were previously available but not in adequate detail to demonstrate that the registered provider had reassured himself of the standard of care and conduct of the home. It was noted that a recent residents’ meeting had also taken place. The home does not look after any money for residents. Some staff files sampled showed no evidence of supervision. Some staff files sampled indicated that some staff had been provided with recent supervision sessions and a copy of the supervision policy was noted on these individual files. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 29 Records of supervision issues indicated, for example, concern regarding the equipment used for residents, or evidence of staff disciplinary procedures taken and ‘profound concern’ expressed regarding the conduct of a staff member. No evidence was recorded of the action planned/taken on these issues although the acting manager was able to advise that a new hoist sling has been ordered. There was no evidence available on the files of those staff offering supervision, including that of the acting manager, that they have had any training on supervision, which was clearly not being offered/managed effectively. There was no evidence to show that the acting manager herself had been offered the support of supervision. Accident records were maintained with appropriate detail, with the exception that pages need to be numbered and the accident record sheet the kept in the resident’s individual file. A photograph was not available on one of the two resident files sampled. A current certificate of Public liability insurance was displayed. A record of visitors was maintained and was available in the entrance hall. It was noted however that not all visitors were requested to sign the book, for example the decorator and the carpenter who were on-site throughout the inspection were not recorded. The risk assessment for the laundry sink only takes into account the risk to staff is not the accessibility to residents. The action identified by the risk assessment requires a notice advising of hot water. This was not in place. Risk assessments relating to safe working practices were not available. Checks on the temperature of the water had been instigated some three weeks previously. These included only the hot water, and only a few rooms each week. This had not been used systematically and some rooms had not yet been checked. Current certificates were available in relation to portable appliances, emergency lighting, fire alarm, fire equipment, gas and hoists. The current certificate in relation to electrical fixed wiring was not available. Evidence was available of a current waste contract. A current certificate of thorough inspection for the lift was not available. The most recent evidence of calibration of the chair weighing scale was dated August 2005. Records were available of weekly checks of the fire alarm and emergency lighting systems. Records were available of monthly checks of the fire exits Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 30 and fire equipment. A monthly fault record sheet shows fire door is not closing properly and emergency light is not operating. The acting manager advised that she had arranged for a general risk assessment and maintenance work to be done. The fire risk assessment includes the action “ staff instructed to ensure every door is properly shut”, but this was not being followed. A record of monthly fire drills was maintained for the past few months, with a separate record of the staff involved. This did not record any times and at least six staff were identified as not having participated. The fire prevention record indicates that all staff have had recent training including the six staff identified as not having participated in a fire drill. The acting manager advised that this fire prevention training was only done by video and was not of a good standard. As noted earlier, oxygen was stored in a resident’s bedroom. There was no fire plan of the premises displayed that identified this risk and no risk assessment had been undertaken. Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 1 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 2 2 x 2 2 1 STAFFING Standard No Score 27 1 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X N/A 1 2 1 Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The registered person must ensure that the statement of purpose and the service user guide are amended to include all relevant/current information, to include that regarding fees, charges and services required by the changes to the Regulation from September 2006. 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, 26/04/06, 14/06/06 and 12/10/06 not met). The person registered must ensure that a full assessment of the resident’s needs is undertaken prior to admission by a person qualified to do so, and that the home is satisfied that it can meet the needs of all residents and the prospective resident assured in writing that, based on the assessment, the home will meet these needs. DS0000015564.V328192.R01.S.doc Timescale for action 01/04/07 2. OP2 5(1) Sch 4(8) 01/04/07 3. OP3 14(3) 01/02/07 Valentine Lodge Version 5.2 Page 33 4. OP4 18(1) 5. OP7 15 The person registered must show 01/04/07 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). The person registered must 01/02/07 ensure that a care plan is in place for each resident. The person registered must ensure that the care plan contains sufficient information to show all the residents needs and how the residents’ needs are to be met in practice. (Previous timescales from 22/11/04 not met). The person registered must undertake appropriate detailed risk assessments and demonstrate safe management of risks to residents, for example relating to bedrails, moving and handling, nutrition etc. (Previous timescales from 22/11/04 not met). The person registered must show that residents’ needs in terms of their health and welfare are identified and met. This refers to preventative pressure area care management and to care recordings demonstrating appropriate monitoring of residents’ health and welfare. (Previous timescales from 22/11/04 not met). The person registered must ensure that there is a safe and effective system operating for the management of medication, including recording, handling, and safe administration. 01/02/07 6. OP7 15 7. OP8 13(4) 12(1) 01/04/07 8. OP8 12 01/04/07 9. OP9 13(2) 29/01/07 Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 34 10. OP10 12(4)a The person registered must ensure that respect for residents’ privacy is demonstrated and action taken to address the sighting of the glass viewing panels in bedroom doors. 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 date not met). The person registered must evidence more clearly that the home is run in a way that provides, and encourages residents to have opportunities to exercise control and choice in their everyday lives. The person registered must evidence more clearly that the home is run in a way that provides, and encourages residents to have opportunities to exercise control and choice in their everyday lives. Arrangements to be made by the person registered to provide all staff with training on Protection of Vulnerable Adults and management of behaviour that challenges. (Previous timescales from 18.02.04 to date not met). The person registered must ensure that the home is kept reasonably decorated and equipment (furniture) is well maintained. (Previous timescales from 29.06.04 to date not met) The person registered must ensure that areas of the home accessible to service users are free from hazards to their safety. DS0000015564.V328192.R01.S.doc 01/04/07 11. OP12 16(2)m 01/04/07 12. OP14 12(3)&(4) 01/04/07 13. OP15 12(4)a 16(2)i 01/04/07 14. OP18 13(6) 01/04/07 15. OP19 23(2)c & d 01/04/07 16. OP19 13(4) 01/04/07 Valentine Lodge Version 5.2 Page 35 17. OP19 23(4)c(i) 18. OP20 23(2)o 19. OP21 23(2)j 20. OP22 23(2)l 21. OP24 16(2)c 22. OP24 12(4) 16(c) This refers to the carpet in the smaller lounge and access to the very hot water in the laundry. (Outstanding from previous inspection) The person registered must ensure that fire safety equipment is maintained at all times. This refers to wedging open the fire doors. (Previous timescales not met) 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 hot water taps in residents bedrooms are secure and emit hot water at a safe temperature. (Outstanding from previous inspection) The person registered must ensure there is adequate storage space and that equipment is not stored in communal space/facilities used by residents. The person registered must ensure residents have appropriate furniture and fittings in their individual accommodation, including overhead and bedside lighting, bedside table etc. The person registered must ensure that residents’ dignity and privacy is respected. This refers to for example providing a lockable storage space, appropriately suitable door locks, and removal of the glass viewing panel windows in the bedroom doors. DS0000015564.V328192.R01.S.doc 29/01/07 01/04/07 01/02/07 01/04/07 01/04/07 01/04/07 Valentine Lodge Version 5.2 Page 36 23. OP25 23(2)o 24. OP26 23(2)d 25. OP26 16(2)k 26. OP26 13(3) 27. OP27 18(1)a The person registered must ensure that adequate natural lighting is provided. This refers to the window in the smaller lounge. The person registered must ensure that the home is maintained in a clean condition, this refers particularly to the bathroom. The person registered must ensure that odour in the home is managed. This refers to odours noted in a bedroom and also from the overflowing bin in the downstairs toilet. The person registered must ensure that there are appropriate systems in place to prevent the spread of infection. This refers both to the overflowing bin used for incontinence pads and also for the poor storage of some foods in the kitchen. 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 ensuring minimum staffing levels are met at all times, and that there are adequate staff to meet all of the residents needs, including their social and emotional needs. 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 in the home and also to the number of hours they work each shift and each week. (Previous timescales from 23/05/05 to date not met). DS0000015564.V328192.R01.S.doc 01/04/07 01/02/07 01/02/07 01/02/07 01/02/07 28. OP27 18(1)a 01/02/07 Valentine Lodge Version 5.2 Page 37 29. OP27 18(1) 30. OP29 19, 17(2) Sch 2 & 4 The person registered must 01/02/07 ensure that at all times there are suitably competent staff on duty to meet residents needs. This refers to ensuring that there is communication between the qualified staff leaving the shift on the qualified staff coming on shift, as well as with the care staff, to ensure the safety and well-being of residents. The person registered must 29/01/07 evidence robust and safe recruitment procedures and have all the required records and documents available at all times. This refers to having current and appropriate Criminal Record Bureau checks available on file for all staff will work at the home. (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 fire, medication etc and resident specific training. (Previous timescales from 18.02.04 to date not met) The registered provider must demonstrate that they that they have taken all steps to ensure that the home is effectively managed. (Previous timescale of 22.11.04 to date relating to the registered manager not met. The requirement remains, as evidence of effective management of the home is required.) 01/04/07 31. OP30 18(1)c 13(5) 32. OP31 9(2)(b)i 01/04/07 Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 38 33. OP31 10(1) & 2(a) 34. OP33 24 35. OP33 26 & Sch4 The registered provider must 01/02/07 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, 26/04/06, 14/06/06 and 12/10/06 not met). The registered person must 01/04/07 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). The registered person must 01/02/07 undertake monthly report all the home and these must be available in the home at all times for inspection. Monthly reports undertaken by 01/02/07 the registered provider need to be 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. Staff must be appropriately 01/04/07 supervised. (Previous timescales from 29.06.04 to date not met). A photograph must be kept in the home of each service user. A record must be kept of any restrictions of a residents rights and the resident’s agreement. An accurate record of all visitors to the home must be maintained. DS0000015564.V328192.R01.S.doc 36. OP33 26 37. OP36 18(2) 38. 39. OP37 OP37 17(1)a 17(1)a Sch 3 17(2) Sch4 01/02/07 01/02/07 40. OP37 01/02/07 Valentine Lodge Version 5.2 Page 39 41. OP37 17(2) Sch4 The duty roster must identify the 01/02/07 hours worked by the acting manager in each of her roles, i.e. when she is part of the care shift and when she is supernumerary and managing the home. 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 that staff working at the care home participate in regular fire drills. 01/04/07 42. OP38 23(4)d 43. OP38 23(4)e 01/02/07 44. OP38 23(4)a The person registered must take 01/02/07 adequate precautions against the risk of fire. This refers to appropriate risk assessment regarding the use of oxygen and identification on the door of any room where oxygen is used or storied. 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). The person registered must ensure the safety of residents and of people who work at the home. This refers to the development of risk assessments in relation to safe working practices. The person registered must ensure the safety of residents and of people who work at the DS0000015564.V328192.R01.S.doc 45. OP38 13(3) 01/02/07 46. OP38 23(2)c 01/04/07 47. OP38 23(2)c 01/04/07 Valentine Lodge Version 5.2 Page 40 home. This refers to the safety of the lift and the fixed electrical wiring. Copies of certificates in relation to both of these must be sent to the commission. 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 previous inspections). The home’s policy on homely remedies should include details of which medications it refers to. Protocols should be in place for as required medications. Residents’ wishes in relation to end of life care and practices should be ascertained and recorded in the care plan. (Outstanding from previous inspections). The registered person should ensure that complaints are logged and investigations and outcomes are recorded separately. The kitchen flooring should be replaced to ensure effective cleaning and infection control. 50 of care staff should achieve NVQ Level 2 The registered manager should achieve NVQ Level 4 in Management and Care. 2. 3. 4. OP9 OP9 OP11 5. OP16 6. 7. 8. OP26 OP28 OP31 Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 41 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. Extracts may not be used or reproduced without the express permission of CSCI Valentine Lodge DS0000015564.V328192.R01.S.doc Version 5.2 Page 42 - 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. 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