Inspection on 08/10/07 for Valentine Lodge

This inspection was carried out on 8th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/05/07

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 8th October 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Valentine Lodge DS0000015564.V349307.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.V349307.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.V349307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing care to be offered to no more than 20 older people. Date of last inspection 14th May 2007 Brief Description of the Service: Valentine Lodge is registered to offer accommodation with nursing care for twenty older people. The home is situated near to local amenities and transport on Canvey Island. There are shared bedrooms on the ground floor, all with a toilet, wash basin and shower, and five single bedrooms on the first floor with hand washing facilities. There are two lounges and a dining room downstairs and there is a passenger lift. There is limited parking to the front and side of the home and an enclosed garden area 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. Valentine Lodge DS0000015564.V349307.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 spent nine hours at the home that day. Five residents, two visitors, three staff and the 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 some of the fifteen residents living at the home at that time and additional records were sampled for specific issues. Information was requested through surveys from residents, relatives and staff. Comments from the residents, relatives and staff, including from completed questionnaires and telephone conversations are also reflected in the report. This is the second key inspection of this home this year. Following the first key inspection, the home was served with a Statutory Enforcement Notice because of the concerns regarding poor recruitment practices. A further random inspection of the home took place in August 2007 to assess compliance with the Notice. Improvements were noted and no further action was taken. The continued improvements made by the manager are noted positively and some requirements and recommendations from the last inspection report have been met. While a number of regulations continue not to be fully met, the slow but continued improvements within the home demonstrate more effective internal management and so the home’s assessed rating has been changed. Work on meeting regulations must continue to ensure best quality care outcomes are provided to residents and must be better supported by the registered owner. Discussion of the inspection findings and full feedback was provided to the manager at the end of this site visit and guidance and advice was given. The inspectors would like to thank the manager, staff team, residents and relatives who participated for their help throughout the inspection process. What the service does well: Valentine Lodge provides a welcome to those visit, and opportunity for residents to build relationships with a friendly manager and staff team. Comments received said they offer “good standards of food and cleanliness” and “they try to make life as normal as possible” and another said “they take great care and consideration of their residents”. One survey told us “ the manageress.. does a fantastic job. She does everything in her power to make life as enjoyable as possible…. The staff also do a wonderful job, always willing to help”. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Valentine Lodge DS0000015564.V349307.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.V349307.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking about using the service at Valentine Lodge will have clear information to help them to make a decision about living there. Prospective residents will have an assessment so that the home can reassure them that their needs will be met there. EVIDENCE: The manager had updated the statement of purpose and service user guide following the first key inspection and copies had been sent to the Commission. Both of these documents, along with the homes most recent inspection report, were clearly displayed and available to visitors in the entrance hall. Surveys received from both residents and relatives indicated that they felt they had had enough information about the home before they moved in so that they could decide if it was the right place for them. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 9 The files for some more recently admitted residents were sampled and each contained a basic assessment undertaken by the manager prior to admission. There was a letter on each file confirming that based on the assessment, the home could meet the resident’s needs. A statement of terms and conditions was available on each of the files tracked and these were signed and dated both by the home, and either the resident or their representative. Since the last inspection, several staff had attended training on diabetes. This is positive and Valentine Lodge needs to continue to provide all staff with specialist training on conditions associated with older people, to ensure residents’ needs are best met. Valentine Lodge DS0000015564.V349307.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has their own detailed care plan so that staff know how to provide care for them in a way that meets their individual needs and wishes. Residents’ dignity and diversity was respected. Residents are not best safeguarded by the medication practices at the home. EVIDENCE: Some care files for residents were looked at and followed through fully and some others were looked at for particular issues. All files looked at had photographs of the resident. This is an improvement. They were well organised and information was easy to find. The care plans have continued to improve and generally they had clear and detailed instructions for staff on how each person was to be offered care that met their individual needs. They covered a wide range of areas including medication, individual areas of personal care needs, specific medical needs such as diabetes, wishes for end of life care and social interests. Guidance was given on including clearer information on occasion for example, a protocol on Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 11 when an enema was needed and clearer detail for staff on managing behaviour that challenges so that care is consistent and effective. Care notes were written regularly but were often repetitive and did not show what each persons day had really been like so that the care plan could be monitored to see if it was the best plan for that person. Risk assessments were in place regarding falls, moving and handling and tissue viability to support the plan of care and were reviewed monthly. There was evidence that the resident or relative had been involved in the care plan and its review and the manager was recommended to ensure this was kept upto-date for all residents. Risk assessments relating to bed rails had clearer details than previously. There were periods of time, up to an hour, when the lounge was unsupervised by staff, although staff were aware that care plans showed the need for some residents to be monitored, for example because of an identified risk of falls. Staff were also observed to be aware of care plans/individual needs of residents and to act on them to provide positive individual care and support. Staff were generally observed to competently and confidently work together in providing safe moving and handling practice while hoisting residents. The residents were spoken to by name and told what was happening at each stage. This is particularly noted improvement. However, it was again disappointing to see an occasion where footplates were not used on a wheelchair, which does not best protect residents’ health and safety. Discussion with a relative and observations of staff interactions and communications showed that residents’ general health was monitored. Records showed regular chiropodist visits, access to specialist services as required and GP attendance. The fluid intake charts and position turning charts for residents who were cared for mainly in bed were seen to be have been completed regularly and were up-to-date. This is a noted improvement. Two residents had been recently unwell and were on antibiotics. There was a general medication/ medical needs care plan for each of the residents but no shortterm plan of care in place about this current need and guidance was given to the manager. Medication is administered only by qualified staff and a sample list of signatures/initials of those staff deemed competent to administer medication was available. The practice observed during the morning medication round was satisfactory. This started at 9:15am and it was not completed until 10:55am, which is not best practice as some residents would be due to have medication again at lunchtime. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 12 The staff members spoken to advised that they are often delayed by needing to stop the medication round to deal other issues, for example a dressing, PEG feeds etc. The system should be reviewed and reorganised. Medication records reviewed were not well maintained containing administration omissions, a lack of detail as to exact dosage administered where there was a choice, no record of prescribed oxygen and no clear guidance for staff on when to administer ‘as required’ medications for individual residents, to support monitoring and effectiveness. Where records of medication administration showed omissions, there was no record that the reason why had been investigated and any adverse outcome for residents addressed. Handwritten entries for additionally prescribed medications were not signed by two staff to support accuracy and safeguard residents. Care plans clearly showed residents’ lifestyle choices such as likes and dislikes with food and preferences on times for going to bed and getting up and respected people’s diversity. They encouraged staff to support and maintain residents’ independence skills and dignity. Residents’ dignity was seen to be protected during moving and handling transfers, and at times of toileting and personal care. All care plan file samples had a separate section regarding death and dying. This indicated the resident’s wishes as to where they would like to be cared for at the end of life and where they or their family had indicated who was to be informed and who would make necessary arrangements. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Valentine Lodge are given the opportunity to take part in recreational activities that they enjoy and to make choices about the everyday things in their lives. Residents are offered meals that they enjoy and their visitors will be welcomed. EVIDENCE: Residents’ recreational interests and religious needs were identified within their plans of care although there was no life story, which would have provided more information and topics for discussion. The activities co-ordinator continues to provide 15 hours support each week, now spaced over four rather than five days. Group activities such as ball games, giant snakes and ladders or listening to and singing with appropriate music and songs were observed to be enjoyed by some residents and other residents were offered one-to-one activities such as being read to. The activities coordinator advised that there is no planned programme as she is flexible as to what is provided dependent on what residents feel like each day. One resident spoken with said that they like participating in the activities provided as it “keeps the mind alert”. Staff were observed to spend some time Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 14 talking with and listening to residents and visitors, which is positive, although one resident said that while they like living at Valentine Lodge, at times they “feel quite lonely”. A relatives survey suggested the need for more activities. The activity coordinator maintained her own record of participation and opportunities given to each person. Care notes also showed that residents took part in activities such as reading, knitting, having their nails or hair done, watching TV in the lounge, playing cards, going out shopping for new clothes with a relative and also having visitors. Visitors were seen to be welcomed at Valentine Lodge. This was confirmed by those spoken with and in the comments received in surveys. Comment included “I and my family are made welcome at all times” and “made to feel welcome and you can visit anytime”. Residents were able to make choices during the day, for example in what drinks they had, in what clothes they wore each day and whether or not to join in activities. Residents were offered the choice of tea or coffee from the morning drinks trolley and have biscuits served using a tongs, which is an improvement on previous practice. Cold drinks were available in the lounge throughout the day, but with little active encouragement to residents to have them. For lunch residents were offered ham, egg, chips and tomatoes, with sultanas sponge and custard for dessert. One resident requested, and was given breadand-butter and it was disappointing that this was not offered to other residents. It was noted positively that residents were offered a choice of cold drinks as well as tea and coffee with lunch. There was no active choice of main meal, although an alternative was provided for one resident. One resident clearly was not wanting their lunch as they were unwell, but staff did not offer anything else and were unclear on what else could be offered when asked by the inspector and the resident themselves suggested an alternative when asked. Five residents spoken with confirmed that the food at Valentine Lodge was good and that there was plenty of it. Care files confirmed that residents are weighed regularly each month. A format for recording the food served to residents was provided for staff to complete. This clearly indicated several gaps particularly in relation to whether the resident had eaten or not. It did not identify where resident had a specialist dietary need, for example a diabetic diet. The recommendation of providing some information for residents about what was on offer at each days menu in a format that they could see and understand, remains outstanding. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives felt able to raise any concerns they may have and know that they will be listened to. Residents were generally safeguarded by staff knowledge that could be enhanced by additional training for all staff . EVIDENCE: Information on the homes complaints procedure was displayed in an easy to read format on the residents’ notice board. Surveys from residents and relatives indicated that they would know how to make a complaint if there was something they were unhappy with. Surveys received also demonstrated that staff were aware of how to respond to any concerns raised. One issue had been raised with the manager regarding the practice of one staff member. This had been reviewed and was found to have been dealt with appropriately. The manager further advised that she realised that there was a training need here for all staff that would be discussed with staff at the next team meeting to ensure that both residents and staff are safeguarded. No other concerns or complaints had been raised with the home or the Commission since the last inspection. The manager advised that no new compliments had been received. The manager’s whistle blowing procedure was displayed on the notice board in the main corridor. The training matrix provided shows that the majority of Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 16 care and domestic staff have had training in safeguarding in the past year. . The staff surveys received confirmed this and also that staff have an awareness of the policies and procedures relating to this. Previous inspection reports have recommended that staff were provided with training on management of behaviour that challenges as this has been a recurrent issue at the home. The manager confirmed that this training will now be sought for staff. It was noted positively that staff responded well to verbal communications from a resident at a point that could have become a difficult situation without sensitive handling. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Valentine Lodge are being offered a home that is improving in the standard of its décor, comfort facilities and safety. Residents would benefit from additional resources to continue to upgrade the premises, its furniture and availability of hot water. EVIDENCE: New carpet had been fitted in the smaller lounge since the last inspection and this has provided a safer environment for residents. Some more bedrooms have been decorated and some have had new furniture and they looked brighter and more pleasant places for residents to spend time in. Care notes show that residents have spent time in the garden and so the development of this has proved a positive experience for those who live at the home. The smaller lounge no longer smelt of cigarette smoke as the room Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 18 previously used by staff as a smoking room is no longer used for this purpose following recent legislation. Some resident’s bedrooms were particularly well personalised. None of the rooms are fitted with appropriate locks that would give residents an active choice as to whether they wished to be able to lock their rooms when they left them, so respecting their privacy. There are several shared rooms where privacy is provided by the use of curtains. Some resident’s bedrooms continue to have shabby and old furniture. Residents have a choice of two lounges, one looking out at the front end the other looking out at the back garden area and a separate dining room which was seen to be pleasantly set at mealtimes. There is no separate room for some residents to have privacy to meet with their visitors. There is a lack of hot water in some areas in the home, including in resident’s bedrooms. One resident advised that the only negative thing they had to say about the home was the there was no hot water in their room to wash with. This has been an ongoing issue that the registered provider is aware of but who has repeatedly advised that there are cost implications to putting it right to an effective standard. The home was generally seen to be clean and safe. The laundry has appropriate equipment and the door was fitted with a keypad to protect residents. A staff survey advised that while the equipment they have is adequate for the job and works, they could do with more, and that the home “needs modernising with regard to décor and furniture and they could do with some new equipment”. Surveys from relatives included comments on the need to continue the refurbishment of the premises, for example, “ I feel that the owner could do more to keep up with the modernisation of the home”, “the interior although clean could benefit from some refurbishment” The home’s Annual Quality Assurance Assessment of May 2007 shows a plan to upgrade the bathrooms at Valentine Lodge. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents felt supported by friendly, caring and familiar staff. Training for staff continues to improve and this will help them to care for residents more effectively. Residents would benefit from better supervision, and more robust staff recruitment and induction practices could ensure better quality care outcomes for residents. EVIDENCE: It was noted positively at the last key inspection that the manager had increased the staffing levels in line with the increased number of residents living there. Four weeks rotas were looked at and these showed that the staffing level of one qualified (nursing) staff and three carers had been maintained during the day, with one qualified staff and one carer at night. A housekeeper/laundry person is employed as well as a cook each day. As noted earlier in this and in previous reports, staff supervision of residents at times was not adequate and residents were left unsupervised at times. A relatives survey as to how the home could improve also noted this “closer supervision of residents who seem to be left unsupervised for long periods”. Some staff were working long days but this was seen to be notably reduced from previous occasions and staff had adequate days off. The manager said they do not use agency staff and their own staff cover are sickness and Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 20 holidays etc by doing some extra shifts, as this gives residents greater continuity of care. Residents’ comments regarding staff were positive and staff addressed residents by name. One relative survey said “ The staff are all very friendly and it’s like one big happy family”. Another said “kindly staff”. The manager has also rewritten the job descriptions for all staff putting the active involvement of all staff in the care of residents and working as a team to provide this, as a priority. The manager confirmed that she has been successful in a bid to obtain a grant to fund staff training and this will now continue and develop. She advised two staff have completed NVQ Level 2 in Care and will be enrolling this week for level 3, two staff are almost completed Level 2, and a further two staff will enrolled this week for Level 2 training. The file was assessed for one staff member who had been recruited since the last inspection was reviewed. The application form was unclear as to what the person had done over a five-year period, and there was no evidence that this had been explored as required. A health declaration was not in place. Two references from work colleagues were available, but not from their previous/current employer, a practice of concern pointed out to the manager previously, prior to issuing of the Statutory Enforcement Notice following the last key inspection. The manager is aware that this cannot happen again and that references will be taken from current/previous employers. The persons Criminal Record Bureau (CRB) check was dated as received the day following their start date as recorded on the contract of employment, and no Povafirst check was available. The manager stated that while the persons contract started on that date as a bank staff member, they did not work until after their CRB check was in place. There was no evidence of an induction having been undertaken for this member of staff, who was currently working in the home. There was evidence of current training in moving and handling and training some two and a half years previously on fire, medication and Parkinson’s disease. The staff member had had more recent training on wound management and principles of phlebotomy. There was no evidence of training regarding Safeguarding vulnerable people. The cook confirmed that they had not had training in food hygiene/handling. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from internal management that has shown commitment to improving standards of care for the people who live there, listening and acting on their views. The registered owner needs to put systems in place to ensure the safety and well being of residents, staff and visitors. EVIDENCE: The manager continues to undertake NVQ Level 4 training. The manager has clearly put much effort into improving the home in the time she has been in this post and expressed commitment to ensuring this is both maintained and developed. She is aware that must continue in a timely way. The Commission previously agreed with the registered owner’s proposal to have Mrs Slater as manager of the home supported by an identified qualified Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 22 nurse to provide clinical supervision. The named nurse has left the employment of the home but the registered provider has not notified the Commission or made a new proposal/request for the Commission’s agreement. The manager had previously sent out quality surveys to residents/relatives and will continue to do this annually. Reports required by Regulation 26 had been undertaken by the registered person, and while brief in detail, were available in the home. Minutes were available of a meeting for residents, relatives and staff, which is organised by the activities co-ordinator. This showed attendance of five residents, four family representatives and five staff members. Minutes record three residents separately saying they were happy with the care provided and four relatives as agreeing that the standard of care offered is good in their opinion. Information on the next meeting was displayed. The manager confirmed that the home do not manage/look after any money for residents. The manager advised that all fees are paid directly to the registered person. The manager confirmed awareness that designated staff need training on supervision to enable them to offer this effectively to support staff. Six staff files were randomly sampled. These showed that staff supervision was spasmodic with one staff not having had supervision since December 2006.The topics covered were basic and guidance on accessing information from National Minimum Standards was given. Fire drills were recorded as occurring regularly and at varied times. This should indicate the outcomes. Discussion with the manager also indicated a need to re site one smoke detector with appropriate professional advice. Current safety inspection certificates were available for portable appliances, gas, the passenger lift, emergency lighting and fire alarm system. The certificate regarding the fire extinguishers was dated August 2006 and so was out of date. There was no current inspection certificate for the electrical fixed wiring, a concern raised previously with the registered owner, who has failed to provide a copy of a current certificate to the commission when requested following two previous Key inspections. Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 3 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/a 2 X 2 Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 OP9 OP18 OP30 Regulation 18(1)c Requirement Residents must be cared for by competent staff that are adequately trained in all areas of the residents’ assessed needs and safety requirements. This includes providing all staff with an induction to a recognised standard, and continuing specialist/ updated training as required for both care staff and qualified nursing staff This requirement is outstanding in parts from previous inspections. 2. OP9 13(2) So that residents are safeguarded medication must be safely managed, for example accurate records must be kept relating to all medications prescribed for resident, administration or non administration of medication and the amount administered where this is variable and protocols must be kept for drugs taken on an ‘as required’ basis . (This is an outstanding requirement.) DS0000015564.V349307.R01.S.doc Timescale for action 01/11/07 08/10/07 Valentine Lodge Version 5.2 Page 25 3. OP15 17 (2) Sch 4 (13 Residents must receive a varied, wholesome, nutritious and balanced diet and detailed records must be kept that show this is met effectively for each person. Residents must have a pleasant and safe place to live. The person registered must ensure that furniture is well maintained, the premises well maintained and decorated and that residents have adequate supplies of hot water for washing at all times. This requirement is outstanding in parts from previous inspections. 01/11/07 4. OP19 23(2)c & d 01/11/07 5. OP27 18(1)aSch To safeguard residents, enough 4 (7) 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 or may be at risk of falls. This is outstanding from previous inspection reports. 08/10/07 4. OP29 19, 17(2) Sch 2 & 4 So that residents are 08/10/07 safeguarded the home must evidence robust and safe recruitment procedures are followed and references taken up from relevant people. 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 DS0000015564.V349307.R01.S.doc 7. OP36 18(2) 01/01/08 Valentine Lodge Version 5.2 Page 26 acting manager. Previous timescale from 29.06.04 to date not met. 8. OP38 13(4) 23(2)c 23(4)c To ensure residents and staff live 01/12/07 and work in a safe environment, equipment must be inspected and maintained. This refers to the safety of the fixed electrical wiring and to the fire extinguishers Copies of certificates in relation to these must obtained and copies sent to the commission. That relating to electrical fixed wiring is outstanding from previous inspections 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 OP7 Good Practice Recommendations Short term care plans should be introduced where this is relevant to ensure the residents current care needs are identified so that staff can meet them consistently. 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 should be given clearer information about the days menu. Staff should sit down with residents when offering support with feeding. 2. OP9 3. OP15 Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 27 4. 5. OP21 OP24 The programme of maintenance should include the flooring in the bathroom and kitchen To demonstrate support for proactive choice, residents’ bedrooms should be fitted with safe and appropriate locks and keys should be offered to each person, unless risk assessment indicates otherwise. 50 of care staff should achieve NVQ Level 2. The registered manager should achieve NVQ Level 4, Registered Managers Award. 5. 6. OP28 OP31 Valentine Lodge DS0000015564.V349307.R01.S.doc Version 5.2 Page 28 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.V349307.R01.S.doc Version 5.2 Page 29 - 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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