Inspection on 10/02/10 for Victoria Lodge Care Home

This inspection was carried out on 10th February 2010.

CQC found this care home to be providing an Poor service.

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

Victoria Lodge Care Home 07/12/09

Victoria Lodge Care Home 18/11/09

Victoria Lodge Care Home 04/08/09

Victoria Lodge Care Home 25/06/08

Victoria Lodge Care Home 03/12/07

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Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Random inspection report Care homes for older people Name: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB zero star poor service 05/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 1 0 0 2 2 0 1 0 Information about the care home Name of care home: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB 01384572567 0138479658 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Select Health Care Limited care home 61 Number of places (if applicable): Under 65 Over 65 0 61 dementia old age, not falling within any other category Conditions of registration: 61 0 The maximum number of service users to be accommodated is 61. The registered person may provide personal care (with nursing - Code N) and accommodation for service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: - Old age, not falling within any other category (OP 61); Dementia (DE 61) Date of last inspection Brief description of the care home Victoria Lodge, a purpose built home was opened in the summer of 2007. It is registered to provide personal and nursing care to people who have dementia and people who have other care needs associated with old age. It can accommodate a maximum of 61 people at any one time. The home is located near to Brierley Hill High Street with easy access to main bus routes and a range of shops and other amenities. Care Homes for Older People Page 2 of 17 1 8 1 1 2 0 0 9 Brief description of the care home The premises consist of three separate floors, with dementia care provided on the first floor and nursing care provided on the second floor. Each floor has communal areas, a dining room and lounge, bathrooms and toilets. All bedrooms are single occupancy with en-suite facilities. There are hoists and pressure relieving equipment available. A passenger lift provides assisted access to all floors. There is a main kitchen and small kitchenettes on each floor. There are also laundry facilities. The small garden areas are accessible to people using wheelchairs. Care Homes for Older People Page 3 of 17 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor compliance with two Statutory Requirement Notices served on 24 December 2009. These related to proper provision for the health and welfare, care and where appropriate, treatment, of all people using the service. This included the prevention and management pressure ulcers and the safe handling and administration of medication. We use Statutory Requirement Notices as part of our enforcement strategy to secure improvements in the quality of the service provided for the safety and well being of people living at the home. This service received a poor, zero star quality rating as a result of our key inspection in August 2009 and failed to demonstrate the required improvements at a series of random inspections in November and December 2009. The purpose built home, which opened in August 2007, previously had Statutory Regulation Notices served in 2008 for breaches of the Care Homes Regulations 2001. This random inspection was unannounced, which meant the home was not given notice of our visit. We spent a day at the home and looked at the medication systems and health care records, especially relating to prevention of pressure damage and wound care. We looked at how peoples healthcare needs were being managed. We also looked at how people were supported and given assistance to prevent damage to their skin and promote healing where pressure damage had already occurred. We looked at some bedrooms, particularly pressure relieving equipment. We talked with people living at the home, staff and visitors. At the random inspection on 18 November 2009 we were told by the previous management regime there was no-one with a pressure ulcer in the home at that time. At this inspection we looked at the wound care records for the five people and saw evidence, including photographs that the information given at that time was not accurate. We had received regular communication prior to this inspection visit from the current acting manager about actions in response to changes in peoples health, such as accidents or hospitalisation for deteriorating conditions. During the inspection we were told about three people with chest and urinary infections. There was evidence of medical support and appropriate medication administered for the treatment of their conditions. The acting manager told us that there were five people on the second floor, nursing unit with pressure ulcers in various stages of healing and one person on the ground floor residential unit whose wound had healed. We saw that all pressure ulcer wounds had been reviewed by the Tissue Viability Nurse on 31 December 2009 and appropriate wound care regimes had been prescribed. We were told that no-one had developed any pressure damage to their skin since that time, apart from a person who had returned to the home with a hospital acquired pressure ulcer to their sacrum. The acting manager had requested a review by Tissue Viability Nurse for this wound. We noted that this wound had healed and preventative measures were in place. The acting manager and nurse explained that revised risk assessments, health screening tools and new more person centred care plans were being put in place but this would be a lengthy process. We saw a sample of old style wound care plans and records, which were adequate, with care plans detailing the care to be given, instructions for weekly Care Homes for Older People Page 4 of 17 photographs and measurements. Unfortunately the care instructions had not been followed by the nurses and management no longer at the home. For example one person who was terminally and developed a grade 4 pressure ulcer on her heel had only one photograph dated 20 November 2009 with no measurements or description. This meant that there was insufficient monitoring to assess whether the wound was healing or deteriorating. Since the Statutory Requirement Notices were served there was evidence of improved practice, however further good practices need to be developed. For example a person who had pressure ulcers on their sacrum and both heels had all their wound care recorded on one chart, which was confusing and made individual wound care audits difficult. We looked at some of the new care records, which showed improvements. We looked at all risk assessments and associated care records for all wound care regimes. There were records to show when wounds were redressed and the dressings used. However there were limitations as audit trails of wound care because there were no grades, descriptions, measurements or photographs. This would give important information about the healing or deterioration of the wound. The senior nurse devised new individual wound charts during the inspection visit, which included wound grade, size, appearance, treatment and frequency to be redressed. We discussed other areas were further development was needed with the acting manager and senior nurse. Examples were: a new care plan for pressure area care recorded reason to care plan: due to my mobility difficulties and general frailty I need support to ensure I dont develop damage to pressure areas, and aim: for me to be supported to maintain my skin integrity and not experience any pressure damage. This did not reflect the fact that this person had already developed three significant pressure ulcers and this information was important to record as part of the care plan. The care instructions included I have a pressure relieving mattress on my bed; staff will ensure this is in good working order on a daily basis and any problems will be reported immediately. I have a pressure relieving cushion on my chair to limit the opportunity for damage to occur. Though this plan appeared to be more person centred, there was no information about the type of pressure relieving mattress and pressure setting to be maintained for the persons body weight. Each person had a moving and handling risk assessment but these should include instructions for the number of staff or equipment to be used, so that they could be assisted safely. There were nutritional assessments and use of the MUST (Malnutrition Screening Tool), with weight records. However there was an example where someones weight had not been recorded diligently each month and appeared to have fluctuated considerably, with weight losses in excess of 10kg in five weeks and gains of more that 3kg in four weeks. We were told that this had not reported to the nurses or acting manager and therefore had not been investigated. We raised a similar issue related to a different person at the random inspection in November 2009. We saw written guidance from the Tissue Viability Nurse to seek dietetic advice for each of the people she had reviewed. We were unable to find referrals to the community dietician. The acting manager acknowledged if there were no records, referrals had probably not been made. She pointed out one persons weight was over 75kg and would not need diet supplements. We recommended that the Tissue Viability Nurses instructions should be followed so that people would have sound dietary advice for a nutritious, high protein diet with appropriate vitamins and essential minerals to promote healing and Care Homes for Older People Page 5 of 17 improved skin condition. We looked at the care of a person who was terminally ill and had returned from hospital to remain at the home. She told us she was happy with the care at the home and that staff were kind and generally attentive. We saw that several types of pressure relieving cushions had been tried, unfortunately none were suitable to use with her own recliner chair, which gave her optimum comfort. We looked at the pressure reliving mattress, which was set at a firmer pressure than was recommended for this persons body weight. She told us that it sometimes felt too hard. We discussed the mattress pressure setting with the acting manager, who reduced the pressure to a more appropriate setting. The acting manager acknowledged that previous recommendation to record pressure settings care plans had not been implemented but assured us this would be implemented. The person told us her appetite was not good and wasnt eating well lately. She told us she was asked what she wanted for her meals but said the meals were too big. She commented, have asked for smaller meals but staff just say leave what you dont want. This was evidently off putting for her. We noted that this person had a recorded weight loss of 2.7 kg in seven weeks and had not been referred to the community dietician. The acting manager assured us that a referral would be made and instructions would be given to staff to offer several small appetising meals each day. We noted that a person on the residential unit with a sacral pressure ulcer, which had healed, was refusing to have a pressure relieving mattress. We spoke to this person who told us the risks had been explained to her and that she preferred to sleep for the majority of time in the chair. This was also recorded and staff were to try to make sure they gave assistance with other measures for position changes, whenever possible with the persons co-operation. We saw that all four nurses currently employed by the home had attended tissue viability training on 23 December 2009, provided by the Tissue Viability Nurse Specialists. The acting manager and senior nurse on duty were knowledgeable about prevention of pressure damage and wound care management. The pharmacist inspector checked the management and control of medicines within the service. We looked at the medication administration record (MAR) charts on the first floor and overall found that they were documented with a signature for administration or a reason was recorded if medication was not given. For example, we looked at the MAR charts for two people. One person was prescribed 16 different medicines including tablets, capsules and ointments. The other person was prescribed 15 different medicines including tablets, capsules, patches, eye drops and ointments. We saw that there were records of the medicines being given according to the prescribers instructions. We checked the amount of medication available in the home in order to determine whether medication had been given as prescribed. We found that the majority of checks for both people were correct, however not all of the medication could be accounted for using the records available. This meant that although there were improved arrangements in place the service needs to ensure that staff are aware of the correct procedures for recording and checking medication has been given. Other medication records were generally up to date, however not all records were correctly documented. For example, we looked at the medicine records for one person Care Homes for Older People Page 6 of 17 recently admitted from hospital. The medication that the hospital had sent out with the person had not been recorded as received into the service. We spoke to a member of staff who agreed that the medication had not been booked in correctly when the person came out of hospital. This meant that the total amount of available in the home for the person was not recorded. We found it difficult to easily locate the persons medication in the medicine trolley. We found that a box of capsules labelled for the person was located on a shelf for another person. We also found a further supply of the capsules packed into a blister pack from the pharmacy located on another shelf in the trolley. This meant that there were two different supplies of the same capsule for the same person located in two different places in the medicine trolley. This meant that due to a lack of organisation within the medicine trolley there was an increased risk of a medication error. Overall we found that there was some improvement in medicine management by the service, however further systems needed to be implemented to ensure that medication prescribed for people could be accounted for and that medication was safely and clearly organised. There were no new admissions to the home, in accordance with an agreement with us, in place since 9 December 2009. There were 48 people accommodated at the home at the time of this inspection. This meant there were 13 vacancies. The atmosphere of the home was less chaotic and generally calmer, attributed to the reduced occupancy and dependency levels. We saw that people looked well presented and were dressed appropriately according to their preference. There was more interaction between staff and the people living at the home than we had seen during previous visits. We spoke with relatives who told us they felt the home was improving with the current acting manager but they said they were aware she was only a temporary manager until a new manager could be recruited and they were concerned about what would happen then. They said communication could be improved, for example they had not been told their mothers primary carer had changed; they had found out by looking at chart on the wall, They told us that the kitchen on the nursing unit had been refurbished, which was an improvement and pictures and an orientation board had been put back on the wall. Although we were told at a meeting with the directors of the organisation in December 2009 that the current acting manager would be submitting an appliaction to us for registration as manager for this home, during this inspection we were told that the organisation was actively recruiting another manager for the home to replace the current amangement arrangements. This would mean that this home would have had seven managers in less than three years. What the care home does well: People looked well presented, cared for, wearing clothing according to their preference. The home had a friendly and welcoming atmosphere where people were encouraged to personalise their rooms to reflect preferences and tastes. All bedrooms were en suite, spacious, light and airy. Care Homes for Older People Page 7 of 17 There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. Relatives said, We feel there are improvements with the current acting manager the home is going in the right direction. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 4 14 Each persons needs must be 01/02/2010 assessed by a competent person, be kept under review and be revised at any time as necessary in relation to any changes. This is to safeguard the health and well being of people living at the home. 2 7 15 To ensure that there are 01/10/2009 health care assessments, risk assessments and care plans, which include all of each persons assessed needs, and are updated to accurately reflect all changes to health and care needs. This is to ensure care for each persons health and well being is properly provided at all times. 3 7 12 Care plans, monitoring and 31/12/2009 management strategies must be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. This will ensure that staff Care Homes for Older People Page 9 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action take required actions to promote peoples health and well being. 4 8 12 To ensure that people with 31/12/2009 changes to their condition such as poor nutritional intake, weight fluctuations are monitored using recognised screening tools as frequently as required by their risk assessments and care plans. This will ensure that staff take required actions to promote peoples health and well being. 5 8 13 To devise and implement 01/09/2009 written protocols agreed with health professionals and obtain appropriate training for staff who undertake blood glucose monitoring, which is an invasive body procedure. This is to safeguard peoples health and well being from risks of harm. 6 8 12 To ensure that staff make timely referrals to health care professionals for specialist assessment, support and advice, with action taken to diligently follow instructions for each persons care needs. This will ensure that staff take required actions to promote peoples health and well being. Care Homes for Older People Page 10 of 17 31/12/2009 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 7 9 13 To ensure that all persons 01/09/2009 living at the home receive their medication as prescribed by their doctor and the Medication Administration Records must be accurately completed to demonstrate either medication has administered or an appropriate code entered to record the reason for non administration. This is to maintain the health and well being of people living at the home. 8 9 13 To ensure that variable 01/09/2009 dosages, such as 1 or 2 tablets, 5mls or 10mls are recorded as administered on MAR sheets. This is to ensure that peoples health and well being is safeguarded. 9 9 13 The records of the receipt, 01/10/2009 administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. This is to maintain the health and well being of people living at the home. 10 9 13 Staff who administer 01/09/2009 medication must be competent and their practice must ensure that people Page 11 of 17 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action receive their medication safely and correctly. This is to safeguard the health and wellbeing of people living at the home. 11 9 13 Risk assessments must be 01/09/2009 put in place for any medication which is self administered, including creams, sprays and inhalers. This is to safeguard the health and well being of people living at the home. 12 9 13 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 13 18 13 To provide appropriate, up to 01/11/2009 date policies and procedures, and safeguarding training for all staff, with monitoring arrangements to ensure the homes and Safeguard and Protect procedures to protect vulnerable people are implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. Care Homes for Older People Page 12 of 17 01/09/2009 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 14 27 12 To demonstrate that the number of staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 01/10/2009 15 29 19 To ensure that all staff 01/09/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to safeguard people living at the home from risks of harm. 16 31 9 To ensure that an application 01/11/2009 is submitted to register the manager. This is to ensure that the home is managed to safeguard everyone at the home. 17 33 24 To implement effective 01/10/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the Care Homes for Older People Page 13 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action health, well being and safety of people living at the home. 18 38 23 All staff, and especially night 01/02/2010 staff must receive fire training and attend fire drills at frequencies approved by the West Midland Fire Service. This is to safeguard people at the home from risks of harm from fire. Care Homes for Older People Page 14 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 The Tissue Viability Nurses instructions, that people with pressure ulcers must be referred to the Community Dietician, should be followed so that staff have sound dietary advice to provide each person with a nutritious, high protein diet with appropriate vitamins and essential minerals to promote healing and improved skin condition. This is a new Good Practice Recommendation. Advice from community dieticians should be sought for all persons assessed to be nutritionally at risk, with records of support and advice offered and that a record be maintained of staff training in relation to nutrition. This is a previously unmet Good Practice Recommendation. The correct pressure setting for pressure relieving mattresses should be recorded in each persons care records with regular documented checks. This is a previously unmet Good Practice Recommendation. Advice from Diabetic specialist nursing service should be sought for any person with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to Page 15 of 17 2 8 3 8 4 8 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations diabetes. This is a previously unmet Good Practice Recommendation. 5 8 Moving and handling risk assessments should include instructions for the level of assistance and equipment required for all transfers. This is a previously unmet Good Practice Recommendation. Carried forward stocks of medication should be recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. This is a previously unmet Good Practice Recommendation. It is recommend that care plan goals in this area should be made clear, and that key workers evaluate actual opportunities offered, taken up or declined each month. This should then provide a sound basis for future planning and goal-setting. This Good Practice Recommendation was not assessed at this Random Inspection. Food should be served at safe temperatures, which ensure people can enjoy their meals, with appropriate levels of assistance given to people unable to eat independently. This Good Practice Recommendation was not assessed at this Random Inspection. Dudley MBC multi-agency Safeguard and Protect procedures for vulnerable adults, and that that staff signatures should be obtained to demonstrate they have read these documents. This Good Practice Recommendation was not assessed at this Random Inspection. Behaviour care plans should be diligently completed with fuller and more specific information which can be used to evaluate, understand and improve the management of behaviour triggers for individual people with behaviour that challenges, such as agitation, aggression and wandering. This Good Practice Recommendation was not assessed at this Random Inspection. The plans to ensure the environment meets the needs of everyone living at the home should be implemented in a prioritised timescale. This is a previously unmet Good Practice Recommendation. Page 16 of 17 6 9 7 12 8 15 9 18 10 18 11 19 Care Homes for Older People Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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