Inspection on 03/12/07 for Victoria Lodge Care Home

This inspection was carried out on 3rd December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Victoria Lodge Care Home 10/02/10

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

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 3rd December 2007 07:00 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 Victoria Lodge Care Home DS0000070198.V349977.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. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Lodge Care Home Address Bent Street Brierley Hill West Midlands DY5 1RB 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) 01384 572567 01384 79658 Select Health Care Limited vacant post Care Home 61 Category(ies) of Dementia (61), Old age, not falling within any registration, with number other category (61) of places Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes 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) The maximum number of service users to be accommodated is 61. 2. Date of last inspection First Key Inspection Brief Description of the Service: Victoria Lodge is registered to provide personal and nursing care to people who have dementia and people who have personal care needs associated with old age. It can accommodate a maximum of 61 people at any one time. Victoria Lodge is a new purpose built home. It was opened in the summer of 2007. The premises consist of three separate floors. Nursing care provided on the second floor. Each floor has its own communal areas dining room and lounge, bathroom and toilets. All bedrooms are single occupancy with en-suite facilities. The home is located not far from Brierley Hill High Street giving easy access to main bus routes from Dudley one-way and Stourbridge the other. In addition to access to a range of shops and other amenities along Brierley Hill High Street and Merry Hill Shopping Centre. A statement of purpose was not available during the inspection so we could not determine if the range of fees were included as they should be. The manager provided us with the minimum and maximum weekly fee ranges applicable at the time of this inspection, which are £353 to £650. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out this unannounced inspection over two days between 6.10 – 18.12 on the first day and 08.00 and 17.00 on the second day. One inspector and a pharmacy inspector who assessed the medication systems and medication safety on the first day carried out the inspection. We had help from an expert by experience for this inspection. An expert by experience is a person who because of their shared experience of using services or them having involvement with someone who uses services, visits a service with an inspector to help them get a full picture of what it is like to live in or use the service. Before the inspection we sent an Annual Quality Assurance Assessment (AQAA) to the management for completion to give us up to date information about the running of the home, services provided, areas that they feel do well in and areas they have identified that need improvement. The AQAA was completed to a satisfactory standard. During the inspection we spoke to people who use the service, relatives, management and staff. Since the inspection we have spoken to two relatives by phone. We spent most of the inspection time on the first and second floor of the home, as this is where people with the most complex needs are accommodated. We spent time in lounges and dining rooms so that we could observe daily routines and involvement between staff and the people who use the service. We looked at the lounges and dining rooms on floors one and two. We partially observed breakfast and lunch times. We looked at four bedrooms, bathrooms, the gardens, the hairdressing room, laundry and kitchen. We looked at records about people who use the service such as care plans and risk assessments to see what care the service was providing to them. We looked at staff files to see how safe recruitment practices are. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Since the home has opened we have received a number of concerns about inadequate staffing levels. We told the home in September 2007 that staffing levels were not adequate and that they must ensure adequate staffing levels at all times to meet needs. Since this time we have received another concern about staffing levels. During this inspection records and our observations told us that staffing levels are still not adequate. Due to poor staffing levels some people who use the service have been and are being placed at risk, they are not safe due to lack of supervision, staff with insuffient knowledge about their needs and inconsistent nursing staff which is causing poor communication. The lack of staff is also having a negative impact on the physical welfare and whole care provided to some people who use the service, in that staff do not have time or are rushed. To add to this the original manager resigned from the home shortly after it opened. During our time at the home we saw evidence to confirm that management systems and monitoring processes are weak, which again places the people who use the service at risk. People who use the service and people who made comments about the service told us; “ Far too few care staff and not enough support”. “ We are very Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 7 worried about the care Mum is getting”. “ They are so pushed for carers it is unbelievable”. “ I am very concerned about staffing levels”. “ I’m leaving before something really bad happens here”. “ Never enough staff. Can’t meet needs, not safe”. “ Never enough staff, we are really rushed”. “ Worried about staffing levels. Main problems being the number of agency staff we use and the type of client, dementia needs”. Evidence gained during this inspection has shown us that the home has not done what we recommended in September 2007 and has continued to allow new admissions despite inadequate staffing levels, which has placed people at risk. This tells us that priority has been to ‘fill beds’ rather than ensuring that needs are met. Medication systems were a great concern to us. We found that medication management and systems within the home are unsafe and potentially place the people who use the service at risk. Complaints and protection processes and practice don’t always give assurance that concerns will be listened to and acted upon and that people who use the service are being properly safeguarded. Whilst it is positive that the home employs a full time activities co-ordinator a number of people who use the service, because of complex needs, are unable to participate in the activities offered. The activities co-ordinator does not have time often to provide one to one attention. Therefore; people who have complex needs do not receive the stimulation and recreational time they need. 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. Victoria Lodge Care Home DS0000070198.V349977.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 Victoria Lodge Care Home DS0000070198.V349977.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): 1,3,4. Quality in this outcome area is poor. Prospective people who use the service do not always have the information they need to make a decision about the homes suitability for them. No person moves into the home without having had their needs assessed but their needs, against staffing numbers are not being considered which, leaves some people who use the service at risk. Due to staffing numbers the needs of a number of people living in this home are not being met and they are not safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at information in the front entrance we did not see a statement of purpose. We asked the manager to provide us with this document but as one was not available he could not provide one. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 10 We looked in the Service user guide and saw that there were no fee ranges included in the document as there should be to inform people how much they will be charged each week. We looked at the files of four of the people who use the service and were pleased to see that a written assessment of need had been carried out. Also in these files were assessment of need papers that had been provided by the funding authority giving additional information to aid the assessment process. We had different views about the home from different people. A number were satisfied with the care they or their relative receives they told us; “ Day to day care of residents is very good”. “ I am very happy with the care and support I receive. It is very good”. “I am very happy at Victoria Lodge”. A number told us about things that really worried us mainly about the impact of inadequate staffing levels, which included; “He was left in bed. I went to the home at 3 o’clock and he was soaked”. “The second floor is not suitable, no stimulation, sitting all day”. “Dressed then left in bed as there is no-one to supervise. We are very worried about the care”. This is a new home. Since Mid summer 2007 it has gone from nil occupancy to nearly full occupancy. After receiving concerns about staffing and other issues we carried out a random inspection on 1 September 2007. At this time we discussed our concerns with the then manager and told her in our report dated 1 September 2007 ‘ It is strongly recommended that staffing levels be increased to deal with shortfalls associated with records, care plans and risk assessments. Also that in future staffing levels, are increased before new residents are admitted. Staffing levels must be sufficient at all times to meet the full needs of the residents accommodated’. Evidence gained during this inspection has shown us that the home has not done what we recommended in September 2007 and has continued to allow new admissions despite inadequate staffing levels, which has placed people at risk. This tells us that priority has been to ‘fill beds’ rather than to ensure that needs will be met. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is poor. Care plans do not all contain information about individuals dementia care needs. People who use the service and their relatives are not always involved in their care plan being produced. Medication is not managed effetely. We found poor practice, which places people who use the service at risk. A number of health and personal care needs are not being met, which potentially place people who use the service at risk. Generally, staff treat the people who use the service with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care plans of four people who use the service. Whilst the layout and style of the care plans was adequate we saw that there was little instruction for staff on how to manage dementia needs for example; triggers to behaviour and what to do. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 12 We did not see evidence to confirm that the people who use the service or their relatives are being consulted about their care and care needs. Three relatives we spoke to confirmed this. All three were not aware that a care plan was in place. All had concerns about the care their relatives receive. We were pleased that we received some positive comments from people who use the service and their relatives about the satisfactory care they receive such as the examples that follow; “ Meeting all my mothers needs. Staff also encourage her to be independent. I have been impressed on how staff have supported my mother with her emotional and psychological needs”. “ I am very happy with the care and support I receive”. However, we were also told about some concerning incidents regarding the health and personal care provided by the home. Our observations showed us that care is not always being provided as it should be and is placing vulnerable people at risk. A person told us that her mother needed supervision at all times because she was prone to falls and had fallen 6 times since being at the home. We looked at this person’s records, which told us, that the home were aware on admission that she was prone to falls. We were concerned because at the front of this persons file ( bearing in mind staff particularly agency staff may see this information and look no further for other instruction) we saw a ‘ User plan of care assessment’ in the mobility and dexterity section it said; ‘ walks independently , just need to observe whereabouts’. However, on the back page of her care plan ( which, may not be noted if other information is noticed first) 1.11.07 it said; ‘ Prone to falls needs 2 carers’. With this in mind we asked a staff member who was on duty 1.12.07 when the person fell and sustained facial injuries if she was being supervised. The staff member told us; “ I was with the doctor and another resident- we came out of the room and saw her walking down the corridor, we saw her fall”. We asked the staff member why the person was on her own and she told us; “ I don’t know, nurse was somewhere else, I was with the doctor and we had an agency on”. We saw that risk minimisation processes to prevent this person falling were inadequate. The Injury action plan read ‘ adjust to new environment. Ensure call bell in place- explained to J’. We were surprised that this had been written as a way to reduce the risk of falls as the assessment provided by the funding authority for this person states in section 5; “ Mental Capacity Act 2005. .. lacks the ability to understand and retain information”. We looked at this person and saw that she had bruising around both eyes and a laceration above her right eye. The relative told us; “ I have complained a number of times to SF and the manager R about the lack of supervision. They moved her up here ( second floor) so she would be safer. She has had two falls since”. Another person told us that she had visited the home a week Tuesday earlier at 3pm and found her Dad still in bed. “ He was soaked right up to his neck and was very cold. The next day he was not well so the doctor was called, he Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 13 had low blood pressure”. This person also told us; “ The next day I went and complained to the manager ( R), I mean what would have happened if I did not come in when I did, or it was someone who had no visitors?”. We found that adequate supervision is also not always being provided as it should be. One person who uses the service told us; “ G keeps coming into our room at night, we don’t like it”. We asked a staff member about this and was told; “ We have moved their room. Now its by the lounge .It’s the nearest room off the lounge for G to enter”. We asked the staff member if it would make the situation better is more staff were available to supervise and they said “ Yes”. About the same person a relative told us; “ That man G keeps walking into Dads bedroom, he does not like it”. We found evidence to confirm that the lack of supervision of this person G was putting this persons Dad at risk as he was locking his door. We saw a diary entry on 2.12.07 saying; “AM tends to lock his door at night. Please let manager know as night staff have no access to master key”. To add to the concerning situations we heard about and saw, another situation occurred which again, could put people at risk. There are few nurses on the second floor who work full time. Most are bank or part time nurses causing problems with communication. On the first day of the inspection 3.12.07 We observed the night/day handover on the second floor. The night nurse went through the names of all the persons on the floor. At the end of handover the day nurse (K) asked her what was wrong with ( W). The night nurse was not able to give this information and had to go through papers to find out. Later on that day we went into W bedroom. We entered the room with the nurse. We saw that W was very distressed. He said; “ About time. I’m dying for a pee”. We saw that W had a dressing to his head and a cast on his arm. When the nurse returned she was really angry she said; “ Did you hear the night nurse telling us that he had a bandage on his head or a cast on? She did not tell us. His fingers are really purple. If I had known I would have been checking his hand. ( We were told later that W had been at the home for less than a week and during this time he had sustained the injuries) I only do 2 shifts a week and need information about people at handover. I did not know J had a fall the weekend either”. On the second day of the inspection a different day nurse was on duty who told us; “ I only do bank here. Work in another home. I don’t know anything about the new people”. We asked her the last time she had worked at this home and she told us; “ 15 November 2007”. To learn that nurses do not have knowledge about the people in their care due to working limited shifts was concerning. During our time at the home we were concerned to learn that a number of staff do not have the knowledge to work with people who have dementia. We looked at four staff files, only one had a certificate to confirm accredited dementia training. We asked a staff member if she knew the different types of dementia and was told; “ Sorry I don’t”. On the second day of the inspection there were four carers on the second floor, with the nurse, (who had not Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 14 worked at the home since 15 November), two were from an agency. One told us that she had only worked at the home three times before and had received one days dementia training, the other had been to the home twice before and had not received dementia training. We observed breakfast time on the second and saw a person B eating his breakfast. Straight after breakfast he kept repeating; “ Where’s my breakfast? I want bacon and egg”. As no one went to this man to give assurance we approached him, he repeated again; “ Where’s my breakfast? I want bacon and egg”. One of the agency staff told us; “ He has had his breakfast”. He may have had his breakfast but it was clear that B did not remember, it was also clear that the carer had little understanding that this person has dementia and evidently a poor memory. Pharmacist Inspector (Morag Ross) undertook inspection of the control and management of medication within the service. There was a list of staff signatures available, which identified members of the care staff and nursing staff team who agreed to administer medication, however there was no evidence that care staff had undertaken training on the safe handling of medication. This means that people who use the service were at risk of being given medication by untrained staff. The medication procedure had been produced by Select Healthcare, which would benefit from a review. For example, a recent medication error had not been reported to CSCI, however there was no medication error procedure available for staff to follow in order to ensure that people who use the service are safeguarded. The service did not make suitable provision for an agreed household remedy list. For example, during the inspection one of the residents complained of a headache, however there was no paracetamol available to administer. Staff had to ring the General Practitioner surgery for advice and paracetamol that was kept for ‘staff use’ was used to administer to the resident. This means that people who use the service are not protected by an agreed and safe list of medication to be administered for the treatment of simple ailments. The service undertakes a monthly check of medication. For example, checks were made to ensure that procedures were being followed and to ensure that suitable storage of medication was available. However, there was evidence that medication was not being administered as prescribed by a medical practitioner. For example, medication had not been administered to one person on the first floor on the morning of the inspection 3rd December 2007. The morning medication rounds had been completed at the time of the inspection and the medication was still present in the pharmacy blister pack for Monday morning and had not been recorded as administered or refused on the medicine records. The medication included treatment for heart failure. This Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 15 means that people who live in the service are not safeguarded by safe medication systems. Medication storage did not always ensure that medication was safe and secure. For example, some medication cupboards on the second floor were not lockable and were located in an open office, which was also used to store staff belongings. Medication for disposal was also seen placed in a disposal unit, which was not locked away, or secure. Medication was therefore accessible and available for unauthorised people to access, which means that there was an increased risk of harm to people who use the service. Storage of medication was sometimes unorganised, which made it difficult to easily locate individual peoples medication. For example, medication stored in a cupboard on the ground floor was haphazard and untidy with no organised or clear system of storage. This means that medication could not be easily located and therefore increases the potential for a medication not to be administered. Medicine tots, which are used to administer medication, were not always stored in a hygienic environment. For example, on the ground floor medicine tots were seen placed upside down on a paper towel to dry next to a toilet bowl. This increases the risk of contamination of the medicine tots and therefore increases the risk of harm to people who use the service. Some medication was not labelled with the name of the person it belonged to. For example, two people were prescribed the same insulin pen and both pens were stored together in the door of the first floor medicine trolley. One of the insulin pens was not labelled with the name of the person. This means that there is an increased risk of a medication administration error and therefore people who use the service are not safeguarded. Systems were not in place to ensure the medication was stored at the correct temperature. The rooms used to store medication on the ground and second floor were very warm, however there was no temperature readings available to ensure that medication was stored safely. The home had also been informed in a written report about temperature and medication storage by a pharmacist visit made on 10/10/07, which stated ‘last room was too hot for medication storage’. This means that people who use the service are at risk of being given medication that has been stored incorrectly and they are therefore at an increased risk of harm. Systems were not in place to ensure that prescribed medication was available to treat diagnosed medical conditions. For example, the medicine records for one person showed that two prescribed medications were not available. The first medication that was not available was an eye drop for the treatment of glaucoma (a condition which results in reduced vision). The medicine records show that there ‘was none to give’ on 17th and 18th November 2007. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 16 The same medicine records also show that a painkiller was not available to administer on the same dates. This means that people who use the service are at risk of harm and are not safeguarded. The medicine records seen were either recorded with a signature for administration or with a code to explain why the medication was not administered. It was therefore disappointing that there were several omissions and discrepancies in the medicine records. For example, one medicine record for the administration of an antibiotic documented that it was administered for the first 3 days then it was ‘not available’ for 2 days and then it was administered again for a further 2 days before ‘course completed 27/11/07’ was written onto the medicine record. There were also omissions within the antibiotic record with no signature for administration. This means that people who use the service were not safeguarded and were at risk of harm. Some individual plans of care did not keep up to date medication records, particularly when a new treatment was prescribed. For example, one individual plan of care did not record when a new medication for the treatment of agitation and restlessness had been started and the reason for the medication. The ‘service users plan of care assessment’ for ‘medication usage’ was blank. This means that due to a lack of up to date records and information staff would not be able to ensure that people using the service were safeguarded. Some medication could not be checked to ensure it had been administered correctly because monthly balances of medicines were not available. This means that accurate checks on medication could not be made to ensure that medication had been administered to the people living within the service. We observed staff during the inspection and were pleased to hear then talking politely to the people who use the service. During our time spent in the home we saw that toilet and bathroom doors were shut when in use to promote privacy and dignity. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. People who use the service do not always find that the lifestyle experienced in the home matches their expectations. People who use the service are encouraged to maintain contact with family and friends. More work must be done to ensure that people who use the service have choices and control over their lives. More attention is needed to ensure that all people who use the service receive a wholesome and an appealing diet and that they are appropriately supervised at meal times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found it very positive that the service provides a full time activities coordinator. We saw photos on the walls of events that had recently taken place at Halloween and bonfire night. The photos showed happy, smiling people. We spoke to the activities co-ordinator and found that she was very motivated and committed to her role. She told us about forthcoming events planned for Christmas time such as a party and possible trips out. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 18 The activities co-ordinator has a schedule of activities for people to enjoy. During our time on the first floor we were pleased to hear staff encouraging people to “ Go downstairs and join in”. We also observed a positive situation with M a female who is accommodated on the ground floor. On the second day we saw her by the front door in a wheelchair and asked her where she was going, she replied; “ It’s my fish day today. J takes me to the fish shop. I get a fish and eat it. I really enjoy this”. However, as we spent more time at the home and observed, we found that the higher and more complex the needs the less likely it is that activities provided can be participated in. We asked the activities co-ordinator how much time she spent on the second floor and she responded; “Short time once or twice a week. I am trying to get more one to one activities arranged but it is time”. We saw people on the second floor such as B who apart from meal times received little attention or interaction from staff. A relative told us; “ He just sits, no stimulation”. We observed a female person (B) on the second floor trying to stand up. At one point the nurse went and sat by her, at another time an agency carer. The action of both staff was the same, as the person tried to stand up they rested their hand on her shoulder to encourage her to sit down. This person became quite upset. We pointed the situation out to the manager who asked the staff to take her to one of the activity rooms to occupy her. That this person is better occupied was confirmed by daily notes which read; 26.11.07, 18.20 ‘very unsettled, mobilised with 2 carers, appears to enjoy this’. 21.11.07 ‘ B presented as restless and agitated, much more settled in the afternoon when staff engaged her in activities’. And that she became agitated when not occupied -24.11.07 ‘ B very unsettled, PRN lorazepam was given at 12.30. Another person told us their experience on the second floor; “ The nurse showed me two small unused lounge areas which she said she would like used for reminiscence or quiet areas for music or light therapy but added that there just isn’t the staff or time. This person also told us; “ The ground floor was a different contrast… The activities diary was large and clear on the wall for everyone to see. People told me about the knitting club and other things that they did”. We were surprised about this contrast and the difference in activities offered to the more able compared to those with more complex needs as the AQAA completed by the home told us; “ We have our own activities co-ordinator who organises daily routines for service users to get involved in. We provide a varied programme of activities.” This indicates that the stimulation and recreational needs of all people who use the service are catered for when this is not the case. Further the homes ‘Service User Guide’ page 5 gives assurance to people who use the service “ The activities Co-ordinator will involve you, your relatives and the whole team to ensure that trips and activities are programmed in accordance with your wishes”. This clearly is not the case for some people. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 19 We saw and spoke with many visitors during our time at the home. No-one gave us any indication that visiting times were restricted or not satisfactory to anyone which is positive. However one visitor told us; “ Only once have we been offered a drink when we visit. When Mum was at home we loved sitting and having a cup of tea and a biscuit with her. We can’t do that now”. We saw a number of bedrooms that held personal possessions and were very impressed with the way the home had handled the needs of two couples. They had been given a room each but had been allowed to use one as a shared bedroom and use the other bedroom as a private living room. However, during our two days at the home we saw little evidence on the first and second floor of people being offered choices, freedom and being enabled to have control over their lives. We were told by staff that ‘one man has to stay in bed because there is no suitable recliner for him to sit in and the easy chairs would not be safe’. This was confirmed by the manager who told us; “ The money has been approved for a special recliner”. We asked if the recliner had actually been ordered and could we see an invoice. He said; “ Not yet the area manager has to sign the form and she has been out of the area for two days”. The ‘easy chairs’ in the lounge second floor are low which restricts peoples’ movement. We saw B and B struggling to get up out of their chairs. We saw the activities Co-ordinator writing on the wipe board meals to be provided on the first day. We looked at menus, which had been written in words no pictorial format to aid understanding, which was surprising as the majority of people at this home have some degree of dementia and may not understand a written menu. We did see that a choice was offered at meal times. For instance breakfast time a range of cereals and hot options were offered. The main meal on the first day consisted of lamb casserole or fish fingers. A person who observed this meal time made the following comment; “ I did think it would have been preferable to ask each resident if they wanted gravy with their fish fingers rather than assume it was the norm”. One staff member on the second floor told us; “ The food is not so good up here we are ‘The forgotten floor’. The food is brought up here last”. During our time in the home we did not see finger foods or other available for people who were unable to feed themselves well. And although we saw two apples on the second floor dining table no staff offered these to the people who lived there. We suggested that fruit is cut up daily and offered to the people who use the service between meals in an attempt to increase their fruit intake. We gave the manager a contact number for an NHS healthy food specialist so that he could access advice on meals. The homes completed AQAA told us; ‘ Meals provided meet all dietary requirements and special dietary needs’. We were very disappointed to be told by a visitor that the home ‘ Is not meeting his Dads dietary needs’ with regard to his ethnic origin. He told us “ He is very rarely given African Caribbean food. They told us that they could meet his dietary needs”. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 20 We asked the cook and manager about this who confirmed that this was a shortfall in this persons care. The cook promised us that he would sort it out within the next day or two. We partially observed meal times on the first and second floor. We saw that the staff were very busy. On the second day of the inspection an agency carer was left in charge of the dining room who had only worked at the home three times before. She was on her own to supervise people with complex needs, one of which was at risk because she has poor swallowing. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 21 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 poor. Complaints and protection processes and practice don’t always give assurance that concerns will be listened to and acted upon and that people who use the service are properly safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a written complaints procedure, which is available within the home and detailed in the homes service user guide. We were surprised that complaints procedures have not been produced in a format appropriate to people who use the service. Although a pictorial version was available in the complaints book this was more appropriate to people who have a learning disability rather than dementia. A further pictorial complaints procedure was available in the home, which referred to complaints or being dissatisfied with things such as the day centre, transport and going out. This version also was not relevant to this service or the people who use the service. We have received a number of complaints about the service in the short time that it has been open. Three at least were concerns about staffing levels each time the home has responded to us in writing telling us that the staffing levels have been addressed but when we have inspected we have found staffing levels still to be inadequate. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 22 The home has received a number of complaints, we were concerned to see the content of one received by the home regarding a situation that occurred on 1 September 2007 where a relative had visited the home and was unable to find their loved one. Eventually the relative found this person on the bedroom floor, feeling cold. The complaint letter was dated 1 September 2007 but there was no date stamp on it to tell us when the home had actually received it. An initial response letter was not sent to the complainant until 16 October 2007 and the feedback letter 22 October 2007 well in excess of the 28 day deadline for dealing with complaints as stated in the homes Service User Guide page 14 which reads; “ Your complaint will be acknowledged within seven days of receipt. It will be investigated and you will be advised within 28 days of the outcome. We found further evidence to confirm that complaints are not being dealt with as they should. A relative told us that they had complained to the manager on 1 December 2007 about a fall that had occurred. Another told us that she had complained to the manager when she had found her Dad soaking wet in bed at 3 o’clock on 20 November 2007. We asked the manager RTB if these relatives had spoken to him and he confirmed that yes they had, but when we looked in the complains book there was no record of this. We asked RTB why these complaints had not been recorded and he told us; “ They were concerns rather than complaints”. We asked RTB don’t you think that the issues raised due to their seriousness should have been recorded? His response was “Yes”. Evidence throughout this report shows a number of omissions and incidents where the home due to poor staffing levels has compromised the safety and well being of the people who use the service. Some of which should have been reported under safeguarding procedures to the Local Authority and have not been. We were further concerned to hear about the way in which a recent allegation of abuse has been dealt with. Although the home did report to the Local Authority and the police as they should have done to date no statements have been given by staff who told the manager that they witnessed this event. Further, the manager RTB told us that a staff member told him that concerns were raised about this alleged perpetrator when he worked in a previous home to the extent that he was supposed to have being monitored, the words used were ‘ abuse watch’. If this situation is correct then a senior person in the home may have knowledge about the staff members previous conduct yet, the person was allowed to work in the home with vulnerable people who use the service. The homes AQAA told us; “ All staff are aware of how to report complaints and … any concerns raised will be investigated. Any abuse if reported would be investigated following company policy and procedures and staff are aware of these”. Including the above incident two allegations of abuse have been made to Dudley Local Authority. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 23 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): 19,25,26. Quality in this outcome area is adequate. Garden space available is very limited and is not private. Infection control processes and cleaning need to be improved upon to protect the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purposed built. It is brand new only opened in the summer of 2007. The building is attractive The home is a three storey building. Each floor has its own living and dining space in addition to smaller lounges areas for use for visiting and activities. All 61 bedrooms are single occupancy with en-suite facilities. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 24 Communal areas are comfortable and attractive with nice furniture and flat screen televisions on the walls The home has larger activity rooms and a pub room, which can be used by the people who use the service and their relatives. There is a hairdressing room on the second floor, which is positive. However, this room is very small and therefore it may be difficult to accommodate people who need to use a wheelchair. We were very surprised to see the limited the garden space. There is a small patio and a grass strip outside of the rear ‘pub’ door, however this is right by the main road, it was noisy due to the traffic and there was no privacy. Other garden areas are provided. There is a small-grassed area by the main door with a fence around it right at the front of the car park, again not allowing any privacy. To the corner of the car park there is a grassed area with table and chairs. Once again this does not allow privacy and may place people who use the service at risk as they can access the car park. Although gates are provided between the car park and the road, during the two days we were on site these gates were never closed and it would not be practical to close them because of cars coming in and out of the car park. We looked at a number of bedrooms these were a good size and well furnished. En-suites are provided in every room, which is positive as these enhance privacy and dignity. However, again the usage of these rooms due to space may mean that wheelchair users would have some difficulty. One person who looked at the bedrooms told us; “ I was struck by the starkness of the corridors and bedrooms. They were adequately furnished with bed, cupboard and freshly painted, being new but lacking any stimulus such as music, soft furnishings or pictures”. When we accessed the home on the first day the first floor felt very warm and cosy. We were surprised when we went to the second floor, as the lounge and dining room were very cold. We saw a female person sitting in a chair, she was asleep with a bed quilt wrapped around her. We felt the radiators and they were cold. We asked the carer why the radiators were not on? And were told; “ Didn’t know they were off”. We turned the radiators up but it made no difference, they did not get warm. We went in the hairdressing room by the office and the bathroom next to it. These rooms were also very cold. The radiators were not on. When we asked about the heating the manager told us; “ Always a problem, engineers always here”. A carer told us; “ Always a problem with the heating too hot or too cold”. The manager asked the engineers to visit the home. After speaking to them the manager told us; “ They say its because the doors are left open in the home. If the heat gets to a certain level then the heating turns off”. He also told us; “ This is a care home, of course doors are left open it needs to be sorted”. By the end of the second day thankfully the heating had come back on. However from what we were told it is obvious that there is potential for the heating to turn off again at any time. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 25 We were very concerned and surprised when looking at bedrooms and bathrooms to see exposed hot pipes by radiators and washbasins. A number of these exposed hot pipes were next to beds and therefore a risk to people who use the service. We felt the pipes and they were so hot that we could not leave our hands on them. We showed the manager, handyperson and estates manager the hot pipes and told them how concerned we were. The manager, handyperson and estates manager confirmed that the layout of each of the three floors was the same so there was the same risk on every floor. By the end of the second day of the inspection most hot pipes had been covered with silver lagging which reduced the risk of burns. We were surprised when entering a toilet on the second floor to be met by a very unpleasant odour. We looked and saw three full, yellow clinical waste bags in the toilet room, the odour was coming from them. The bags were placed directly on the floor. This toilet room is provided for use by people who live at the home. This practice could very well place these people at risk from infection contamination. We asked the night nurse to show us the sluice room and mechanical cleaner, she could not. We were told that there was no sluice room. We asked if bedpans or urinals were used and if they were how were they cleaned. The night nurse told me; “ Urinals are used we use bacterial liquid”. We were very surprised that in a new build home-sluicing facilities had not been provided. We asked the residential manager why there were no sluicing facilities and she told us; “There are, on every floor”. A carer told us; “ We have never had training so can not use them”; Then we asked the manager about this he told us; “ The reason they have not been used is because they have never been commissioned ”. We asked him to seek confirmation about this. He gave us ‘ A commissioning and installation report for Dolphin 1484, 1485, 1486 dated 12 November 2007 which read ( same on each page) ‘ Complete commissioning of Panamatic midi. The manager then told us that the reason the sluice facilities were not used was because the plumbing was inadequate. This evidence told us that people are being placed at risk of infection transmission by the service not providing adequate sluice facilities to clean urine bottles and staff not being aware of sluice rooms and using toilets to store clinical waste. We were further concerned when looking outside of the home to see two large steel clinical waste boxes stored by the rear kitchen door. There was an odour coming from these boxes and there were no locks provided to prevent unauthorised people accessing them. We saw black dustbin liners stored directly on kitchenette floors on both the first and second floor. These contained waste. We saw people walking by these bags and then walking through the lounges. The bags were open at the top and situated by food serving areas again, an infection control risk to the people who use the service. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 26 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. The numbers of staff and the inconsistency in the provision of nurses is preventing the needs of many people who use the service being met. Inadequate staffing levels are having a negative on the care provided by the service and are placing people at risk. Recruitment practices and staff training need to be improved upon to prevent risk to the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have detailed throughout this report our concerns about the inadequate numbers of staff provided and the provision of inconsistent nursing staff. We have given an account of our observations of poor practice and findings of needs not being met which are having an impact on the health, safety and well being of the people who use the service. We brought attention to the service concerns made by various people regarding inadequate staffing levels in August and October 2007. We told the service during our inspection carried out on 1 September 2007 to increase staffing levels and recommended that no further admissions are made until staffing levels are adequate. During this inspection we still found plenty of evidence to confirm that staffing levels are poor. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 27 A key staff member told us; “ I am very concerned about staffing levels. There are not enough staff. I thought we were meeting the ratios, I have been told that we are meeting the ratios of staff to residents”. We told this person that we were very concerned and asked if they felt that the needs of the people are being met? this staff member replied; “No”. We asked, in what respect did they think needs were not being met and were told; “ Needs too great, not enough staff, supervision, activities, records, nurses, run on bank or part time staff, motivation of staff”. We quoted to this person Regulation 18(1)(a) of the Care Home Regulations 2001 and highlighted the fact that adequate staff must be based on needs not just numbers. We asked to see rotas on the second floor. The manager told us; “ I have not got any valid rotas for nurses at the moment. They were not accurate and the nurse manager is redoing them”. The manager told us that he had been trying to improve the staffing situation. One improvement is that a dedicated nurse manager has been appointed recently to run and manage the nursing floor. She has only been in post for two weeks. The manager told us that two new nurses are being employed and that he has received an application from a full time nurse. On the second day of the inspection the manager had increased carers on the first and second floor from three to four. One staff member told us; “ I’ve never seen so many staff here, it’s a big improvement”. Two days after the inspection we spoke to a relative over the phone who told us; “ I don’t know what you did when you were there on Monday, but it has worked. More staff, better care”. This evidence shows that by increasing staffing the people who use the service can be better cared for and are safer. During this inspection we were so concerned that we issued an immediate requirement for the service to address the shortfalls concerning staffing numbers. The staff that we observed and were involved with during our time in the service were very hard working, kind, friendly and wanted to look after the people in their care. A person told us; “ Staff that I met were very helpful and genuinely caring and supportive to the residents they were with”. The AQAA provided by the service told us that there are thirty five care staff and thirty three have NVQ level 2 or above. Permanent carers we spoke to confirmed that they have NVQ and two of the three care staff files held certificates to further evidence NVQ attainment which is very positive. As there are a lot of agency staff used in the home we asked the manger what checks are carried out before and when the agency staff arrive at the service. The manager told us; “ We use a registered agency”. We asked the manager if he asked for evidence that checks had been carried out and to confirm training the staff had received to satisfy him that these staff were safe and adequately trained. His reply was “No”. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 28 The manager came to us later and gave us a list. He told us; “ I have phoned the agency and they have sent this information about each staff member. They did this really quickly”. We looked at the personal files of four staff three carers and one nurse. For one there was no previous employment history before 24.1.07. The person had declared a health issue on the health declaration but there was no risk assessment to ensure their well-being. It was unclear the position of the one reference, the other one was from a friend. The Criminal Records Bureau (CRB) check dated 24.1.07 had been carried out by the previous home worked in which was satisfactory as it was the same company who owns this home. The second file only held one written reference not the required two. This reference had been provided by the person’s previous manager who was also her cousin. The third file showed that the person had been allowed to commence employment on a POVA first dated 26 September 2007. The principal statement of employment showed that this persons employment commenced on 28 September 2007. The CRB was dated 9 November 2007. There was no evidence to confirm that proper safeguards (due to commencing employment before the CRB had been received) had been put into place, as they should have been to protect the people who use the service such as a named supervisor. Further there was only one written reference on file not the required two. The reference highlighted that they had only known this person for three months. The file for one nurse showed an expiry date of 30.11.07 for her nursing registration. The manager confirmed that no new details or expiry date had been received. We saw that this nurse was working on the second floor during this inspection, which was after the date of 30.11.07. This evidence shows that recruitment practices do not all meet the Regulations and therefore do not give assurance that vulnerable people are being safeguarded. We saw evidence of in-house induction for staff on files. Agency staff we spoke to confirm that when they arrived at the home they were shown fire exists and told about emergency procedures. This is positive as being given this information enables staff to keep the people who use the service safe. We asked for evidence of formal Skills for Care induction standards and a completed folder to look at. Due to lack of availability these were not provided to us. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 29 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 poor. By not providing adequate staff and allowing ineffective monitoring of systems and practice the management of this service have seriously placed the vulnerable people who use the service, at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager resigned with immediate effect only a few months after the home opened. Another manager was appointed and commenced employment in mid October 2007. Since opening a number of serious incidents have occurred within the service as detailed throughout this report, which should not have done. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 30 Evidence shows that there has been insufficient direction and leadership within the service, which has caused poor practice and placed people who use the service at risk. The new manager told us that he has identified a number of concerning shortfalls since being employed. For example the inadequate staffing levels and has produced an action plan to address these shortfalls The manager told us that quality assurance and monitoring are being introduced. It was evident to us that effective monitoring systems were not in place as we identified so many concerning shortfalls within the service. Further, when asked, the manager could not provide us with any Regulation 26 reports. These reports should be completed once a month by the owner following their visit to the service, to show us how they are monitoring the service provided. We checked the money of four people who use the service which is held in ‘safe keeping’. We found that balance of this money was correct against records, which is positive. We were concerned to see the state of the kitchenettes on the first and second floors. There was no evidence of fridge temperature monitoring. The cook confirmed that this was not being done. The fridges were so dirty when the doors were open there was an unpleasant smell. There were food items in the fridge without dates of opening showing. The stainless steel food trolleys were dirty with spillages and dried on food . Victoria Lodge Care Home DS0000070198.V349977.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 x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 2 2 x x x x x 2 2 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 2 2 x 2 Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 15(1)(2) Requirement The service to ensure that needs are met and that people who use the service are safe must ensure that care plans reflect all risks and needs, that they are reviewed when needs change and are made available to the individual person. The service must implement systems and processes to ensure that the people who use the service are protected from risk. Care plans must be in place for all medications prescribed on an ‘as required’ basis to ensure that people who use the service are safeguarded. Suitable arrangements must be made to ensure that medicines are stored securely with restricted access to authorised members of staff to ensure that people who use the service are protected from harm. Immediate requirement issued. Timescale for action 21/12/07 2 OP8 13(4)( c) 21/12/07 3 OP9 13(2) 23/12/07 4 OP9 13(2) 05/12/07 Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 33 5 OP9 13(2) Medication must be clearly identified for the person it is prescribed in order to ensure that people who use the service are safeguarded. Immediate requirement issued. Medicine records for the administration of medication must document what has been administered or record a reason why it was not administered in order to ensure that the people who use the service are safeguarded. Immediate requirement issued. 05/12/07 6 OP9 13(2) 05/12/07 7 OP9 13(2) Arrangements must be in place to ensure that medication is available to administer as prescribed by a medical practitioner. This is in order to ensure that the people who use the service are protected from harm. Immediate requirement issued. The service must ensure that care staff who administer medication have received training on the safe handling of medicines. This will ensure that the people who use the service are administered medication from trained and competent staff. 05/12/07 8 OP9 13(2) 15/01/08 9 OP16 22(3)(4) The service to assure people who 21/12/07 use the service and their relatives must ensure that all complaints and concerns are recorded and acted upon. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 34 10 OP18 13(6) 11 OP27 18(1)(a) The service must ensure that that poor practice and omissions in care delivery are reported to the Local Authority through safeguarding procedures to make sure that people who use the service are safe. The service to make sure needs are met and that people who use the service are safe must provide staffing levels to ensure that they are adequate. This to include regular and consistent nurses. Immediate requirement issued. 21/12/07 05/12/07 12 OP27 18(1)(a) 13 OP29 19(1)(a) 19(1)(b) 14 OP33 24(1)(2) (3) The service should accept no further admissions until we are satisfied that staffing levels are adequate and safe. Immediate requirement issued. To prevent risk of harm to the people who use the service no person should be employed unless all of the required documents have been obtained. To ensure that the people who use the service are safe adequate management arrangements and monitoring of service delivery must be in place at all times. To ensure that the people who use the service are safe adequate management arrangements and monitoring of service delivery must be in place at all times. 05/12/07 21/12/07 21/12/07 15 OP33 26(1)(2) (3)(4)(5) 21/12/07 Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 35 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 OP1 Good Practice Recommendations To ensure that people who use the service are fully informed of the services provided we strongly recommend that an up top date statement of purpose containing the full range of fees is readily available at all times. To ensure that the needs of people using the service are met we strongly recommend that all staff receive accredited dementia training. The medicine policy should be reviewed and updated in order to ensure that the health and welfare of people who use the service and take medication are safeguarded. Care plans should document up to date medication records. This is in order to ensure that medication records for people who use the service are accurate. A safe system should be introduced to ensure that the hygienic storage of medicine tots in order to prevent possible contamination and therefore protect the people who use the service from harm. A system should be introduced to ensure that balances of medicines are carried over onto a new medicine chart in order to ensure accurate medicine audits can be done and check that people who use the service have been administered medication according to the directions of a General Practitioner. A system should be introduced which demonstrates that medication is stored at a safe temperature in order to ensure that people who use the service are protected from harm. To ensure that the needs of people who use the service are fully met we strongly recommend that activity availability within the home is increased. To ensure that the needs of people who use the service are met we strongly recommend that outside garden provision is improved upon and extended. To ensure that the people who use the service are safe and comfortable adequate heating must be provided at all times. DS0000070198.V349977.R01.S.doc Version 5.2 Page 36 2 3 4 5 OP4 OP9 OP9 OP9 6 OP9 7 OP9 8 9 10 OP12 OP19 OP25 Victoria Lodge Care Home 11 12 OP26 OP38 To prevent infection spread to people use the service we strongly recommend that the sluice rooms and equipment are put into operation as soon as possible. To prevent risk to people who use the service we strongly recommend that kitchenette areas and equipment on all floors be adequately clean at all times. Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Victoria Lodge Care Home DS0000070198.V349977.R01.S.doc Version 5.2 Page 38 - 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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