Inspection on 24/08/05 for Walker Lodge Residential Home

This inspection was carried out on 24th August 2005.

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

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

Other inspections for this house

Walker Lodge Residential Home 13/06/08

Walker Lodge Residential Home 24/08/07

Walker Lodge Residential Home 14/09/06

Walker Lodge Residential Home 09/03/06

Walker Lodge Residential Home 31/08/04

Walker Lodge Residential Home 26/04/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Walker Lodge Residential Home Wharrier Street Walker Newcastle upon Tyne NE6 3BR Lead Inspector Janine Smith Announced 24 August 2005: 09:30 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 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. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Walker Lodge Residential Home Address Wharrier Street Walker Newcastle upon Tyne NE6 3BR 0191 224 3677 0191 224 2657 walker.lodge@fshc.co.uk Tamaris Healthcare (England) Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant CRH 48 Category(ies) of DE(E) Dementia - Over 65 - 36 registration, with number OP Old Age - 15 of places Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Two service users in the OP category are under pensionable age. Date of last inspection 31/8/04 Brief Description of the Service: Walker Lodge can provide care for up to 36 older people who require residential care due to dementia type conditions and for up to 15 older people who require residential care due to general old age conditions, up to a combined maximum number of 48 places. Nursing care is not provided. The building is large with a ground and upper floor. All of the bedrooms are single and each room has ensuite facilities. There is a passenger lift to the upper floor. There is an assisted bath or shower on each floor. The home has gardens that are easily accessible. The other half of the building is used as a separate nursing home, Brampton Court. Both homes are run by Four Seasons which is a private company. The home is located in Walker, close to shops, pubs, leisure centre, a post office, public park and other local amenities. There are good public transport networks in the area. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection which took place over 11 hours and was carried out by two inspectors. A partial tour of the premises took place and a sample of care records were inspected as well as other records. The Manager, three of the staff on duty, seven residents and two visitors were spoken to. There were 46 residents staying in the home on the day of inspection. Before the inspection comment cards were left in the home for residents and relatives to complete and send to the Commission. 18 comment cards were received from residents and 6 from relatives. Comment cards were also sent to GP practices and other health and social care professionals who visit the home, and 7 replies were received. Before this inspection, the lead inspector made an introductory visit to the home on 8th August 2005. At this visit the inspector talked to the Manager and three residents, and had a brief tour of the building. Since the previous inspection the Registered Manager has left and a new Manager, Mrs Marion Taylor, has been appointed. She has not applied to be registered yet. What the service does well: Comment cards were received from four GP practices used by residents and they confirmed that the home communicated clearly and worked in partnership with them; that the staff demonstrated a clear understanding of the care needs of residents and that they were satisfied with the overall care provided to residents in the home. One card included the additional comment, ‘Home’s management has recently changed and there has been a noticeable improvement in the general care given in this home.’ Mixed views were received from the eighteen residents completing comment cards. 13 said they liked living here; 2 said they did sometimes. 14 said they feel well cared for; 2 said they did sometimes. 15 said they were treated well by the staff and 3 said they were sometimes. Six comment cards were received from relatives who indicated that they welcomed into the home and were satisfied with the overall care provided with the exception of one who commented about poor care of their relative’s feet. Two relatives made additional positive comments as follows:Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 6 ‘I have always found the carers very helpful and willing. My relative is very happy being looked after at Walker Lodge. They are all very attentive.’ ‘My relative is well looked after. The staff love him and take care of him.’ Two visitors seen during the inspection were satisfied with the care provided to their relatives, although not with the laundry arrangements There has been no staff turnover amongst the care staff, which provides stability and consistency for residents in their day-to-day care. What has improved since the last inspection? What they could do better: There are a number of things that the Home needs to do to make sure that the residents get good quality care. Care planning needs to be improved to ensure that care staff have the information they need to be able to care properly for the people living in the home. The Management need to make sure that residents can see chiropodists and dentists at appropriate intervals, to ensure that their feet and teeth are appropriately cared for, and that records are kept of this. The care of some residents is good but the basic care of other residents in the home, particularly those who have dementia, is not good enough. Some residents who need help with their personal care, dressing and continence, are not receiving the help they need. A carer did not offer a resident help although she had obviously been incontinent of urine. Some of the residents were wearing clothing that looked dirty, some had dirty finger nails, and a resident was unshaven. Where residents need help with their personal care, the staff Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 7 need to be aware of what help they need and there needs to be enough staff to provide this help. Some residents need more support to ensure that they get enough to eat at mealtimes. There needs to be enough staff available at lunchtimes and they need to be trained in how to assist residents with dementia with meals. It is important that the staffing levels in the home are reviewed to ensure that there are sufficient competent staff on duty to enable them to provide the intensive support that some residents need. In addition, the home needs to improve the basic training of staff. The home has not yet met the standard for induction training for new care staff and only a third of the care staff team have obtained an NVQ qualification. Further training should also be provided on the needs of people with dementia to ensure that staff have a good understanding of these conditions and are fully aware of current good practice. Some of the staff had not had any specialist training in this condition even though the home is registered to provide this specialist area of care. Some of the staff also require training in food hygiene and infection control which helps promote the health and safety of residents and staff. Details of the investigation and outcome of any complaints need to be recorded more clearly to show that any concerns have been addressed. The Manager should be given training in the procedures to follow if there are suspicions or evidence of abuse, which take account of the multi-agency approach to be followed. The staff team should also be given formal training in adult protection, which helps to safeguard residents by making staff aware of what is good and bad practice, and what they should do if they have concerns. Some essential equipment is in need of repair, including a bath seat and several extractor fans. The home was generally clean apart from some parts of the first floor, which smelled strongly of urine. These areas need to be kept cleaner to ensure the control of infection and to provide a pleasant home environment. In order to ensure the health and safety of residents, the following steps should also be take:. Some residents have televisions and audio equipment placed on high tables, which may place them at risk of harm if they are accidentally pulled over. Risk assessments should be carried out to identify and eliminate any risks as far as possible. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 8 Where residents smoke and there are risks of them injuring themselves or causing a fire, their risk assessment should be reviewed with the aim of reducing risks. A thermometer provided for testing hot water temperatures of baths was unsuitable for the purpose. This means residents could be placed at risk if staff are not able to properly check that the hot water will not scald a resident before it is used. It is recommended that the electrical wiring system be checked as this has not been done since 2002, to ensure that this is safe. Currently there is no development plan for the home, which is an outstanding requirement from an inspection carried out in April 2004. This should be done in order to ensure that strategies are put in place, and action taken, to address those areas which need improvement. Some residents have indicated by comment cards that they do not like living in the home or the way they are treated by staff. Further steps need to be taken to find out why this is and to do something to improve the lives of these residents. The development plan also needs to include other statutory requirements that have been outstanding since the April 2004 and August 2005 inspections; that is, the failure to provide care induction training to the accepted NTO standard; provide the Statement of Purpose in other formats, and produce health and safety procedures and practices specific to this particular home. 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. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 9 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 Standards Statutory Requirements Identified During the Inspection Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. A previous requirement to produce the Statement of Purpose in other formats remains outstanding. EVIDENCE: Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10. The care plans in place are not sufficiently detailed or reviewed often enough. This means that adequate arrangements have not been agreed with residents as to how their care needs are to be met and staff do not have all the information they need to satisfactorily meet these needs. Residents had not seen dentists and chiropodists at regular interval. This means that their health care needs are not being attended to as often as they should. Some of the residents in this home are not being provided with the personal support they need with bathing, dressing and continence car. This means they are not being cared for properly or treated with respect. EVIDENCE: Two care plans were inspected. Both care plans were very narrow in focus, addressing mainly personal care, mobility and night care. Both residents had dementia conditions and one had also had serious mental health problems in the past, but neither care plan acknowledged or addressed these needs, even though the home is being run to meet this particular specialist area of care. One care plan had been reviewed at monthly intervals, but the other had not. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 12 There was noevidence that one person’s care plan had been formally reviewed within the past year in conjunction with the next-of-kin and other relevant health care professionals. GPs and Community Nurses are consulted for advice and treatment. Comment cards were received from four GP practices used by residents and they confirmed that the home communicated clearly and worked in partnership with them; that the staff demonstrated a clear understanding of the care needs of residents and that they were satisfied with the overall care provided to residents in the home. Additional comments were also received from two practices as follows:‘Home’s management has recently changed and there has been a noticeable improvement in the general care given in this home.’ ‘The staff and management are as good as any in the area if not the best.’ There was a lack of evidence from the care records seen to show that residents are being helped to see dentists and chiropodists at appropriate intervals. The record showed that one resident had not seen a chiropodist for seven months. A relative completing a questionnaire commented that they had found that their father’s toe nails had not been cut for some time and were curling under his feet. Three comment cards were received from social workers, who indicated that the home communicated clearly and worked in partnership with them and that they were satisfied with the overall care provided. Of those residents spoken to, who could comment, 2 said that they were treated well by the staff, 1 said his clothes had gone missing and he did not like two people working in the home. One resident said the home was ‘ok but not like home’. Mixed views were received from the 18 residents completing comment cards. 13 said they liked living here; 3 said they did not and 2 said they did sometimes. 14 said they feel well cared for; 2 said they did not and 2 said they did sometimes. 15 said they were treated well by the staff and 3 said they were sometimes. Similarly, 15 said their privacy was respected and 3 said it was sometimes. 16 residents said they felt safe here; 1 said they did not and 1 said they did sometimes. 6 comment cards were received from relatives who said that they were welcomed into the home and were satisfied with the overall care provided with the exception of 1who commented about chiropody as above. A comment was Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 13 also received that the home could not tell them how their relative got a bruise. Two relatives made positive comments as follows:‘I have always found the carers very helpful and willing. My relative is very happy being looked after at Walker Lodge. They are all very attentive.’ ‘My relative is well looked after. The staff love him and take care of him.’ Two visitors seen during the inspection were satisfied with the care provided to their relatives, although not with the laundry arrangements due to clothing going missing. This inspection identified concerns about the care of residents on the first floor who primarily have dementia type conditions. Three residents were seen to have very dirty fingernails; one man remained unshaven at 2 p.m. in the afternoon. Some residents’ clothing was not clean and they looked unkempt. For instance, one gentleman was wearing a very stained jumper, another dirty tracksuit trousers and his shirt partially hanging out, another had brown marks on his trousers. A female resident was wearing a skirt, which was inside out with the label on the outside. A carer was observed to walk into a resident’s bedroom without knocking or asking permission to enter. She brought a female resident from the room who smelled very strongly of urine and whose skirt was very obviously wet and uncomfortable to the resident. This resident was led into lunch without being offered the opportunity to be cleaned or change her clothing. This help was only given some time after the lunch time meal was over at 2 p.m. The medication system was not examined during this inspection. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15. Social activities are carried out though these are limited in range and are not providing as much variation and stimulation for people living in the home as they could be. There are insufficient staff available to provide the assistance that residents on the first floor need at meal times, which means that some residents may not get enough food to eat for their well-being. EVIDENCE: There is a programme of activities in place including scrapbooks, pamper day, arts and crafts, ball and board games, sing-a-longs and reminiscence. An Activities Organiser has been employed for 20 hours a week. A resident said that entertainers occasionally visited the home. A member of staff was observed playing dominoes with a group of residents. Staff said that it could be very busy in the home but they tried hard to carry out social activities in the afternoons. One carer thought that more training should be provided to help staff provide worthwhile social activities for residents with dementia. 7 of the residents completing comment cards said the home provided suitable social activities; 8 said they did not and 2 said they did sometimes. The lunch time meal for residents on the first floor was observed. Most of these residents have a dementia condition. 3 staff were involved in plating up Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 15 meals, then 2 were left to assist the 17 residents in the dining room. Several residents were observed to struggle to feed themselves with the cutlery provided. The staff were observed to intervene on one occasion to tell a resident not to put their knife in their drink. A resident had to be assisted after choking on some food and a carer intervened when some food was thrown. A resident was observed to stop eating several times; one of the carers asked if she had had enough and on getting no reply removed the largely uneaten meal. No attempt was made to physically prompt her to carry on eating. Throughout the meal there was a loud, distracting noise coming from elsewhere in the home. This turned out to be a dvd playing in a lounge. The dvd had stuck and was constantly replaying the sound of horn blowing. Two different main courses were available on the day’s menu, one being cottage pie with turnip and cabbage and the other, pasta in sauce with roast potatoes and vegetables. It was observed that those residents served the pasta sauce were given the roast potatoes but no other vegetables. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a complaint procedure in place but this needs to be improved to show that any complaints made by residents and their representatives are listened to and concerns acted upon, and that residents and relatives have confidence in the system. The Manager does not have a clear understanding of the multi-agency approach to adult protection. Training must be provided to the manager to enable her to understand and follow the correct procedures when necessary. Whilst staff have some awareness of types of abuse, formal training should be provided to strengthen the protection of residents. EVIDENCE: The home has a complaints procedure in place and there was evidence that this had been used. A record book is kept of the complaints made but the outcome of these was not always recorded. It was apparent that some pages had been torn out of the book. Since the last inspection, the record showed that the home had received five complaints. Three of these were about the laundering of items, one was about a room and carpet being smelly and the fifth was also about a room being dirty and smelly and that a resident was not wearing any socks or shoes. Since the last inspection, one complaint has been received by the Commission, which was referred to the company running the home for further investigation. The complainant was concerned about unfilled posts in the home, including an administrator, laundry and domestic posts and the new manager working parttime hours. Three elements of this complaint were upheld. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 17 Most of the residents and relatives completing comment cards were aware of the procedure for making complaints though two residents and one relative were not. A relative contacted prior to this inspection had been concerned about the quality of care provided to their relative but had not felt comfortable about raising this with the home. Given that some residents have indicated through the comment cards that they are not happy living in the home and not satisfied with issues such as the care provided, further steps should be taken to regularly obtain their views and address any issues of concern. This could be done through the care review process. A procedure for responding to allegations of abuse has been drawn up previously. The Manager was not fully aware of the procedure to follow if adult protection concerns were brought to her attention, specifically how this would be dealt with within a multi-agency approach. Two of the staff spoken to were aware of types of abuse and the importance of reporting any concerns. However, none of the staff have received formal adult protection training although the Manager has put together some information packs, which staff sign when they have read them. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. Re-decoration of parts of the home has taken place, providing residents with updated living areas. Repairs of some equipment are necessary for the benefit of residents. The home was generally clean and well-kept, apart from a lounge and dining room which smelled of urine and would not be pleasant for residents and visitors to use. EVIDENCE: A tour of the premises was undertaken and a small number of bedrooms were seen. Since the last inspection new flooring has been laid in the ground floor dining room. The Manager has also organised re-decoration of other parts of the home. It was noted that some extractor fans were not working properly and one needed cleaning. An assisted bath seat was not in working order. The home was found to be generally clean, however, a strong smell of urine was noticeable in a first floor lounge and dining room. The Manager stated that repeated cleaning of the carpets had failed to remove the smells. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. There are shortcomings in the quality of care provided to some residents which suggests that the numbers and skills of staff on duty need to be reviewed to ensure that the needs of residents are met at all times. The arrangements for the induction and training of staff are inadequate which means that the staff had not been given a clear understanding of their roles. Additional staff training is needed to ensure that all of the care staff have a thorough understanding of dementia conditions and how to provide appropriate skilled care in line with current good practice. There is a stable care staff team in place, which provides a good basis on which to build good practice. The procedures for the recruitment of staff are robust which helps to ensure the protection of people living in the home. EVIDENCE: Discussion with the Manager and with members of the staff team provided evidence that the numbers of care staff on duty, excluding the Manager, are as follows:8 am to 8 pm 7 care staff (including 2 senior carers) Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 20 8 pm to 8 am 4 waking night care staff (including 1 senior carer) The Manager’s hours are not included in the above or staff employed for duties such as food preparation, laundry and cleaning. Two of the care staff spoken said that they had a lot to do and were particularly busy in the mornings. The findings of this inspection in relation to the day-to-day care of residents would suggest that the staffing levels need to be reviewed by the company to ensure that residents are given the help they need. All of the care staff had been employed for more than one year, and over 70 of the care staff have worked in the home for more than three years. There has been some staff turnover of ancillary posts in the home since the last inspection. The records of three recently employed ancillary staff were examined and it was found that appropriate vetting procedures had been carried out. Induction training had been carried out in relation to their particular job. A statutory requirement made at previous inspections concerning the induction training for care staff has still not been fully met although the Manager is trying to address this issue. The Manager confirmed that seven of the care staff team (33 ) have achieved an NVQ2 or above. Other staff are working towards this and it is hoped that the required standard will be met by the end of 2005. Two of the staff said that they had received training in understanding behaviours than can be presented by people with dementia, although this was some years ago. There was a lack of documentary evidence to show that other staff had received any specialist training in meeting the needs of people with dementia. This should be provided to ensure that all staff are equipped with the skills to provide specialist care for those residents with this condition, given that the home is registered to provide this care. As stated earlier in this report, some positive comments were received from relatives completing comment cards about the staff but also one who was not satisfied with the quality of care. There have also been a mix of views from residents completing comment cards, with some satisfied with their quality of care and treatment but some not totally satisfied. Observations made during this inspection also showed varied practice amongst the staff. The inspector observed one carer demonstrating good listening skills and patience and understanding with a resident whilst another did not respect a resident’s right to privacy or to be provided with timely care and attention after being incontinent. This underlines the need for more intensive training and supervision of staff. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 and 38. An application for registration of the Manager must be made in order to safeguard and protect residents. A programme of one-to-one supervision is in place which provides an opportunity for the manager and staff to discuss practice and address any areas of concern. The home regularly reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of residents, relatives and staff. However, an annual development plan has not been produced, which would be helpful in ensuring that a plan of action is in place to address any issues. The current arrangements for the storage of money belonging to residents are unsatisfactory. The Company is trying to address this problem, which will increase the protection for residents and staff involved in administering any financial matters on their behalf. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 22 Some health and safety issues were raised, which need addressing to ensure that the home provides a safe environment for residents. EVIDENCE: Since the last inspection, the manager has left and a new manager, Mrs Marion Taylor, has been appointed. An application for registration of the manager had not been made to the Commission at the time of this inspection. Members of staff spoken to during the inspection gave positive comments about the way in which the home was being managed and one said that the new Manager was very supportive. Staff confirmed that they receive 1-1 supervision and there were records supporting this. The home has a quality assurance programme in place, which includes seeking the views of residents, relatives and other interested parties, to provide feedback on the quality of care provided. The Manager has also held two meetings with residents to obtain their views. Various audits are carried out in respect of training, medication and health and safety issues, for example. Currently there is no development plan for the home, which is an outstanding requirement from an inspection carried out in April 2004. The Company are currently in the process of changing the arrangements for storage of money held on behalf of residents, as the current arrangements are unsatisfactory both for the protection of residents and staff. In the days prior to this inspection a fire occurred in the care home operating within the same building. The causes of the fire and the fire safety measures taken are currently being investigated by the Fire Brigade. The thermometer provided to test the temperature of hot water supplied to a bath was unsuitable for this purpose as the temperature range was insufficient, which means residents may be being put at risk. Failure to notice this indicates that staff need further training about the risks from hot water. Some televisions or audio systems were placed on high tables which may place residents at risk of harm if they are accidentally pulled over, for instance if a resident falls. Some of the residents who have dementia illnesses smoke heavily. One of these residents’ bedrooms was viewed and it was noted that there were cigarette burns in his bed-head and bedroom carpet. A carer confirmed that despite close monitoring of smoking and preventing access to matches or lighters, the resident had been found smoking in his bedroom unsupervised. A risk assessment had been put in place but this needed to be reviewed to Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 23 address this problem and look at ways of reducing risks, for example, flame retardant clothing, fabrics, increased supervision. Steps have not yet been taken to produce health and safety procedures and practices for those aspects of safety which are specific and relevant to this particular home. There is a system in place to ensure that the staff team are given training in moving and handling skills and fire safety and regular fire instruction updates. However, there was a lack of evidence that staff had received training in first aid and food hygiene. The Manager stated that all of the staff have recently completed first aid training but the Certificates for this training had not yet arrived. Training is also needed in infection control, which the Manager was trying to arrange. There was documentary evidence to show that fire safety checks are carried out in the home including checks on the fire alarm, emergency lighting and fire fighting equipment. A Periodic Inspection of the electrical wiring system does not appear to have been carried out since 2002. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 1 x 2 x 2 3 x 2 Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 25 Yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 4 Requirement Provide a statement of purpose in a range of formats. This requirement has been outstanding since the April 2004 inspection. The care plans must address all identified needs. Reference should be made to Standard 3.3. Care plans must be reviewed monthly with the service user. Residents must be provided with access to dentists and chiropodists at appropriate intervals. The Manager must effectively monitor the care provided to ensure that residents are provided with the help they need in respect of personal care and continence. Staff must be given instruction regarding residents rights to dignity and privacy. Review the social activities provided with the residents to ensure that these meet their needs. Ensure that the staff are adequately trained to provide stimulating, worthwhile activities for residents with dementia. Staff must be given training in assisting residents with dementia Timescale for action 31/12/05 2. 7 15 31/12/05 3. 8 12(1) 30/11/05 4. 10 12(4) 30/11/05 5. 12 16(2)(m) 31/12/05 6. 15 12(1) 31/12/05 Page 26 Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 at mealtimes. 7. 8. 15 18.2 16(2)(i) 13(6) Residents must be offered the meal as stated on the menu to ensure nutritional balance. The Manager must receive training in the multi-agency procedures to follow in respect of suspicion or evidence of abuse. The staff team must be given formal training in adult protection including signs/symptoms of abuse and types of abuse. Carry out necessary repairs to bath seat and extractor fans. Ensure all details relating to the investigation and outcome of complaints are recorded. Improve odour control in shared areas as necessary or provide new carpets where cleaning can not remove the unpleasant smells. Review care staffing levels to ensure sufficient staff are on duty to meet the care needs of residents who need help with their personal care and at mealtimes. Continue NVQ training programme to meet 50 target by the end of 2005. Provide suitably in-depth training for care staff to ensure that they understand and can provide specialist care for people with dementia in line with current good practice. Provide a system to ensure that all newly appointed care staff receive induction training and foundation training to NTO specifications within 6 weeks and 6 months of appointment respectively. This requirement is outstanding from the inspection of 24/4/04. 30/10/05 31/12/05 9. 18 13(6) 31/3/06 10. 11. 12. 19 16 26 23(2)(c) 17(2) 16(2)(k) 30/11/05 30/11/05 30/11/05 13. 27 18(1)(a) 30/11/05 14. 15. 28 18 31/12/05 31/3/05 27, 28 & 30 18 16. 30 18 31/12/05 Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 27 17. 18. 31 38 9 13(4)(c) 19. 20. 38 33 13(4)(c) 24 21. 38 18 22. 23. 38 23 13(4)(c) 23 An application for registration of the Manager must be made. Carry out risk assessments concerning the storage cabinets/tables in use for residents televisions or heavy audio equipment to ensure any unneccessary risks are identified and eliminated. Suitable thermometers must be provided for the testing of hot water supplied to baths. Provide an annual development plan for the home reflecting the aims and objectives of service users. This requirement has been outstanding since the April 2004 inspection. Provide training for staff as necessary in food hygiene and infection control. Provide evidence that first aid training has been successfully completed. Review risk assessments for smokers to reduce the risk of fire and injury. Implement health and safety procedures / safe working practices specific to Walker Lodge. This requirement has been outstanding since the August 2004 inspection. 30/11/05 30/10/05 30/10/05 31/12/05 31/3/06 30/10/05 31/12/05 24. 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. 2. 3. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 28 Refer to Standard 38 Good Practice Recommendations Ensure that Periodic Inspection of the electrical wiring system is carried out at appropriate intervals. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection Northumbria House Manor Walks Cramlington NE23 6UR National Enquiry Line: 0845 015 0120 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 Walker Lodge Residential Home B53 B03 S461 Walker Lodge V234701 240805 Stage 4.doc Version 1.30 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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