CARE HOMES FOR OLDER PEOPLE
Wells Lodge Nursing Home Wells Lodge Nursing Home 60 Earls Avenue Folkestone Kent CT20 2HA Lead Inspector
Lisbeth Scoones Announced Inspection 7th February 2006 09:30 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 Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 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. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Wells Lodge Nursing Home Address Wells Lodge Nursing Home 60 Earls Avenue Folkestone Kent CT20 2HA 01303 850898 01303 220590 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) Wells Care Ltd Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users with a diagnosis of DE(E) restricted to three (3) whose DOB are 22/03/1924; 23/09/1916 and 09/04/1924. Service users receiving palliative care are restricted to one whose DOB is 29/09/1917. 15th June 2005 Date of last inspection Brief Description of the Service: Wells Lodge is a recently registered Care Home providing nursing care for 22 older people. The registered provider is Wells Care Ltd which also owns Wells House in Sandgate. The premises comprise a two storey extended and adapted detached house with gardens in the centre of Folkestone. There are eight parking spaces available as well as off street parking. The home is located near the M20 motorway. Shops, bus stops and the railway station are nearby. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out over 7.5 hours and comprised discussions with the Company’s responsible person Mr P Burns, acting manager Mrs J Sharp, registered nurse, two care assistants, cook, housekeeper and other staff. The inspector met with 8 residents, toured the building and examined records. An assistant care manager, who had requested to join the inspector to aid his professional development, accompanied the inspector. Prior to the inspection, the responsible person had completed a questionnaire pertaining to the service and 9 residents and 14 relatives completed a comment card. Information thus received is incorporated in the report. The great majority praised the home, the atmosphere and the kind and caring staff. What the service does well: What has improved since the last inspection? What they could do better:
It is only recently that the manager left. This did not only pose a senior staffing problem, but several outstanding managerial duties in respect of audit, staff training and supervision have also been delayed but are receiving the acting manager’s full attention. The responsible person is actively trying to
Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 6 recruit a new manager. There are some staff shortages but agency staff are currently filling these. Whenever possible, the same staff are employed. The acting manager is in the process of reviewing the structure of the care plans. Whilst there was evidence of recent review, several recommendations were made for improved recording in respect of mental health needs, continence promotion, nutritional needs and a review of the pain charts. Medication charts were in general well maintained. However, a protocol needs to be devised in respect of “as required” and “as directed” medication with a further referral to such medication in resident’s care plan. A homely remedies procedure is also needed of which the home is aware. Further scrutiny is required in respect of varying doses of analgesia and the correct use of pain charts to reflect its efficacy. Oxygen cylinders kept in the clinical room should be secured in order not to pose a risk of falling. When the new manager is in place, attention needs to be given to a training programme that clearly identifies training provided and planned. Such training should reflect the care needs of the residents and should include adult protection, continence promotion and dementia care. There is a delay in the introduction of a formal quality assurance system and currently, the management relies on verbal feedback to ascertain residents’ views. Formal visits as required by regulation are also not undertaken. A safe system to keep residents’ records securely is yet to be introduced. 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. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 The home has a combined Statement of Purpose and Service User guide, which provides excellent information for current and prospective residents to decide whether they wish to move into the home. Residents are only admitted to the home following an assessment of need. EVIDENCE: The Service User Guide, which includes the complaint procedure, has recently been updatated. It was said that the guides are offered to all residents and their families but that few residents had shown an interest. It was recommended that these continue to be readily available. Residents said they would know who to talk to if they wish to make a complaint. The inspection reports are available to all although one relative said “I am not sure if I have access to a copy of the inspection report.” From discussions with the manager and records seen, it is confirmed that no resident is admitted to the home unless a full and comprehensive assessment of need is made.
Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9, 10 Whilst care plans have improved, additional information and attention to detail is needed to provide staff with the information they need to meet the residents’ needs. Residents’ health care needs are met with evidence of multi-disciplinary health professionals input but further attention is needed in respect of nutritional needs and continence promotion. Good medication systems are in place but a protocol is needed in respect of “as required medication” and “as directed” medication Personal care is offered in a way, which protects the residents’ privacy and dignity and promotes their dependence. EVIDENCE: A sample of care plans examined demonstrated that these are reviewed and informed by risk assessments. However mental health needs were not clearly defined and further detail is recommended in respect of continence promotion and nutritional needs.
Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 10 The manager ensures that appropriate health professionals are involved with the care provision as e.g. dentist, optician, continence advisor and community psychiatric nurse. A resident had recently been referred for a psychiatric assessment. The clinical room was tidy and clean with due regard for infection control and universal precautions. Medication charts were in general well maintained but a protocol is needed in respect of “as required” and “as directed” medication with a further reference to such medication in resident’s care plan. A homely remedies procedure should be available of which the home is aware. Further scrutiny is needed in respect of varying doses of analgesia and the correct use of pain charts to reflect its efficacy. Oxygen cylinders kept in the clinical room should be secured in order not to pose a risk of falling. See also standard 38. A risk assessment was seen for a resident who self-medicates but this should be regularly reviewed. Good systems for the disposal of out of date and unwanted medication were seen. Residents said that staff are kind and courteous and treat them with patience and respect. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 15 Residents are provided with suitable activities. Residents receive wholesome and varied meals and have a choice of what they would like to eat. EVIDENCE: An activities coordinator has been appointed who provides social activities. It was said that the programme is being developed and would include one to one contact with those residents who wish to stay in their rooms or who are too frail to attend communal activities. Since the previous inspection, a new chef has been appointed who demonstrated a good knowledge of the nutritional needs of older people, their preferences and dietary requirements. The cook said she makes all her own soups and cakes. Fresh fruit and vegetables are provided. Menus are to be reviewed in consultation with the residents. Residents said they liked the food. The kitchen was visited and records viewed. A relative said, “The food is good.” The Environmental Health Officer recently inspected the kitchen and found it to be of good standard. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16, 18 The home has a complaints procedure, which residents and their relatives are confident to use knowing that their complaints and concerns will be listened to and acted upon. Staff have an understanding of adult protection issues but have not had recent training. EVIDENCE: A recently received complaint was investigated, well recorded and a satisfactory outcome was achieved. Residents said that they feel comfortable in bringing any issues of concern to the attention of the manager and her staff. A relative commented that “at no time have we had cause to complain about the care and attention my relative receives.” Staff demonstrated that they have an awareness of adult protection issues, would know who to report to if abuse was ever suspected or witnessed but have not had any recent training. This was discussed with the acting manager and staff training has been booked. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19, 22, 26 Residents live in a safe, well-maintained and homely environment. Residents are provided with the specialist equipment they require but for one bed-bound resident, the possibility of supplying a suitable specialist chair should be explored. The home provides a clean, odour free environment. EVIDENCE: This newly registered home provides a comfortable and attractive environment for the residents. Residents’ room are well personalised and there are a number of communal spaces, including two dining areas, available. Residents have been provided with a lockable drawer to store away any private possessions. A resident used the lockable drawer to safely keep his medication. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 14 For a resident on permanent bedtest, the possibility of purchasing a specialist chair was discussed. The acting manager said this would be looked into. The home employs a housekeeper and laundry person from Monday to Friday. The manager said this was a satisfactory arrangement. Good clinical waste disposal systems were observed. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The numbers and skills of the staff meet residents’ needs and ensure residents are in safe hands. The home’s sound recruitment procedures support and protect the residents but, due to recent changes at senior level, formal induction training is currently delayed. Staff are trained and competent but a formal training structure and programme needs to be put in place. EVIDENCE: On the day of the inspection, for the morning shift, in addition to the acting manager who assisted with the inspection throughout, the home was run by a registered nurse and 4 permanent care staff. The responsible person said that the home is recruiting more staff. Staff spoken to said that they enjoyed caring for the residents but that they were at times very busy, especially during the morning shift, resulting in some of the residents getting up late. One relative commented, “On occasions, during the day, staffing levels appear to have difficulty in coping with the demands of the residents”. The home encourages staff to undertake NVQ training. Induction training is to be reviewed in line with the Skills for Care standards. Staff said they receive regular training. Recently this has included moving and handling, Diabetes,
Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 16 sub-cutaneous fluid administration and PEG feeding. Due to recent staff changes, a formal training programme has yet to be devised. This should incorporate dementia care, continence promotion and adult protection training. See also standards 7, 8 and 18 in this respect. It was recommended that a training matrix be devised and that each member of staff has an individual training and development assessment and profile. See also standard 36 in respect of supervision. A sample of staff files was viewed and confirmed the home’s robust recruitment procedures, which include two written references, POVA and enhanced CRB checks. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 The acting manager has a good understanding of her role and the needs of the residents but is in need of more support to manage effectively. Quality assurance systems need to be developed to ensure that the home is run in the best interest of the residents. Staff are not appropriately supervised and supported. Residents’ care records are not kept secure. The health, safety and welfare of the residents and staff are promoted but for a risk identified with oxygen storage. EVIDENCE: As already identified, the home is currently managed by an acting manager and the responsible person is actively trying to recruit a manager. The acting
Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 18 manager is supported by the responsible person, another manager and other trained staff. She is currently working many additional hours. Once the new manager is in place, delegation, roles and responsibilities need to be clearly defined. Such responsibilities would included auditing care plans and medication records, staff training, staffing levels, job description review and formal staff supervision. The residents praised the acting manager and the staff for their flexible approach and commitment to provide a good service. A relative said, “I would like to say how pleased I am with the care and attention my relative receives and especially with the care and kindness and unfailing good humour from all the staff.” Another resident said,” You have to go a long way to find a better place.” Formal quality assurance systems to ascertain residents’ views are currently not obtained. The responsible person said that such a system would now be introduced. Whilst there is no doubt that the responsible person spends much time in the home and has in the past produced formal reports in accordance with Regulation 26, such reports have recently not been received. The home does not deal with residents’ monies and residents’ relatives are invoiced monthly. As identified at the previous inspection, care plans are kept in an unlocked office, which may compromise the security of such records. At the previous inspection it was said that lockable filing cabinets would be purchased for this purpose. This has not yet happened. Staff are provided with statutory training in respect of fire safety awareness, moving and handling, food hygiene, first aid and infection control. Accident records were examined. These were well maintained and where relevant resulted in a risk assessment review. The safe storage of oxygen cylinders has already been referred to in standard 9. Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 19 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 Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 20 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 3 2 2 3 Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP33 Regulation 26 Requirement That the responsible person visits the home in accordance with the Regulation Timescale for action 15/03/06 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 Refer to Standard OP7OP8 OP9 OP30OP18 Good Practice Recommendations That care plans contain all care needs including mental health, nutrition, continence promotion and pain control That protocols for “as required” medication and “homely remedies” be devised. That oxygen cylinders are securely stored That a training matrix be devised to incorporate adult protection training. That the induction programme be reviewed. That every member of staff has a training and development assessment and profile That a management structure be devised with clear roles, job descriptions and lines of responsibilities That a formal quality assurance system be introduced That a programme of formal staff supervision be recommenced
DS0000062481.V273821.R01.S.doc Version 5.1 Page 22 4 5 6 OP31OP32 OP33 OP36 Wells Lodge Nursing Home 7 OP37 That residents’ records are stored securely Wells Lodge Nursing Home DS0000062481.V273821.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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