Inspection on 08/08/06 for Wells Lodge Nursing Home

This inspection was carried out on 8th August 2006.

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

Wells Lodge Nursing Home 13/02/07

Wells Lodge Nursing Home 07/02/06

Wells Lodge Nursing Home 15/06/05

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Wells Lodge Nursing Home Wells Lodge Nursing Home 60 Earls Avenue Folkestone Kent CT20 2HA Lead Inspector Lisbeth Scoones Unannounced Inspection 8th August 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.V299727.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. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 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) www.wellscare.com 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.V299727.R01.S.doc Version 5.2 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. 7th February 2006 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 on street parking. The home is located near the M20 motorway. Shops, bus stops and the railway station are nearby. Current weekly fees are in the range of £483 to £650. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 6.45 hours and comprised discussions with the Company’s responsible person Mr P Burns, nurse in charge, three care staff, housekeeper and the cook. The inspector met with 7 residents and three visiting relatives, toured the building and examined records. Occupancy comprised 21 residents with an admission expected. This inspection was further informed by a questionnaire pertaining to the service completed by the responsible person. A number of comment cards were distributed to residents, GP’s and care managers. Some of these were returned. A comment read, “Staff are always very helpful”. What the service does well: What has improved since the last inspection? What they could do better: At the previous inspection, an acting manager managed the home. At that time managerial duties were outstanding. The acting manager left a few weeks prior to this inspection and whilst registered nurses are on duty, the role of acting manager has not been formally assigned. As an interim solution, another home manager, who was in the home at the time of the inspection, supports the staff. Efforts continue to be made to employ an individual to take charge of the home who, in due course, may become the registered manager. The registered person spends much time in the home to carry out his responsibilities and provide staff support. However, as a result of the absence of a nurse manager, managerial duties in respect of care plan review, review of policies and procedures, audits of medication, formal induction, ongoing training and staff supervision remain outstanding. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 6 In respect of care planning, recommendations were made for timely review and improved recording in respect of continence promotion, nutritional needs and use of pain charts. Medication charts were in general well maintained. However, staff must ensure that records of medication “no longer required” are maintained. Urgent action is needed to ensure that new staff receive the Skills for Care induction and that a training programme be devised. Such training should reflect the care needs of the residents and should include adult protection. 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. The responsible person said that his other care home is piloting a quality assurance programme, which would be introduced to this 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. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. The home has a combined Statement of Purpose and Service User guide providing detailed 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, is regularly updated. It was said that the guides are offered to all residents and their families but that few residents had shown an interest. Two residents spoken to said they would like a copy. Residents said they would know who to talk to if they wish to make a complaint. From discussions with the nurse on duty and records seen, it is confirmed that no resident is admitted to the home unless a full and comprehensive Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 9 assessment of need is made. A resident said she visited the home before admission to have a look around. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome group is adequate. This judgement is based on information available at the time, which includes a visit to the service. Whilst care plans contain comprehensive information, staff must ensure that these are regularly reviewed. 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 timely review of risk assessments. Medication administration records are well maintained but staff must ensure that comprehensive records are kept of disposed of 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 informed by risk assessments but had not been reviewed since 22 May 2006. Some risk assessments had not been signed or dated. A nutritional assessment scored Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 11 as very high risk had not been reviewed and a continence assessment not completed. A high risk of developing pressure ulcers had not been reviewed since May 2006. A body map had not been reviewed. Residents are not routinely invited to contribute to their care plan. The inspector spoke with 2 residents who said they would welcome an input. Appropriate health professionals are involved with the care provision as e.g. dentist, optician, continence advisor, physiotherapist and community psychiatric nurse. The clinical room was tidy and clean with due regard for infection control and universal precautions. Medication charts were in general well maintained but “gaps” (non-signing) need to be investigated. Not all residents prescribed regular analgesia are supplied with a pain chart to monitor efficacy .The home is required to maintain records pertaining to the disposal of medication in accordance with the guidance of The Royal Pharmaceutical Society. Oxygen cylinders kept in the clinical room are now safely secured. See also standard 38. Residents said that staff are kind and courteous and treat them with patience and respect. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 12 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, 13, 14, 15 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents are provided with suitable activities. Residents receive wholesome and varied meals and have a choice of what they would like to eat. EVIDENCE: The inspector met with the activities coordinator who is employed for 20 hours a week. Many residents enjoy the events organised and the one to one sessions with those residents who wish to stay in their rooms or who are too frail to attend communal activities. A resident said he just enjoyed reading the paper. “Life Reviews” are recorded for some but not all of the residents. The inspector met with the chef who demonstrated a good knowledge of the nutritional needs of older people, their preferences and dietary requirements. Residents said they liked the food. The kitchen was visited and menus viewed. A relative said, “The food is good.” The chef said she gets good feedback from the residents and relatives. Lunch served looked appetising. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 13 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 quality in this outcome group is adequate. This judgement is based on information available at the time, which includes a visit to the service. The home has a complaints procedure but not all complaints are recorded. Staff have an understanding of adult protection issues but have not had recent training. EVIDENCE: Residents said that they feel comfortable in bringing any issues of concern to the attention of the staff. The home has received no complaints since the past inspection. However, in conversation with a resident, an incident was highlighted which should have been investigated under the complaint procedure. The circumstances of the incident are now being looked into. A daily record mentioned a complaint from a relative, which should have been entered into the complaint record. Staff demonstrated that they have an awareness of adult protection issues, but have not had recent training. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 14 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, 26 The quality in this outcome group is good. This judgement is based on information available at the time, which includes a visit to the service. Residents live in a safe, well-maintained and homely environment. The home provides a clean, odour free environment. EVIDENCE: The home provides a comfortable and attractive environment for the residents. Residents’ room are personalised and there are a number of communal spaces, including two dining areas, available. Residents are provided with a lockable drawer to store away any private possessions. A resident used the lockable drawer to safely keep his medication. A proposal to enlarge the current nurse’s station was discussed thus providing a better working environment. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 15 The home employs a housekeeper and laundry person from Monday to Friday. Good clinical waste disposal systems were observed. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 16 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 quality in this outcome group is adequate. This judgement is based on information available at the time, which includes a visit to the service. The numbers of staff meet residents’ needs and ensure residents are in safe hands. The home’s recruitment procedures support and protect the residents but formal induction training is delayed. Staff are trained and competent but a formal training structure and programme needs to be put in place. EVIDENCE: The responsible person said that the home has recently recruited more staff. The home is not yet fully staffed and agency carers supplement those employed permanently. On the day of the inspection, for the morning shift, the home was staffed as follows: nurse in charge who was introducing a recently employed RN to the residents, a senior carer, two permanent and an agency carer. Three residents said that, “staff are pushed in the morning” and “It sometimes takes a long time for the bell to be answered“, “Staffing is not so good as some permanent staff have gone”. These comments were discussed with the responsible person. Currently 4 care staff have a NVQ qualification, which represent 40 of the care staff. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 17 At the last inspection it was reported that the induction training was to be reviewed in line with the Skills for Care standards. This has not yet happened in the home but is currently piloted in Wells Care Ltd’s other home with a view to introduce it. Newly appointed staff currently receive moving and handling and fire training but no records are maintained of their progress through induction. As already recorded, there is no formal training programme. It was again recommended that a training matrix be devised and that each member of staff has an individual training and development assessment and profile. The inspector was advised that the responsible person is negotiating a training package for the home, which would address all outstanding training. See also standard 36 in respect of supervision. A sample of staff files was viewed and confirmed that references are requested, POVA and enhanced CRB checks undertaken and staff provided with a contract and job description. For two recently employed care assistants, some sections of the application form were incomplete and the difficulties in obtaining references were discussed. It was recommended that interview notes be kept where issues relevant to their performance may be recorded. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 18 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, 38 The quality in this outcome group is adequate. This judgement is based on information available at the time, which includes a visit to the service. The home currently has no assigned nurse manager. No recorded quality assurance systems are used to ensure that the home is run in the best interest of the residents. Staff are not appropriately supervised and supported. The health, safety and welfare of the residents and staff are not promoted. EVIDENCE: As already identified, the home currently has no nurse manager. Until a manager or acting manager has been appointed, delegation, roles and responsibilities need to be clearly defined. Such responsibilities would include Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 19 auditing care plans and medication records, staff training, determining staffing levels versus residents’ dependency and formal staff supervision. The responsible person said that the nursing staff at Wells Care Ltd’s other home would be working with the staff at Wells Lodge to produce best practice protocols. The outcome would be that the two homes operate according to similar working practices and procedures. At the previous inspection, the responsible person said that formal quality assurance would be introduced. At this inspection, the inspector was advised that the process is delayed. The home does not deal with residents’ monies and residents’ relatives are invoiced monthly. Staff are provided with statutory training in respect of fire safety awareness and moving and handling. A monthly monitoring chart of residents’ falls had been wrongly completed. Accident records were examined but these did not include an incident discussed. The issue of safe transport of oxygen cylinders was discussed. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 3 2 x 2 Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 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. 2. 3. Standard OP9 OP18 OP31 Regulation 13 (2) 13 (6) 8 (1) (a) Requirement That records of disposed of medication be maintained That all staff be provided with adult protection training That progress in appointing an individual to manage the Care Home be reported to the CSCI Timescale for action 31/08/06 30/09/06 15/09/06 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. 4. 5. 6. Refer to Standard OP7 OP8 OP16 OP18 OP28 OP30 Good Practice Recommendations That care plans are regularly reviewed. That nutritional and skin integrity risk assessments be timely reviewed. That all complaints be recorded. That a training matrix be devised to incorporate adult protection training. That at least 50 of staff are NVQ trained. That the induction programme be reviewed. That every member of staff has a training and development assessment and profile. Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 22 7. 8. 9. OP31 OP32 OP33 OP36 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 Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 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 © 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 Wells Lodge Nursing Home DS0000062481.V299727.R01.S.doc Version 5.2 Page 24 - 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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