Inspection on 10/08/07 for Wessex Lodge [Poole]

This inspection was carried out on 10th August 2007.

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

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

Other inspections for this house

Wessex Lodge [Poole] 06/08/08

Wessex Lodge [Poole] 23/05/06

Wessex Lodge [Poole] 07/10/05

Wessex Lodge [Poole] 05/04/05

Wessex Lodge [Poole] 05/11/04

Wessex Lodge [Poole] 27/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wessex Lodge 16 Munster Road Parkstone Poole Dorset BH14 9PU Lead Inspector Debra Jones Key Unannounced Inspection 10th August 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wessex Lodge DS0000004067.V348370.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. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wessex Lodge Address 16 Munster Road Parkstone Poole Dorset BH14 9PU 01202 738234 01202 730215 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) Mr Arthur Roy Bolson Mrs Doreen Bolson Ms Julie Lorraine Dayman Care Home 29 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (14) of places Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. With effect from 1st January 2004, service users whose mobility requires the use of equipment must not be admitted to the upper level of the first floor of the home. One named person (as known by the CSCI) under the age of 65 may be accommodated to receive care. This condition will be removed upon the service users 65th birthday. 23rd May 2006 2. Date of last inspection Brief Description of the Service: Wessex Lodge is a care home providing personal care and accommodation for a maximum of 29 older people. The home can accommodate a maximum of 15 people with a diagnosis of dementia. Wessex Lodge is owned by Mr & Mrs Bolson and managed by Mrs Julie Dayman. Wessex Lodge is situated in a residential area between Canford Cliffs and Parkstone. Set back from the road, the home is secluded by mature trees and shrubs to the front with parking spaces for several cars. The rear of the home has pleasant grounds, which provide seating for service users in the summer months. Wessex Lodge is not on a main bus route but the local communities of Parkstone, Poole, Bournemouth and Westbourne are a short drive away. The home is a twostorey house that has been extended. There are 23 single bedrooms, 15 with en-suite facilities, 3 shared rooms 2 with en-suite facilities. Each floor of the home is accessible by means of a central stairway and a passenger lift. A stair lift also accesses the first floor. The first floor is on two levels part of which is accessed by two steps necessitating full mobility of service users accommodated in the rooms accessed by the steps. Communal sitting and dining room space is provided with a lounge area on both the ground and first floor. Also on the ground floor are the kitchen and laundry areas. Weekly fees (reviewed at least annually) range from £360.00 to £420.00. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are made for hairdressing, dry cleaning and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. The home hold a copy of the most recent inspection report, which is available, on request. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 10 August 2007. Debra Jones was the inspector who carried out the visit. Julie Dayman, the registered manager, helped the inspector in her work. The main purpose of the inspection was to check that the residents living in the home were safe and properly cared for and to review progress in meeting requirements and recommendations made as a result of previous inspections. Most made at the last key inspection in May 2006 had been addressed by the time of the brief ‘random’ visit made to the home in February 2007. The inspector was made to feel welcome in the home throughout the visit. A tour of the premises took place and a variety of records and related documentation was examined, including care records. Time was spent talking with residents and relatives in the communal areas and in their rooms. Six requirements and recommendations were made as a result of this visit and one requirement was carried over from the previous report. Some good practice suggestions were discussed at the inspection and these are referred to in the report, intended to encourage improvement. The management of the home have demonstrated through their success in complying with previous requirements that there is capacity for the service to further improve. The following are comments from residents on the day of the visit. ‘They are very good here, very kind.’ ‘I’ve nothing to grumble about.’ ‘I am happy here.’ ‘The food is good.’ A relative returned a comment card to the Commission and said ‘I am full of admiration for what they do. They treat all patients with patience tolerance and care.’ What the service does well: The home has a clear set of information to give to people before they move to the home that tells them about what they can expect from the service. A range of community health professionals support the care staff in looking after residents. Residents confirmed that they were treated with respect and kindness and their right to privacy was upheld. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 6 Residents are encouraged to exercise choice in their daily lives. Activities are on offer at the home that residents can join in with if they choose to. Visitors are always welcome at the home and residents are encouraged to maintain and develop relationships with people in the home, with their families and friends and maintain links with the local community. Meals are varied and based on the preferences of the residents. The dining areas are pleasant and comfortable. The complaints and adult protection procedures reassure residents and their representatives that the well-being and comfort of residents is important to the home and that any concerns raised will be properly investigated and resolved. The premises are comfortable and homely and the home is kept clean. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. What has improved since the last inspection? What they could do better: In order to ensure that only people who have needs that the home can meet move into the home they must all be fully assessed before admission. This assessment must be written down and used to inform that care plan. To reassure people that the home can meet their needs the decision to offer a place there along with a commitment to meet these needs must be made in writing to the prospective resident. As part of the care planning process residents or their representatives must be involved in the drawing up of the care plan and subsequent reviews so that they agree what care they can expect from the home. Further safeguards must be put in place in respect of medication administration recording to ensure that this significant aspect of care is as risk free as possible. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 7 Staff have access to a range of important training that equips them to do their jobs well, however residents would benefit from management and more care staff having national vocational qualifications in care. In respect of future recruitment the manager will have to have obtained the proper checks required by law for potential employees so that only suitable people work at Wessex Lodge looking after residents. Certain records listed in the Care Home regulations need to be kept, for example records of visitors to the home and rosters, with fuller information about who is working in the home and what they are doing. Also records need to be kept in accordance with the data protection act e.g. the accident records. Some improvements are needed to fully ensure a safe environment for residents, especially given the levels of confusion that some residents face. These include having moving and handling assessments in place, risk assessing and keeping items that pose hazards to health safely stored e.g. denture cleaning tablets and cleaning products. In addition to the requirements and recommendations made in this report the following good practice suggestions are made that the home is urged to adopt and act upon. The home is encouraged to • Obtain the clinical triggers available on the CSCI website in respect of continence, dementia, falls and nutrition. • Give consideration to incorporate current good practice relating to the environment of a dementia care setting, which may help to minimise confusion. For example colour and cues provided by décor and fittings such as paintwork and floor coverings • Check that the home’s infection control policy is consistent with the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care. • Add to their policies how staff in the home are to keep commodes and bottles clean. • Access more in depth dementia care training to enable management and staff to have a better understanding and be better able to meet the specialist needs of residents with this condition in their care . • Carry out a fire training session at night, as this is when most serious fires in homes have taken place recently. • Complete accident forms more clearly e.g. be clearer about how staff came across accidents or if they witnessed them, what they did and any follow up that was needed. • Carry out a regular analysis of accident records and act on the findings. The home is also asked to amend their statement of purpose with the information currently contained on their certificate of registration, namely that residents whose mobility requires the use of equipment will not be admitted to the upper level of the first floor of the home. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 8 All residents at the home are currently over the age of 65. Should the home wish to retain the flexibility over age that their certificate currently allows for they might also wish to add this to their statement of purpose. Once amended the home is asked to submit this document to the Commission. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are obtained for most prospective residents to ensure that residents whose needs can be met by the home are offered places there. EVIDENCE: Files for residents who had recently moved into the home were seen. Mrs Dayman, the registered manager, informed that for each person referred to the home, a care management assessment is obtained and any issues arising from this assessment are discussed as to how needs can be met with the care manager. She also said that the assessment and any discussions enable the home to make the decision to offer a place or not. Where no care management assessments are available e.g. where residents are privately funded and not involved with a local authority, the home does not carry out a written pre admission assessment. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 11 Residents are not routinely visited before moving to the home though prospective residents and their relatives are welcome to visit and are offered copies of information relating to the service that is provided. One resident who had recently moved to the home came to visit, decided they wanted to live there and did not leave. The home carries out their own assessment at the point the person moves into the home that forms the basis of their care plan. Mrs Dayman said that all prospective residents are informed in writing of the decision of the home to offer a place or not. A copy of this letter was not available on the files reviewed at this visit. From discussion with the manager and meeting with residents it appeared that residents were principally placed at Wessex Lodge because of their personal care needs rather than their need for a specialist dementia care service. The home’s statement of purpose makes it clear that what Wessex Lodge offers is a general residential care service for older people but makes up to half their bed spaces available to people with low level dementia care needs. They are clear that they are not offering a specialist dementia care service. At a previous inspection it was identified that the home could not accept people with dementia who were at risk of wandering from the home as not all of the exits from the building could be secured. It was therefore recommended at that this information be included in the Statement of Purpose as this document sets out the service provision for prospective residents. It was found at the inspection visit of February 2007 that this document had been amended in line with this recommendation. The home is asked to further amend this document with the information currently contained on their certificate of registration, namely that residents whose mobility requires the use of equipment must not be admitted to the upper level of the first floor of the home. Currently all residents at the home are over the age of 65. Should the home wish to retain the flexibility over age that their certificate currently allows for they might also wish to add this to their statement of purpose. Once amended this document should be submitted to the Commission. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. Arrangements for the recording, handling, safekeeping and administration of some medicines need further safeguards to be put in place to fully protect residents. Residents say that they are treated with respect and that their dignity is maintained. EVIDENCE: All residents have care plans. Mrs Dayman informed that these are re-written each month to ensure that they are kept current. The plans seen reflected the basic care needs of the residents. Care plans did not demonstrate the involvement of residents / their representatives in their development or review. Not all assessments needed to inform the care plan were in place i.e. moving and handling assessments for residents with theses particular needs. (See ‘management and administration’ below.) Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 13 Daily records are maintained by the staff in respect of residents to evidence the delivery of care and are used to inform the review of care plans. In documentation and through discussion it was clear that the home were getting support from local health professionals in the care of the residents. Visiting professionals include GPs, District Nurses, chiropodists and community psychiatric nurses. One visitor talked of how the home were quick to keep them informed of matters relating to their relative and of how much they had appreciated it when an accident had happened and the home had organised a taxi for them both to go to the hospital. Mrs Dayman said that where equipment is introduced into the home training is given either by the supplier of the equipment or from nurses. Equipment seen included pressure relieving cushions and mattresses, zimmer frames, rollators, walking sticks, hoists and wheelchairs. At the time of inspection one of the residents was confined through ill health to their bed and has been for about a year. A specialist mattress has been supplied to this resident and staff were completing a ‘turning sheet’ as part of the care plan to prevent skin breakdown. Mrs Dayman said that the resident had been reviewed by their placing authority since they had been receiving all care in bed and that meeting the residents’ needs was within the home’s abilities. The home has policies and procedures for the safe administration of medication in the home. At the time of inspection all of the residents were having medication administered by the staff. The manager has delegated responsibility for medication in the home to her deputy. A unit dosage system is used and most medicines are delivered to the home in this way. Medicines delivered in this system were compared with records and accorded, with the exception of one which had arrived at the home at a different point of the month to the others. It was not clear how many tablets should have been in the home and therefore it could be checked that the resident had received what they should have. Staff who administer medication have received training through the pharmacist. The pharmacist also visits the home to advise on procedures, record keeping and storage. The home keeps patient information leaflets and has a returns book showing what medicines go back to the pharmacy unused. The medication cabinet was seen and it was found that medicines were stored correctly with the exception of lactulose which was being kept in the fridge unnecessarily (this just needs to be locked away with the other medicines). A locked metal box is used to store medicines in the fridge rather than a recommended plastic one. The medication administration records were reviewed. Those seen did not contain details of allergies, or where appropriate ‘none known.’ There were no gaps in the records in respect of medication administered, but where hand Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 14 entries had been made the person making changes was not signing them. Good practice dictates that in addition to this a second competent member of staff should also countersign handwritten entries to confirm their accuracy. A set of sample signatures of staff who give medicines was not in place. The home is not currently carrying out self audits of their medication system. Most bedrooms at Wessex Lodge are single occupancy, giving residents opportunities for privacy. The shared rooms seen contained screens to offer privacy to residents when receiving personal care. All residents spoken with said that they were treated very well. There is a notice board in the dining area on the ground floor that has information displayed about individual residents’ needs and how they are met. This is not information that should be available to other residents or general visitors to the home. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of general basic activities are available to interest and stimulate people living at the home. Residents are encouraged to make choices about their life style and to maintain contact with their family and friends. A balanced and varied diet is provided for the enjoyment of residents. EVIDENCE: Wessex Lodge provides organised activities such as visiting entertainers, craft sessions, and manicures. Items made at the craft sessions were on display around the home. On the day of inspection most residents were in their rooms in the morning, reading daily papers or books, watching TV or listening to the radio. Residents moved to dining areas for lunch and most spent the afternoon in the lounges. A group of women residents spent the afternoon together watching the very large TV in the upstairs lounge and enjoying each other’s company. Other residents had visitors. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 16 The question of what was provided to stimulate residents who suffer from dementia was returned to at this inspection visit. Mrs Dayman said that the residents with dementia join in with the singing groups, and other activities, and that more time was spent with them carrying out personal care tasks. Church of England and Holy Communion services are held regularly in the home. The home has a visiting policy and a visitors book for people coming to the home to sign. Visitors are welcome at any time and residents can go out of the home whenever they wish, and for as long as they wish. Some talked about the local trips they went out on with their families. Visitors spoke about how welcome they felt when they came to the home. Residents are encouraged to pursue their own lifestyles within Wessex Lodge and make choices wherever possible. These include choosing what to wear, what to eat or drink and to generally go anywhere within the home and do as they wish during the day. Some bring their own possessions with them and personalise their bedrooms. Wessex Lodge has two dining areas, one upstairs and one downstairs. People are free to eat where they wish but generally the residents able to eat without assistance use the dining room upstairs and those who require assistance use the downstairs dining room. A few residents choose to always have their meals in their own rooms. The main meal of the day is at lunchtime. On the day of inspection lunch was steak and kidney pie served with gravy, cauliflower and runner beans. Dessert was angel delight. Two residents were having an alternative, soup and toast, by choice. The menu is on a four-week cycle, based on what the home know that residents like; two roast dinners are served weekly. Records are kept showing that residents are offered a varied diet. Mrs Dayman said that all of the staff who prepare food have had suitable basic food hygiene training. People spoken with at the visit said that the food provided in the home was always of a good standard and that there was plenty to eat. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a complaints procedure. Available guidance and staff training in abuse protect residents from harm. EVIDENCE: The home maintains a log for the recording of complaints made about the home. Two have been raised since the last inspection and have been dealt with as per the home’s procedure and within target timescales. The complaints procedure is detailed within the terms and conditions of residence and also within the Statement of Purpose. At the point of admission the resident or their relatives are given copies of these documents and therefore they are informed of the procedure. Residents and relatives spoken with at the visit said that they had nothing to complaint about and had not had to make a complaint. At the last key inspection in May 2006 concern was raised about the lack of training in adult protection. At the follow up visit in February 2007 this had been addressed and the home had engaged an outside trainer who provides training in adult protection and prevention of abuse. A sample of certificates was seen. As no new staff have been recruited since the last inspection the home were not able to evidence that staff are employed at the home only after the Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 18 Protection of Vulnerable Adults list has been checked to confirm their suitability. (A requirement was made in respect of this at the last inspection. See ‘staffing’ below.) Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Continued investment in the upkeep of the home results in an increasingly, comfortable environment for residents to live in. EVIDENCE: A tour of the premises confirmed that the home is suitably decorated and furnished. Space is available for residents to sit outside and enjoy the garden and appropriate garden furniture is provided. One resident spent time sitting on the bench in front of the home in the sun reading a book during the visit. The home is registered for 29 people, 15 of whom can be admitted with specialist dementia needs although Wessex Lodge does not have any environmental features to distinguish it from a general care home for older people. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 20 The home is permitted to use 3 rooms as doubles. Most bedrooms have en suite facilities. There are also a number of communal bathing areas in the home; one general bathroom was in the process of being transformed into a wet room at this visit. Aids and adaptations are available throughout the home e.g. raised toilet seats, and some residents with particular needs have their own personal equipment to assist with their independence. Residents are able to personalise their rooms with furniture and general belongings as they wish and in agreement with the home. There is a passenger lift, enabling easy access between the floors. However, the first floor is on two levels with part of it being accessed by two steps meaning that only residents with full mobility are able to be accommodated in the rooms in this part of the building. There are emergency alarm bells throughout the home, in each bedroom and in communal areas. Wessex Lodge residents’ have all their laundry done on the premises and the home has suitable machines to launder clothes and bedding at appropriate temperatures. The laundry room was clean and tidy. The home has an infection control policy and have obtained the most up to date guidance from the Department of Health e.g. Essential Steps to Safe Clean Care. It is suggested that they check that their policy is consistent with the guidance and add to their policies written guidance as to how staff in the home are to keep commodes and bottles clean. At previous inspections concerns had been raised about odours around the home. This was not the case at this inspection. Carpets had been replaced in various areas, including the main hallway and lounge. Residents and visitors said that they had no problems with cleanliness at the home and that their clothes and bedding were regularly washed and their rooms cleaned. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient, suitably trained care staff are employed and deployed to ensure that the care needs of residents can be met. Residents have been potentially exposed to risk by not all recruitment checks having been undertaken in respect of the staff. EVIDENCE: The present roster shows that there are 2 care staff on duty at all times of day and night with up to five care workers on duty at peak times. In addition the home employs separate staff for cleaning and cooking. The manager is supernumerary to the above staffing. Staff commented on the good teamwork at the home. Mrs Dayman said that the home employs a staff team of 22 carers of whom 3 have completed training to NVQ level 2. Six more members of staff are working towards this qualification. At inspections last year concerns were raised about recruitment practices. Requirements had been partially met by the time of the inspection visit in February 2007. Since then no new staff have been recruited and so the home was not able to evidence that they had changed their practice in respect of Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 22 staff not starting work until a clear POVA First check or CRB had been returned. Staff have received training in core subjects such as fire safety, moving and handling, induction and foundation training, first aid and infection control. District Nurses are invited to talk with staff about areas of interest concerning residents’ care e.g. pressure areas and dressings. Whilst it is good that staff have undertaken distance learning in the care of people with dementia this level of training is suitable for an ordinary older persons home but not sufficient for a specialist service which Wessex Lodge is registered to deliver. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed and run with the interests of residents in mind but is currently not entirely protecting residents in respect of their health, safety and welfare. EVIDENCE: The registered manager, Mrs Dayman, has completed NVQ level 4 in management but says she does not have a qualification in care. She has a number of year’s experience of running the home. Mrs Dayman has completed a distance-learning course in dementia, involving about 5 hours input. The owners of the home, Mr & Mrs Bolson, have a property on site of the Wessex Lodge and are actively involved supporting the manager. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 24 Prior to this inspection the home completed an annual quality assurance assessment (AQAA), which they submitted to the Commission for Social Care Inspection. This identifies how the home have taken into account the views of residents and their supporters in the running of the home and sets out their plans for improvement over the next twelve months. The home has also recently sent out and made available comment cards for the Commission as requested. Letters of thanks are retained to testify that the home is run in the interests of the residents. The home provides safekeeping for money for one resident and keeps records of transactions and the running balance. The system for this was reviewed and found to be satisfactory. All other residents look after their own affairs or have relatives who take on this role. All records were available as requested at the inspection. An up to date insurance certificate was on display along with the home’s registration certificate. There were photographs of residents as required by law on files that were reviewed. The information contained on staff rosters was not sufficient to meet the regulations. Rosters did not contain the full names of staff, what jobs they were doing in the home and the manager was not included. A visitors book was in place but had not been signed since June 2007 thereby not meeting the regulations of there being a record of all visitors to the home including their names. Dorset Fire and Rescue visited the home recently and have required some door closers to be fitted around the home. This is being done. The home have carried out their own fire risk assessment and have not identified any matters that need addressing. Regular checks are carried out of the fire fighting equipment and staff receive quarterly training. It is suggested that a fire training session is carried out at night, as this is when most recent serious fires in homes have taken place. Some residents need help from staff with moving and handling, including the use of hoists. Moving and handling assessments were not in place for these residents. These assessments must be in place and regularly reviewed, and where appropriate updated, in order to inform their care plans. The potential risks of tubes of denture cleaning tablets being left out around the home, easily accessible to residents i.e. in a number of residents rooms, was discussed. Denture cleaning products pose danger to residents, for instance, should anyone mistakenly eat one. The risk is greater to some of the Wessex Lodge residents given their confusion and that some residents go in and out of other residents’ rooms. The home is was advised to carry out risk Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 25 assessments in relation to the tubes of denture cleaning tablets and take appropriate action to minimise risk. A stock of Denture tablets and other cleaning substances that pose a risk to residents were being kept in the laundry room, which is not kept locked. Accident records were looked at. Accident forms seen were generally well completed but in some cases could be clearer about how staff came across accidents or if they had witnessed them, what they did and any follow up that was needed. A regular analysis of accident records is not taking place. Records were not being kept in accordance with the data protection act. Information sent to the Commission prior to the inspection confirmed that the home is undertaking appropriate checks of equipment and facilities at appropriate intervals. Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 26 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The registered person shall not provide accommodation to a service user at the care home unless their needs have been assessed by a suitably qualified or suitably trained person. The registered person shall not provide accommodation to a service user at the care home unless they have confirmed in writing to the person that having regard to the assessment the care hone is suitable for the purpose of meeting he service user’s needs in respect of his health and welfare. Timescale for action 30/09/07 2. OP4 14 30/09/07 3. OP7 15 Unless it is impracticable to carry 30/09/07 out such a consultation, the registered person shall after consultation with the service user or a representative of his, prepare a written plan as to how the services user’s needs in respect of his health and welfare are to be met. The registered person shall make 30/09/07 DS0000004067.V348370.R01.S.doc Version 5.2 Page 28 4. OP9 13 Wessex Lodge arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home, including: • Clear records must be kept of all medicines that come into the home. Medication Administration Records must contain details of allergies known or unknown. Where handwritten entries are made onto medication administration records these must be signed and counter signed, for accuracy, by competent persons. • • 5. OP29 19(4)(b) (i) Care staff must not start working 31/08/07 with service users until a clear POVAFirst check / CRB has been returned. Requirement repeated and timescale extended. 6. OP37 17 A copy of the roster of persons working at the home and a record of whether the roster was actually worked must be kept; including full names and designations. A record of all visitors to the care home, including their names must be kept. 30/09/07 7. OP38 13 The registered person shall make 30/09/07 suitable arrangements to provide a safe system for moving and handling service users, based on individual moving and handling assessments. DS0000004067.V348370.R01.S.doc Version 5.2 Page 29 Wessex Lodge Unnecessary risks to the health and safety of residents must be identified and so far as possible eliminated e.g. cleaning products and denture cleaning tablets must be suitably stored. This applies to bedrooms and the laundry room. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended • That a lockable plastic box replaces the lockable metal box for medicines stored in the fridge. • That a sample signature sheet is kept for staff administering medication. And • That the home carries out self audits of their medication system. Any information relating to the care of residents should be kept out of sight of other residents or visitors to the home. A minimum of 50 of care staff at the home should be NVQ level 2 qualified in care. Staff should have training in dementia care to a level suitable for the specialist service that Wessex Lodge is registered to provide. The manager should obtain a National Vocational Qualification Level 4 in Care and suitable training for running a specialist dementia care service. Accident records should be stored in accordance with data protection legislation. 2. 3. 4. OP10 OP28 OP30 5. OP31 6. OP38 Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 30 Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wessex Lodge DS0000004067.V348370.R01.S.doc Version 5.2 Page 32 - 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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