CARE HOMES FOR OLDER PEOPLE
Wessex Lodge 16 Munster Road Parkstone Poole BH14 9PU
Lead Inspector Tracey Cockburn Unannounced 05 April 2005 10:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wessex Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Wessex Lodge Address 16 Munster Road, Parkstone, Poole, BH14 9PU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 738234 01202 730215 Mr Arthur Roy Bolson Mrs Doreen Bolson Ms Julie Lorraine Dayman CRH 29 Category(ies) of OP 14 registration, with number DE(E) 15 of places Wessex Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 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. Date of last inspection 05 November 2004 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 accommdate 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. Wessex Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 4 hours in the late morning and early afternoon. The reason this inspection took place was to review the care practices within the home following an adult protection investigation in October 2004. Following the investigation the manager had put new care practices in place and this inspection looked at how effective they are. The progress of the requirements and recommendations from the previous inspection in November 2004 were also reviewed There have been no additional visits made to the home since the last inspection. A tour of the premises took place and care records were examined. Two of the six staff on duty, ten of the twenty- eight current residents and the manager and owner were spoken to. One resident was in hospital at the time of the inspection. What the service does well: What has improved since the last inspection?
At the conclusion of the inspection in November 2004 there were seven requirements and fifteen recommendations. All the requirements and recommendations have been achieved. The requirement regarding the quality assurance system was met, however further development is needed to ensure Wessex Lodge Version 1.10 Page 6 that they are able to demonstrate that the home is run in the best interests of the residents. At the previous inspection it was discussed with the manager that the home should be much clearer to prospective residents about whether or not their care needs could be fully met. This process has improved and has resulted in a staff team who seem happier in their role. The previous inspection recommended that care staff complete training on understanding dementia. This has been achieved and is having an impact on the support they are able to offer residents, giving them a better understanding of how to support someone whose memory is poor. Improvements in the reporting of health care issues such as skin breakdowns have resulted in residents being seen by staff from their GP’s surgery sooner and treatment starting quickly. One resident said she had been given some nice sheepskin boots to wear. The manager has also put care practices in place, which means that care staff are more aware of how quickly problems can become serious. Residents health care needs are being fully met and poor care practice is identified and care staff supported in learning how to achieve good care for individuals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Wessex Lodge Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Wessex Lodge Version 1.10 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 standard(s) 1,3,4 the home is not registered to provide intermediate care and therefore standard 6 is not applicable. People who use the service receive clear information to enable them to make a choice about whether or not they might wish to live in the home. The omission of important assessment information means care staff do not always have the detail needed to inform good care practice. Improvements in admission criteria mean prospective residents know the home can meet their needs. EVIDENCE: Assessments contain information outlining the care needs of individuals living in the home. Assessments were on individual files, these assessments were completed by care management personnel from the funding authority. Some assessments were incomplete in areas such as: social activities and interests, likes and dislikes, mental health needs, nutritional assessment. Assessments lack detail, which suggest that care plans will be poorly informed. Wessex Lodge Version 1.10 Page 9 Residents said that care staff understand their care needs, one resident said that care staff are getting to know her needs as she has only been in the home a month. One resident said they were unable to remember if they were involved in the assessment process. Another resident asked what an assessment was. Records for four residents including the most recent admission showed that those residents funded by the local authority had an assessment in place, which demonstrated either their involvement or the involvement of a relative. The most recent resident described her care needs, which were different from the original care management assessment. The manager also confirmed that they have not seen any sign of the behaviour the resident had been exhibiting prior to admission into the home. The resident’s views of their care needs did not match either the homes view or the care managers view. All care staff have undertaken training in moving and handling and understanding dementia. Care staff were observed supporting residents who needed assistance to walk and taking time to explain what was happening. Since the last inspection the care staff appear more confident in their abilities. This was demonstrated in their approach to residents and the atmosphere in the home. Residents said that care staff are often busy but some take the time to chat. Wessex Lodge Version 1.10 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 standard(s) 7,8,10 The care planning system is clear, but lacks clarity in the detail of the tasks to be completed. This means that care staff may be confused about how to complete a care task and residents could be vulnerable. Residents receive support from health care professionals as soon as a problem is identified. This means that residents health care needs are met by people qualified to provide treatment and give guidance to staff. Personal support in this home is offered in a way, which promotes and protects resident’s privacy, dignity and independence. EVIDENCE: Some of the care plans lack the detail needed to ensure that the care staff complete the tasks fully. Residents said that care staff always take time over personal care tasks. One care plan stated, “fluids should be pushed” there was no other comment in the care plan about how this should be achieved or what was meant by the comment. The overall goal of one care plan, provided by the funding authority stated, “to provide support to remain at home” The resident had moved from their own home into residential care and much of the care plan bore no relation to the residents needs in a care home. Daily records for residents detailed visits to a variety of health care professionals including, dentists, and chiropodist’s. There was also evidence
Wessex Lodge Version 1.10 Page 11 that District Nurses are visiting to treat pressure areas. This information was in the daily records for the individual and they were seen wearing pressure relieving sheep skin boots, suggested by the district nurse. Since the last inspection the manager has put in place a process for monitoring the pressure areas of all the residents. This is done in several ways; through monitoring each resident who receives assistance with personal care, this information is recorded in the daily record. Two times a week residents have the pressure areas on their feet monitored. The care staff report back to the manager and any concerns are immediately reported to the district nurse who then comes to check the pressure area and advise the home accordingly. There were pressure relieving cushions and mattresses for those residents who were identified as at risk. Individual plans of care are reviewed every month by the manager using information from daily records and in discussion with care staff. The manager has a much closer overview of the care needs and areas of concern of all the residents than at the previous inspection. Residents said that they are able to see relatives privately in their rooms. Care staff were observed assisting residents to eat their food in a way that was mindful of their needs such as poor sight or not wishing to be hurried. Care staff were also observed knocking before entering a residents room and using the correct form of address which was recorded in their personal file. Wessex Lodge Version 1.10 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 standard(s) 13,15 The home encourages residents to maintain contact with family and friends, this means they are able to be in contact with the people that matter to them in their lives. The meals in the home offer choice and variety and cater for special dietary needs, in pleasant surroundings. EVIDENCE: Residents were observed going out on their own. One resident is taken every week to a local community group of which he is a member. At the time of the inspection there were family members visiting. Throughout the home there is evidence of residents having contact with family. The manager also spoke of the contact with relatives particularly when arranging the birthday party for one resident who is one hundred and seven years old. There is evidence of cards and thank you letters being received from friends and relatives. The food in the home is varied and plentiful, residents commented positively about the food they have, the lunch on the day of the inspection was roast chicken with roast potatoes and vegetables. Some residents said that the meal was not as they would have cooked it but none the less very good. Most of the residents sit round large communal tables in the ground floor dining room and in the first floor lounge dining room. Residents said that they enjoy this form of dining as you are able to have a good conversation with other residents. Some residents choose to eat in their private rooms.
Wessex Lodge Version 1.10 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 standard(s) 18 Not all care staff have received training in adult protection issues therefore the policy and procedure alone will not ensure residents are fully protected from abuse. EVIDENCE: Some care staff who have undertaken NVQ2 will have received training on adult protection issues not all staff are currently working on this qualification. The manager has arranged for an outside training organisation (Learn Direct) to put together a suitable course. At the time of the inspection there were no dates available. The home has an adult protection policy in place. The manager explained that care staff are aware of the policy and have discussed its contents at staff meetings. Training has not yet materialised from a local health centre on pressure care management. Wessex Lodge Version 1.10 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 standard(s) 26 Unpleasant odours have been eliminated giving the home a more pleasant ambience and better impression to prospective residents. EVIDENCE: The home no longer has an unpleasant odour as you enter. The manager has found a cleaning product, which has eliminated this. The 2 bathrooms on the ground floor near the entrance hall were both clean. There was one cleaner on duty at the time of the inspection. Rooms were cleaned, carpets vacuumed. All care staff had protective clothing on when undertaking personal care tasks. There is a new washing machine in the laundry room. The floor in the laundry room is damaged, making the floor permeable. Wessex Lodge Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The home has a good training programme encouraging care staff to be responsible for developing their skills and enabling them to be competent at their jobs. EVIDENCE: Since the last inspection and the adult protection investigation the care staff have received training in how to spot concerns about pressure care. The manager told the inspector that all staff were spoken to about the importance of informing health care professionals immediately if there are worries and not trying to manage the problem themselves. The system in place means that the manager is aware of any concerns at the time it is first spotted and it is recorded in the daily record. Care staff are aware of the process. Care staff were observed checking residents feet as part of a pedicure. There have also been changes made to the dependency levels of residents with the manager saying that they are now refusing to take new residents if they require a high level of care. This was demonstrated throughout the inspection as there are very few current residents who are immobile. The manager says she feels able to say no and admits that she no longer sees it as a failure if the home can no longer cope with the care needs of a resident. Care staff are participating in Learn direct and on the day of the inspection were due to see a tutor and discuss their learning needs with the manager. Several of the staff have worked in the home for over 7years. There were 4 members of staff currently on the NVQ level 2. Wessex Lodge Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,38 There has been improvement to the quality assurance system in the home, however this does not follow the aims and objectives in the home’s statement of purpose and service user guide. Therefore it is difficult to establish if the home is run in the best interests of those who live there. There are systems in place, which promote the health, safety and welfare of people using the service, ensuring that they are protected. EVIDENCE: The manager has produced a questionnaire, which covers topics such as; food, entertainment and visitors. It does not cover other topics such as attitude of care staff or quality of the care provided or the environment. The results of the questionnaires are not collated or published. The manager does talk to residents and ask for their views but this is done in an informal way. There was no evidence that the views of people other than residents and family are sought.
Wessex Lodge Version 1.10 Page 17 The equipment used in the home is regularly checked and maintained. All care staff have received manual handling training. All care staff have also received fire training, first aid, food hygiene and infection control training and refresher training when required. Wessex Lodge Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x x 2 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 2 x x x x 2 Wessex Lodge Version 1.10 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Requirement Care plans must set out in detail the actions which need to be taken by care staff to ensure all aspects of the health, personal and social care needs of the resident are met. All care staff must receive training in Adult Protection Timescale for action 01/06/05 2. 18 18(1)c (i) 31/08/05 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 3 26 33 Good Practice Recommendations Assessments should cover social interests, hobbies, nutritional needs and mental state. The floor in the laundry room should be repaired. The quality assurance system should be developed to ensure that the home is measuring how successful it is in meeting its aims, objectives and statement of purpose. Wessex Lodge Version 1.10 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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