Inspection on 06/08/08 for Wessex Lodge [Poole]

This inspection was carried out on 6th August 2008.

CSCI found this care home to be providing an Poor service.

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] 10/08/07

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Wessex Lodge 16 Munster Road Parkstone Poole Dorset BH14 9PU Lead Inspector Gloria Ashwell Unannounced Inspection 6th August 2008 11:30 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 Wessex Lodge DS0000004067.V367094.R02.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.V367094.R02.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.V367094.R02.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. 10th August 2007 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 including no more than 15 people with a diagnosis of dementia. 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 two-storey 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. Fees are charged weekly; the fee range quoted by the manager at the time of inspection was (per person) £369 to £471. Up to date information on fees can be obtained from the service. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1A65A7AFD347B/0/oft780.pdf Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. This inspection was unannounced; the inspector arrived at 11:30 on 6 August 2008, toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks and together with registered manager Mrs Dayman discussed and examined documents regarding care provision and management of the home. The duration of the inspection was 4 hours 45 minutes. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. In advance of the inspection an Annual Quality Assurance Questionnaire was completed by Mrs Dayman and returned to the Commission; the information it contained has been used to inform the findings of this inspection. During this inspection compliance with all key standards of the National Minimum Standards was assessed. An Immediate Requirement relating to the control of infection was issued during the inspection. What the service does well: What has improved since the last inspection? Since the previous inspection the home has installed a ‘wet room’ on the ground floor, containing a shower, toilet and wash hand basin. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 7 What they could do better: 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.V367094.R02.S.doc Version 5.2 Page 8 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.V367094.R02.S.doc Version 5.2 Page 9 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): 3 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not record assessment of the needs and circumstances of prospective residents so is unable to establish that their care needs can be properly met. EVIDENCE: The files for two residents who had recently moved into the home were inspected. Neither contained evidence of pre-admission assessments and the manager stated that it is not the policy of the home to have contact in advance of admission in with prospective residents for the purpose of assessing their needs and circumstances. Accordingly the manager was unable to show the inspector any records of pre-admission assessment , for any resident of the home. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 10 At the time of a new residents admission the home thereby is without sufficient or accurate details about the needs of the person to enable a plan to be made giving the staff information about how to meet their needs. As more fully described in the ‘Health and Personal Care’ section of this report, the failure to record pre-admission details of a recently admitted resident resulted in confusion regarding the medicines this person was prescribed and thereby placed the resident at risk of harm. The report of the previous inspection contained a requirement relating to preadmission assessment, which is repeated in this report. The manager said that the home now writes to prospective residents confirming agreement and ability to accommodate and care for them; however, the absence of pre-admission assessment means the home cannot reliably confirm ability to fully meet the assessed needs. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is insufficient evidence that residents receive the care they need. Associated records and care practices require improvement to ensure staff have sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care, risks of cross-infection, and incorrect medicine administration might cause. EVIDENCE: Care records of 3 residents were examined and found to be of generally poor standard, all without relevant risk assessments forming the basis for care plans, thereby rendering the plans unreliable and not reflective of separately recorded descriptions of condition of each person. The failure to provide adequate plans of care for these residents placed them at risk of poor and inappropriate care because their needs and circumstances had not been Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 12 reliably assessed and thereby were not recorded in the care plans, and may not be known to staff. For example, records of some residents’ body weight are kept in a separate notebook, on occasion being recorded in metric values, on other occasions in Imperial values. Care plans make no reference to the weight records and accordingly there is no evidence that the home is aware of weight being stable or changing. Most residents are not weighed and no alternative means of judging weight loss/gain is used. The home does not use established ratings tools to assess the moving and handling, nutritional or skin care conditions of residents and the care plans of these persons did not indicate that consideration had been afforded to the potential for specific nutritional attention. For one person the daily records described signs of pressure damage to skin, stated that a skin cream had been used, and later stated that a wound dressing had been changed. There was no other record of the condition of the skin relating to pressure, no indication of the particular cream used, and no description of the wound, its treatment and progress. The care plan of another resident stated that the person has diabetes, but other than stating that a “diabetic diet” was to be provided gave no other guidance to staff on the condition e.g. any testing required, specific precautions including the likely indications of health deterioration and the action to be taken in such event. One resident uses a bed fitted with a safety rail; the home has not recorded an associated risk assessment and has not obtained the consent of the resident (or representative) for this potential restraint. There home does not assess residents for risks of falls and there was insufficient evidence that all accidents to residents are thoroughly investigated with findings reflected in the care plan, to ensure that future risks are minimised. It is required that for each resident the home record an accurate, reliable and comprehensive care plan with associated records to ensure the provision of sufficient information to staff to enable them to properly care for and safeguard every resident. Standards of medicine handling must be improved to safeguard residents from the risks of harm that incorrect administration and poor practices may cause. For medicine handling the home uses a monitored dosage system, whereby most of the medications are stored in blister packs, to simplify the process of administration. Staff trained in this work carry out medicine handling; two of Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 13 the currently accommodated residents manage their own medicines although the home has not recorded associated risk assessment. From examination of a sample of Medication Administration Records (MARs) and discussion with the Manager and deputy manager there was evidence that in general medicines are properly administered in accordance with the prescriber’s instructions. However, the failure to carry out and record preadmission assessment of a recently admitted resident resulted in the home being unclear regarding the medicines prescribed to this person. For example, the prescription written by the doctor stated that the person was to receive Quetiapine 25mg “take 3 twice a day for 14 days” – but the MAR indicated that the home had administered the medicine for 23 consecutive days. To improve medicine handling processes it is recommended that when an ‘as required’ medicine is prescribed, the reason for administration (e.g. leg pains) be recorded on the MAR instructions, that all handwritten MAR instructions be signed and dated by the author and countersigned by a person who has checked the accuracy of the record, and that there are clear records of the date on which particular medicines are discontinued by the prescriber. To ensure there is a clear audit trail, when a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. Medicines are stored in a metal cabinet in an anteroom of the kitchen; it is recommended that the maximum/minimum temperatures of the cabinet are monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. From direct observation and discussion with a care worker there was evidence that staff do not fully understand or practice good ‘control of infection’ techniques – a care worker was seen walking about the home wearing examination gloves and had been in direct contact of the skin of a number of residents without changing or washing the gloves. Subsequent conversation with the inspector indicated that the care worker was aware only of the risks to herself and was unaware of the risks of cross infection to residents. An Immediate Requirement was issued during the inspection. More should be done to ensure that good practice is observed at all times and that residents are protected from harm. During lunch in the ground floor dining room two carers were seen standing over the residents they were feeding. The inspector drew this to the attention of the manager who had appeared unaware of the ‘good practice’ aspects of carers sitting by the person they are assisting to eat. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 14 During the afternoon three care staff were sitting in the garden while taking a break, the manager, deputy manager and owner were having lunch in the ground floor dining room and the residents in the ground floor lounge were unattended. The inspector drew to the attention of the manager the predicament of a resident who was in the process of sliding from her chair to the floor; all the residents in the room at the time had dementia and none had alerted staff to this imminent accident. Wessex Lodge DS0000004067.V367094.R02.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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are few opportunities for the residents to engage in recreational and social activities; in consequence many are likely to become bored, apathetic and restless. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Residents do not have sufficient choice of the meals that are provided to them. EVIDENCE: Recreational and social activities rarely take place; during the tour of the premises no programme of activities was seen and those residents who were able to express an opinion did not think there is a planned programme. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 16 The home does not employ an activities organiser instead placing reliance on care staff, who also carry out all housekeeping duties including cleaning and cooking. In the Annual Quality Assurance Questionnaire completed in advance of the inspection the manager stated that “it is a problem at times generating interest”; it is therefore particularly desirable that a person skilled in arranging a variety of social and recreational activities suited to the preferences and abilities of residents be engaged. No social activities were seen to take place during this inspection and there was little positive engagement observed between residents and staff other than to perform tasks; some residents said they preferred to read and there was evidence that books are regularly changed by a visiting library. Some residents said they had visitors, and the relatives of one resident arrived in the home as the inspector was leaving. Residents able to express an opinion did not know if there is a menu for the week and none was seen displayed during the tour of the home. Residents confirmed they are offered a choice at breakfast and supper, but some said they are not satisfied that for the main meal of the day, served at midday, there is no choice of main course or dessert. It is recommended that improvements be made to the meal provision to ensure that residents are provided with sufficient choice. Wessex Lodge DS0000004067.V367094.R02.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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident their complaints are listened to. Induction training, including the Protection of Vulnerable Adults, must be provided to all staff to ensure service users are safeguarded against risks of abuse in its various forms. EVIDENCE: The manager stated that since the last inspection no complaints against the home have been received or investigated, but that during September 2007 there were concerns relating to aspects of safeguarding vulnerable adults involving standards of care provided to one resident by the home. The manager is still awaiting written information in order that the matter may be formally closed, but has been told that investigation by Social Services did not uphold the complaint. There was insufficient evidence that all staff receive training in safeguarding vulnerable adults. The manager said that the home had not previously provided formal induction training to staff, but has engaged the services of a Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 18 private consultant who will be arranging this within coming weeks. The records of two care staff employed by the home were examined showing that one had received training in this subject but there was no evidence that the other, in the employ of the home for more than one year, had ever received this training. An associated recommendation is made in this report. Wessex Lodge DS0000004067.V367094.R02.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, 22, 23, 24 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Many parts of the home present an institutional aspect, with little evidence of personalisation in many bedrooms, and an overall impression of shabbiness and overcrowding of the ground floor communal areas. EVIDENCE: Wessex Lodge is a traditionally built detached house with a more recently constructed extension; there are gardens to front and rear. Car parking spaces are available in front of the building and parking is unrestricted on the road outside the home. The home is generally clean but many areas have become shabby, much of the furnishing appears institutional and out dated and a number of rooms had a Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 20 bleak and uncared for aspect. The lounges appeared cluttered, containing unattractive and inappropriate items e.g. behind the armchairs in the first floor lounge were stacked boxes of care supplies, and other items in black refuse bags. The ground floor lounge appeared crowded, with armchairs placed close together in a line. Bedrooms seen during the inspection were decorated to an acceptable standard. All bedrooms have a wash hand basin; some have separate en suite hygiene facilities including a toilet; a number of bedrooms contained commodes. With the exception of two bedrooms for shared use by 2 persons, all bedrooms are for single occupancy. Both shared bedrooms were accommodating unrelated residents, although the home had a vacant single room. Neither of the shared bedrooms had a screen available to protect the privacy of the residents. Many bedrooms contained few visible personal possessions of the occupants, some have been fitted with vinyl floor covering and the manager said it is intended to replace more carpets with vinyl, items of furniture were damaged e.g. handles missing from drawers. The carpets of a number of bedrooms were wrinkled, presenting ‘trip hazards’, in one bedroom was a tubular metal commode without protective covering to the back rest; a user would thereby be leaning against a metal pipe. There is a passenger lift for access to the first floor from the ground, but on the first floor some rooms are separated from the level accessed by the passenger lift by 3 steps; there is a stair lift which enables access to some of these rooms, but for a further 4 bedrooms and 2 bathrooms it necessary to negotiate additional steps; some residents whose bedrooms are upstairs must therefore be able to independently manage steps. For the safety and encouragement of residents who are able to walk alone, or with the assistance of staff it is recommended that hand rails be fitted to appropriate locations; in particularly this should be considered for long sections of first floor corridor. There is one bathroom for use by persons requiring assistance; the bath is fitted with a ceiling mounted hoist but the bathroom is not large so suited only for use by persons who require low levels of assistance. Since the previous inspection the home has installed a ‘wet room’ on the ground floor, containing a shower, toilet and wash hand basin. All laundry is carried out on the premises using a machine that will wash to high temperatures, has a sluicing facility and complies with the “Water Supply Fittings Regulations 1999”. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 21 A number of significant concerns were identified regarding the control of infection. It is recommended that fabric covered divan bases of beds be protected with surfaces suitable for effective cleaning e.g. divan trims to reduce cross infection risks. Three baths had a build up of lime-scale preventing effective cleaning, and thereby posing risks of cross-infection. In the kitchen were two large waste bins, both containing large amounts of kitchen refuse. One of the bins was fitted with a lid, which was wide open; the other had no lid. The door of the sluice room (which opens from the ground floor entrance hall and is thereby in a prominent location and bears an incorrect sign stating ‘Toilets’) was fully ajar; the waste bin was filled to capacity with clinical waste including used gloves. The lid of the bin was fully open. As stated for the ‘Health and Personal Care’ section of this report there was evidence that staff do not fully understand or practice good ‘control of infection’ techniques. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a comprehensive training plan and much of the training is out of date; the lack of suitable training means that staff may not have the skills to properly care for the residents. EVIDENCE: There was insufficient evidence that staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. In addition to providing personal and social care for the residents, care staff are responsible for all cleaning, cooking and laundry tasks because the home does not employ staff for these separate roles. The manager is responsible not only for the management of the home and staff, but also for the collation of staff timesheets, arranging wages and the associated taxation. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 23 It is recommended that a thorough review of all staff roles and responsibilities be carried out, leading to amendment of job descriptions and the employment of separate staff for housekeeping and business administration. The records of 2 recently employed care staff were examined and found to contain essential information including Criminal Records Bureau (CRB) disclosures obtained in advance of employment. However, for one person there was only one written reference (a minimum of two should be obtained) and for neither of the applications was there evidence of interview. The manager said that when the care staff who are currently training for the National Vocational Qualification (NVQ) in care have received the award there will be approximately 46 of staff with the qualification. This report contains a recommendation for the standard of 50 to be met. The manager was unable to supply evidence that recently employed staff had received induction training, periodic appraisals, and had individual training plans and said that the home has engaged the services of a private consultant who will be arranging these essential aspects, and developing a training programme for staff. The records of training of two staff were examined; one had been in the employ of the home for longer than a year but there was no evidence of this care worker having received any training in control of infection, and safe methods of moving and handling residents. In addition to improving the frequency of training provided to staff the home is recommended to introduce a matrix chart to enable ‘at a glance’ monitoring of the training status of each employee. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 24 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, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is inadequate to the current circumstances. The registered person has failed to reliably monitor the operation of the home and prior to the inspection had not identified the many weaknesses identified in this report. The poor management of the home means that people who use the service cannot be assured it is run in their best interests and are not properly protected from harm. EVIDENCE: Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 25 Mrs Dayman is the Registered Manager and has held this role for a number of years. The responsibilities of the manager include the administration of staff wages and she is hampered by the absence of an office. Mrs Dayman said she has a very small office in the private home of a staff member, located in the grounds of Wessex Lodge, and considered it would be inappropriate for the inspector to visit this office to access documents, because it would “impose” on the privacy of the tenant; accordingly the inspection was conducted from a variety of locations including the ground floor lounge, entrance hallway, and a vacant bedroom. The home provides questionnaires to recently accommodated residents to assist the home assess the quality of the service they provide; however, many of these persons have dementia and their responses may be unreliable. Quality assurance monitoring has not been implemented as a core management tool; this report contains an associated recommendation. The home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. Some aspects of recruitment processes must be improved and the manager was unable to supply evidence that recently employed staff had received formal supervision. The training, development and supervision of staff is inconsistent with current standards. Records are kept of accidents and their investigation; to minimise risks of accident recurrence it is recommended that periodic audit e.g. of time, place, person, activity, be recorded to identify any trends or high aspects of risk. The manager said that no-one employed by the home has competency in first aid; this report contains a requirement that al all times there is present in the home a qualified First Aider. Records indicated that fire safety equipment has been checked and tested at the required frequencies. It is recommended that the fire safety assessment be expanded to include a detailed escape plan including reference to the currently accommodated residents. The manager provides all fire safety training to staff but said she has not herself received fire training for at least 10 years so is recommended to renew this training in order to establish her competency in this subject. A sample of records relating to the maintenance and safety of the premises and equipment were examined; there was no evidence of safety of a number of aspects including the mobile hoist, gas and electrical installations, periodic safety checking of portable electrical items and of the safety of the water Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 26 supply with regard to bacteriological analysis; it is required that these aspects receive early attention. Records included a letter from the company which had checked the ‘Spectra’ bathroom ceiling track hoist during May 2007 stating “advise you not to use the hoist until the repair has been attended to” but there was no subsequent evidence of the safety of this item. The manager said the bath is never used but the home has no other assisted bath and there were indications that the bath is used including a damp mat on side of bath. In general, windows above the ground floor are restricted to prevent wide opening and the associated risks of accidental falling, but the window of the first floor staff toilet (with a door which cannot be locked from outside) was seen to be unrestricted and wide open and the manager said that no associated risk assessment had been recorded. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 27 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 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 2 2 X 1 STAFFING Standard No Score 27 2 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 1 Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 28 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. Previous timescale of 30/09/07 not met. 2. OP4 14 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 home is suitable for the purpose of meeting he service user’s needs in respect of his health and welfare. Previous timescale of 30/09/07 not met. 3. OP7 15 The registered person shall, after 06/09/08 consultation with the service user, or a representative of the service user, prepare a written DS0000004067.V367094.R02.S.doc Version 5.2 Page 29 Timescale for action 06/09/08 06/09/08 Wessex Lodge plan (‘the service users care plan’) as to how the service users needs in respect of health and welfare are to be met, and shall keep the plan under review. Care plans and other care records must be improved to ensure provision of accurate information to staff to enable them to properly care for residents. The registered person shall make 06/09/08 suitable arrangements to provide a safe system for moving and handling service users, based on individual moving and handling assessments. Previous timescale of 30/09/07 not met. 5. OP9 13 (2) The registered person shall make 06/09/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This means that: An accurate record of each instance of medicine administration must be kept for each resident. When a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. Where handwritten entries are made onto medication administration records these must be signed and counter signed, for accuracy, by competent persons. 4. OP8 13 Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 30 There must be recorded assessment of residents who wish to self-administer prescribed medicines, to ensure risks of incorrect administration, to themselves and other residents who might gain access to the medicines are minimised. Previous timescale of 30/09/07 not met. The registered person must consult with service users and make provision for recreational and social opportunities based on their needs and preferences. 6. OP12 16(2)(n) 06/09/08 OP26 7. 13 (3) 8. OP29 19 9. OP38 13 (4) Previous timescale of 30/09/07 not met. The registered person shall make 06/08/08 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. A robust recruitment procedure 19/08/08 must be maintained including acquiring 2 references for all staff 06/09/08 The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This means that: suitable precautions must be taken to minimise risks of service users accidentally falling from windows on upper floors, risks of trips, slips and falls associated with worn and uneven floor coverings must be minimised There must be evidence of the safety of the premises and Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 31 10. OP38 18 equipment including of the gas and electrical installations and all lifting equipment. With particular reference to the ceiling mounted Spectra hoist, this item must be prevented from use unless there is adequate evidence of its safety. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers and are appropriate for the health and welfare of service users. This means that there must be safe working practices including provision of a qualified first-aider at all times. The registered person must ensure that unnecessary risks to service users are eliminated as far as possible. This includes ensuring that equipment servicing and water maintenance and checks are carried out at the intervals specified in the relevant regulations. 06/10/08 11. OP38 13(4(c) 30/09/08 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. Refer to Standard OP8 OP8 Good Practice Recommendations Care staff should receive training to ensure they observe good practice when assisting residents to eat. Residents unable to themselves summon assistance should DS0000004067.V367094.R02.S.doc Version 5.2 Page 32 Wessex Lodge 3. OP9 4. 5. OP9 OP9 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. OP12 OP15 OP18 OP19 OP22 OP22 OP23 OP24 OP24 OP26 OP27 16. 17. 18. 19. OP28 OP29 OP30 be adequately monitored to minimise risks of accident. The maximum/minimum temperatures of the medicines storage cabinet should be monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. All handwritten MAR instructions should be signed and dated by the author and countersigned by a person who has checked the accuracy of the record. When a medicine is prescribed for ‘as required’ administration, the intended reason for administration (e.g. ‘anxiety’, ‘abdominal pain’) should be written on the administration record. A person skilled in arranging a variety of social and recreational activities suited to the preferences and abilities of residents should be employed. An accurate menu should be displayed providing residents with opportunities for choice. The home should be able to supply robust evidence that all staff have received training in safeguarding vulnerable adults. An office should be provided within the home for the use of the manager, and for the safekeeping of documents necessary to care staff to guide and instruct their work. Hand rails should be fitted to appropriate locations; in particularly this should be considered for long sections of first floor corridor. The sign ‘toilets’ should be removed from the door of the sluice room. Where rooms are shared, there should be reliable evidence that they are occupied by residents who have made a positive choice to do so. Screening should be provided in shared rooms. Residents should live in safe, comfortable bedrooms with their own possessions around them. Fabric covered divan bases of beds should be protected with surfaces suitable for effective cleaning e.g. divan trims to reduce cross infection risks. A thorough review of all staff roles and responsibilities should be carried out, leading to amendment of job descriptions and the employment of separate staff for housekeeping and business administration. A minimum of 50 of care staff at the home should be NVQ level 2 qualified in care. A record of all staff interviews should be kept to provide reliable evidence that the recruitment procedure is based on equal opportunities. The home should improve the frequency of training DS0000004067.V367094.R02.S.doc Version 5.2 Page 33 Wessex Lodge 20. OP33 21. 22. 23. OP38 OP38 OP38 24. OP38 provided to staff the home and is further recommended to introduce a matrix chart to enable ‘at a glance’ monitoring of the training status of each employee. There should be continuous self monitoring of the service, using an objective, consistently obtained, reviewed and verifiable method and internal audit should take place at least annually. Periodic audit of accident details e.g. of time, place, person, activity, should be recorded to identify any trends or high aspects of risk. The fire safety assessment and escape plan should be expanded to include specific reference to the currently accommodated residents. There should be reliable evidence of the specific competency of any person who provides training to staff of the home; this includes the provision of fire safety training. There should be written evidence of the periodic safety checking of portable electrical items and of the safety of the water supply with regard to bacteriological analysis. Wessex Lodge DS0000004067.V367094.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V367094.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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