CARE HOMES FOR OLDER PEOPLE
Wessex Lodge 16 Munster Road Parkstone Poole Dorset BH14 9PU Lead Inspector
Tracey Cockburn Unannounced Inspection 10:20 7 October 2005
th 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.V250148.R01.S.doc Version 5.0 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.V250148.R01.S.doc Version 5.0 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.V250148.R01.S.doc Version 5.0 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. 5th April 2005 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 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 DS0000004067.V250148.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place unannounced over 4 hours from mid morning until early afternoon. The purpose of this inspection was to review the requirements and recommendations from the previous inspection in April 2005. Care records, resident’s records, staff files and policies and procedures were viewed. 2 members of staff were spoken to and 12 residents. The registered manager and registered provider were also present during the inspection. One the day of the inspection there were 5 care workers on duty 2 cleaners and 1 cook. A tour of the premises took place. There were 28 residents accommodated 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 April 2005 there were 2 requirements and 3 recommendations. Care plans now contain all the information about the health; personal and social care needs of the resident and how these needs should be met. Assessments now ensure that social interests, hobbies, nutritional needs and mental state are recorded before residents are admitted to the home. Full assessments mean that the home is able to assure prospective residents that their needs can be met. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 6 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. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. Standard 6 was not assessed, as the home is not registered to provide intermediate care. EVIDENCE: Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 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 are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: The care files of 4 resident’s were viewed. The care plans now contain information on the mental health needs of residents however one care file viewed advised staff to look our for signs of depression but could have been more specific as care workers might not know what they should be looking for. There was also information in the care plans about an individual’s preferred lifestyle. This gave care workers the information they needed to ensure that this individual’s rights and choices were respected. One resident said that the care staff understand her care needs and she does not need to explain to them, she also said that some staff were better at listening than others. There was evidence of care plans being reviewed monthly. An incontinence chart in one resident’s room was out of date and the terminology used, wet/dirty was inappropriate.
Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 10 The home has a policy and procedure for the receipt, storage and dispensing of medicines. They have reviews by Boots Pharmacist twice yearly. No resident in the home self medicates. 4 of the senior staff have received training in the safe handling of medication. The manager confirmed this, but no documentary evidence was seen. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 The lifestyle of the home overall meets resident’s expectations, they are able to participate in activities that interest them. However residents who have dementia do not have activities, which are tailored to their needs. Systems in the home mean that care workers understand residents need to have choice and control over their lives. EVIDENCE: Several residents said that there is entertainment in the home, which they can participate in if they wish and that a musician comes to the home. There was no evidence of any specific activities for those residents who have dementia. Records seen demonstrate that leisure interests and hobbies are recorded. There is also recorded information on resident’s religious practices and their social relationships. There was evidence through observation that resident’s are able to live in the way they choose. Information is available to residents and their representatives of external agents such as advocates. There was evidence in resident’s private rooms that they are able to bring their own possessions into the home Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The homes complaints policy should give residents and their relatives confidence that their complaints will be taken seriously and action taken. 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: There have been no complaints made either to the home or to the commission since the last inspection. Several residents said they would talk to the manager if they had a problem. The care workers who are enrolled on the NVQ courses receive adult protection training as part of the course. The manager does a short training with other staff including a questionnaire. The homes policy is available for staff to read and they have to sign once they have read it. This will not always ensure that they understand the procedure. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home is safe and there is evidence that the environment is maintained. Unpleasant odours have been eliminated giving the home a more pleasant ambience and better impression to prospective residents. However repair work is needed to ensure hygiene is maintained. EVIDENCE: One the day of the inspection, the manger explained that all the chairs in the dining room have been re stained. The pathways outside the building were clear. There is a programme of routine maintenance and a record is kept of when work is completed. The home was odour free at the time of the inspection. There were some issues about a bathroom in a poor state of repair with panelling coming away from the bath. The manager said they are awaiting the plumber. She also said that the bathroom is seldom used. The floor of the laundry room is not yet repaired the hole in the floor has been temporarily covered with a rug.
Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 The home provides sufficient staff to meet resident’s needs. Ensuring that there is the right number of staff with the skills needed to provide a stimulating and caring environment. Good induction and training provide care staff with knowledge and skills to care for residents safely however not all staff are fully aware of the adult protection policy. The home’s recruitment practices do not fully support and protect vulnerable residents. EVIDENCE: At the time of the inspection there were 5 care staff on duty and 2 cleaners. The manager was also present. There is a rota, which shows which staff are on duty day and night. The manager has more staff on duty than is necessary so that care workers will not be rushed. Several residents said that the staff have time to stop and talk. Care staff are actively involved in achieving their NVQ qualification. An NVQ assessor was visiting a member of staff at the time of the inspection. The home does not use agency workers. The files of 2 new members of staff were looked at. One of the files did not contain 2 references. 1 file did not contain proof of whether the member of
Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 15 staff had the correct papers to work in this country. There was evidence on their file that they had correspondence from the Home office but this was dated June 2004. The manager explained that she was unsure whether new member of staff had had a POVA first check. She did say that no new member of staff is left to work unsupervised. A new member of staff said that she shadowed a more senior care worker. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 The home is managed by someone who takes their responsibilities seriously and wants to ensure that resident’s health and welfare is protected. There are systems in place to monitor the aims and objectives of the home and the service it provides however this information is not made public so that the people who use the service can see how well the home they live in is doing. The home has a system in place to ensure that resident’s financial interests are safeguarded. EVIDENCE: The manager spoke very candidly about shortcomings in the recruitment procedures for the home and said she was concerned about the delay in receiving CRB checks from the umbrella body that they use. The manager also said she was unsure if the POVA first check was being done. The manager demonstrates an understanding of her responsibilities to the vulnerable people living in the home. There have been improvements in the care planning and in
Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 17 the system is in place to ensure that residents have their skin checked for possible breakdown. The manager has a job description which clearly states their roles and responsibilities. The home has improved their quality assurance system by changing the questions they ask to better reflect the aims and objectives of the home. The manager also said that she does not always write down comments made in passing by residents and their relatives. The manager explained that they do not manage anyone’s finances but advise relatives and residents to seek legal advise and make their own arrangements. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 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. 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 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 1 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x x Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP7 OP18 OP29 Regulation 15(1) 18(1)(c) (i) 19 (4)(c) Requirement Care plans must be specific in detailing the action to be taken to ensure that needs are met. All care staff must receive adult protection training within 6 months of employment The manager must ensure that 2 references are obtained before a care worker is employed. The manager must ensure that prospective employees have the correct paperwork in place to work in this country. The manager must be proactive in seeking this information. Care staff must not work in the home unsupervised without the POVA first check completed. Timescale for action 31/12/05 30/11/05 30/11/05 4 OP29 19 (4)(b)(i) 30/11/05 5 OP29 19(4)(b) (i) 30/11/05 Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 20 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 OP12 OP26 OP33 Good Practice Recommendations The manager should consider a programme of activities for residents who have dementia which will stimulate their senses and encourage their abilities. The floor in the laundry should be repaired. The manager should ensure that the views of residents and other stakeholders discussed in conversation are incorporated into the quality assurance system of the home. Wessex Lodge DS0000004067.V250148.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office 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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