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Inspection on 13/06/05 for West Lodge Care Home

Also see our care home review for West Lodge Care Home for more information

This inspection was carried out on 13th June 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents generally feel well cared for and they like the environment in which they live. The staff give a warm welcome to visitors to the home. Some of the care planning is well documented with the monitoring of health care needs such as the management of Diabetes clear and auditable. The Environmental Health Department has complemented the home on the `high level of food hygiene practices and procedures` and the cook`s `high level of food safety knowledge.` A good example of care planning was seen in relation to communicating with a person who has Dementia and another that explains the possible reasons for particular behaviours.

What has improved since the last inspection?

The monthly weight checks of the people case tracked were being undertaken and recorded as were other routine urinalysis and blood tests. Confirmation was seen that staff have applied for Adult Protection Training. There is now a contract in place for the maintenance of the fire alarm system. Progress has generally remained static in other areas. The Registered Manager stated the previous inspection report had been mistakenly filed and therefore action has not been taken to meet all of the requirements and recommendations made.

What the care home could do better:

The homes records and systems need to organised more efficiently and with consideration to the Data Protection Act 1998. The information available to prospective and current residents about the services the home provides and about their care plans must be accessible. A corresponding care plan must be written for each assessed need. The Registered Manager must promote a culture whereby staff clearly understand and adopt the values of privacy and dignity within their everyday practice. The arrangements to meet peoples` preferences regarding how they spend their leisure time must be transparent. A review of the systems in place at meal times must take place to ensure that people are assisted to eat in a discrete and sensitive manner and that food is served at the appropriate temperature. Robust recruitment procedures must be followed.

CARE HOMES FOR OLDER PEOPLE West Lodge Care Home 238 Hucknall Road Sherwood Nottingham NG5 1FB Lead Inspector Sharon Rosenfeld Unannounced 13 June 2005, 09:00 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. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service West Lodge Care Home Address 238 Hucknall Road Sherwood Nottingham NG5 1FB 0115 9606075 0115 9606075 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) Ms Razma Vanessa Alishan Ms Razma Vanessa Alishan Care home with nursing 27 Category(ies) of OP Old age, x 21 registration, with number PD Physical disability, x 4 of places TI Terminally ill, x 2 West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of beds a maximum of 4 beds may be used for the category PD 2. Within the total number of beds a maximum of 2 beds may be used for the category TI Date of last inspection 25 January 2005 Brief Description of the Service: West Lodge Care Home was established in 1987. It now provides nursing and personal care for 27 residents. Within this number, the registration allows admission for up to 4 people who have a Physical Disability and 2 people who are terminally ill. The home is privately owned by Ms Razma Vanessa Alishan. Located on a main road in Sherwood, it is on a main bus route into Nottingham city centre. The home consists of a large converted house, with a purpose built conservatory. There are 6 double bedrooms and 13 single rooms 4 of which have en-suite facilities. There is ramped access to the building and a passenger list serves all three floors. The homes grounds are mainly to the front of the building and are well maintained although there is open open access to the road. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted over 7hrs. Prior to the inspection the previous requirements set at the last inspection of the home were identified. The main method of inspection used was called case tracking which involved selecting four residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. Six residents and three staff members were spoken with to obtain their views on the home. The home was welcoming, and the residents spoken with were all happy with the care provided. The Registered Manager stated she had only recently found the previous inspection reports and therefore action to address the requirements made had not been taken. New timescales have therefore been set for compliance. If the Registered Manager fails to respond to these, consideration will be given to the implementation of legal action. The previous report directed the Registered Manager to refer one person to a Psycho Geriatrician for assessment. This person is now more settled and the Registered Manager does not feel this action is warranted. What the service does well: The residents generally feel well cared for and they like the environment in which they live. The staff give a warm welcome to visitors to the home. Some of the care planning is well documented with the monitoring of health care needs such as the management of Diabetes clear and auditable. The Environmental Health Department has complemented the home on the ‘high level of food hygiene practices and procedures’ and the cook’s ‘high level of food safety knowledge.’ A good example of care planning was seen in relation to communicating with a person who has Dementia and another that explains the possible reasons for particular behaviours. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 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 West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 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, 2, 3, 4, 5. Prospective residents are not provided with good information on which to make a decision to enter the home and assurances that the home can meet their needs. Each prospective resident receives an assessment by a qualified person. EVIDENCE: The Statement of Purpose was developed in 2003. There have been changes at the home and this needs to be updated to meet the legal requirement. This document does not describe how the home meets the needs of people attending the day care service. Each service user is provided with a statement of the terms and conditions of contract. A copy of a contract was seen. It states the home is ‘governed by the rules and regulations of the Health Authority and Service Standard Unit’ but this is no longer the case and therefore requires amending. It also shows that the resident is given a settling in period, considered a trial period of one month. A review of the placement took place and confirmation of the outcome of this was seen. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 9 Records of recently admitted residents show that they received an assessment prior to coming into the home by external specialists, these assessments were then used to formulate a plan of care when the person was admitted. The records seen did not contain written confirmation that the home could meet their assessed needs. This requirement is outstanding from the previous inspection. On resident confirmed that his family visited the home prior to his admission although he was unable to do so. The home does not provide intermediate care services. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 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 nursing staffs interpretation of the needs of residents can differ from one to another. Not all identified needs are translated into a plan of care and some care plans are illegible. This could lead to needs not being appropriately assessed and met. There are some good examples of care planning that are individually tailored to meet peoples assessed needs. Staff do not consistently maintain peoples ‘status, respect and dignity’ in accordance with the homes Philosophy of Care. EVIDENCE: The three residents case tracked each had a care plan with risk assessments to cover aspects of their health, personal and social care needs. One person’s pressure area and manual handling risk assessments had been repeated on subsequent days, both had different scores, and one was significantly different. The care plans did not consistently describe how the risks identified would be managed. Having said this four of the residents spoken with stated their health care needs were met. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 11 The nurse in charge stated that no one was prone to falls however one risk assessment seen assessed the person to be high risk. The low number of actual falls would indicate that care planning in this area is effective. Some care plans are reviewed on a monthly basis or as needs change others are not. Residents have good access to specialist, medical, dental, chiropody and therapeutic services and residents at risk of pressure sore development had access to pressure relieving equipment. Care plans were not written in a way that reflected consultation had taken place and that residents preferences were being considered. They refer to the need to consult with relatives about, for example, dietary preferences yet the residents spoken with were all able to voice their own opinions about this. One care plan was illegible and the nurse in charge could not confirm what it said. A good example of care planning was seen in relation to communicating with a person who has Dementia and another that explains the possible reasons for particular behaviours. This is good practice. Throughout the inspection staff were observed interacting with the residents. Some people were treated with respect and had their dignity maintained, others were not. One staff used the term ‘feeders’ to collectively describe the people who require assistance to eat. One person gets ‘a little upset that there is no privacy.’ The District Nurse delivered treatment to one person in the lounge. Three residents spoke of being treated well and of being able to make choices two others said their opinions are not always asked. One resident is assisted to go out and utilise local facilities. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 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) 12, 13, 15. Residents receive visitors at any reasonable time. The social and recreational needs of the majority of people were not planned or facilitated. Although the majority of residents enjoyed the meals presented the current arrangement of serving food to people who are unable to eat independently does not show respect for their dignity. EVIDENCE: Residents take their meals in one of two dining rooms or in the main ground floor lounge area. The meals were nicely presented and suitable for those requiring a soft diet. Two people said they enjoyed their meals at the home and said they had a plentiful amount of food. One person said that the food was ‘okay’ though ‘much the same from day to day’. The space restrictions at the table forced staff to stand at the side or behind the residents to feed them. At breakfast one staff was seen dipping the food into a cup of tea by hand before placing it in the residents mouth. At lunchtime, a variation from sausages to mince had been made because people requiring a soft diet ‘could not eat the sausages’. Staff assisted seven people to eat. The staff did not interact appropriately with the residents as carried out this task. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 13 One person’s meal was placed in front of her but it was a full 20 minutes before a staff member was available to assist her to eat it. Another persons’ meal was reserved on the unheated trolley whilst the district nurse treated her. The meal was cold when it was delivered to her and needed to be re-heated in the microwave. The prescribed food supplements stored in the fridge were out of date. The care plan format encompasses ‘work and play’ and state that people should be encouraged to ‘participate in any activities in the home.’ No activities were available and people spent their time watching television snoozing or reading. One person said he enjoys reading but did not know if the home made arrangements for him to acquire books. His care plan was not specific about how this interest would be maintained. There are no restrictions on people receiving visitors unless at the request of the resident. A telephone is available for residents to access. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 14 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) Not assessed on this inspection. EVIDENCE: West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 15 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) 25. The home meets the needs of the residents spoken with although the temperature in the lounge was at times unacceptably cold and draughty. EVIDENCE: The main communal areas of the home were generally bright and well maintained. They have an open plan layout consisting of a lounge and dining room. From the lounge there is access to the conservatory. Several residents complained about the low temperature and draughts felt in the lounge when the conservatory door is left open. This was the only concern raised by the residents about the comfort and standard of the accommodation. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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) 27, 29. The number of staff in the week of the inspection was enough to ensure that resident needs could be met. The staff shortages in the preceding week could not guarantee that all care needs would be met. The staff files are disorganised and sensitive information is not maintained in accordance with the Data Protection Act. The protection of residents from staff who may be unsuitable to work with vulnerable people could not be fully evidenced. EVIDENCE: The Statement of Purpose does not give information about the number and skill mix of staff. The duty rota showed there were sufficient staff on duty to meet the needs of the residents however in the preceding week there were three carers not the required minimum of four per shift. One staff member works full time on night duty at another home. His file does not contain information about the hours he West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 17 Two staff files were seen. These were disorganised and contained sensitive information about other carers and about the funding arrangements for one resident. There was no evidence of the use of Protection of Vulnerable Adults (PoVA) First processes undertaken and one person commenced work before their Criminal Records Bureau (CRB) enhanced disclosure was received. The records do not confirm if safeguards have been put into place to protect vulnerable residents where the CRB has revealed previous criminal convictions. The residents spoken with liked the staff and felt they worked hard to meet their needs. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 31, 32, 33, 37. The residents and staff are satisfied that the delivery of care at the home is well managed. The organisation of records required for the effective running of the business and management of staff needs to improve. The home does not measure their success in achieving the stated philosophy of care. EVIDENCE: One staff member stated the Registered Manager is a approachable and supportive. Three residents stated they are happy with the quality and the management of the care they receive. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 19 The staff files were examined in the manager’s office. One file could not be located initially. Documents containing sensitive information were misfiled in other peoples’ records. Evidence of how the Registered Manager had dealt with personnel issues and concerns suggesting that the quality of care was not acceptable was not available. The Registered Manager stated that she had only recently found the previous inspection report and had not therefore taken action to meet the requirements made. There is no evidence that the views of residents and other stakeholders is sought and influences the delivery of services. West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 1 COMPLAINTS AND PROTECTION x x x x x x 2 x STAFFING Standard No Score 27 2 28 x 29 1 30 N/A MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 1 x x x 1 x West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 21 Yes 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 1 Regulation 4, 5 Requirement The Statement of Purpose and Service User Guide must be updated to meet the requirements. (See Schedule 1 of the Care Homes Regulations 2001) Include in the Statement of Purpose and Service User Guide the arrangements for providing day care services at the home. Individual assessments must include how the residents oral health care needs are to be met. Confirm in writing to prospective residents that the home can meet their assessed needs. (Unmet from the inspection dated 25/01/05). The Statement of Purpose and Service user Guide must include information about how the needs of people who have Dementia / Cognitive Impairment is met. All assessed needs must have a corresponding care plan that says the action to be taken by staff to meet them. The care plans must be legible to make them accessible to residents and staff. A review must be undertaken of Timescale for action 31/08/05 2. 1 4, 5 31/08/05 3. 4. 3 4 14, 15 14 31/07/05 31/07/05 5. 1 4, 5. 31/08/05 6. 7 14, 15 31/08/05 7. 8. 7 7 15 14, 15 31/08/05 31/08/05 Page 22 West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 9. 10. 11. 7 7 10 15 12, 15 12, 13 12. 13. 8, 10 10, 24 12 12, 16 14. 12 16 15. 15 16 16. 15 12, 23 the risk assessments to ensure they accurately determine the level of need. Review the care plans on a monthly basis. Consult with residents in the care planning and review processes. The staff must be instructed about how to treat people with respect and preserve peoples individuality ad dignity. The use of collective terms such as feeders must not be used. Medical consultations and treatments must be carried out in private. Provide all residents with a room key unless a risk assessment determines a reason why this should not happen. Consult with residents about how they prefer to spend their leisure and recreation time and formulate a care plan to action this. Food must be maintained at the appropriate temperature and not served until the resident is ready to eat. Review the arrangements to assist people to eat to ensure that staff undertake this task with sensitivity and discretion. Instruct the staff not to feed people with their fingers. The temperature or comfort of residents using the lounge must not be adversely affected by the draughts from the conservatory. Staffing levels must always be sufficient to meet to meet the residents assessed needs.(Unmet from the inspection of 25/01/05). Evidence that PoVAfirst checks or 31/07/05 31/08/05 11/07/05 11/07/05 31/08/05 31/08/05 11/07/05 31/07/05 17. 18. 15 25 12, 13 23 11/07/05 11/07/05 19. 27 18 11/07/05 20. 29 19 11/07/05 Page 23 West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 21. 22. 33 37 24 17 CRB enhanced discosures have been received prior to the employee commencing work is required. The Registered Manager must also document the safeguards put into place to protect residents when CRBs reveal previous criminal convictions. Implement a Quality Assurance 31/09/05 system for the home. (Unmet from the inspection of 25/01/05) The homes records must be well 31/09/05 maintained, up to date and available for inspection at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West Lodge Care Home C53 C03 S26478 West Lodge V232884 130605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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