Inspection on 16/12/08 for West Lodge Residential Care Home

This inspection was carried out on 16th December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Lodge Residential Care Home 24/04/09

West Lodge Residential Care Home 21/05/07

West Lodge Residential Care Home 10/04/06

West Lodge Residential Care Home 17/10/05

West Lodge Residential Care Home 06/07/05

West Lodge Residential Care Home 09/03/05

West Lodge Residential Care Home 20/10/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: West Lodge Residential Care Home 32 Palmerston Road Buckhurst Hill Essex IG9 5LW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Buckle     Date: 2 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: West Lodge Residential Care Home 32 Palmerston Road Buckhurst Hill Essex IG9 5LW 02085044542 02085044542 sirdit.westlodge@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Dr S Seyan,Mr J Kotecha care home 19 Number of places (if applicable): Under 65 Over 65 19 19 dementia old age, not falling within any other category Additional conditions: 0 0 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 19 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 19 persons) The total number of service users to be accommodated in the home must not exceed 19 persons Date of last inspection Brief description of the care home West Lodge is a large detached property in Buckhurst Hill which offers residential care to 19 people over 65 years of age. The home is also registered to accomodate individuals who suffer from dementia. There are 15 single rooms and 2 double rooms along with a passenger lift to the first floor and a stair life to the mezzanine floor. To the rear of the property there is a garden and a car park. The home is accessible by public transport and there are shops and amenities nearby. A copy of the most recent report by the Commission for Social Care Inspection is displayed in the entrance hall Care Homes for Older People Page 4 of 35 Brief description of the care home and a copy of the service user guide which included a statement of purpose was present in the service users rooms. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: This was a routine key unannounced inspection to West Lodge carried out by one Regulation Inspector. The inspection focused on the core standards for older people. The inspection process included a visit to the service. During the site visit 3 members of staff and 2 residents were spoken with. A tour of the premises was undertaken, and observations were made of staff and resident interaction. A number of documents were examined including residents care plans, medication records, staff rotas, recruitment, training and supervision records and records relating to health and safety. This report has been written using accumulated evidence gathered before and during Care Homes for Older People Page 6 of 35 the inspection and includes information received in the annual quality assurance assessment (AQAA). 4 staff surveys and 1 relative survey were completed on the day of the site visit. 4 resident surveys were also handed out, however the staff on duty did not feel that any of the residents would be able to fill the surveys in. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At West Lodge, there was some evidence that assessments completed by care management teams are used to decide whether the needs of a prospective resident can be met, however, there was limited initial assessment completed by the management at the home. Evidence: During the site visit to this service two personal care plans were looked at in relation to initial assessments. The first care plan examined contained detailed information which had been completed by the care management team at the residents placing authority. This specified what tasks were to be undertaken by the home to support the resident, and these included, encouragement to allow a carer to help with washing and dressing and (the resident) can be quite resistant to accepting help and (The resident) will need help to prompt medication and have all (their) meals and drinks prepared. Give (the resident) a choice in clothing and encourage (them) to take part in Care Homes for Older People Page 10 of 35 Evidence: social activities. Please also monitor (the residents) mood as (they) have become very low in mood recently. There was no evidence of a specific assessment undertaken by the manager of the home contained within the file. There was a section which contained the persons details and this outlined their religion, marital status, preferred name and reason for admission, which stated no longer able to cope. It also stated that the resident would need help with personal hygiene, assistance with meds and all meals and drinks prepared. The second file examined did not contain any more detailed information and did not have a specific initial assessment carried out by the manager other than the information contained within the document outlining the service user details. One relative survey was completed and returned to the Commission and in the section asking whether the care home gives the care or support to your relative that you expect or agreed, the person has stated that this is sometimes the case, rather than always or usually. As a national minimum standard a comprehensive and accurate assessment of prospective residents needs should be completed with the involvement of the person concerned their relatives or representatives and any health or social care professionals involved in their lives. This assessment tells the home and the staff team all about the person and the support they need. There was not evidence that this level of assessment had been undertaken at West Lodge. The annual quality assurance assessment (AQAA) completed by the owner of the home does state that the relative or prospective service user is invited to view the home, the room and have lunch in the home. It also states that either the manager or one of the providers always visit the prospective service user in their own home or in hospital to carry out an independent assessment before admission unless it is an emergency placement, however, there was no clear evidence of this happening in either of the care plans examined. West Lodge does not provide intermediate care. Care Homes for Older People Page 11 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines at the home are task based and not person led. Care plans that are in place are not comprehensive and do not clearly outline the specific actions the staff team must take to support the individual. Medication practice places residents at risk of potential harm. Evidence: Personal care plans of one case tracked resident and one other resident were examined during the course of this inspection. The support plans seen were not person centred and did not contain comprehensive details regarding the actions staff should take to meet their needs. For example, one care plan had a support plan for washing and dressing and this stated needs assistance with washing and dressing, hairdresser to cut hair, staff to cut fingernails and chiropodist to cut toe nails. This information is all task based and does not include details about the specific individual and their abilities or likes and dislikes. Care Homes for Older People Page 12 of 35 Evidence: Similarly a support plan regarding toilet needs and continence states just reminding and directing to the toilet. In some instances there had been significant changes in the needs or behaviours of a resident and the support plan had not been updated to reflect this i.e. one resident had district nurse intervention for an ulcer, and their skin care needs support plan still stated no pressure sores on admission, good skin intact and but has got very dry skin on legs have got cream from GP to be rubbed into legs daily. The care plan stated legs to be kept clean and carer to rub cream into both legs daily. The daily care notes were examined and there was no evidence that cream was being applied to the residents legs contained within these. However, in November 2008 a carer did notice a sore on the resident and the daily care notes record that the district nurse visited and said it was an ulcer and that the resident had had it for some time. There were further significant examples of changes that were recorded in the daily notes but not updated on the care plans. All medicines prescribed by a GP for a resident in a care home must be recorded when given. This is also the case with prescribed creams. Care plans should detail what the creams are prescribed for, a medication administration record should be signed by the staff member and the information should be recorded in the daily care notes for the person concerned. All medicines prescribed by a GP for a resident in a care home must be recorded when given. This is also the case with prescribed creams. Care plans should detail what the creams are prescribed for, a medication administration record should be signed and the information should be recorded in the daily care notes for the person concerned. The daily notes were completed by all of the staff team, however, these were scant in the amount of detail they recorded and were in the main part task based. For example,02/11/08 (the resident) ate both meals well, assisted (themself) with washing and dressing, tea and drink given. Toilet no problems at present and night stated slept well, meds given, checked at regular intervals. The entries on 03/11/08 and 04/11/08 were the same. The daily care notes for a second resident on 14/12/08 stated Slept well. Checked at regular intervals, medication given. (The residents) nose is running like water and on 15/12/08 Breakfast served, assisted with washing and dressing, brought downstairs. Eaten lunch very well, no problems. Night stated Slept well. Due medication and fluids given, checked throughout the night. All care needs given. Daily care notes can be a good source of demonstrating the care that is being provided by a home, and when these are detailed the manager can use them to audit the care people are receiving and ensure that it is in line with their support plans. This level of detail was not contained within the daily care notes at West Lodge. Care Homes for Older People Page 13 of 35 Evidence: There was no support plan in place regarding monitoring one residents mood which had been low of late as identified in the care management assessment. Many sections of the care plan were not completed at all i.e. hobbies, interests, religious and cultural and social life was not completed, mental health and cognition was not completed, medication was not completed neither was family involvement and relationships, social networks, health care networks etc. As a national minimum standard care plans should include recorded care needs that are based on current assessments. The care plan should include clear guidance on how the care required will be implemented by the staff team and this information should be up to date. There was some evidence of the residents health needs being met. For example, one residents care plan regarding eating and drinking identified that they had dentures but hadnt worn them for years, an appointment was made to see a dentist and the outcome was recorded. The daily care notes contained some records of district nurse visits, but not all of these were recorded. However, one resident who had GP prescribed cream for dry skin was able to develop an ulcer as outlined earlier in the report. There was not a risk assessment or a risk management plan in place for this resident regarding pressure area care. Risk assessments seen were completed in basic detail and did not cover all areas of risk. For example, one resident had been found outside of the home by a member of staff when they were on their way home. There was no specific assessment of the risk of this person leaving the home without telling anyone, the risk to the person if they did go out or what action staff should take if they found the resident missing. However the home does have a generic missing persons procedure. Risk assessments seen were task based i.e. can the resident undertake an activity such as walking, getting in and out of bed, washing etc. The question was answered yes or no and if no, whatever assistance was required was recorded, such as 1 x carer. One risk assessment was dated 12/03/08 and had a review date recorded as 12/09/08, however, there was no evidence of a review. One care plan examined did have evidence of some review taking place, however, from January 2007 to December 2008 all of the reviews stated no change. Medication administration records (MAR) were examined during the visit to this service. There were no photographs of individuals in place on the MAR for identification Care Homes for Older People Page 14 of 35 Evidence: purposes. There were many gaps in the recording of medication without reasons being given. For example, one resident was prescribed Quetiapine 25mg Take ONE prehalved tablet twice a day. At 07:00 these were all signed as given, at 22:00 there was no signature on 09/12/08; 10/12/08; 13/12/08; 15/12/08. There was no reason given for this. A second resident was given as required medication on a daily basis at 07:00 and 22:00, with no reason recorded and no protocol in place detailing why and when the medication should be given. A third resident had a handwritten medication profile stating Quetiapine. Take one when required. There was no dosage recorded or time of day when it should be given, or how many times each day if required the drug should be administered. There was no signature, or amount received recorded. There was also no protocol in place to state when and why this should be given. The medication was signed as given on 11/12/08 at 17:00, and no reason for this was recorded. As a national minimum standard and in order to safeguard people who live at the home the providers or manager at the home should ensure that all of the details from the prescription are recorded on the MAR chart to inform care staff administering the medication of the correct dosage and time for the medicine to be given. Where possible, this handwritten information should be signed by a witness to prevent the possibility of error. Where as required medication is prescribed, as a national minimum standard care workers must have clear directions about what medication to give and when, therefore detailed information should be contained within the care plan to reflect the doctors orders. A fourth resident had been prescribed Docusate 1 50mg/5ml solution, with 20 ml to be administered twice a day. There was no signature to show this had been given on 14/12/08 at 07:00 or on 9/12/08; 10/12/08; 11/12/08; 12/12/08; 13/12/08 and 15/12/08 at 17:00. The same resident was prescribed Senna 7.5mg/5ml oral solution, with 10ml to be taken twice a day and there was no signature in place to show this had been given on 14/12/08 at 07:00 or on 9/12/08, 10/12/08; 11/12/08; 12/12/08; 13/12/08 and 15/12/08 at 17:00. The MAR sheets of fifteen residents were examined and all of these bar 2 had omissions and anomalies. At the last key inspection in May 2008 and at a random inspection in December 2008 medication issues were raised as a concern and requirements were made. Compliance with these requirements has not yet been met. During the course of this site visit the residents were observed sitting in two lounge areas. Little staff interaction with residents was observed. One member of staff was overheard and observed assisting a partially sighted person to mobilise to use the Care Homes for Older People Page 15 of 35 Evidence: toilet. The resident and staff member were in the hallway outside of the managers office. The resident had a walking frame and was clearly expressing anxiety about moving stating I cant see, I cant see and Oh dont pull me to the staff member who was pulling the walking frame towards the toilet area. No reassurances were heard until they had reached the toilet, when the member of staff stated well done. Recent staff meeting minutes dated 21/11/08 examined during the inspection stated Staff are reminded again not to ever grab or pull a resident. Residents who are mobile do not require being held just ask them to follow you. And when you do have to assist residents help them in the correct manner they mark very easily. In response to this draft report the registered providers of West Lodge stated that The resident has poor sight and staff are fully aware of this and when toileting her they guide her by gently moving the zimmer frame forward. She routinely makes the same statement no matter how gentle the staff are when guiding her. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers at West Lodge have tried to provide a stimulating environment for the people that live there for some of the time. This still needs improving as there was no clear evidence that the wishes and choices of the people who live at the home are considered. The food at the home was satisfactory and balanced to meet the residents dietary needs. Evidence: The residents at West Lodge were observed at various times during the course of the site visit to this service. On each occasion the majority of the residents were sitting in one of the lounges, and although the TV was on, there was nothing else engaging or stimulating happening. The lack of stimulating and meaningful activity for the residents at West Lodge has been an on going concern and a requirement was made regarding this at the last key inspection. During a random inspection in December 2007 the requirement was found not to be complied with. During the course of this inspection some small measures had been made to make improvements, such as a handwritten activities list in a display cabinet, which stated that on Monday the residents would play games/cards and Care Homes for Older People Page 17 of 35 Evidence: scrabble; on Tuesday they would do reminiscence, on Wednesday the residents would be taken for a walk, weather permitting; on Thursday they would have a quiz one week and a visit from the hairdresser and exercises the next and Friday nails would be trimmed and painted for the ladies and every fortnight an entertainer would visit. The key inspection to this service took place on a Tuesday and no evidence was seen of reminiscence work being undertaken with the residents. On one occasion, 10 residents were sitting in the large lounge, dozing or disengaged without a member of staff being present in the room. 2 further residents were sitting in a smaller lounge, again with no member of staff present. One relative survey stated that the home would improve by providing more activities and by staff conversing with the residents, taking more interest in the residents and taking them out. One resident spoken with stated that it was often very boring at the home and that there was nothing much to do. However, one staff survey said that the service Makes residents happy by chatting and joking with them. One member of staff spoken with stated that some of the residents, approximately 8 had gone to the theatre the week prior to the inspection. In discussion, the manager stated that there is now an activities coordinator twice weekly from 10:00 to 16:00 and that 2 of the residents go out to the shops. She also stated that there is an exercise lady who visits once a fortnight and a music man once a fortnight. The daily care notes that were examined did not provide much evidence of stimulating or meaningful activity taking place and there were no further records seen of activities or which residents had been involved and what the outcome had been. One member of staff spoken with stated that the majority of the people living at the home had dementia to some degree. It was therefore not possible to gain insight into how most of the people felt about the level of engagement at the home, however, observation during the course of the site visit did confirm that residents were sitting in a lounge with the TV on and limited engagement was taking place. One senior member of staff was spoken with during the site visit to West Lodge and she stated that most of the food at the home is fresh and that there is a meat delivery once a week and a vegetable delivery twice a week. She said that a cooked lunch is provided for the residents every day and there are roasts on Wednesday and Sunday. Sometimes the residents have a cooked tea, but mostly it consists of sandwiches. The senior member of staff expressed some concern that kitchen staff do not see the care plans for residents, as they are therefore unaware of any specific dietary needs. She said that one resident at the home does have a specific dietary need, but that kitchen Care Homes for Older People Page 18 of 35 Evidence: staff are unaware what this is, even though they have requested the information a number of times. The care plan for this resident was checked and it clearly stated that they did not like pork. Some of the residents have a soft diet and the senior member of staff spoken with stated that these meals are not pureed separately so people can differentiate between the items they are eating, instead all of the items are pureed together. This is not good practice as it precludes the resident being able to make a choice regarding what they are eating. It also does not look attractive. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints made at West Lodge are not being appropriately recorded. There is inconsistent knowledge and practice within the staff team regarding the safeguarding of the people who live at the home. Evidence: According to the annual quality assurance assessment completed by the service, there have been no complaints or safeguarding referrals made since the last key inspection. The complaints log was examined and the last recorded complaint was in March 2007. The last recorded compliment was received in August 2006. Many of the people living at the home have dementia and therefore may not have the cognitive awareness to be able to express their views. One relative survey completed stated that they did not know how to make a complaint. The minutes from a recent staff meeting were examined and within these there was evidence of a complaint being made regarding the way the residents are being dressed. This was not recorded in the complaints log, but staff were told not to put socks on when ladies are wearing a dress and to make sure that petticoats are not hanging three inches below the skirt or dress. During the site visit to West Lodge, some of the female residents were wearing socks with skirts or dresses. Care Homes for Older People Page 20 of 35 Evidence: A record of all complaints made should be kept at the home as a national minimum standard and this can be used as a tool for making improvements to the service. There was no clear over view regarding training completed by staff at the home. One member of staff spoken with stated that POVA training is regularly undertaken by the staff group, and they were clear about the procedure if an incidence of abuse was suspected, however, two staff files examined did not have evidence of this training. Training information received after the site visit to West Lodge contained a table of training completed by the home, which stated that all of the members of staff at the home have completed safeguarding training in February 2008. No certificates were seen as evidence of this. It was of considerable concern to note that the staff meeting minutes completed in November 2008 referred to marks and bruises being found on residents and not being recorded i.e. ....if (staff) know when a resident has knocked into anything and if a member of staff has accidentally caught a resident perhaps when changing them with their nails and caused the resident to have a scratch, sometimes these things do happen but you must write it down and tell the senior so we are aware SO IF ANY VISITOR ASKS WE CAN TELL THEM not just say we dont know. Care Homes for Older People Page 21 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment that meets the physical needs of the people who live there. People who use the service can personalise their rooms. The home is generally clean and tidy, however there are some maintenance issues that still need to be addressed and some areas that require cleaning. Evidence: West Lodge provides an environment that meets the physical needs of the people that live there. There has been refurbishment undertaken since the last key inspection, with a new walk in shower/bath and new sluice room fitted on the mezzanine floor, redecoration of the lounge area and new non slip flooring in the main lounge, hallways, stairs and landing. A partial tour of the premises was completed during the site visit to the home. It was positive to note that refurbishment had been undertaken and that most areas of the home were clean and tidy, however, there were some areas that need to be addressed. One bathroom and toilet on the lower floor had 2 exposed light bulbs with no shades fitted, a tired looking vanity cupboard housing the sink and what looked like blood on the toilet seat. There was a mop and bucket in the corner of the bathroom. The room was not homely, warm or inviting. Care Homes for Older People Page 22 of 35 Evidence: On the same floor the corner of a wall had been badly damaged with the wall paper ripped and metal and plaster work exposed . There was also a large rubber edged mat on the floor in the hallway, which one resident with a walking frame had difficulty maneuvering across. In discussion the resident stated that they found getting round the corner with the mat in situ dangerous. A member of staff was asked to move the mat as it posed a significant risk to the health and safety of residents. This was done during the inspection. Residents bedrooms were looked at, and these had varying degrees of personal effects contained within them. One resident had a warm and cosy room, filled with photographs of their children and grandchildren. It was noted that the doors to some of the bedrooms were very heavy, and one resident stated that at night, if the door closes they find it too heavy to open. A downstairs toilet was found to be slightly odourous, with urine splashed on the floor and splashes of faecal matter on the wall. One bedroom was also found to have a slight odour of urine. Overall, the home was clean and tidy, but there were some areas that needed attention and some refurbishment that needed to be completed. The register providers have stated that re-decoration of the hallways, stairs and landing is scheduled to start in February 2009. West Lodge is a specialist home for people with dementia and the environment did not reflect this. For example, there was no signage on the bedroom doors of the people that live in the home to aid them in their orientation or to act as memory prompts. The AQAA completed by the service details many areas in the what we do well section of the environment outcome group. These include ensuring that the building is kept safe, maintaining a smoke free environment, keeping all rooms and toilets clean, guards for all radiators and all staff receiving infection control training. Care Homes for Older People Page 23 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing at West Lodge is not sufficient to meet the identified needs of all of the people that live in the home all of the time. Recruitment practice is not sufficiently robust to protect residents from potential harm or abuse. Staff training is in place at the home for some core areas but there are gaps. Evidence: The current staff rota was examined during the inspection and it was noted that there is one member of staff on duty at night along side one sleep in member of staff. The last inspection found this to be of concern and recommended that the service review their staffing levels in relation to this. The layout of the building is complicated, with bedrooms on the ground floor, first floor and on a further floor. Some of the rooms are tucked away around corners. The AQAA completed by the service states that there are 3 people in the home who require two or more staff to help with their care both during the day and at night. It also states that 12 of the residents at the home have dementia. The daily care notes made some reference to people wandering at night, and to some challenging night time behaviour. One member of staff spoken with stated that when people wander at night one member of staff is not enough and that the layout of the building is difficult for one member of staff to manage. The current staffing complement at the home is 1 senior and 3 carers in the morning, Care Homes for Older People Page 24 of 35 Evidence: 1 senior and 2 carers in the afternoon and evening until 8pm. Between 8 and 10 pm a carer is on duty alongside the waking night staff who works from 8pm to 8am. The sleep in staff is also on duty in the morning between 7 and 8 am. At the last inspection there was concern expressed regarding the manager of the home having few hours in which to manage the service. According to the rota for December 2008 the manager had 6 hours to manage the service one week on 03/12/08 and 12 hours the following week on 10/12/08 and 12/12/08, during the last 2 weeks of December there is one 6 hour slot of management hours showing on the rota. 6 or 12 hours in a week does not constitute enough time for a manager to work effectively. One member of staff stated that when the manager is part of the team of staff on duty, she is sometimes not available as she is in the office and this leaves them short of a member of staff. A senior member of staff expressed concern that the seniors and carers think of the manager as one of them and do not distinguish her clearly as the manager. Of the 4 staff surveys completed, 2 stated that there are always enough staff to meet the individual needs of the people who use the service and 2 stated that there usually are. According to the AQAA there are 19 staff at the home. Of these 13 are care staff, and 5 of these have completed NVQ Level 2 or above and 6 members of staff are currently working towards NVQ 2 or above. One relative survey completed stated that the care staff at the home sometimes rather than always or usually have the right skills and experience to look after people properly. Two staff recruitment files were examined. The first of these contained all of the specified information however, their start date was recorded as being prior to receipt of both a POVAFirst check and a Criminal Records Bureau check. This was also the case for a second employee looked at, who joined West Lodge in March 2007 but had a CRB check dated 14/06/07. All of the checks required by regulation should be completed on every staff member prior to their starting work, to ensure that the residents are protected from the possibility of harm. During the inspection training files were examined, however, these were not clear and it was not possible to gain a clear picture of the training staff had completed alongside the evidence that this had been done. One staff file examined had evidence of training in manual handling, depression in older people, dementia, dealing with death, incontinence and staff attitudes towards each other and service users. All of this had been completed in 2008. However, there was no evidence of training in safeguarding. After the site visit to this service, information regarding training was forwarded to the Commission, this demonstrated that the manager at the home had given training Care Homes for Older People Page 25 of 35 Evidence: sessions on various topics, i.e. 14/01/08 medication and mealtimes, 11 staff attended and staff attitude towards each other and to service users, also with 11 attendees; 24/01/08 incontinence, which 5 staff attended; 28/02/08 keeping the home tidy and using the washing machine at the correct temperature with 9 attendees; 21/03/08 infection control, with 5 staff in attendance; 04/04/08 feeding service users, with 6 staff attending; 30/04/08 depression in older people, attended by 6 members of staff; 30/05/08 dealing with death in the home; 06/03/08 maintenance of flooring with 12 attendees and 28/02/08 recycling and nurse call, with 6 attendees. Certificates were also forwarded which showed that 8 members of the staff team completed manual handling training in April 2008 and 3 in June 2008; 11 of the staff team had completed training in dementia on 10/06/08; 8 members of staff had completed first aid training on 03/07/08 and 9 members of staff completed fire safety on 28/08/08. A training table stated that 20 members of staff had completed POVA training as an in-house course on 21/02/08, however no certificates were seen to verify this. During the site visit to West Lodge there was no clear system in place where this information was recorded with the appropriate evidence. Care Homes for Older People Page 26 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the manager of the home is qualified and deemed fit West Lodge currently lacks leadership, purpose and direction. Training, development and supervision of staff is inconsistent, person centred care is not in place and the people who use the service are not adequately protected from harm. Evidence: It was noted at previous inspections that the manager of West Lodge has a maximum of 2 x 6 hours on duty in which to manage the service on a weekly basis, with the rest of her working time spent working shifts at the home. This is still the case, with the manager having just 4 x 6 hour management shifts on the rota for December 2008. The manager completed her Registered Managers Award on 10/04/08 and has also undertaken manual handling training and appointed persons first aid. She has been registered by the Commission as fit to carry out her role as manager, however, the insufficient management hours available adds to the ineffective management of the Care Homes for Older People Page 27 of 35 Evidence: service. The staff meeting minutes referred to previously within this report do demonstrate that the manager is trying to make changes within the home, however, there was no evidence during the inspection to suggest that these were being implemented within care practice. West Lodge is currently not a well run home. Care plans are not completed in sufficient detail and are not used as working documents by the staff team; supervisions have been completed for some staff and not for others, records are not maintained and there is no clear picture regarding staff training. Staff recruitment is not robust and care practices within the home are not always in the best interests of the residents. There is also insufficient meaningful stimulation for the people that live at the home and not enough staff on duty at all times. This was also the situation at the last key inspection which was in 2007. Limited progress has been made towards improvement of the service for the people that live there. Some quality assurance has been carried out by the service, however, the results of this had not been compiled into a report and made available to the Commission. Health and safety certificates were examined and these were seen to be in date. For example the gas safety record was completed on 22/02/08; the patient lifting hoist was inspected on 06/08/08; PAT testing had been carried out and the retest is due in July 2009. Water temperatures were recorded weekly from 07/01/08 until 10/11/08 with nothing further recorded. A fire risk assessment was carried out by the manager of the home, however, the date of review was recorded as 15/11/08 and no review had been completed. Care Homes for Older People Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13(2) When medication is 31/12/2007 administered to people living at the home it must be clearly recorded, to ensure that people receive correct levels of medication. This is a repeat requirement that did not meet the agreed timescale of 31/05/07. 2 12 16(2)(n) 31/12/2007 People living at the home must be provided with various activities to stimulate and enhance their lives. This is a repeat requirement that did not meet agreed timescales of 31/12/05, 31/05/06 and 31/08/07. 3 31 18(1)(a) The person in charge must 31/12/2007 ensure that the registered manager is supported to work sufficient management? hours to promote smooth and efficient running of the care home for the benefit of the people living there. This is a repeat requirement that did not meet agreed timescales of 30/04/06 and 31/05/07. Care Homes for Older People Page 29 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person should not provide accommodation to a prospective resident unless a full needs assessment has been carried out. The management team at the home must ensure that a comprehensive assessment is carried out prior to anyone being admitted to the home so that the service and staff team are able to meet the individual needs of the person and to support them appropriately to have a good quality of life. 06/02/2009 2 7 15 The registered person must prepare a care plan in consultation with the resident or their representative to demonstrate how their individual needs are to be met by the home. This 06/02/2009 Care Homes for Older People Page 30 of 35 should be kept under review and updated as necessary. The care plans at West Lodge do not detail the specific actions staff are to take to support the people that live at the home. Changes in need are not recorded. 3 9 13 The registered person must 30/01/2009 make arrangements for the safe administration of medication. The registered person must ensure that all medication is given to residents as prescribed by their GP, that records are up to date and accurate, that PRN medication is used appropriately. Residents are placed at risk of potential harm if their medication is not well managed. 4 12 16 The registered person must consult with residents as far as possible to determine their social interests and make arrangements for them to engage in these. Residents quality of life would improve if the possibility for them to engage in meaningful activity on a daily basis were available. 5 14 12 The registered person must ensure that the residents at West Lodge are enabled as far as possible to make 06/02/2009 06/02/2009 Care Homes for Older People Page 31 of 35 decisions and be involved in choices regarding the care they receive. The quality of life of the residents would improve if they were able to be involved in making choices and taking some control of their lives. 6 16 22 The registered person must ensure that any complaint made under the complaints procedure is fully investigated, and ensure that all relatives or representatives of the residents at the home are aware of how to make a complaint. No complaints have been recorded but there was evidence at the inspection that at least one complaint had been made and not written up in the log. 7 18 13 The registered person must make arrangements to ensure that people who live at West Lodge are not placed at risk of harm or abuse by training the staff team and ensuring that correct procedures are followed regarding reporting and recording incidents of harm or abuse. The registered person must ensure that all residents are moved and aided in the correct manner to prevent them experiencing harm. 20/01/2009 06/02/2009 Care Homes for Older People Page 32 of 35 There was insufficient information available regarding safeguarding training at the home and clear evidence that residents are being harmed during routine situations within the home and that this is not being recorded or reported. 8 27 18 The registered person must 06/02/2009 ensure that there are at all times suitably qualified and competent persons working at the care home in such numbers as are appropriate for the health and welfare of the people who live in the home. This is in relation to 1 waking night staff on duty when 3 residents require 2 carers to provide their support, the layout of the home is complex and some staff have expressed that the staffing level is not adequate. 9 29 19 The registered person must ensure that all recruitment checks necessary to promote and protect the safety and welfare of people living at the home are made prior to new staff starting work at the home. Recruitment checks such as CRB and POVAFirst checks must be undertaken to protect residents from potential harm and abuse. 06/02/2009 Care Homes for Older People Page 33 of 35 10 30 18 The registered person must ensure that the staff team receive training appropriate to the work they are to perform. This is because there is an unclear picture of training completed at the home and no clear evidence to suggest that all staff have completed core training and specialist training or that this is updated. 27/03/2009 11 31 10 The registered provider and 06/02/2009 the registered manager shall carry on or manage the care home with sufficient care, competence and skill. This is in relation to the manager having insufficient time to effectively manage the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 GP reviews should be sought where PRN medication is needed on a daily basis, and PRN protocols established and adhered to. Handwritten medication profiles should be signed and countersigned and contain full and detailed information regarding the prescribed dosage and frequency of the drug to be given. Ensure that the residents wishes regarding their diet is taken into account and that all food is presented in a pleasant manner, allowing for choices to be made regarding what is eaten. The cleaning levels within the home must be improved to prevent the risk of infection. 2 15 3 26 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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