CARE HOMES FOR OLDER PEOPLE
West Lodge Residential Care Home 32 Palmerston Road Buckhurst Hill Essex IG9 5LW Lead Inspector
Jane Greaves Unannounced Inspection 17th October 2005 09:15 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 West Lodge Residential Care Home DS0000017995.V258965.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. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service West Lodge Residential Care Home Address 32 Palmerston Road Buckhurst Hill Essex IG9 5LW 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) 020 8504 4542 02085 044542 Dr S Seyan Mr J Kotecha Mrs C J Knight Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19) of places West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 19 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 19 persons) The total number of service users to be accommodated in the home must not exceed 19 persons 6th July 2005 Date of last inspection Brief Description of the Service: West lodge is a large detached property in Buckhurst Hill, which offers residential care to 19 people over the age of 65 years of age. The home is also registered to accommodate individuals who suffer from Dementia. There are 15 single rooms and 2 double rooms. There is a passenger lift to the first floor and a stair lift to a 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. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place 17th October 2005 over 3 ¼ hours. 14 of the 38 National Minimum Standards were assessed at this inspection 6 were met. A partial tour of the premises was undertaken and practice was observed. During the course of the inspection views were gathered from 12 residents at West lodge, 3 members of care staff, the cook, laundry person, a district nurse and the two service providers. On the day of this inspection the registered manager was away from the home, a senior care staff member assisted the inspector. The inspector appreciated the co-operation in the inspection process given by all the staff team at West Lodge. For the purposes of this report the service users stated that they would prefer to be referred to as residents. What the service does well: What has improved since the last inspection? What they could do better:
During the course of this inspection the inspector witnessed conversations between staff members that did not serve to protect the residents’ privacy or dignity. The previous inspection contained a repeat requirement for the provision of appropriate social activity specifically designed to meet the needs of residents with Dementia. The registered person had not made any progress in this area West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 6 at the point of this inspection; the agreed timescale for action was 30th November 2005. The partial tour of the premises confirmed that most of the bedrooms had been redecorated and some furniture replaced. However all residents’ beds seen at this inspection were in excess of fifteen years old, stained and tired, the residents would benefit from the provision of new beds. The service providers reported to the inspector that there was a rolling programme of refurbishment and redecoration. This programme included refurbishment and refurnishing of the lounge areas as was reported at the previous inspection. There was a strong smell of urine throughout the home. The registered providers reported that one room had lino flooring laid to replace the previous carpeting and that this was proving to be effective. The staff team had not attended training in the control of infection. The previous inspection raised a requirement for the registered person to conduct a review of the staffing hours at West Lodge. The registered providers reported a staffing review was undertaken monthly. On the day of the inspection it was observed that the three care staff on duty were still attending to the residents’ needs and assisting them to wash and dress very shortly before the lunchtime meal was served. The domestic staff hours were also recommended for review. The home is currently coping with one domestic staff member. The residents at west Lodge would further benefit from a staff team with a minimum of 50 of staff trained to NVQ level 2 or above. The target date for this is 31st December 2005; this will not be achieved. A previous inspection requirement with an original agreed timescale of 30th November 2005 was for the registered person to establish an effective quality assurance system and to forward the Commission for Social Care Inspection. This was still under development at this inspection. 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 Residential Care Home DS0000017995.V258965.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 West Lodge Residential Care Home DS0000017995.V258965.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): 3 No resident moved into West Lodge without having their needs assessed and being assured that these will be met. EVIDENCE: The registered manager undertook a pre admission assessment of individual needs before new residents were admitted to West Lodge. This assessment covered all aspects of residents’ daily lives and detailed what assistance the individuals wished and needed. Social Services assessment forms were present on file providing a basic ‘snap shot’ of the residents’ requirements. West Lodge Residential Care Home DS0000017995.V258965.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 and 10 The residents’ health, personal and social care needs were set out in individual plans of care. Residents reported they were treated with dignity however the inspector’s experiences at this inspection did not confirm this was always the case. EVIDENCE: A plan of care had been developed incorporating information from the preadmission needs assessment and the Social Services assessment. Residents, their families/representatives and social workers were encouraged to participate in this process. The plan of care provided detailed instruction for care staff members to follow in order to meet the assessed needs and wishes of individual residents. Residents reported they were treated with dignity and respect and that their privacy was protected. However, on the day of the inspection some of the staff team were discussing residents’ healthcare issues in the hallway of the home in a disrespectful manner that did not in any way protect the dignity of residents.
West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 10 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 Residents’ social, cultural, religious and recreational needs were not adequately identified or met. EVIDENCE: Care plans contained very little information about the residents’ choices regarding activities and pastimes. Residents reported that some activities took place within the home such as playing ball and sing-a-longs however there was little enthusiasm shown for these activities. Care staff reported that a singer attended the home fortnightly and exercise sessions took place monthly. Records of activities participated in were not found in the residents’ care plans. A repeat requirement with an agreed timescale of 30th November 2005 had been made at the previous inspection for the registered person to provide appropriate activities specifically designed to meet the needs of residents with dementia. At the date of this inspection progress had not been made towards meeting this requirement. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 11 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 and 18 Residents could be confident their complaints would be listened to and taken seriously. Residents were protected from abuse. EVIDENCE: Records showed that one complaint had been received by the home since the previous inspection and had been referred to PoVA. The incident identified had not been handled appropriately in the first instance; a recommendation was made for the registered persons to attend further training in the protection of Vulnerable Adults from abuse. The home had robust policies and procedures in place to ensure residents and their families/representatives/staff members were aware of how and to whom to complain to should they become unsatisfied with the care provided at West Lodge. Staff members at West Lodge received induction training that included the protection of Vulnerable Adults from abuse. Annual refresher training in this area had been provided for the majority of care staff, the registered providers were reminded of the importance of ensuring all the staff team received regular updates. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 12 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): 24 and 26 Residents’ bedrooms were safe and comfortable however the beds were in need of replacement. There was a strong offensive odour present throughout the home on the day of the inspection. EVIDENCE: There was a rolling programme of refurbishment of residents’ bedrooms. Most had been decorated and some had replacement carpets. All of the beds seen at today’s inspection were old with soiled and stained mattresses. One room had carpet replaced with waterproof flooring as dictated by the resident’s needs. This decision had been made in consultation with the resident’s family. The registered providers reported this style of flooring was to be considered for further residents’ rooms and were aware of the need to consult with residents and their families/representatives and for the rooms to be homely and domestic in nature. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 13 On the day of the inspection there was a strong offensive odour throughout the home. Staff members reported that carpets were regularly shampooed however the odour remained. One member of domestic staff had recently left the employ of the home and efforts were being made to recruit a further staff member. No training had been provided for the staff team in the control of infection. West Lodge Residential Care Home DS0000017995.V258965.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 and 30 Sufficient staff members were not able at all times to meet the residents’ needs in a timely manner. Staff had the skills and knowledge to meet the assessed needs of the residents however 50 of the care staff team must achieve NVQ level 2 in care. Residents’ safety and well-being were protected by the home’s recruitment procedures. EVIDENCE: On the day of the inspection there were three care staff on duty as was the norm according to the rota. All of the 18 people living at West Lodge required some assistance with washing and dressing; some residents’ needs were such that two care staff members were needed. The ringing of the doorbell and telephone calls to the home meant that the care staff team were continuously being interrupted whilst providing care to the residents. It was observed that some residents were washed and dressed ready for the day just in time to sit down for lunch. Mandatory training and regular annual refresher training had been provided for the majority of staff members with the exception of infection control. Some individuals had not been available to attend some of the courses. 14 care staff members were employed at West Lodge, 3 had achieved NVQ level 2 in care and a further three were due to enrol. The desired ratio of 50 of care staff trained to this level will not be achieved by the target date of December 31st 2005. West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 15 2 staff files were sampled at this inspection and contained all items required to protect the safety and well being of the residents at west lodge. West Lodge Residential Care Home DS0000017995.V258965.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): 33 and 36 Residents and their families/representatives could not be confident the home was run in their best interests. Staff members received appropriate supervision. EVIDENCE: The previous inspection raised a requirement with an agreed timescale of 30th November 2005 for the registered person to develop an effective system of quality assurance to ensure the home is run in the best interests of the residents. Families and representatives had completed surveys but at the point of this inspection these had not been developed into a plan of improvement for the home. Evidence of regular documented staff supervision sessions was seen at this inspection. Seniors and the registered manager worked alongside the care
West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 17 staff team providing practical supervision daily. It was noted that there was no system of practical supervision for the night staff. West Lodge Residential Care Home DS0000017995.V258965.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 3 X X West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP10 Regulation 12(4)(a) Timescale for action The registered person shall make 17/10/05 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. The registered person shall, 31/12/05 having regard to the size of the care home and the number and needs of service users, consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the specific needs of service users, appropriate activities in relation to recreation and fitness. 31/01/06 The registered person shall, having regard to the size of the care home and the number and needs of service users, provide in rooms occupied by service users adequate furniture, bedding and other furnishings including curtains and floor coverings, and equipment suitable to the needs of service users.
DS0000017995.V258965.R01.S.doc Version 5.0 Page 20 Requirement 2 OP12 16(2)(n) 3 OP24 16(2)(c) West Lodge Residential Care Home 4 OP26 16(2)(k) 5 OP26 OP30 18(1)(c) 6 OP27 OP28 18(1)(a) 7 OP33 24 The registered person shall, having regard to the size of the care home and the number and needs of service users, keep the care home free from offensive odours. The registered person shall, having regard to the size of the care home, the statement of purpose, and the number and needs of service users, ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform. This specifically relates to training in the control of infection. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. OP28 specifically relates to staffing levels. The registered person shall establish and maintain, in consultation with residents and their families, a system for reviewing and improving the quality of care provided and supply to the commission for Social Care Inspection a report in respect of this review and make a copy available to the residents and their families. There is an existing agreed timescale for this requirement. 31/10/05 31/12/05 31/12/05 30/11/05 West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 21 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 OP18 Good Practice Recommendations It is recommendations of good practice for the registered persons to receive further training in the protection of Vulnerable Adults from abuse and to ensure all care staff receive regular refresher training in this area. It is a recommendation of good practice that a minimum of 50 of care staff members are trained to NVQ2 or equivalent. 2 OP28 West Lodge Residential Care Home DS0000017995.V258965.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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