CARE HOMES FOR OLDER PEOPLE
West Lodge Residential Care Home 32 Palmerston Road Buckhurst Hill Essex IG9 5LW Lead Inspector
Jane Greaves Final Unannounced 06 July 2005 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 Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 02085 044542 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 I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not exceed 19 persons) 2. Persons of either sex, aged 65 years and over, who require care by reason of demential (not to exceed 19 persons) 3. The total number of service users to be accommodated in the home must not exceed 19 persons. Date of last inspection 09 March 2005 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 I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place on 6th July 2005 over 4½ hrs. 13 of the 38 National Minimum Standards were assessed at this inspection and 7 were met. During the inspection process the inspector gathered views and experiences from the registered manager, three residents, two care staff, the cook, laundry and domestic staff, one relative, the visiting hairdresser and an NVQ assessor. 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?
Since the last inspection the Statement of Purpose and the Service User Guide had been updated to accurately reflect the service that West Lodge Residential Care Home offers to existing and prospective residents. The registered manager had changed the pharmacy service the home had been receiving. The new Pharmacy service provides training for all staff over a six-week period and will undertake regular audits of the home’s medication procedures. The system used will still be the blister pack system and training for staff members is due to commence 28th July 2005. There had been some redecoration of residents’ private space since the last inspection. Most bedrooms had been painted and some furniture replaced. Some new carpets had been fitted.
West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 Prospective residents had the information they needed to make an informed choice about where to live. EVIDENCE: The Service User Guide and the Statement of Purpose had been further reviewed and developed; a copy of these documents had been forwarded to the Commission for Social Care Inspection. A copy of the Service User Guide was present in residents’ bedrooms. The registered manager reported that a full assessment of needs would be made and a copy of the Social Service Assessment received before a new resident would be admitted to the home. A prospective resident would be offered a ‘trial stay’ at West Lodge before making the decision to enter the home on a permanent basis. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 standard(s) 7 and 9 The residents’ health, personal and social care needs were set out in an individual plan of care but not the detail of how to meet the assessed needs. Residents were protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: The assessment of needs made by the home when a new resident was admitted contained detail of the needs identified, however there were no instructions as to how to meet these needs. One file sampled stated simply that a resident liked to have a weekly bath. Details as to how, when, what support would be required by the resident to undertake this task or any other specific instructions were not available. Residents’ health care needs were documented and there was evidence of healthcare professional involvement in meeting the identified needs. The registered manager reported that the Proprietors were developing a new care plan format for use across the group of homes. The registered manager had recently changed pharmacy supplier. The medication was still administered under a blister pack system and the new Pharmacy was scheduled to provide training over a 6 week period starting 28th
West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 10 July 2005. Medication was stored in a secure trolley and the Medication Administration Records were completed with no gaps in recording. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 Residents’ lifestyles experienced in the home did not satisfy their recreational interests and needs. Residents were supported to exercise choice and control over their lives. Residents received a wholesome, appealing and balanced diet. EVIDENCE: The registered manager had attempted to recruit a designated activities person in order to provide stimulation and recreation for the residents. This had not been successful. Care staffing hours provided were not adequate for residents to be accompanied for outings or for staff to provide entertainment and stimulation for the residents. Residents were supported to exercise choice and control over their day-to-day lives. Residents stated that they went to bed when they wanted to and, provided staff members were available, were able to arise when they wished. On the day of the inspection some residents were in their rooms in their night clothes waiting for a member of staff to become available to assist them with washing and dressing. Residents selected their own clothing, had a choice of meals daily and were treated with dignity. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 12 There was a four-week food rota with a varied menu incorporating fresh fruit and vegetables. An inspection of the kitchen evidenced a good stock of foodstuffs maintained at the home. The daily teatime meal was prepared and served by care staff. The inspector observed stocks of processed foods such as ‘potato waffles’ and ‘smiley faces’. The cook reported that care staff do not have the time to prepare food for the afternoon tea therefore convenience food was necessary. Residents said they enjoyed all the meals provided at the home and observation on the day confirmed this. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 13 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) 18 Residents living at West Lodge were protected from abuse. EVIDENCE: All staff members received induction training that included the Protection of Vulnerable Adults from Abuse. A refresher training session in this area was booked for August 2005. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 14 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) 21, 24 and 26 Residents had sufficient and suitable lavatories and washing facilities. Most residents lived in safe and comfortable bedrooms with their own possessions around them however some rooms were in need of refurbishment. The home appeared clean but there was an offensive odour present throughout on the day of the inspection. EVIDENCE: Overall the bathrooms were sufficient for the needs of the residents at West Lodge. One facility sampled during the course of the inspection was dirty with dusty pipe work, soiled shower stool and there was no soap for hand washing. The domestic staff had been working hard all morning but by lunchtime this facility still had not been cleaned. The liquid soap dispenser was broken; a new supplier had been sought but had not yet installed the new dispensers. Most of the residents’ bedrooms had been decorated, re-furnished and received new bedding. These rooms looked bright and fresh but many had not
West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 15 had the carpets replaced and the aroma of urine was strong throughout the unit. On the day of the inspection the registered manager reported that there were just 6 residents’ bedrooms remaining to be decorated. The manager said that both the lounges were scheduled to be re-decorated and have new furnishings later this year. There was a dedicated team of domestic staff employed at the home but the workload and the demands of this unit are such that more hours need to be assigned to this area. There was a smell of urine emanating from the carpets and these needed to be replaced with carpeting appropriate to the purpose. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 and 30 Residents’ needs were met by an appropriate skill mix of staff however staffing numbers appeared insufficient for the care provision required. Staff members were trained and competent to do their jobs. EVIDENCE: Care staff had the appropriate skills to deliver the care required to meet the identified needs of the residents however it became apparent during the course of the inspection that the level of staff cover was not sufficient. Residents were sat in their nightclothes waiting for a member of the staff team to assist them with dressing at 10.30am. Over the lunch period the three care staff on duty served the residents, assisted those needing help with eating and administered medications. Staff members were provided with training in all mandatory areas. The registered manager is developing a training matrix in order that the home’s and individual staff member’s training requirements may be easily identified. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 17 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) 33 The registered person’s system of Quality Assurance did not demonstrate that West Lodge is run in the best interests of the residents. EVIDENCE: The registered manager confirmed that an annual survey is undertaken of residents and representatives views regarding the services, care and facilities provided at the home. The registered manager was not able to demonstrate how this survey had been summarised and provide the resulting action plan to address any issues raised. There were no records to evidence that previous Quality Assurance surveys undertaken had altered the home’s practise. A copy of the annual Quality Assurance survey should be forwarded to the Commission for Social Care Inspection annually together with the resulting plan of actions to be taken to address areas identified for improvement.
West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x x 3 x x 2 x 2 STAFFING Standard No Score 27 1 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x x x x x West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 19 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 OP7 Regulation 15 Requirement The registered person must ensure that all care plans indicate the actions to be taken to address each need and that regular reviews take place to relect current requirements. THIS IS A REPEAT REQUIREMENT WITH AN ORIGINAL TIMESCALE FOR ACTION OF 30TH APRIL 2005 The registered person must provide appropriate social activity specially designed to meet the needs of residents with dementia. THIS IS A REPEAT REQUIREMENT WITH AN ORIGINAL TIMESCALE FOR ACTION OF 3Oth APRIL 2005 The proprietor and the registered manager must ensure an urgent review of staff hours is undertaken for care and domestic staff . 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 Timescale for action 30th November 2005 2. OP12 16(2) and 12(4)(b) 30TH November 2005 3. OP27 18(1)(a) 31st July 2005 4. OP33 24 30th November 2005 West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 20 respect of this review and make a copy available to the residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP24 OP26 OP26 Good Practice Recommendations Carpeting throughout the home but especially in residents bedrooms should be assessed with a view to replacement. The registered person should undertake a review of domestic staffing hours to assess if they are sufficient to maintain the home in a clean and hygeinic manner. The carpets that are stained and soiled should be replaced in order to eliminate offensive odours. West Lodge Residential Care Home I56-I05 S17995 West Lodge V237088 UI 060705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex C01 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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