Inspection on 15/05/06 for Westleigh Lodge

This inspection was carried out on 15th May 2006.

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

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

Other inspections for this house

Westleigh Lodge 17/11/08

Westleigh Lodge 26/06/08

Westleigh Lodge 01/11/07

Westleigh Lodge 25/10/06

Westleigh Lodge 05/12/05

Westleigh Lodge 11/05/05

Westleigh Lodge 04/10/04

Westleigh Lodge 15/04/04

Westleigh Lodge 21/11/03

Westleigh Lodge 27/05/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Westleigh Lodge Nel Pan Lane Leigh Lancashire WN7 5JT Lead Inspector Judith Stanley Unannounced Inspection 09:30 15 ,16 & 20th May 2006 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 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. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Westleigh Lodge Address Nel Pan Lane Leigh Lancashire WN7 5JT 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) 01942 262521 01942 674783 Southern Cross Healthcare Services Limited Miss Michaela Marie Keeley Care Home 48 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (48) of places Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 48 service users, to include: Up to 48 service users in the category of DE(E) (Dementia over 65 years of age); Up to 3 service user in the category of DE (Dementia under 65 years of age) may be accommodated within the overall number of registered places The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 5th December 2005 2. Date of last inspection Brief Description of the Service: Westleigh Lodge is a purpose built three-storey nursing home that offers care for up to forty-eight people over the age of 65 years, of either sex who are suffering with a dementia illness. The Home is owned by Southern Cross Health Care and is situated on the outskirts of Leigh town centre. The Home is within easy reach of local shops and facilities and is well served by public transport. There is a car park to the front of the Home and gardens at the rear. Accommodation is provided on the ground and first floor; both floors have a communal lounge and dining rooms. There is a passenger lift to all floors; the third floor houses the homes kitchen, laundry and staff room. All residents have a single room with en suite facilities. The current rate of fees at Westleigh Lodge is £325.55 per week. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 13 ½ hours over a course of 3 days, and was unannounced. The manager was available to assist with the inspection. Part of the time was spent looking at residents records (care plans) and other documents that the home needs to keep and the rest of the time was spent watching staff going abut their daily duties, and talking with staff, residents and relatives, as well as making tour of the building. What the service does well: What has improved since the last inspection? What they could do better: The way staff are deployed on both days and nights must be reviewed by the homes manager to ensure the needs of the residents are met. More domestic staff hours are required. Staff must not be taken off the floor to cook to cover for holidays. Extra staff must be available. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 6 Activities within the home are poor; the activity co-ordinator must address this and split her time evenly between both floors. The menus at both dinner and tea time must be reviewed to offer a more varied and nutritious diet and the way in which pureed diets are served must be addressed. A substantial supper must be served that includes a choice of snack and drinks including milky drinks such as Horlicks or Ovaltine. The home requires a second hot trolley to ensure that food on both floors is hot when served. Suitable aids, for example plate guards are to be used to assist residents at meal times. The nurse in charge of the floor must take responsibility for the running of the floor; this is to include more involvement in the care of residents and to oversee care staff and not just in the administration of medication and in the writing up of care plans. The upstairs floor requires a new vacuum cleaner as one is broken and staff have to share one between both floors. The hoist must be replaced or repaired to enable residents to be moved in a safe and secure manner. New curtains are required in the upstairs dining room and main lounge, these are old and looking shabby. The day room upstairs needs a new carpet and furniture, in its present state it is not fit for residents to use. The gardens must be made safe for residents to access. An immediate requirement was made at the inspection relating to this. Both corridors would benefit from some comfortable chairs being placed near the dining area, as this would enable residents the to sit down and have a break as several walk about the building a lot. The corridor carpets on both floors are stained and need replacing. More orientation aids and pictorial signage is required around the home to assist residents. The manager would benefit from her own office, this is currently shared with the administrator which makes it difficult for the manager to speak confidentially to people and for the administrator to carry out her role. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 7 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. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 8 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 Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 9 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): 1 and 3 – standard 6 does not apply at Westleigh Lodge. Quality this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The service user guide does not present in a suitable format for residents to help them make an informed choice about coming to live at the home. The pre admission assessment now focuses on the mental health and dementia care needs of prospective residents to ensure that the home can offer the right level of care. EVIDENCE: Both the service user guide and the statement of purpose have been rewritten. Both documents contain so much written information that most prospective residents wishing to move in to Westleigh would not have the capacity to take in. A requirement made at the last inspection the service users guide should contain pictorial information about who the staff are, the layout of the home, bedrooms, bathrooms and what goes on in the home. Southern Cross Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 10 Healthcare Ltd believe the documents they produce are appropriate and meet the requirement. There was evidence in some files inspected to show that the new pre admission assessment form had been used. The information is now completed prior to admission and gives a clearer picture of the mental health and the type and level of dementia care the prospective residents will require care for. The manager confirmed that the forms have been a success, as previously a full assessment could not be carried out until the resident had moved in to the home. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 11 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): 7,8,9 and 10 Quality in this outcome is poor. This judgment has been made using available evidence including a visit to the service. The records show that the health, personal care needs of the residents had been identified, were monitored and reviewed. There are satisfactory medication system in place for the safe storage of and recording of medication, however the method of administration of medicines was inappropriate at times. Residents and relatives may not be fully confident that residents are treated with dignity and with respect at all times. EVIDENCE: Four care plans were looked at to see if full consideration had been made for the each resident’s, health and personal care needs. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 12 Each record contained contact details, next of kin, residents GP and other relevant information Risk assessments were in place for all four residents, including those relating to moving and handling, the use of bedrails if required, prevention of falls, nutritional needs and pressure care. The plans had been updated monthly or more frequently if required. There was evidence to show that other professional health workers had been contacted as and when required. Daily progress sheets are completed by the trained staff at least twice a day. It was noted that there were photographs of residents, some of these were very dated and do not now look like the resident, these need to be replaced. It was discussed with the manager that a more in depth social history is required to help build up a detailed picture of the resident’s past life experiences, this will help staff to talk with residents and generate conversation. The staff were observed caring for the residents, staff were seen to be friendly and kind to residents, but sometimes appeared complacent to some of their needs, for example one resident was struggling to button up her cardigan and was stood in front of a member of staff who must have noticed what she wanted but failed to ask if the resident wanted assistance. With regard to respecting dignity it was noted that clean, continence products were piled up on the back of the toilet cisterns, these should be stored away in residents rooms. On the early morning visit to the home one resident was seen walking round in pyjama bottoms, socks, no slippers, and a stained shirt tucked in his pants, this was the third time that week that the Inspector had seen the resident wearing the same shirt. Even when the Inspector mentioned that he had no slippers on, none of the staff made any effort to go and find them. It was also noted, during the visits that some of the gentleman were unshaven and some ladies had unsightly facial hair. With regard to the medication, the morning medication round was observed. The manner in which the tablets was given needs to be addressed, this was not done in an unkind manner but with no thought to what the resident was doing at the time. The Inspector observed the nurse putting tablets in to the resident’s mouth whilst he had a mouthful of breakfast and then giving him a drink. The resident ended up chewing the tablets with his breakfast. This was discussed with the manager for her to observe and deal with if this is normal practice. It was also discussed, why does the medication have to be given half way through a meal and not wait until the end. The systems for the storage and for the recording of medication were checked and were found to be satisfactory. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 13 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): 12,13,14 and 15 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. The activities in the home are poor and therefore do not provide stimulation for the residents. Relatives are welcomed and encouraged to visit the home whenever they wish. Residents are encouraged to make choice, however this can be limited. Dietary needs for the residents are not well catered for, are not varied or well balanced or presented in a manner to meet the resident’s needs. EVIDENCE: The home employs an activities coordinator, however on the day of the first day of the inspection she was doing the cooking, the second day she rang in sick. During the course of the inspection no activities took place. There is no regular plan of activities and when the Inspector spoke with the activity coordinator she did not appear to have an understanding about what activities could be offered or how activities should be seen as a main component of a positive approach to dementia care. Activities are important for people with Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 14 dementia because they provided opportunities for, retaining the highest possible level of functioning, rebuilding and sustaining confidence and self esteem, social interaction, assessment, exercise and enjoyment, relaxation and stress reduction. Staff spoken with said that activities were not carried out on a regular basis and that when they were it mainly took place on the ground floor and not upstairs. Events have been planned, for example a jumble sale and a Summer Fete, this will help raise residents funds, however residents will not be able to take an active part, as the Summer Fete is at the front of the home which is not secure for residents to go out unless a family member or staff is available to accompany them and not residents would have little understanding of what goes on at a jumble sale. It was observed by the Inspector that residents were left to their own devices, many residents were seen to be wandering round aimlessly with little or no staff intervention. It was noted that televisions were left on in the lounges but this appeared to be more for the staffs benefit. On examination of some resident’s files it was noted that the activity coordinator had been called for jury service for two weeks, therefore what little activities there were had been suspended, no other member of staff was moved over to cover in her absence. A full activity programme must be devised taking in to account the capabilities of the residents and the activity coordinator must divide her time between the residents on both floors. Up to date information about activities should be circulated or displayed to resident in formats suited to their capacities, it will also inform relatives of what goes on in the home. A copy of the planned activities must be forwarded to the Inspector. Four visitors were spoken with and confirmed that they could visit the home at any time and were always made welcome. One visitor attends about three times a week and spends all day there. One relative spoken with said, “the care provided is good and that there was nothing that gave cause for concern”. Other relatives spoken with were also happy with the care they relatives received. With regard to choice, this can be limited, however staff were heard asking residents what food choice they would like for lunch. Some residents had decided to stay in their own rooms and not get dressed, this was not an issue. With regard to the food served, the menus were inspected and do not offer enough variety to provide residents with a nutritious and well balance diet. The menus were planned on a four weekly basis, and were seen to be bland and uninteresting, for example most days breakfast was the same, at nearly every lunch time creamed potatoes were served, there was no new potatoes or jacket potatoes. Desserts alternated from sponge and custard one day and a milk pudding the next day, there was no homemade cakes, cheesecake, stewed fruit and cream, cheese or biscuits or any other variety offered. It would appear that these desserts were made for cook’s convenience using a Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 15 sponge mix. The use of a wide range of convenience food was noted in the supplies looked at in the freezers. The Inspector visited the home at 05.30 and noted that three residents were up and other were starting to get up, staff on duty said that residents are given a drink, however there was no evidence to confirm this. Breakfast is not served until approximately 09.30, therefore some residents have been up for 4 hours without something to eat or drink. Residents must be given a drink of their choice and something to eat, toast for example when they get up early. It would be beneficial if breakfast were served on a flexible basis, to allow residents to eat when they wanted. The home needs to purchase another hot trolley, one for each floor to allow the food to be served at the correct temperature. On the first day the inspection, for breakfast it was porridge served from a thermos jug which was very hot when given to residents, tomatoes with toast or toast and jam. Tea was served; residents should be offered a choice of tea or coffee. A carton of orange juice remained unopened until the Inspector asked staff if any one would like juice. Staff then offered juice after the meal and the hot drink had been served. There was no variation for example prunes or grapefruit available. The tomatoes and porridge should have been kept hot at the correct temperature in a hot trolley. Lunch is the main meal of the day; the Inspector observed that staff started to bring residents into the dining room at 12.00 and at 12.40 the lunch arrived by this time 5 residents were asleep, this practice is not acceptable and was discussed with the manager for her to address. The Inspector sampled the lunch which was chicken casserole, creamed potatoes, carrots and frozen mixed vegetables, followed by instant mousse, as the stand in cook had not time to make the planned dessert. The chicken meal was acceptable and adequate portions served. An alternative to the chicken was sausage, which was served with the above vegetables, this was very dry and appeared uninteresting. On the second day the kitchen assistant took charge, lunch consisted on braised steak, creamed potatoes, garden peas and cauliflower, the lunch was sampled and was nicely cooked and again adequate portions served, the dessert was semolina pudding. The option offered was frozen battered fish fillets, served with the vegetables, again this was very dry and would have benefited from some parsley sauce. The braised steak was placed on the plates in large pieces; some residents were observed struggling to cut the meat. The Inspector offered assistance and eventually staff helped residents to cut their meat. Some staff were seen sitting feeding those residents who could not help themselves. One resident was observed enjoying his dinner, but due to limited use of his hands the food was shovelled to the edge of his plate, more food was over the resident and the table. The Inspector asked if the home had plate guards. Staff confirmed they had they but there was not enough room of the trolley for the cook to send them down. This is not acceptable and the nurse in charge of the floor should make sure that plate guards are used. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 16 A pureed diet was required for a least one resident; this was presented mixed together in one bowl. This mixture was bright green and was served to the resident with no pureed meat to accompany. The Inspector sampled the pureed food and it just tasted of garden peas, the Inspector asked 2 members of staff to taste the food, which they did reluctantly, then promptly left the room to spit it out. The pureed food was described as ‘disgusting’, however it was served to residents. Several staff had completed NV Q level 2, which covers diet and the way food should be presented. Staff were aware when asked, and said, “pureed food should be blend separately and served in individual portions”. Staff said that the manager had bought trays that had individual sections for pureed food, however these are not used, as there is not enough room on the trolley. The nurse in charge of the floor should ensure that food is pureed and served in acceptable manner. The teatime menu must be reviewed; most days it’s packet soup and sandwiches served. The Inspector noted that the sandwiches made would not be enough to ensure that residents received a substantial meal. The cook should be preparing homemade cream soups and sandwiches one day and a variety of teatime snacks, for example, cheese and tomato quiche with salad, fish cakes with baked beans or tomatoes, scrambled or poached egg on toast, followed by a dessert, maybe yoghurt, fresh fruit, fruit and cream or homemade cake. The Inspector suggested that the manager should obtain a copy of the Caroline Walker book, Eating well for Older People and Food, Drink and Dementia from the University of Sterling (Helen Crawely). Staff on nights were asked about suppertime, they informed the Inspector that residents had a jam sandwich and a cup of tea. The Inspector has discussed with manager that a proper supper should be provided, for example toast, teacakes, crumpets and milky drinks for example, hot chocolate, Ovaltine or Horlicks should be available. Staff said that it would be difficult to make a supper as the kitchen is on the top floor and staff would have to leave the floor to go and make supper. Again the question is raised with the manager whose needs are being met, residents or the staff. This was discussed with the manager, was there a possibility of having a kitchenette area on each floor or that thermos jugs of drinks are made in advance and brought down on to each floor. The time lapse from the main meal served at lunchtime to the next main meal at breakfast is 21 hours. This is not acceptable and must be addressed. When asked, staff said at times several residents may be up during the night, therefore a choice of drinks should be readily available. It was discussed with the manager that residents preferences and culture requirements should be taken in to consideration when planning the menus. The cook should be aware of this and offer an appropriate diet. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 17 Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 18 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a suitable complaints procedure in place, residents and their supporters can be assured that their complaints and concerns will be listened to and appropriate action taken. The home has a robust adult protection policy in place, however not all staff have been trained in this area which could potentially place residents at risk. EVIDENCE: There had been three complaints made since the last inspection. One complaint is still on going and is being dealt with by the manager; the other complaints have been suitably dealt with. There have been no complaints made to CSCI. Up to date policies and procedures on the protecting and safeguarding residents from abuse in any if its forms were in place. There has been one incident that required a Protection of Vulnerable Adults Investigation. Most staff have received training in the Protection of Vulnerable Adults, 8 staff still have to undertaken training in this area. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The standard of the environment needs to be improved to provide residents with a safe a homely place to live. Infection control procedures are good, making this a clean environment for residents. EVIDENCE: As brought to the attention of the manager at the last inspection the ground floor is maintained to a higher standard than the first floor. This is not acceptable and must be addressed to ensure that residents are offered the same standard of accommodation. On a tour of the premises it was seen that bedrooms were clean and tidy and suitably furnished. The lounge on the first floor needs new curtains, the existing ones are old and tatty. The day room on the first floor (the snoozelum) is out of action, this need to be utilised. The carpet needs replacing as it is burned in places, and there are no curtains at Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 20 the windows and the two shabby chairs in the room need replacing with some new furniture. Residents would benefit from some comfortable seating outside the main dining rooms on both floors, as this is a main place where residents tend to congregate. The TV upstairs needs attention; staff said that the channels had to be turned over by sticking a pen a hole on the TV. Staff said they feel that residents would benefit from a DVD player but their requests had not granted. This was discussed with the manager. It was discussed with the manager about the lack of orientation aids and pictorial signage to assist the resident’s move around the home. All residents bedroom doors, bathroom and toilet doors are all the same colour, it was noted that some symbols were on some doors. The outside area of the home must be made safe and secure and accessible for residents. This was brought to the managers attention at the last inspection and an Immediate Requirement for prompt action to taken was left following this inspection. A lengthy conversation with the domestic staff took place. It was evident from tour of the premises that the staff worked hard to keep the home clean and free from any adverse odours. Staff said that their hours had been reduced when home was not full, the intention being to up the hours when the home had reach capacity. This has not happened. Staff said that although 4 domestic staff are employed there is only 3 on duty as one is always day off. Staff said that a new vacuum cleaner was required for the first floor as the other had broken and had not been replaced. The laundry was inspected and all the equipment was seen to be working order. Staff said that it was difficult to get through the amount of laundry as no staff worked in the laundry after 15.30. The home would benefit from another member of the domestic team or to increase staff hours. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 21 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The deployment of staff in the home is not appropriate to meet the assessed needs of the residents. Staff were subject to an appropriate recruitment process that provides the necessary safeguards to protect residents living at the home. Staff NVQ training is progressing slowly therefore residents are not being cared for by care staff that are suitably qualified to deliver the care required. EVIDENCE: At the time of the inspection there was not enough staff working the floors to meet the assessed needs of the residents. On each floor there was on a nurse on duty and four care staff, there are twenty-four residents on each floor. The recommended ratio for caring for people with dementia is one to five. However, the nurses on both floors are doing other tasks and were rarely seen offering care. The nurses carry out the medication rounds, write up the care plans and spent several hours doing the reordering of medication. This in effect left four care assistants to provide care for the residents. The nurses in charge on both floors did not assist at meal times and therefore could not oversee what was happening at meal times. These arrangements need to be addressed, and it was discussed with the manager that it would be beneficial if Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 22 the night staff did the reordering of medication at night when there was not as much activity going on. The nurses on the floor must take full responsibility of their shift, it was observed that care staff were left to their own devices and the care staff continually asked the manager about issues or concerns rather than the nurse in charge. The staff on each floor should be properly deployed to attend to the needs of the residents during the day. An early morning visit to the home to speak with staff on night duty took place. On the both floors there was one nurse and one carer and another carer that worked between both floors. Three residents were up at 05.30 on the ground floor, no residents were up on the first floor, however some were starting to stir. The Inspector was told that drinks were available but there was no evidence to demonstrate that residents had been given a drink. When asked about suppers, staff said, “ we can’t make proper suppers as it would mean having to leave the floor and go up to the kitchen”. This is not acceptable. There should be a minimum of one nurse and two care assistants on each floor to ensure that the residents are given a substantial supper and drinks and something to drink and eat when they get up for example toast, as breakfast is not served until 09.30. Staff training is progressing slowly with only 22 of care staff having completed NVQ level 2. Eight staff still need to complete POVA training and not all staff has completed Health and Safety training. Staff have completed Dementia Training, Fire Training, Basic Food Hygiene. Other training is planned (no dates submitted) to cover Challenging Behaviour, POVA, First Aid, Health and Safety, Infection Control and Dementia. Four staff files were looked. All files contained an application form, two written references and a CRB disclosure check and other forms of identification and job descriptions. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The manager is qualified to carry out her role but lacks support from the trained staff. Quality assurance systems are in place, however this area needs to be developed to ensure that the home is run in the best interest of the service users. The home has a satisfactory system in place to safeguards resident’s finances. Procedures and practices within the home safeguard the health and safety of people living and working in the home. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 24 EVIDENCE: The manager is qualified to run the home, however it was evident that she lacks support from the other trained staff. The manager is capable of dealing with her managerial role, but is also seen to be covering and dealing with everyday minor problems that the nurse in charge of the floor should be dealing with and then feeding back to the manager. Care staff were observed on numerous occasions throughout the inspection to ask the manager to come and look at a resident, or can you come and check this, when the nurses where in the office. The manager must delegate some tasks and the nurses must take responsibility for their shift. The home is currently without an administrator, which again has put added pressure on the manager as she is dealing with administration duties. The manager would benefit from her own office as hers is currently shared with the administrator, when in post. This makes it difficult for the manager to discuss any issues that may arise in confidence. Quality assurance systems are in place, however the home relies heavily on the views and opinions from relatives. There was no resident at the time of the inspection who could voice their opinion on the home, the standard of care, the food or social events. The manager holds six monthly reviews of residents and the family are invited to attend. Satisfaction questionnaire are sent to relatives, the results of these surveys must be published and made available to all interested parties, including the CSCI. A named person from Southern Cross Healthcare should visit the home at least once a month and provide a written report (Regulation 26 visit). This has not been done as required and the last one was dated for the 10/04/06. Visits must be carried out, accompanied by a written report and a copy of the report must be forwarded to the CSCI. The finances for four residents were checked. Personal finances are held individually and are securely stored. Personal balance sheets are kept on computer and of the finances examined no discrepancies were found. The homes accident book was looked at and accidents and incidents had been appropriately recorded. There has been an unaccounted gaps in the information regarding accident or incidents (Regulation 37 forms) that the CSCI should have been notified about. The manager confirmed that there had been several occurrences and the appropriate forms completed, however the CSCI have not received them. The following safety and servicing certificates were examined and were found to be up to date: gas, electric, lift, and fire alarm systems. A fire drill was carried out during the inspection. Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 25 Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 26 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 2 X 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x 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 2 x 2 x 3 x x 3 Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 27 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 OP9 Regulation 13 Requirement The method of dispensing of medication to be reviewed, with regard to the way and the time the tablets are given. Continence products to be suitably and discreetly stored. Residents to be suitably dressed at all times. A range of activities to be planned and implemented. A copy of the plan is to be displayed on both floors in the home and a copy forwarded to CSCI. The menus must be revised to ensure that residents receive varied, well balance diet. Copies of the menus to be forwarded to CSCI. Suppers must be provided. Early morning drinks and snacks to be provided to early risers. Drinks should be available at all times during the day and night. Timescale for action 07/07/06 2 OP10 13 07/07/06 3 OP12 16 07/07/06 4 OP15 16 07/07/06 Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 28 A second hot trolley must be purchased to ensure the food is served at the correct temperature. The time that residents are brought in the dining room and left to wait for meals to be served must be reduced as some residents were sat 40 minutes waiting for their lunch. Appropriate adaptations must be in place to assist residents to eat independently. Pureed meals must be served and presented in an appealing manner. Cultural preferences should be considered and introduced. 5 OP18 18 All staff must receive training in the protection of vulnerable adults. (This is outstanding from the last two inspection 31/08/06 and 05/12/05). 07/07/06 6 OP19 23 The garden areas are to be made 07/07/06 safe for residents. (This outstanding from the last inspection and an Immediate Requirement was made at this inspection). The day room on the first floor requires attention, the carpet has cigarette burns in it and the furniture needs replacing. 07/07/06 7 OP19 23 8 OP27 18 9 OP27 18 There must be an adequate 07/07/06 number of staff to ensure laundry and other domestic tasks are completed. All staff (including nurses) must 07/07/06 be properly deployed in their duties to ensure needs a DS0000005703.V289019.R01.S.doc Version 5.1 Page 29 Westleigh Lodge 10 OP31 9 11 OP33 24 12 OP33 26 recommended ratio of 1 – 5 caring for residents during the day. The registered manager must 07/07/06 ensure that there are clear lines of accountability within the home. The manager must ensure that senior staff are carrying out their role effectively. Effective quality assurance 07/07/06 systems must be developed and results published to all interested parties including CSCI. Monthly visits to the home from 07/07/06 a named person from Southern Cross Healthcare must carried out and a written report produced, a copy of which must be forwarded to the CSCI. 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 OP1 OP27 OP31 Good Practice Recommendations The format of the service user guide needs reviewing. To ensure that 50 of care staff are qualified to NVQ level 2 in care. The registered manager should continue to work to complete the Registered Managers award, (estimated date for completion is September 2006). Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Westleigh Lodge DS0000005703.V289019.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!