Inspection on 06/04/05 for Whitchurch Lodge

This inspection was carried out on 6th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Whitchurch Lodge 09/07/08

Whitchurch Lodge 13/07/07

Whitchurch Lodge 20/04/06

Whitchurch Lodge 21/06/05

Whitchurch Lodge 08/12/04

Whitchurch Lodge 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Whitchurch Lodge 154-160 Whitchurch Lane Edgware Middlesex HA8 6QL Lead Inspector Clive Heidrich Unannounced 6th April 2005, 10:00hrs 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. Whitchurch Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Whitchurch Lodge Address 154-160 Whitchurch Lane, Edgware, Middlesex, HA8 6QL 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) 020 8952 5777 020 8952 5777 Finbond Limited Mrs Beatrice Anne Donlevy CRH PC Care Home only 32 Category(ies) of OP Old Age registration, with number of places Whitchurch Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 8/12/04 Brief Description of the Service: Whitchurch Lodge is a care home providing personal care and accommodation for up to 32 older people. The registered provider of services at the home is Finbond Limited, a local company, in which the partners are Mr Raithatha and Mr Mehta. Mr Raithatha is more actively engaged and visits the home a number of times each week. The home itself has been operating as a care home since 1965. The premises consist of a two-storey building that was adapted from local houses. It was significantly rebuilt in the mid-1990s. It blends in well with surrounding homes.The home is located within a residential area of Edgware, near Canon’s Park tube station, within the London Borough of Harrow. It is around five minutes’ walk from shops and a park, and has a bus stop outside the home for buses on the #186 route between Harrow and Edgware. The home has a driveway that can take about six vehicles. Five of the home’s bedrooms are double rooms. All bedrooms are fully furnished. They have either built-in hand-wash basins or en-suite toilet facilities. The home has five communal bathrooms and nine communal toilets. Access to the first floor is by stairs or a lift. The home has a large dining room, and a large main lounge that is arranged into three separate areas. The home has a fair-sized open garden, with an extensive patio area and suitable garden furniture. Management informed the inspectors that one registered double room is being used as a single room. Hence maximum occupancy is 31 people. This maximum had been achieved by the final day of inspection. Whitchurch Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place partially as a result of the CSCI agreeing to investigate a number of individual complaints of mistreatment and abuse of residents in the home made by one staff member, consequently supplemented by single complaints from a council reviewing officer and from an anonymous source. The investigation involved analysis of a number of records and interviews of a number of staff. The investigation was almost completed by the time of drafting this report. The inspection also considered how well the home has responded to the large number of requirements made within the last inspection report. The home was visited throughout the days of 6th, 14th and 15th April 2005 by the inspectors Mr Heidrich and Mr Schwarz. The latter two days were planned visits to interview staff. The home was also visited unannounced by the pharmacy inspector, Ms Shaw, on the 11th April. Regulation manager Ms Freeman accompanied Mr Heidrich for short visits in respect of one of the complaints on 21st and 27th April. The inspection involved a partial tour of the premises, the checking of records, and discussions with the majority of residents, a few visiting relatives, and a number of staff. CSCI questionnaires were sent out to relatives and friends of all residents following the first day of visiting the home. 15 replies were received at the time of writing the report, most of a positive nature. Their comments are incorporated in the report. The inspectors thank everyone at the home for their help with the inspection. What the service does well: What has improved since the last inspection? There were few improvements noted. A big effort to improve on the safety of the moving and handling of residents within the home has taken place through refresher training by an external consultant. The only improvement observed Whitchurch Lodge Version 1.10 Page 6 during the inspection following this training was however that footplates are now being used on residents’ wheelchairs. Residents’ individual records and care plans are starting to be kept more upto-date, and are being reviewed regularly. Staff now need guidance about how to use the reviewing process to make improvements in residents’ lives in practice. Some areas of the home, including the laundry room and the medication trolley, were noticeably cleaner than at the last inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whitchurch Lodge Version 1.10 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 Whitchurch Lodge Version 1.10 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 No progress has been made with distributing the new service user guide to relevant people. Without a detailed guide about services in the home, prospective residents and their relatives will not be able to make a fully informed choice about whether to move into the home or not. Current residents and their relatives are not being kept up-to-date in writing about the services offered at the home. EVIDENCE: It was previously required for the updated version of the resident guide to be supplied to both relatives, residents who are capable of using it, and to the CSCI (along with the similarly updated statement of purpose). One resident was able to confirm that they do not have a copy of guide. The CSCI did not have copies of the updated documents at the time of drafting this report. It is therefore judged that prospective residents and their relatives are unlikely to receive a copy of the guide either. Whitchurch Lodge Version 1.10 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, 8, 9, and 10 The inspectors observed that residents’ needs were not sufficiently addressed during this inspection, raising serious concerns about the standards of care provided. Dental, foot-care and continence needs were identified for immediate action during the visit, although the home benefits from district nurse and GP support. Standards of care in terms of residents’ appearance was sometimes poor. It was usually poor in terms of support to manoeuvre residents. Although there were a number of positive comments about the care provided by staff, care is judged by the inspectors as too task-based and routine driven, and as such individual needs within this are not easily met for individual residents. Care is backed by individual plans and assessments, but these often did not reflect the care needed or given to individual residents. EVIDENCE: Feedback received in general about the care provided, from both relatives and residents, was in the main positive. Comments such as “staff are very friendly and actually talk to, not at, the residents” were common amongst relatives. Individual plans of care were now in place, and being reviewed monthly, for the six residents checked on in detail. The plans remained insufficient in terms of failing to record and address needs in terms of many areas. Health care Whitchurch Lodge Version 1.10 Page 10 issues were often not recorded about, whilst the areas of continence, mobility, and daily routines for instance gave insufficient individual information. In a number of cases, the care observed did not match with that on the plan, in particular for mobility needs. The monthly reviews of plans, and sometimes of generic risk assessments rarely altered the care plans, even in instances where the assessments highlighted increased dependence. Daily records continued to record vague statements about residents, where key details about events would be useful for monitoring and communication purposes. Some residents noted about lacking the support of a dentist, and one was unhappy about the length of her nails. There remained insufficient continence support for dependant residents according to staff feedback and inspector observations. At one point, one inspector pointed out to staff that the trousers of a resident in the lounge were soaked through. The inspector was later informed that this person would have been double-padded, which is poor practice. Discussions with staff found toileting support to be lacking individual planning and monitoring. Individual residents’ records tended to note a lack of appropriate professional input in all these areas alongside insufficient planning. These issues were highlighted within the urgent action letters sent to the registered people in advance of this report. The CSCI pharmacy inspector’s report of her visit of 11th April 2005 noted some improvements on the previous visit, but highlighted eight areas for improvement, some of which remained from the previous visit. The report is available on request. Whilst improvements had been made on ensuring that wheelchair-dependant residents were supported in appropriate wheelchairs, there were occasions seen of staff wheeling people one-handed or backwards, and of staff transferring people poorly. The hoist was not seen to be used, as confirmed by a number of staff. There were also a number of occasions when some residents were seen to be wearing ill-fitting, poorly maintained, or dirty clothing during the visit. One resident commented that the clothing lady is good with clothes, but other staff tend to mix them up. The afore-mentioned person was on leave on the first day of the inspection. These appearance and resident handling issues were highlighted within the urgent action letters sent to the registered people in advance of this report. Whitchurch Lodge Version 1.10 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, 13, 14, 15 The inspectors observed during this inspection that residents’ routines were based around staff tasks of support with personal care and meals. There was little in the way of activities and stimulation. Serious concerns were raised about the frequency of residents being left unattended in the lounges. Dependant residents were not receiving sufficient support with drinking drinks. Staff did not appear to be sufficiently qualified or monitored to achieve these standards. Planning and monitoring records for individual residents were lacking. Residents hence lack sufficient choice and control over their lives. The home does enable good contact with friends and family. EVIDENCE: All 15 relatives and friends wrote within feedback forms that they are always welcomed into the home by staff and the owners, and that they can visit their friend/relative in private. The majority said that they are kept informed, and are consulted about, their friend/relative’s care. This is encouraging. It was also noted that the home has a new phone system. Some residents have phones in their rooms from which it was checked that they can dial out directly. Initial problems were reported with transferring incoming calls, although one resident reported that this was being temporarily addressed through staff bringing the new portable phone to them. The inspectors were struck by the late rising routines of residents across the days visited. In one case, there were just six residents in the lounges at 11am. Whitchurch Lodge Version 1.10 Page 12 Feedback from staff confirmed that it was standard practice for breakfast to be served for most people in their rooms and for some residents to be supported to get up and dressed shortly before lunch. Staff paid little attention to those residents in the lounge before lunch, aside from the mid-morning drink and snack routine. Many residents in this situation were observed to sleep. An audit of what each resident would prefer in respect of morning routines (e.g. times of getting up, getting dressed, and having breakfast, and in what order) recorded about within each individual plan, and with a consequent plan of action to best meet group needs, is required. In a similar vein, concerns were expressed, by the CSCI within one urgent letter to the registered people, about there sometimes being no staff present in either lounge when residents were present. Key times for this included during the morning when staff are supporting residents to get up, and around 7pm when staff are writing reports. Additionally, at one stage in the early afternoon, a resident came to staff in the dining room to ask for support with an argument developing between two other residents in the lounge. One relative commented that there are not enough staff to keep an eye on everyone to keep them safe (see also standard 27). The safety of residents in the lounges is compromised when they are not monitored directly, which must be addressed. Residents’ feedback about activities in the home found there to be little beyond the TV, a visiting weekly musician, and occasional exercise. Some more-able residents spend time in their rooms using TVs or radios. Observations during the inspection found one music session, one birthday celebration, and sometimes staff talking with residents, but residents were often either left to watch TV or listen to the radio (and in one case, both at the same time). There was no evidence of an activities co-ordinator as was previously the case in the home (nor of any additional staffing to cover this), and no residents were able to say in advance as to what activities were due to take place. Stimulation of residents must be reviewed and improved. Lunch on the first day of the inspection was chicken in a rich sauce, with potatoes, carrots and sliced green beans. The vegetables tasted fine and soft. A fruit cocktail with cream was for dessert. The cook blended leftover vegetables, along with others that were freshly chopped, for the soup for tea. Lunch did not tie in with the menu. The menu-choice book, for residents to choose from two different options, had not been filled in for five days prior to the first day of inspecting. No residents were aware of choices for meals, although their general feedback about the food was that it is reasonable. There was little in the way of food and drink intake records with which to monitor residents’ consumption. There was evidence that practical support for enabling some residents to drink their drinks was also missing, causing some residents to miss out on their drinks. This must be promptly addressed through proper equipment, staff support, and records. Whitchurch Lodge Version 1.10 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) 16, 17, 18 The inspectors found during this visit that complaints and whistle-blowing procedures were not being robustly followed, and that a number of residents were not confident about their complaints being acted on appropriately. Some residents exhibit aggression or wandering. Guidance to staff about handling individual needs in this respect was poor, as were monitoring records of incidents. Staff training in this respect has been required since 2003. The view of the inspectors is that staff are not adequately equipped to work with residents who challenge the service, that monitoring of such residents’ behaviours is poor, and hence that the residents are not being kept sufficiently safe. EVIDENCE: 8 of the 15 feedback forms from friends and relatives noted that they are aware of the home’s complaints procedures. Residents’ feedback about complaints found more people saying that the manager and deputies do not act on complaints, although some disagreed with this. The inspectors found evidence in support of the lack of action, as at the previous inspection, which must be addressed. Some staff additionally reported concerns to the inspectors which they had not addressed with the registered people for various reasons. The registered people must ensure that whistle-blowing procedures are clear, effective, and are used. One specific resident’s needs, in terms of being cared for in their room, was questioned by the CSCI to the registered people within one urgent action letter. This was based on staff members’ incorrect perception of how to manage the resident’s infection status. It was consequently clarified that this was not the only reason for the resident not being supported to leave the Whitchurch Lodge Version 1.10 Page 14 room, but the registered people must ensure that all residents have the freedom of the home as far as reasonably practical. A few staff members noted that some residents continue to provide challenging behaviours to the services provided. Some residents reported about taking their own measures, such as through locking their door, to prevent a few key residents wandering into their rooms at night. Individual plans and risk assessments included minimal information for those residents that wander, and nothing for residents who can be aggressive. Records, as noted under standard 7, provided little feedback about incidents for monitoring and reassessment purposes. Staff confirmed that there was still no training in how to handle the challenging behaviours of residents. This key aspect of some residents’ needs is consequently not being addressed, putting residents and staff at risk. The manager has for instance notified the CSCI since the inspection visits about one resident absconding from the home for a period of hours. The registered people must urgently ensure that the needs of residents who can exhibit challenging behaviours are positively addressed. Whitchurch Lodge Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 22, 25, and 26 It was noted during the inspection visits that although the environment is reasonable, it has a number of areas that must be improved upon. Issues such as faulty equipment, banging doors, and one area of poor cleanliness should be easy to address. Odour control issues remain in the home as at the last inspection, which reflect both poor continence management and acceptance of lowered standards of hygiene. The effectiveness for residents of the staff-call alarms system is additionally questioned. EVIDENCE: There has been no significant change to the décor of the home since the last inspection. The standard was reasonable but in some areas untidy. It was noted that the television in the small lounge was not working during the first visit, and that the grandfather clock there was never working. Equipment for residents’ use must be fixed or replaced promptly. There was also evidence of large items being dumped in the garden, sometimes in view of residents, so compromising their view as well as having potential health and safety risks. Whitchurch Lodge Version 1.10 Page 16 The main toilets for residents from the small lounge were in a worn state of repair. The requirements to change flooring and fix a lock from previous inspections had not been addressed. The bin in that area contained black mould around its base across the first two days of inspections. The registered people must review and ensure the effective cleaning of this toilet area. Feedback from residents about the effectiveness of the staff-call alarm system varied. One resident noted that it takes a long time before getting a response. The inspectors also observed varied responses. There was no clear system amongst staff for responding to the alarms. There was feedback that the alarm is not always clearly heard by staff. The registered people must review and ensure the effectiveness of the alarm equipment and staff responses to it. Feedback from residents about the warmth of the home varied. Some said that their rooms are warm, others noted that improvements could be made. The home generally felt warm enough to the inspectors during the visits, but one resident’s bedroom was a clear exception. This was partially addressed during the inspection. One resident commented positively on the continual cleaning that they saw within the home by staff. There is a team of dedicated cleaners employed within the home. One relative commented on the unacceptable odours within the home. There were offensive odours within areas of the home during the inspection. The entrance hall and the lift were noted for this at times. One residents’ room, and the corridor outside, remained with strong odour throughout the visits. This was put to the registered people as unacceptable within the second urgent action letter (see also standard 8). There was some feedback amongst staff that the two dogs in the home contribute to the odour. These staff felt that they cannot oversee the dogs as well as residents, which was observed to be the case. The registered people must ensure that the offensive odour issues are addressed. Whitchurch Lodge Version 1.10 Page 17 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, 28, 30 Staffing levels were found during the inspection to be generally upheld, with occasional exceptions at night. It remains unclear as to whether these levels are sufficient, as the CSCI await an audit of this from the manager. Staff have still had little in the way of training from external sources. The evidence of poor outcomes in many areas for residents, as per other sections of this report, show that staff need this training to be competent to do their jobs. The current staffing set-up is not enabling residents’ needs to be met. EVIDENCE: Feedback from residents showed that they generally feel that there are not enough staff working in the home. A typical comment was that the home needs one more staff at all times, as on some days staff are very busy. Relatives tended to feel that staffing levels are sufficient. The inspectors observed, as per the evidence under standards 12-15, insufficient staffing in the home in terms of such things as residents’ stimulation and enabling residents to get up well before lunch. The manager has been required to justify the staffing levels with evidence since the previous inspection. This was reiterated within the first urgent action letter following the first day of this inspection. At the time of drafting this report, the issue remains outstanding. Daytime rosters indicate that the manager aims for 7 care staff in the mornings and 5 in the afternoons, in addition to domestic staff. Rosters just prior to the inspection indicated that this is usually upheld, through current staff covering any form of leave. This suggests that it is not a shortfall between planned and actual staffing levels during the day that is causing the difficulty in Whitchurch Lodge Version 1.10 Page 18 meeting the needs of residents as a whole. It is also encouraging that cover for leave was organised by the staff team, as the manager was noted to be on leave herself during this period. The manager’s presence must now also be included on the rosters. Checks of the rosters for the home for 2005 found a number of cases of there being only two staff working at night. This has the potential for incidents to occur, especially with respect to the concerns raised about wandering residents under standard 18. The registered people must use agency staff if necessary to uphold staffing levels at night. Staff commented that the only training they had received since the last inspection was refresher training about how to manoeuvre residents correctly. Feedback found very low levels of staff with NVQ qualifications, with no-one currently undertaking them. The manager has since stated to the CSCI that there has been no training budget available, and that she is liaising with the Learning Skills Council to start enrolling staff onto NVQ courses in care as a priority. The registered people must ensure that all past training requirements are now addressed, as the evidence within this report, particularly between standard 7-18, is of a staff team that is insufficiently trained and competent to meet the needs of the current residents. Whitchurch Lodge Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37, 38 From this inspection visit, the inspectors judged that the home lacks clear leadership and management, from both the registered people and within the deputy team. This is based on the poor outcomes for residents detailed throughout this report, particularly in terms of both not meeting residents’ needs and the poor quality of monitoring of care services in the home. Staff are not sufficiently supervised. There are some aspects of health and safety that compromise residents’ and staff welfare. EVIDENCE: There was some feedback received from residents and relatives about concerns about the manager’s absence. Observations of the systems of management in the home during the inspection, all in the absence of the manager through sick leave, were of one deputy taking responsibility for overseeing some aspects of the care provided, with no-one overseeing other management responsibilities such as admissions, training and supervision. Regardless of the manager’s Whitchurch Lodge Version 1.10 Page 20 presence, feedback and observations showed that staff were lacking in management support and monitoring. Staff confirmed a lack of formal supervision, with some noting that grievances are not addressed by the registered people. Other aspects of this report show how this lack of management is having an adverse effect on residents. The registered people must ensure that residents and staff benefit from clear leadership and management, both in the presence and in the absence of the manager. The manager must also achieve the NVQ level-4 qualification in care and management. Based on concerns raised by some staff about the home (see also standard 16), the registered people must audit the views of the staff team about care practices in the home. It is recommended that this be through an anonymous survey. Similar quality audit practices have previously been required by the CSCI, for residents and relatives’ viewpoints. There was no evidence of this having taken place during this inspection, although the manager has since stated that relatives and residents’ meetings will be re-introduced. The registered people must ensure that effective quality audit systems for the home take place. The notifications to the CSCI about deaths of residents in the home has now been re-established. Some shortfalls about similarly notifying for serious injuries and incidents to residents (including hospital admissions from these) were identified, which the registered people must ensure now happens. The main files for residents are routinely left in the dining room by staff, so that they can read and update them on an ongoing basis. Whilst this is of clear benefit to staff, it allows the confidentiality of residents’ information to be broken. At one stage, a resident was seen to be reading the deputy handover book whilst sitting with a report-writing staff member. The registered people must ensure that confidentiality of residents’ information is upheld. The inspectors identified aspects of health and safety in the home that must be improved upon. Some aspects, such as monitoring the temperatures of all fridges in the kitchen instead of only some, have remained from the last inspection. Others, such as ensuring that fire doors are properly used, and that large items are never placed in front of them preventing their use, are from this visit only. A full list of these are contained in the requirements at the end of the report, to be addressed so as to minimise risks to residents and staff. Whitchurch Lodge Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 1 COMPLAINTS AND PROTECTION 2 x 1 2 x x 2 1 STAFFING Standard No Score 27 1 28 2 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 2 1 1 1 1 2 x 1 1 1 Whitchurch Lodge Version 1.10 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(2), 5(2) Requirement Copies of the updated statement of purpose and service user guide must be supplied to the CSCI as per the legislation (timescales of 1/10/04 and 31/1/05 not met). The new version of the service user guide must be distributed to relatives, and to those service users capable of using it (timescales of 1/9/04 and 31/1/05 not met). Individual plans of all service users must be developed to be sufficiently broad, covering the areas listed under standard 3.3 [including in particular about health matters]. (timescale of 1/4/05 not met). Service user risk assessments must be developed to include the assessment for the prevention of falls (timescale of 31/1/03 not met). The assessments must clarify the actions to be taken to prevent falls, including both from walking and from beds where applicable, and must state when these actions have been taken. The monthly reviews of individual plans must reflect any Version 1.10 Timescale for action 31/1/05 2. 1 5(2) 31/1/05 3. 7 15 15/6/05 4. 7 13 31/1/03 5. 7 13(4), 14(2), 31/7/05 Whitchurch Lodge Page 23 15(2) 6. 7 15(1), 15(2)(c) 7. 7 17(1)(a) schedule 3 part 3 8. 8 12(1),(4), 15, 18(2) 9. 8 10. 8 11. 8 12, 13(1)(b), 15(2)(bd), 16(2)(k), 18(1)(a), 18(2) 12, 13(1)(b), 18(1)(a), 18(2) 12, 13(1)(b), 18(1)(a) changes to the residents care needs. This includes for where generic risk assessments have highlighted increased dependence. The monthly reviews must ensure that care planning and practices for individual residents is consistent. Individual plans must be agreed with the service user or their representative where this is practical for these people. There must be evidence of this agreement (timescales of 1/10/04 and 1/4/05 not met). Records about each service user kept on a daily basis must be more informative than statements such as “all care given.” (timescale of 1/2/05 not met). It is required that continence plans are kept on applicable service uses’ files, for clear guidance to staff about their responsibilities (timescale of 1/12/03 not met). Further input from the continence nurse must be sought for dependent service users, so that clear and effective continence plans for them can be set up and followed. The input of a dentist to visit dependent service users must be obtained. Where staff have the necessary skills, and with appropriate resident consent, if fingernails are too long, staff must support relevant service users to trim their nails. Plans for appropriate professional support (e.g. chiropody) in respect of finger and toenail care of residents Version 1.10 1/4/05 15/6/05 1/12/03 25/4/05 13/4/05 16/4/05 12. 8 12, 13(1)(b) 20/4/05 Whitchurch Lodge Page 24 13. 9 13(2), 17(1)(a) schedule 3 part 3(i) 13(2), 18(1)(a) 14. 9 15. 9 13(2) 16. 10 12, 13(4, 5), 15(2)(bd) 17. 10 13(4), 15, 18(1)(c) 18. 10 12, 13(5), 18(1)(c), 18(2), 21, 23(2)(n) must be promptly made and actioned. Records must always be kept of medicines being received into the home, by the timeframe and ongoing thereafter (timescale of 15/12/04 not met). All employees who handle medication (six staff and the manager) must receive update training by a competent professional in the best practice guidance for the safe handling of medicines (timescale of 1/3/05 not met). The requirements of the CSCI pharmacy inspector’s report of her visit of 11th April 2005 must be addressed within the timescales provided. All service users’ moving and handling assessments must be reviewed, updated and implemented (including acquisition of correct slings where applicable) by a competent person. They must then continue to be reviewed and updated as needs change, or at least annually (timescale of 19/1/05 not met). Individual moving and handling guidance that leaves no room for misinterpretation of how to support the service user to be manoeuvred, must be in place. (timescales of 1/7/04 and 19/1/05 not met). Any difficulties experienced by staff in following any service user’s moving and handling plan must be reported to management. Records must be kept of this. The issues must be promptly addressed. Staff must otherwise follow the revised plans. (timescale of 31/1/05 not met). Version 1.10 1/5/05 15/6/05 Within the timescales provided 1/6/05 19/1/05 1/6/05 Whitchurch Lodge Page 25 19. 10 12, 13(5), 15, 18(1)(a), 18(2) 20. 10 10(1), 12, 18(1)(a) 21. 10 10(1), 12, 15(2) 22. 12 12, 14(2), 15(2), 24 23. 12 12(3), 16(2)(m, n) 24. 12 16(2)(n), 18(1)(a) Staff must use hoists to lift service users in scenarios identified as needing hoists. Staff must never lift service users themselves, due to risks of injury to themselves and the service user. Professional input must be used to resolve situations where service users continue to refuse to be hoisted. Staff must take all reasonable actions, with respect to those residents who have the capacity to choose their own clothing, to ensure that residents wear clothing that is well-fitting, wellmaintained, clean, presentable, and appropriate to the individual, and that clothing does not compromise the dignity of any resident. Where any resident lacks capacity to choose their own clothing, their plan of care must be adjusted to include statements about clothing needs. This will include both their preferences and clarifications about appropriate clothing. An audit of what each resident would prefer in respect of morning routines (e.g. times of getting up, getting dressed, and having breakfast, and in what order) recorded about within each individual plan, and with a consequent plan of action to best meet group needs, is required. Service users must be provided with varied, service-user led, activities within the home, with community activities occasionally planned for and provided (timescale of 15/2/05 not met). Cover must be provided for when the activities people are not present. Service users must be asked Version 1.10 8/4/05 8/4/05 25/4/05 1/7/05 9/8/05 31/1/05 Whitchurch Lodge Page 26 25. 12 10(1), 12, 13(4), 18(1)(a), 18(2) 12(2, 3), 16(2)(i) 26. 15 27. 15 12, 13(4), 15, 16(2)(g, i), 16(4), 18(1)(a) 12(5), 21, 22, 17(2) schedule 4 parts 11, 12 28. 16 29. 16 17(2) schedule 4 parts 11, 12 30. 16 12, 13(6), 18(1, 2), 21, 22(3) about their views on having morning activities, and about what activities they would like provided. (Timescales of 1/9/04 and 31/1/05 not met). Staff must be working in the lounge with service users at all times that service users occupy the lounge, except in emergencies. The manager must ensure that service users have a choice made available to them through the meal-choice book system every day. There should hence be no blank pages in the book (timescale of 15/2/05 not met). There must be sufficient practical support for enabling dependant residents to drink their drinks. This must be promptly addressed through proper equipment, staff support, and monitoring records. Clarification must be made to all employees about how the process of recording complaints in the complaints book is to be followed, with this then being consistently upheld. This should include about what a complaint that requires recording is, and about who can access the complaints procedure.Complaint records must also be updated, to record those missing from the book (timescales of 17/12/04 not met). An ongoing record of all complaints about care practices in the home, actions taken to investigate, and outcomes, must be kept. This covers complaints from residents, staff, and visitors. The system of staff awareness and use of whistle-blowing procedures, and management Version 1.10 13/4/05 1/6/05 18/5/05 1/6/05 18/5/05 15/6/05 Whitchurch Lodge Page 27 31. 32. 16 17 12, 13(6), 21, 22 10(1), 12, 13(1, 3), 18(1)(a), 18(2) 33. 18 17(1)(a) schedule 3 part 3(j), 18(1)(a) 12(5), 15, 17(2) schedule 4 part 12, 18(2) 34. 18 35. 18 13, 18 36. 18 15, 18(2) 37. 18 10(1), 12, 13(4), 15(2). decisions and records in response to the receipt of allegations of misconduct, must be effective. A copy of the whistle-blowing policy must be sent to the CSCI (timescale of 1/2/05 not met). The registered people must ensure that all service users have the freedom of the home as far as reasonably practical. There must be good and recorded reasons for not supporting anyone to leave their room during the day. Records about any challenges presented by service users must give factual descriptions of what happened, not simply summarise that the service user was challenging (timescale of 15/2/05 not met). Management must ensure that systems for handling the situation of any service user attacking a staff member, and for the appropriate support of involved people after such a scenario, are in place and are clarified to all staff. Accident records for such situations must be kept. (timescale of 1/3/05 not met). Training is required for staff in understanding and managing challenging and aggressive behaviour (timescales of 31/7/03 not met). Individual guidance for how staff will work with service users who challenge must be clear to all staff within applicable service users’ files (timescales of 1/1/04 not met). The registered people must urgently ensure that the needs of residents who can exhibit challenging behaviours are Version 1.10 15/6/05 8/4/05 1/6/05 1/6/05 31/7/03 1/1/04 15/6/05 Whitchurch Lodge Page 28 38. 39. 19 19 23(2)(c) 23(2)(o) 40. 19 12(4), 23(2) 41. 21 16(2)(j), 23(2)(d) 12(4), 23(2)(b) 42. 21 43. 21 23(2)(b) 44. 22 12, 13(4), 18(1)(a), 23(2)(a, n) 23(2)(c) 45. 22 positively addressed. This includes for residents who are aggressive, and for those that wander. Equipment for residents’ use must be fixed or replaced promptly. Waste items or equipment must not be dumped in the garden. Any such remaining items must be promptly disposed of. A number of doors throughout the home were found to make a banging noise upon closing. This must be audited and addressed (timescale of 1/3/05 not met). The registered people must review and ensure the effective cleaning of the main toilets for residents from the lounge. The near-side toilet from the small lounge (opposite room 23) must have a working lock. Extractor fans in the toilets there must automatically work (timescale of 1/2/05 not met). The flooring in the near-side toilet opposite room 23, where a leak from above had happened, must be changed due to wear (timescales of 1/7/04 and 15/2/05 not met). The flooring in the far-side toilet of the pair must be replaced due to an old leak from the cistern (timescales of 1/11/04 and 15/2/05 not met). The registered people must review and ensure the effectiveness of the staff-call alarm equipment and staff responses to it. Professional inspection certificates for the lift must be promptly copied to the CSCI (timescales of 1/11/03, 15/8/04 and 31/1/05 not met). Version 1.10 15/6/05 1/6/05 1/7/05 1/6/05 15/6/05 15/2/05 1/7/05 31/1/05 Whitchurch Lodge Page 29 46. 47. 25 26 12(1)(a), 13(4), 23(2)(a) 16(2)(k) 48. 26 23(2)(b) 49. 26 50. 27 10(1), 13(1)(b), 16(2)(k), 18(1)(a), 18(2). 10(1), 12, 13(4), 18(1)(a) 51. 52. 27 27 17(2) schedule 4 part 7 10(1), 18(1) 10(1), 18(1) 10(1), 18(1),(2), 21 Thermostats to prevent scalding must be fitted to all sinks (timescales of 1/2/04 not met). The registered people must ensure that the offensive odour issues in the home are permanently addressed. The carpet in the double room upstairs was seen to be very grubby and stained. The stains must be removed, or the carpet must be replaced by the home (timescale of 1/3/05 not met). The odour control issues upon entry to the home and in one service user’s room must be addressed (timescale of 31/1/05 not met). The manager must provide written evidence to justify about the amount of staff needed for each shift (in terms of meeting service users’ identified needs and ensuring health and safety systems are controlled). A copy of this must be sent to the CSCI (timescales of 1/3/05 and 25/4/05 not met). [This must include about all emplyees in the home] The manager’s presence must be included on the rosters. The registered people must uphold staffing levels of at least 3 staff at night. They must use agency staff if necessary. The registered people must ensure that at least 50 of care staff become qualified in NVQ level-2 in care. A general training plan for all staff must be set-up in writing, detailing what training will be provided to whom, by whom and by when. This must then be followed. A copy must be provided to the CSCI (timescale Version 1.10 1/8/05 1/6/05 1/7/05 19/4/05 25/4/05 1/6/05 12/5/05 53. 28 1/11/05 54. 30 1/6/05 Whitchurch Lodge Page 30 of 20/12/04 not met). 55. 30 10(1), 18(1), (2) Essential (statutory) training, through funding within the home’s budget of otherwise, must happen for all staff (timescales of 1/4/04 not met). [This will include for food hygiene, health and safety, infection control, fire safety, and emergency first aid] 10(1), 12, Individual training profiles for all 18 staff must be maintained (timescales of 31/7/03 not met). 10(1), Training in the needs of people 18(1)(c) with dementia must be provided for all care staff (timescales of 1/4/04 not met). 10(3) The manager must achieve the NVQ level-4 qualification in care and management. 10(1), 12 The registered people must ensure that residents and staff benefit from clear leadership and management, both in the presence and in the absence of the manager. 10(1), Management must ensure that 12(5)(a), all staff are aware of, and have 18(1)(c), access to, the home’s grievance procedure. Clarification must 21, 23(3)(a)(ii include about expectations ) around whistle-blowing and around what management will do with grievances (timescales of 1/10/04 and 1/3/05 not met). 21 The registered people must audit the views of the staff team about care practices in the home. It is recommended that this be through an anonymous survey. 21, 24 A summary of feedback about the services of the home, from service users, relatives, staff, and other people in contact with the home, must be published within the home and copied to the CSCI (timescales of 1/3/04 Version 1.10 1/4/04 56. 57. 30 30 31/7/03 1/4/04 58. 59. 31 32 1/11/05 1/6/05 60. 32 1/3/05 61. 32 1/8/05 62. 33 1/3/04 Whitchurch Lodge Page 31 not met). 63. 33 24(1) Annual audits of the home, and a development plan, as per the new policy on quality assurance, must be set up and take place (timescale of 1/4/05 not met). It is required for the owners, or an independent representative of theirs (not anyone working in the home), to begin making monthly reports about the care being provided in the home, and to promptly send a copy of these reports to the CSCI. These must include records of meeting both sufficient numbers of staff, service users and visitors as to provide opinions about the care provided in the home (timescale of 1/3/05 not met). The registered provider must ensure that an up-to-date insurance certificate in respect of liability is on display in the home. A copy must be sent to the CSCI. The registered provider must provide the CSCI with the annual accounts for the home, certified by an accountant, for the periods 03/04 and 04/05. Supervision must be provided at least six times a year for all care staff (timescales of 31/7/03 not met). The manger must ensure all staff are aware of and understand the policies of the home (timescales of 31/3/03 not met). Notifications about any further issues [including for incident and injuries to residents that require hospital support] must be sent without undue delay (timescale of 20/12/04 not met). The accident/injury record system must be consistently Version 1.10 1/9/05 64. 33 26 1/7/05 65. 34 25(2)(e) 1/6/05 66. 34 23(2)(a) 1/6/05 67. 36 12, 18 31/7/03 68. 36 12, 18 31/3/03 69. 37 37 15/5/05 70. 37 12(5), 17(2) 1/6/05 Whitchurch Lodge Page 32 71. 37 schedule 4 parts 11 and 12, 21, 22 16(2)(a)(ii ) used to record all accidents and injuries in the home (timescale of 17/12/04 not met). Management noted that the fax could only send outgoing messages, not receive any. This must be fixed (timescale of 1/4/05 not met). The registered people must ensure that confidentiality of residents’ information is upheld. All fridges must be kept clean of food stains at all times. Accurate temperature checks must be made of all six fridges and freezers on a daily basis (timescale of 1/2/05 not met). The thermometers in the fridges and freezers in the kitchen must be reviewed. They must be replaced if not working. The cupboard used to store COSHH (household and industrial cleaning) materials in the kitchen, just next to the dining room, was seen to lack a working lock. This must be addressed. (timescale of 1/2/05 not met). The risk assessments about general systems in the home were last recorded with dates from 2002, most being from 2001 or 2000. These must all be reviewed and updated, to ensure or to implement appropriately safe systems of work in the home (timescale of 1/3/05 not met). Fire doors must remain closed at all times. The only exception to this is where an integrated fire alarm system, which automatically closes the doors in the event of the alarm being sounded, is in place and is fully operational within the home. Version 1.10 1/7/05 72. 73. 37 38 12, 17(1)(b) 10(1), 16(2)(j) 1/6/05 15/5/05 74. 38 16(2)(j), 23(2)(c) 10(1), 13(4), 23(2)(c) 15/5/05 75. 38 1/6/05 76. 38 10(1), 13(4) 1/7/05 77. 38 10(1), 23(4) 8/4/05 Whitchurch Lodge Page 33 78. 38 10(1), 12, 13(4), 23(4) 10(1), 17(2) schedule 4 part 14, 23(4) 13(4), 18(1)(a), 23(4) 79. 38 The fire safety risk assessment for the home must be updated by a competent person. It must include about these fire door issues. The manager must ensure that weekly recorded checks of the fire alarm system are reestablished and upheld. 3/5/05 15/5/05 80. 38 81. 18 13(6), 18(1)(a) A fire exit corridor and door were 12/5/05 blocked by a mattress and a tall cupboard at the start of the inspection. The registered people must ensure that fire exits and escape routes are always accessible. The registered people must 1/8/05 ensure that all employees receive professional training about the prevention of abuse to 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. Refer to Standard 7 Good Practice Recommendations It is suggested that daily records prompt for whether key support was provided and whether key issues were addressed, such as in areas of health, nutrition, falls, activities, sleep, mood, and personal care. Whitchurch Lodge Version 1.10 Page 34 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH 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 Whitchurch Lodge Version 1.10 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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