CARE HOMES FOR OLDER PEOPLE
White Lodge South Strand Angmering-On-Sea Littlehampton West Sussex BN16 1PN Lead Inspector
Mrs D Peel Unannounced Inspection 1st February 2006 01:00 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 White Lodge DS0000014835.V280970.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. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service White Lodge Address South Strand Angmering-On-Sea Littlehampton West Sussex BN16 1PN 01903 784415 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) South Coast Nursing Homes Limited Mrs Lesley Margaret Trudgett Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 30 persons in the registration category OP over 65 years Date of last inspection 1st August 2005 Brief Description of the Service: White Lodge is a care home able to offer personal care and support for up to 30 residents who are over 65 years of age. The property is a two storey extended house, set in its own grounds approximately 200 yards from the sea and village centre. Accommodation is provided in 27 single rooms and 2 double rooms. All bedrooms are currently been used for single occupancy. Bedrooms have en suite facilities and rooms on the upper floor can be accessed by a passenger lift. Communal areas consist of a lounge, conservatory and dining room on the ground floor with an additional lounge on the upper floor. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 3 hours on the 1st February 2006 and was carried out by a Regulatory Inspector and a Pharmacist Inspector. This was the second visit to the home this year and it was carried out to complete White Lodge Care Home’s annual inspection programme for the year 2005 required by the Care Standards Act 2000. The inspectors arrived at 1pm and were met by the registered manager and, staff on duty. During the visit the inspector saw the majority of the 24 residents living at the home and spoke with 5 residents at length about there views of the home. The care records of two residents were examined during the visit along with other records, which showed how care needs were being met. Two visitors were spoken to during the visit to gain their views of the home and the service provided. Not all the National Minimum Standards for Older People were assessed at this inspection but throughout the year all key standards have been assessed. This report may be read in conjunction with the previous report dated 1st August 2005 to gain broader view of the homes provision of a care service. What the service does well: What has improved since the last inspection?
Since the last visit to the home at least six bedrooms have been redecorated and refurbished. These rooms now have a lockable cupboard for residents to use. The laundry room has been refurbished has been extended and refurbished with modern equipment. The front garden has been landscaped and residents say that it will be appreciated in the summer but in the mean time those residents who have rooms looking out onto the garden enjoy the view. As a result of the last visit to the home the windows in the upper lounge have been risk assessed and measures taken to lessen the risk of residents falling out.
White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 6 Whilst the care plans viewed at previous visits to the home were of a good standard, further improvements have been made to ensure that the plans are user led and contain all the information needed for staff to assist residents to maintain their dignity and independence. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,5 Prospective residents, their relatives and friends have an opportunity to visit the home to look at the facilities available and assess its suitability before moving in for a trial period. EVIDENCE: A resident spoken with who had recently moved into the home said that a family member and a friend had visited a number of care homes on their behalf because they were in hospital. Another resident spoken with explained that they were staying at White Lodge whilst their relative was on holiday. This was the second time this resident had visited for a short stay and they felt that it was a good way of deciding if the home is satisfactory. This resident commented that they liked the home and had no doubts about returning again. The home has a contract which states the fee paid and what the fee covers. The manager confirmed that the number of the rooms occupied is now written on the contract. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Systems for care planning give information to assist with all aspects of health, personal and social care needs. Heath care needs are monitored so that signs of residents becoming unwell are recognised. The home has medication policies but these are not always being adhered to which has resulted in medication being unaccounted for. EVIDENCE: Two care plans were examined at this visit along with other records, which provided information about how resident’s well being is monitored. The home is currently introducing a new care planning system, which is being used throughout the organisation. The new system was viewed in use along side the previous system. Records show that visits by health care professionals are recorded and residents spoken with confirmed that they have access to the normal heath service professionals. Medication policies and procedures were available to staff. Staff who administer medicines had received training from a local college or the supplying pharmacist. Before staff administer medicines on their own, senior staff had given further support and assessment, although this process was not
White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 10 recorded. A list of sample signatures of staff did not identify those authorised to administer medicines, on their own. Risk assessments were seen for residents who wish to retain responsibility for all their medicines. Not all medicines kept in resident’s rooms were in locked storage. For medicines administered by staff storage was lockable. The temperature medicine storage, including the medicines refrigerator was not monitored. Records of receipt, administration and disposal were examined. For a course of antibiotics, receipt and regular administration were recorded but two tablets could not be accounted for. Supply and records were correct for checks on other medicines. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 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 the following standard(s): 12 The home provides a lifestyle that respects privacy, dignity and choice, matching resident’s expectations and individual preferences. EVIDENCE: The inspectors visited after lunch when many of the residents had returned to their bedrooms for a nap. Other residents were relaxing in the lounge or in their bedrooms watching television, reading etc. During the visit four residents were spoken with at length in the privacy of their rooms to find out if they felt that the lifestyle in the home met their needs. One resident commented that they had everything, which they needed. The matron and staff are caring and “matron sorts all your troubles out”. Another resident, who had met one of the inspectors at a previous visit when they had just moved into the home, confirmed that they had settled in well and felt that their needs were being met. This resident commented that they try to remain independent but some days need more assistance from the staff than others. This resident had had lunch in their bedroom and confirmed that this is by their choice. A hairdresser was visiting a number of residents at the home at the time of the visit. She explained that they had been visiting the home for a number of years and liked visiting the home.
White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 12 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): 18 The home has policies and procedures for responding to adult protection matters and training is provided to ensure that staff are able to recognise and report abuse. EVIDENCE: White Lodge has its own policies and procedures to safeguard residents from abuse in addition to the West Sussex Multi Agency policies and procedures. Adult protection training is on the company-training schedule and the inspector was told that staff are encouraged to attend the training. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 13 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): 19,20,21,22,23,24,25,26 White Lodge is well maintained and provides a safe environment for residents to enjoy. The home is clean; residents have a homely environment to live in with comfortable individual bedrooms. EVIDENCE: The communal areas within the home are furnished and decorated to a high standard. Residents have well equipped bedrooms, which are nicely decorated. At the time of this visit one vacant room was being redecorated. The decorator confirmed that it is the usual practice in the home to redecorate rooms as they become vacant. Carpets are replaced if needed and bedroom furniture is gradually being replaced. The new bedroom furniture includes a lockable cupboard for residents to use. Since the last visit to the home at least six bedrooms had been redecorated and the laundry room has been refurbished and decorated. At the last visit to the home the inspector expressed concern about the windows in the upstairs lounge, which did not have restricted openings. These
White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 14 windows have now been risk assessed and measures taken to lessen the risk of residents falling out. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 15 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): 28,29 White Lodge provides well-qualified staff so that residents are able to feel safe and well looked after. EVIDENCE: The company has an organised training programme, which provides all staff the opportunity to gain the skills, which they need to provide a safe home for the residents to live in. Seven out of the eighteen care staff working at the home have an NVQ level 2 or 3 and there are currently another three staff undertaking an NVQ, however this standard is not fully met as the minimum ratio of 50 of care staff had not been achieved by the end of 2005. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36,38 There is no formal quality assurance system in place to measure how successful the home is at meeting its aims and objectives and the Statement of Purpose of the home. Environmental risk assessments are in place, which protect residents from the majority of environmental risks to their heath and safety. EVIDENCE: White Lodge has yet to establish a formal quality assurance system. There is documented evidence that residents are consulted with at residents meetings and residents spoken with confirmed that they could speak to the manger about anything which is troubling them. Formal supervision of staff is not currently being carried out at least 6 times a year. The manager confirmed that staff are supervised as part of the normal management process on a continuous basis. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 17 Environmental risk assessments were observed to be in place. A recommendation has been made in standard 9 to ensure that risks to other residents are considered when completing risk assessments for those residents who wish to retain control of any of their medicines. White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 X 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 1 X 2 White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13.2 Requirement An incident report, about the tablets unaccounted for and the actions taken must be sent to the Commission. A formal quality assurance system must be established Formal supervision must take place. Timescale for action 05/03/06 2 3 OP33 OP36 24.1 18.2 01/05/06 01/05/06 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 OP38OP9 Good Practice Recommendations Risk assessments should be completed for residents who wish to retain control of any of their medicines and should take into consideration other people in the home. A lockable space should be available for storage The temperature of medicine storage should be monitored to ensure that medicines are stored acording to manufacturers directions. Records should be kept of assessment of competence in medicine administration
DS0000014835.V280970.R01.S.doc Version 5.1 Page 20 2 3 OP9 OP9 White Lodge White Lodge DS0000014835.V280970.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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