Random inspection report
Care homes for older people
Name: Address: White Lodge Residential Home White Lodge Fenn Green Alveley Nr Bridgnorth Shropshire WV15 6JA two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Becky Harrison Date: 0 1 0 2 2 0 1 0 Information about the care home
Name of care home: Address: White Lodge Residential Home White Lodge Fenn Green Alveley Nr Bridgnorth Shropshire WV15 6JA 01299861120 01299862038 white-lodge@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oldfield Residential Care Limited care home 36 Number of places (if applicable): Under 65 Over 65 15 21 dementia old age, not falling within any other category Conditions of registration: 0 0 Maximum number of Service Users is 36 (Thirty Six). Date of last inspection Brief description of the care home White Lodge is a large adapted building currently providing personal care and accommodation for up to 36 older people. The home is located in a rural position on the A 442 between Bridgnorth and Kidderminster offering both single and double bedroom accommodation. The front door to this home is kept locked with a number of keypad entries to internal doors around the home. The home is owned by Oldfield Care Ltd with White Lodge being one of a number of care homes within this company. Information about the home and the provision of the service are available in the
Care Homes for Older People Page 2 of 9 Brief description of the care home statement of purpose and service user guide. Care Homes for Older People Page 3 of 9 What we found:
This unannounced inspection was triggered following a referral made under safeguarding adult procedures. Concerns were raised about the lack of care documentation and risk assessments for one individual following a formal review undertaken by Shropshire Social Services in December 2009. It was also noted that care plans and risk assessments for other residents at White Lodge were not up to date. Other concerns identified included the lack of supervision for residents in the lounge due to staff taking breaks together and the medication trolley being left unattended at times. Shortfalls were fully acknowledged by the new manager during an adult protection meeting held in January 2010 and following the meeting an action plan to address identified concerns was developed by the manager and copies provided to Social Services and CQC. The new manager stated that she was putting procedures in place to rectify deficiencies in the system and that care plans would be reviewed and updated within a set time scale in addition to sourcing an outside trainer to provide staff with training on care planning. We randomly selected the care documentation held for three individuals with diverse needs. We found care plans were available for all three people and had recently been reviewed and updated, as reported in the action plan. Records evidenced that these were previously reviewed in July 2009. This is not at the required frequency or when peoples needs had changed. Care plans seen provided basic information about the health and personal care needs of individuals. There was evidence that individuals or a relative had signed to say that theyd seen the plan of care however care plans need to be further developed to make sure they contain detailed information for staff to understand the care people require. Care plans were not based on an individualised approach to meeting individual care needs to ensure people receive their care in a way that they prefer. The new manager has recently acquired a useful tool to audit care plans and hopes to undertake a full audit of care plans shortly and she fully acknowledged the shortfalls identified at this inspection. She reported that training in care planning documentation had been sourced and staff will attend this in March 2010 in addition to a number of other training courses. This should equip staff with the skills and knowledge to effectively support the needs of the individuals in their care. Records sampled for all the three individuals, whose care we looked at in detail, evidenced that identified risks such as falls, nutrition, pressure areas, continence, moving and handling and dependency had been assessed, reviewed and updated. However these were inadequate for example the moving and handling risk assessment for one individual, who is unable to mobilise independently or weight bear did not detail the type of hoist used, the size of sling, the persons weight or height and the techniques required for staff to follow to ensure the health and well-being of the individual or staff members. The safe systems of work risk assessment for another individual stated that the person requires 1 - 2 carers for dressing, getting out of bed, bathing and showering. Again this fails to provide staff with the specific information they need to effectively safeguard the individual concerned. This individual is diabetic and records evidence that the persons health needs have changed and the person is no longer insulin dependent. However the plan of care failed to detail how the persons diabetes is managed for example how their
Care Homes for Older People Page 4 of 9 blood glucose levels are tested, when, by whom and any specific dietary requirements. Records also evidence that the person has lost a considerable amount of weight over the last year and had not been weighed at the required frequency or reasons for the weight loss investigated. People may be placed at risk of not receiving the care they need because of omissions of information and inconsistencies within care plans and risk assessments. We spoke to four staff on duty and received a mixed response about information held in care plans. Two of the staff felt care plans contain sufficient information for the delivery of care and the other two staff felt that although these had improved more information is required. One member of staff was unaware that care plans had not been reviewed or updated for six months last year, which is of concern as care staff need to be aware of documentation held on peoples files. We were advised that each individual now has a designated key worker and co-worker who will take responsibility for ensuring all care plans and risk assessments are reviewed and updated at the required frequency and failure to do this may result in disciplinary action taken by the provider. Records sampled evidence that people receive support from district nurses, a community psychiatric nurse and general practitioners and most outcomes were found recorded. However we had to ask a member of staff for the outcome for an individual who had been assessed for a hoist. We were advised that this was no longer the case but the care records failed to detail the outcome of the assessment. Concerns were raised about residents being left unsupervised whilst staff took their breaks or ate meals together in the dining room away from the residents. We spent time sitting with residents in the lounge and observing staff practice and assessing whether there was sufficient staff on duty to ensure residents are not left unsupervised. Residents appeared well presented and looked relaxed and happy and staff were readily available and seen to interact well with people in their care. We discussed staffing levels with the manager, looked at the staff rota and undertook a brief tour of the home. We found that staffing levels were adequate to meet the needs of the 29 residents accommodated at the time of our visit. The manager advised us that she has made changes to staff breaks and that only two members of staff are allowed to take a break at any one time. This was also confirmed in discussions held with four staff. The manager also informed us that the medication trolley is now kept in a secure location and we observed that the medication trolley was not left unattended during the medication round. What the care home does well:
A new manager has very recently been appointed and discussions with her evidence that she is committed to improve the service and put things right in the best interests of the people who live at White Lodge. She has yet to complete an application for registration and reasons for this were shared with us. The manager has started to implement a number of changes and is being supported by the Operational Director, who was present at the home undertaking a monthly quality assurance visit. These monthly visits are required by Law to monitor and report on the quality of the service being provided. At the adult protection meeting held in January 2010, we asked the provider to send us a copy of the reports until further notice and they have done this as requested. The most recent report supports the findings of this inspection and states that staff are keen to make
Care Homes for Older People Page 5 of 9 changes that the manager has recommended and that staff acknowledged there was a lot of work to be done on care plans and risk assessments and that they would receive a lot of input to get them up to the required standard. The Operational Director fully acknowledged the findings of our inspection and committed to making the necessary improvements in the best interests of people using the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 6 12 The home must ensure any 28/02/2010 risks to the health, safety and well-being of people living at the home are identified, recorded and kept under review. This is to ensure that unnecessary risks to the health and safety of people are identified and as far as possible eliminated. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Care plans should be person centred, sufficiently detailed and reviewed as to ensure staff understand what is required for the delivery of care and people can be sure their needs will be met. Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - 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!
