Inspection on 16/02/07 for White Lodge Residential Home

This inspection was carried out on 16th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

White Lodge Residential Home 26/09/08

White Lodge Residential Home 27/09/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE White Lodge Residential Home 62 West End Kemsing Sevenoaks Kent TN15 6QB Lead Inspector Helen Martin Key Unannounced Inspection 3:30 16 and 20th February 2007 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 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 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 Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Lodge Residential Home Address 62 West End Kemsing Sevenoaks Kent TN15 6QB 01732 761227 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) Synchronized Limited Mrs Brenda Dorathy Turley Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: White lodge is a detached house located in the village of Kemsing, close to shops and other amenities. There are gardens and off road parking for several cars. The home provides care for up to thirteen older people. Accommodation is arranged on two floors with bedrooms on the ground and first floor, all bedrooms are currently for single occupancy and eight have en suite facilities. One room can be shared. There is a choice of communal areas with two lounges and a separate dining room. There is a passenger lift between floors. Synchronized Limited owns the home. Care staff, working a roster, give 24hour cover that includes one member of staff on waking night duty and one sleeping-in. Staff currently undertake catering, housekeeping and domestic duties in addition to caring for residents. Current fees for the home range from £480.00 to £590.00 per week. Additional costs include hairdressing, chiropody and newspapers. Full information about the fees payable, the service provided and the home’s Statement of Purpose are available from the manager. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 16th and 20th February 2007. The inspection included talking with the manager, three staff members, which included one senior, and four people who live in the home. Some judgements about the quality of life within the home were taken from observation and conversation. Some records were looked at. A tour of the premises was undertaken. The home has given the CSCI a completed pre-inspection questionnaire and this information has been used within this report where appropriate. Postal surveys from five residents and two relatives of residents have been received by the CSCI and used within this inspection process. Currently there are eleven residents accommodated with two vacancies. Comments received by residents in postal surveys and by those spoken with at the time of this visit included: ‘I was able to look around the home before I moved in’ ‘It’s different to how it used to be’ ‘The house is clean’ ‘I like the garden but it’s a shame; it needs tidying up’ ‘The staff are excellent, kind, thoughtful and helpful’ ‘The carers are very good, I can’t fault them, although they’re not always so good at the weekend’ ‘Carers do the cooking and cleaning sometimes’ ‘The cleaner is very good but is now busy doing the cooking’ ‘I like the food very much’ ‘I don’t know if I could ask for something else that was not on the menu; sometimes we are asked for what we like’ ‘They can always find an alternative to meals, which is good, but the quality of the meals is not always good’ ‘Some meals are good, others are poor’ ‘Cooking at the weekend was bad but now it’s improving’ ‘Different people prefer different types of meals, we do get fresh fruit and vegetables, although not so much as we used to’ ‘I have my breakfast at 07.30, it’s a bit early but it’s prepared by the night staff’ ‘I have breakfast in bed’ White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 6 ‘The laundry system is very good, my clothes are always clean and ironed’ ‘Staff always knock on my door and respect my privacy’ Comments received from residents relatives in postal surveys included: ‘Gives individual care and support in a warm, friendly manner. Visitors are always welcomed warmly whenever they arrive. Most staff give help beyond their call of duty, creating an excellent atmosphere and staff relations with the manager and each other are friendly.’ ‘The home provides very good individual care. Encouraging and realistic, very patient and understanding…Any shortcomings are generally resolved in time and are usually the result of mistaken views…’ ‘…it would be good if there was more of an activity programme available’ ‘There has been an effort recently to provide more in the way of entertainment…it gives a purpose for coming together in the social areas and creates a better community’ What the service does well: What has improved since the last inspection? What they could do better: Residents are put at some risk by the procedures for staff recruitment and training and the administration of medication. The regular testing and maintenance of all systems, facilities and equipment within the home would improve their protection. A review of the staff numbers and supervision, policies and procedures and quality assurance would improve residents’ quality of life. Their personal, health and social care needs could be better reflected in White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 7 care plans. Residents would benefit from a review of meal choice, quality and presentation. An increased number of activities to choose from and improved maintenance of the gardens would improve their quality of life. Prospective residents would benefit from some updates to the service users’ guide. 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. The summary of this inspection report can be made available in other formats on request. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 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 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are able to look around the home before they decide whether to move in; they are given written information, although this would benefit from some updating. Prospective residents are assessed to ensure that the home can meet their needs. EVIDENCE: All residents spoken with said they were happy at the home. Many have connections with the local area and value being able to maintain contact with familiar places and friends; some knew the home before they moved in. One resident mentioned that they had the opportunity to look around before they decided to move in. There is a statement of purpose and service users guide, which gives written information about the home. Parts of the service users’ guide need updating to White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 10 include the appropriate name for the CSCI and an accurate date for the last inspection report. Although requested a standard contract for residents including terms and conditions of accommodation was not provided, therefore it was not possible to include this within the inspection process. Residents were assessed before they moved in, in order to ensure that the home was suitable to meet their needs. There have been no new admissions since the home was registered. Previous recorded pre-admission assessments were brief in detail; the manager said that this would be recorded appropriately in future. The manager demonstrated a good understanding of the needs of individuals that the home could and couldn’t meet. Whilst the home aims to care for people throughout all stages of older age, where this is not possible support is given until a more suitable placement can be found. The home does not provide intermediate care. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect. Arrangements are in place to maintain their privacy and dignity. Residents’ personal, health and social care needs are met, although these could be better reflected in care plans. Residents are not fully protected by the procedures in the home for the administration of medication. EVIDENCE: Each resident has a care file which records information about the person. Documentation seen reflected their changing needs and included details about risk assessments, personal information and contacts. Care plans are reviewed on a regular basis, although some documents are undated and notes recorded daily could be kept in greater detail. Residents’ social activities are logged but not all files contain a care plan about this. Care plans include information on consultation and referral to medical professionals, such as GP and district nurse. Some residents go to their own GP and dental appointments independently. Residents have access to a White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 12 chiropodist. No residents have pressure sores. Those at risk of developing pressure sores are assessed and a care plan is recorded. Subsequent to the inspection, the owner stated that detailed scoring of the assessment is kept separately to the care plan. Specialist equipment is provided where necessary. Discussion took place regarding the recording of one resident’s nutritional assessment. It was said that although it is not possible to weigh this individual, as they are immobile, their weight is stable and appropriate. The resident is provided with a soft diet. Although an action plan is in place, it is not possible to fully evidence on what this is based, as the nutritional assessment is inconclusive and makes no recommendations and food and fluid intake is not recorded. Residents spoken with were very happy with the personal care that they received from staff; it was reported that they were helpful, respectful and responsive. Some residents are enabled to look after their own medication and those spoken with described how they did this. Not all of these individuals are provided with a lockable facility within their rooms in which to store their tablets. Self-medication is not recorded as a care plan or risk assessment; there is no evidence that the GP agrees with this practice. Residents who are not able to administer their own medication are not fully protected by the systems in place within the home. There are no details regarding individuals’ current medication recorded in care plans. Storage is secure, although not suitably placed as the cabinet is in the kitchen. A monitored dosage system is used. Tablets and creams are stored together and the latter are not labelled with the date of opening. Loose tablets were seen in pots marked with a residents name; these were said to have been refused and awaiting return to the pharmacy. Records for the administration of medication are kept together with photographs of residents; comments received in postal surveys said that medication was given on time. A signature list of trained staff is not maintained. Medication received and returned to the pharmacy is said to be checked but this is not recorded or signed for. A designated controlled drugs storage facility and logbook are not used. Recent guidelines from the Royal Pharmaceutical Society for the administration of medication in care homes are not provided. Due to the arrangements in place it was not possible to fully audit the system for administration of medication by the home. Staff have been provided with training booklets from a local chemist, although no external training course has been provided. The manager said that they would arrange this as soon as possible. Residents spoke very highly of the staff team and felt that staff respected their privacy and dignity. During the inspection, staff were seen to attend to their needs in privacy and respond quickly when asked. Residents said that their clothes came back from the laundry clean and ironed. The home provides a hairdresser. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 13 White Lodge aims to be a home for life. The manager demonstrated a good understanding of needs that the home could and couldn’t meet and sensitivity to the issues involved. Families are able to visit as often as they wish and health care professionals can be accessed where appropriate. Residents’ care plans contain information about death and dying. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are recognised as individuals and are able to exercise choice over their lives. Residents enjoy the activities available, although an increased number to choose from would improve their quality of life. The quality of the food received mixed reviews. EVIDENCE: Residents move into White Lodge knowing the nature of the service; this fits into the local area and is homely and friendly. Discussion took place with some residents about the changes in the home since the new owners took over. Residents are enabled to be as independent as possible; they are able to make choices within the constraints of group living and their own capabilities. They can choose whether to spend time in their rooms or in the communal areas and when to get up and retire, some are able to go out independently when they wish; the routines of the home are generally flexible. Residents spoken with enjoyed the activities provided by the home. Weekly coffee mornings are organised to watch slide shows or listen to music. Recently an outing was arranged to a garden centre; the manager said that more are White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 15 planned. The manager explained that they were planning raised beds in the garden for residents to use. At the time of this visit, residents were enjoying their own pastimes such as watching TV, reading the newspaper, listening to the radio, reading and doing a crossword. Some are able to go out independently to the local shops and library. The minister from the local church visits the home. Others mentioned that they went out with their relatives and to meet their friends. The manager said that they would continue to develop the activities available for residents. Residents are encouraged to keep in contact with their relatives and friends if they wish. Visitors are welcome in the home at any reasonable hour. Residents spoken with said that they enjoyed regular visits from members of their family. Residents spoken with had mixed views about the quality of meals; some liked the food, some didn’t and some said it was dependant on who was doing the cooking. A menu is displayed in the home; this is for the main meals only and there are no choices included. Most residents spoken with mentioned that staff cooked an alternative if they requested it and that they always got a choice at suppertime. The manager explained that discussion about the meal of the day took place in the mornings and that menus were developed from asking residents for their likes and dislikes; preferences are recorded in care plans. The home provides drinks of residents’ choice. Records of food consumed are kept for suppertime but not for breakfast or the main meal. Specialist diets are provided such as soft and diabetic. One resident on a soft diet has the different parts of their meal, for example meat and vegetables, mixed together in one bowl; these are not kept separate for differences in texture, flavour and appearance in order to encourage appetite and nutrition. Subsequent to the inspection, the owner stated that the resident would not eat separate items and that the decision to mix food had been agreed by a care manager and family. Residents can choose whether to eat in their bedrooms or the communal dining room. The manager stated that they would review the timing of breakfasts to ensure that all residents are happy with this. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The views of residents and their representatives are listened to and receive appropriate consideration. Residents are able to vote. They are not wholly protected from potential abuse due to poor staff recruitment procedures. EVIDENCE: At the time of this visit, residents were at ease talking with staff and the manager who listened to their views. Staff seen demonstrated a good understanding of residents. There are positive relationships between both staff and residents with a good balance between professionalism and friendliness. The manager said that no complaints had been received since they had been in post, although the home had the facility to record these should this be the case. Residents spoken with confirmed this. Comments received in postal surveys stated that any shortcomings are resolved and are usually the result of misunderstandings. There is a written complaints procedure available. Residents are encouraged to vote and some use postal votes. The manager has obtained a copy of the Kent and Medway guidelines for the protection of vulnerable adults, although the home does not provide it’s own policy. There is a procedure for whistleblowing. The manager is aware of adult protection procedures. Staff recruitment procedures within the home do not protect residents. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy living in a warm, clean, homely and comfortable environment, although their quality of life may be improved by improved maintenance of the gardens. Residents could be better protected by a review of hot surface and hot water temperatures. EVIDENCE: The home is comfortable, warm, well maintained and homely. All areas seen were clean and tidy and this was confirmed by comments from residents. The manager described how an under floor leak in a downstairs bedroom had been repaired. Residents use the gardens surrounding the house in the summer. Many spoken with liked the garden but felt sad because they said, it is not maintained as well as it used to be and some of it had been chopped down and not replaced. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 18 There is a choice of attractive communal areas with two lounges and a separate dining room. A toilet is located close to these. Individual rooms reflect the occupants personalities and have personal effects and in some cases furniture. Accommodation is arranged on two floors with bedrooms on the ground and first floor, all bedrooms are currently for single occupancy and eight have en suite facilities, four of which include shower as well as toilet facilities. Furnishings and fittings throughout the house are good quality. A shaft lift provides easy access between floors. Aids and equipment to give increased confidence and support are provided as necessary. The home is warm and well lit and rooms are naturally ventilated. Radiators, although not guarded, are provided with individual thermostatic controls. Hot water temperature is not regularly checked or recorded. No arrangements are in place to reduce the risk from Legionella. The kitchen and laundry area are maintained in a hygienic manner. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from staff who care for, understand and anticipate their needs and wishes. A review of the staff numbers would improve their quality of life. Residents are put at some risk by the systems within the home for staff recruitment and training. EVIDENCE: All residents spoken with praised the qualities of the staff highly. Care staff are very committed to their role and knowledgeable about the running of the home. Staff seen at the time of this visit demonstrated a good understanding of residents. A core of staff have worked at the home for some years. There have been some recent additions to the team. There is good interaction between staff and residents. There are mostly two staff, sometimes three on duty during the day with one waking and one sleeping member of staff on duty at night. Comments from residents included that if they needed to use the staff call bell, someone always came immediately. Staff spoken with did not feel they were rushed. Although no designated ancillary staff are used, it was unclear as to the allocation of duties for staff at any given time. Staff multi task, being used to care, cook, garden or clean where needed. In addition they provide activities for residents. At one time during the visit, only one of the two staff present White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 20 was a carer, although one resident using a hoist requires two carers. The manager said that they were looking to employ a gardener. The written roster is a planned template and does not include any dates or a record of hours actually worked. The manager said they would amend this together with ensuring that all staff employed are recorded with their full names and allocated duties on shift, including the identification of senior staff. Discussion took place, both with residents and the manager regarding the staffing of the home at the weekends. The manager explained that many agency workers used to be used to cover the time that the previous owners worked in the home at the weekends. It was said that now there are additional permanent staff, this had reduced. The manager said that they were in the process of recruitment for the remaining weekend vacancies. It was stated that the previous agency used by the home had been changed following feedback from residents. Discussion regarding staff ongoing training took place. Staff spoken with said that they had undertaken courses in manual handling, first aid and food hygiene. Although provided with training booklets from a local chemist, no external courses have been provided for the administration of medication. Staff have not been provided with updated fire training. The manager stated that there are some gaps in training and some is out of date; they are in the process of reviewing, planning and arranging appropriate updated courses for all staff. Although some course certificates were seen in staff files, due to the nature of the records held it was not possible to fully ascertain which course updates had been undertaken and which had not. The manager said that they would develop a training matrix. Staff are not provided with a recorded induction process. The manager stated that they would develop this in line with ‘Skills for Care’ recommendations. The home’s pre-inspection questionnaire states that five out of fifteen staff are NVQ qualified. Subsequent to the inspection, the owner stated that this had increased to seven. The manager explained that they had recently obtained funding for an additional five NVQ qualifications, they planned two level 3 and three level 2, and that these would commence shortly. It was said that they are working towards 50 of the staff team being qualified. The recruitment procedure in place within the home does not protect residents. Two staff files were looked at. Although evidence was in place for some of the required pre-employment checks for one, the recruitment file of the other did not evidence this; although verbal references had been undertaken, they were not recorded. No written references had been obtained; references from the most recent employer and from previous work within care had not been requested. There was no employment history provided with the exception of the most recent employer. It was said that proof of identification had been checked for a Criminal Records Bureau (CRB) check application, although this was not documented. There was no evidence of a check against the Protection White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 21 of Vulnerable Adults (POVA) list and a full CRB had not been received. Qualification certificates of applicants for employment are not checked as part of the recruitment process. There is no evidence of equal opportunities monitoring. Discussion took place about pending full CRB checks and that staff must not be employed unless a POVA First check and other pre-employment checks have been undertaken. The manager agreed that written references and a POVA First check for a newer member of staff would be requested by 21st February 2007. The current application form for employment with the home does not contain the facility to provide a reference from the most recent employer, a full employment history, together with any gaps in employment, relevant training courses, a statement as to the applicants physical and mental health, equal opportunities monitoring or a self-disclosure regarding police cautions. Discussion took place regarding the recruitment of family members of the manager. The manager agreed that in future the provider would undertake the recruitment process and interviews, in order to evidence that there is no conflict of interest. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a friendly home, which is run by a manager and staff who aim to provide a good quality of life for older people. This could be improved however, by a review of staff supervision, policies and procedures and quality assurance. The regular testing and maintenance of all systems and equipment within the home could improve the protection of residents’ health and safety. EVIDENCE: The manager has experience of working with older people, five years of which was in a managerial role; they were registered by the CSCI as the manager of White Lodge in September 2006. They have obtained an NVQ level 4 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 23 qualification, have recently completed the Registered Managers Award and await the certificate. The atmosphere of the home is open and friendly and this was confirmed both by residents and relatives. There is a lot of discussion and feedback between residents and staff on a day-to-day basis. Relationships between residents, staff and the manager are friendly and professional. Residents indicated that any comments they had about the service would be listened to. Comments from relatives mentioned that the new management had taken over smoothly. The manager explained that currently the home does not have a formal quality assurance system. It was said that the manager and the provider were in the process of developing this to include questionnaires to residents, their families and health and social care professionals. The home provides written policies and procedures, although these are undated and not comprehensive. For example, currently there is no written policy regarding quality assurance, risk management or residents finance and the health and safety policy does not contain sufficient detail. The manager explained that they and the provider are in the process of reviewing and updating all policies and procedures. The home is not an appointee for any resident and keeps no cash or valuables on their behalf. It was said that individuals themselves, friends or relatives deal with their financial issues. Both the manager and staff said that, as the home is small, issues are discussed as they arise. Since they have been in post, the manager has introduced a formal appraisal system, which was confirmed by staff spoken with. The manager said that following the appraisals, one-to-one supervision would be provided and recorded. Discussion took place regarding formal supervision and appraisal for any family members of the manager employed within the home. The manager agreed that it would be good practice for the provider to undertake these in future. The manager assured the inspector that a new member of staff employed is constantly supervised whilst on shift and is not left alone with residents; planned rotas seen evidenced this. Records of accidents and incidents are recorded appropriately. The manager explained that any significant accidents or incidents would be notified to the CSCI. Other records looked at as part of this visit have been mentioned elsewhere within this report where appropriate. Discussion took place regarding the testing and maintenance of systems and equipment within the home; it was evident that whilst some had been checked appropriately, such as gas and hoists, others had not. Recommendations made during an electrical hard wiring test in December 2006, one of which was for urgent attention, had not been addressed. The manager agreed to arrange an appointment with an electrician by 27th February 2007 to rectify this. The manager explained that staff regularly checked the emergency call system, White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 24 although these tests were not recorded. There is no external maintenance contract for this. The home’s pre-inspection questionnaire stated that the lift was last serviced in October 2006. The home’s fire logbook evidences regular checks of systems within the home, although fire drills and staff training are overdue. Documentation evidenced that fire systems and equipment within the home had been serviced; the manager said that they were awaiting the actual certificates. There is a fire procedure and risk assessment, although this needs updating. Wedges propping open fire doors were removed at the time of this visit; the manager assured the inspector that these would not be replaced. The manager stated that they would contact the fire officer for advice regarding the home’s risk assessment and appropriate fire door closures. The laundry area is maintained in a hygienic manner although it was noted that cleaning chemicals are not locked away. The home has a clinical waste contract although a ‘sharps box’ is not available for used diabetic equipment. Fridge and freezer temperatures are checked regularly and recorded, although cooked hot food temperatures are not. Window restrictors are provided throughout the house. Issues regarding staff training have been mentioned previously within this report. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 25 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X N/A 2 2 1 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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) Timescale for action The registered person shall make 23/03/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that: The home must review it’s procedures for medication in light of the Royal Pharmaceutical Society’s guidelines for the administration of medication in care homes. Care plans must include details regarding individuals’ current medication, including selfmedication, which must be risk assessed and agreed by the GP. Self-medicating service users must be provided with a lockable facility. The medication cabinet must be suitably placed away from heat. Creams must be labelled with the date of opening. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 27 Requirement Medication received and returned to the pharmacy must be checked, recorded and signed for. Appropriate, updated training for the administration of medication must be provided for staff. 2 OP18 OP33 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. In that: the home must develop a formal quality assurance system. Written policies and procedures must be updated and expanded and must include adult protection, quality assurance, risk management, residents finance and health and safety. 3 OP18 OP29 OP37 19 The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home; …they have obtained in respect of that person the information and documents specified in…Schedule 2. In that: the staff recruitment procedure must be reviewed in order to protect residents. The recruitment process must check and record: proof of identity, including a recent photograph, a POVA First and full CRB check, two written references, one from the most recent employer, information from previous work in care if this is not the last employer, White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 28 06/04/07 23/03/07 qualifications and training, a full employment history and any gaps, a statement as to the persons physical and mental health. 3 OP18 OP29 OP37 19 Pending the receipt of a full CRB check, staff must not be employed unless a POVA First check and other pre-employment checks have been undertaken. The manager agreed at the time of this visit to apply for a POVA First check and written references for a newer member of staff by 21st February 2007. The manager also agreed to inform the CSCI of the outcome. 4 OP19 OP38 23(4) 21/02/07 The registered person shall after 23/03/07 consultation with the fire and rescue authority take adequate precautions against the risk of fire…make adequate arrangements for…containing…fires…for the evacuation…of all persons in the care home and safe placement of service users…for reviewing fire precautions…make arrangements for persons working at the care home to receive suitable training in fire prevention; and to ensure by means of fire drills and practices at suitable intervals that the persons working at the care home and…service users are aware of the procedure to be followed in case of fire, including the procedure for saving life. In that: Appropriate staff training and fire drills must be provided at suitable intervals. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 29 The home’s fire procedure and risk assessment must be reviewed and updated. Door wedges must not be used to prop open fire doors. The manager agreed at the time of this visit to contact the fire officer regarding the above. 5 OP25 OP38 13(4) The registered person shall ensure that all parts of the home to which service users have access are…free from hazards to their safety; any activities in which service users participate are…free from avoidable risks; and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In that: A review must be undertaken to ensure that residents are protected from hot surface radiator temperatures. Hot water temperature must be regularly checked or recorded. Cleaning chemicals must be locked away. 5 OP25 OP38 13(4) Recommendations made during an electrical hard wiring test in December 2006, one of which was for urgent attention, must be addressed. The manager agreed at the time of this visit to arrange an appointment with an electrician to rectify this by 27th February 2007. The manager also agreed to inform the CSCI of the White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 30 23/03/07 27/02/07 outcome. 6 OP27 OP30 18(1)(a) The registered person 23/03/07 shall…ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service users. In that: A review of staffing numbers and the allocation of duties must be undertaken to ensure that there are sufficient staff on duty to meet all the needs of all residents at all times. A review of staff training must be undertaken. Appropriate updated training must be arranged in order to meet the needs of residents. This must include medication (for those administering medication), fire, manual handling, POVA, food hygiene, first aid and induction. 7 OP27 OP37 17(2) The registered person shall maintain in the care home the records specified in Schedule 4: A copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked. In that: The written roster must include dates, a record of hours actually worked and ensure that all staff employed are recorded with their full names and allocated duties on shift, including the identification of senior staff. 06/04/07 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 31 8 OP38 13(3) The registered person shall make 23/03/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. In that: Arrangements must be introduced to reduce the risk from Legionella. A ‘sharps box’ must be provided for used diabetic equipment. Cooked hot food temperatures must be regularly checked and recorded. 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 OP1 Good Practice Recommendations It is strongly recommended that the appropriate name for the CSCI and an accurate date for the last inspection report should be amended within the service users guide. It is recommended that, with regard to care plans: 1. All documents should be dated. 2. Daily notes should be recorded in greater detail. 3. Care plans should be provided for social interaction and activities. 3 OP7 OP8 OP37 It is strongly recommended that, with regard to care plans: 1. Waterlow risk assessments for pressure sores should be kept together with the detail of scoring in addition to the summary. DS0000066253.V324941.R01.S.doc Version 5.2 Page 32 2 OP7 OP37 White Lodge Residential Home 2. The nutritional assessment for one resident on a soft diet should be reviewed to confirm that the action plan recorded is appropriate. 3. Food and fluid charts should be maintained for one resident on a soft diet, who is not weighed. 4 OP9 It is strongly recommended that, with regard to medication: 1. A signature list of trained staff assessed as competent to administer medication should be kept. 2. Controlled drugs should be stored in a controlled drugs cabinet. 3. The administration and audit of controlled drugs should be recorded in a controlled drugs logbook. 4. Tablets and creams should not be stored together. 5. Tablets awaiting return to the pharmacy must be clearly labelled. 6. Recent guidelines from the Royal Pharmaceutical Society for the administration of medication in care homes should be obtained. 5 OP12 It is recommended that the manager should complete their stated intention to continue to develop the activities available for residents. It is recommended that, with regard to food: 1. A review should be undertaken to ensure that all meals provided for residents are good quality. 2. The home should be proactive in offering residents a choice of food: all residents should be aware of their choices; the written menu should contain these. 3. Records of food consumed should be kept. 4. The home should seek advice from a nutritionalist regarding residents provided with soft and pureed diets; especially with regard to separate blending of different parts of a meal in order to maintain White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 33 6 OP15 differences in texture, flavour and appearance to encourage appetite and nutrition. 5. The manager should complete their stated intention to review the timings of breakfasts to ensure that all residents are happy with this. 7 8 OP19 OP28 OP30 It is recommended that the garden should be kept tidy and maintained appropriately. It is strongly recommended that, with regard to staff training: 1. The manager should complete their stated intention to develop a training matrix, in order to facilitate the audit of course updates. 2. The manager should complete their stated intention to provide a minimum of 50 of the staff team who are NVQ qualified. 9 OP29 OP37 It is strongly recommended that, with regard to the recruitment process: 1. Telephone checks for references and verbal references should be recorded. 2. In addition to police convictions, a self-disclosure regarding police cautions should be recorded. 3. Equal opportunities should be monitored and recorded. 4. The provider or another qualified individual should undertake the recruitment and selection process for family members of the manager, in order to evidence that there is no conflict of interest. 10 OP36 It is strongly recommended that, with regard to staff supervision: 1. The manager should complete their stated intention to provide formal one-to-one recorded supervision at appropriate intervals. 2. The provider or another qualified individual should undertake the appraisal and supervision of family members of the manager employed within the home White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 34 in order to evidence that there is no conflict of interest. 11 OP38 It is strongly recommended that, with regard to the staff emergency call system: 1. Regular checks of the system undertaken by staff should be recorded. 2. An external maintenance contract should be put in place. White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 White Lodge Residential Home DS0000066253.V324941.R01.S.doc Version 5.2 Page 36 - 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. 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