Inspection on 09/05/08 for White Lodge Residential Home

This inspection was carried out on 9th May 2008.

CSCI found this care home to be providing an Adequate service.

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 14/11/07

White Lodge Residential Home 14/12/06

White Lodge Residential Home 06/02/06

White Lodge Residential Home 15/08/05

White Lodge Residential Home 13/12/04

White Lodge Residential Home 06/07/04

White Lodge Residential Home 16/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE White Lodge Residential Home 67 Havant Road Emsworth Hampshire PO10 7LD Lead Inspector Jan Everitt Unannounced Inspection 9th May 2008 09:30 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 DS0000043778.V363473.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 DS0000043778.V363473.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Lodge Residential Home Address 67 Havant Road Emsworth Hampshire PO10 7LD 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) 01243 375 869 WLCareltd@aol.com Mrs Jill Cathryn Dowsett Mrs Kay Ellen Smy Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Agreement to accommodate one named service user D.O.B 7/10/1945 in the category P.D (Physical Disability) 14th November 2007 Date of last inspection Brief Description of the Service: White Lodge is a residential care home providing care and accommodation for up to twenty-five service users aged 65 years and over; situated on the Havant Road, in Emsworth. The home is privately owned. White Lodge is a detached building set back from the main road. There are parking facilities and gardens to the front and rear of the home. The home has twenty-five single bedrooms, sixteen of which have an en suite toilet facility. The home’s weekly fees range from £331.02 to £575.00. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced, inspection visit to White Lodge Residential Home, took place over a one-day period on the 9th May 2008. The manager, Mrs. Smy, attended the home; this being her day off and the proprietor were present to assist throughout the visit. The previous key inspection visit of November 2007 identified a poor service and an improvement plan was requested by the CSCI to address the noncompliance of regulations identified at that visit. The focus of this visit was to evidence the information stated in the improvement plan document and other information received by the CSCI since the last fieldwork visit, and also to assess other key standards and to re- evaluate the overall rating of the service. The manager had also returned the Annual Quality Assurance Assessment (AQAA) to the CSCI in September 2007 and this is referred to in the main text of the report and is used as evidence to support the findings of this visit. Documents and records were examined and staff’s working practices were observed. Service users spoken to were generally complimentary about the their home and the care they receive. Surveys had been distributed to service users, relatives, care managers, GP and other visiting professionals. Three service user surveys, three staff surveys were returned to the CSCI. The outcome of the surveys indicated that there was generally a high level of satisfaction with the service and that people were pleased with the care the home provides. Staff indicated that they enjoyed working at the home and were supported in their role by the management team. There were 23 residents living in the home at the time of this visit. None were from an ethnic minority group. The outcome of this visit demonstrated that in the areas identified as being poor at the last inspection, an improvement in the standard has been achieved. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The improvements made since the last inspection are those stated on the improvement plan received by CSCI. All service users now have the opportunity and choice of seeing a dentist if they so wish and this is documented in the individual care plans. The recording of controlled drugs is being double signed and counted each time they are administered. The distribution of staffing hours has been improved and there is now three staff on duty in the early morning. The recruitment practices are now more robust and staff do not commence employment until all appropriate checks from POVA and CRB have been received by the home. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 7 Key storage safes have been installed in appropriate locations to ensure that keys are maintained in a safe environment when they are not with senior staff. Service user’s records are maintained in a safe environment in the office which is attended at all times or if not the door is kept locked. Risk assessments of the unguarded radiators have been reviewed and all radiators are to be covered gradually in the maintenance programme. Risk assessments and safety procedures have been carried out and reviewed regarding the risk of service users falling from first floor windows. This risk has been assessed as low. Fire alarms are now checked weekly and records maintained. What they could do better: The care plans should be more person centred and reflect how service users wish their care needs to be met. Details of all medical visits, consultations with action outcomes from those visits should be documented in the appropriate care plan. Medication procedures and practices must improve to ensure all medication that is prescribed and administered is signed as evidence that this has taken place. All service users choosing to self-medicate must have a risk assessment and a care plan detailing how this has been agreed with the GP as being safe and that the service user is monitored to ensure they are complying with the prescribed regimen. The manager/senior staff must ensure that service users, who are selfmedicating, store their medication in a locked environment within their rooms to ensure protection of other service users. All prescribed medication must be recorded on Medication Administration Sheets as evidence of what medication service users are prescribed and taking. The home should acquire a copy of the latest reviewed Royal Pharmaceutical Society Guidelines for management of medication in a social setting. Information in this document should guide good practice and support the policy and procedures of the home. All levels of staff must undertake updated training on the policies and procedures that guide the ‘Safeguarding of Vulnerable Adults and must be made aware of the recently reviewed policy written by the proprietor on how to deal with witnessed or alleged abuse in the home. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 8 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 DS0000043778.V363473.R01.S.doc Version 5.2 Page 9 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 DS0000043778.V363473.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment is comprehensive and would allow the home and the service user adequate information to ascertain if the home could meet their needs. EVIDENCE: A sample of four service users pre-admission assessments was viewed. The records show that following a referral for possible admission to the home an assessment of need is carried out by the manager, deputy or the provider. This involves visiting the service user to carry out an assessment. For those referred by social services, the home obtains a copy of the care manager’s assessment and care plan. Other relevant information is gathered from relatives and medical information from hospitals. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 11 The pre admission assessments contain information about the needs of residents including their personal preferences such as cultural and religious needs. The assessment tool was observed to be comprehensive and would allow the home and the service user adequate information to ascertain if the home could meet their needs. A letter and a small brochure are supplied to prospective residents, which gives details about the service provided by the home. The home also has a Statement of Purpose and a Service Users’ Guide. Opportunities are available for prospective residents and/or their relatives to come and have a look around the home to decide if it is the right choice. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have care plans documented, however, these need to be more person centred and reflect individual needs and risks with details of how risks and care is managed. Service users healthcare needs are met. Service users are not protected by the home policy and procedures for the management of their medication. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: A sample of 4 service user’s care plans was viewed. These evidenced that the plans give details of how needs can be met with guidance for staff to follow in the following areas: • Mobility • Washing and dressing White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 13 • • • • • • • • • Continence Social needs and interests Dietary needs Mental and emotional health Eyesight and hearing Sleeping Lifting and handling Hobby care plan The care plans were repetitive and not person centred in as much as they were reviewed every month and recorded, but there was no specified changes identified in the reviews, and although this may have been the case for many of the residents, there must have been some variations in some service user’s abilities over time. An example of this was one resident whose condition was very variable and who was generally deteriorating, this was not reflected in the care plans. The care plans, therefore, demonstrated that when reviewed they were just replicated from the month before and told us that service user’s needs were not changing at all, which was not totally reflective of what was happening in the home. Daily notes are maintained for each service user and everything is recorded in these. This was discussed with the manager and provider. Changes in a person’s needs and outcomes from any visits from medical professionals should be recorded in the appropriate care plan and not get lost in the daily notes. The provider agreed that the care planning system needs to be reviewed to reflect a more person centred approach to care and that this needs to be developed by she and the staff. The home is meeting the health care needs of the service users in general. There are currently issues with one service user whose condition is variable and the home are struggling to meet their needs and have got the support of the primary care team. The district nurse visited the home twice at the time of this visit owing to the deteriorating condition of this service user, and she together with the GP and care manager will reassess the suitability of this person for the home) Service users spoken with at the time of this visit indicated that their health care needs are met and that they see their GP when necessary and attend outpatient appointments with an escort. The manager said that the GP will visit the home at their request and will review service users at the home’s request. It was recommended to the manager that records be maintained of visits to service users by professionals White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 14 stating the outcomes of the visits. It was also recommended that these records would be better identified if they were maintained in individual care plans on a separate recording sheet and not get over looked in the daily records amongst other information. The home now has the services of a visiting dentist who was to visit the home imminently to see service users who had expressed a wish to see him. There was evidence in the care plans of the service users signing to say they had agreed to see a dentist or did not want to see a dentist. This was a requirement from the previous inspection and has therefore been complied with. The medication procedures and processes were observed. It was initially observed that the medicine trolley was not attached to a wall when returned to the office. The office door is locked most of the time but as the day of this visit was very warm the door was being wedged open and although there was someone in attendance, this is not safe practice. The manager said she would organise a bracket for an attachment immediately. The Medication Administration Records (MAR) were checked. It was identified that there were gaps in the recording and this was pointed out to the deputy manager. We identified that two service users had chosen to self medicate some of their own prescribed medication. There was no evidence of a risk assessment having been undertaken to ensure they were able to do this safely and whilst independence is encouraged, there was no records on the MAR sheets to identify who was self medicating, nor what and how much of the medication was being prescribed and taken. There were no records that the medication being self-administered was being monitored for compliance by the senior staff. We observed that one service user, who was very able to self-medicate, was taking her prescribed night medication and this was observed to be on the bedside table and not in a safe environment. We discussed this with her and she agreed to keep it in the locked draw by her bed. A service user, who had been admitted four days previously, was found not to have any MAR sheet records of medication being taken. The manager/deputy did not have any knowledge of what this service user was taking; it was only documented on the assessment. The home has complied with the requirement from the last inspection in recording the controlled drugs and this includes the night sedation Temazepam. The records are being documented in a loose page folder. The provider was advised that although Temazepam is not classed as a controlled drug it must be stored as such, and good practice recommends that it is also recorded as such and balances of stock held are recorded every time a tablet is administered. We also discussed with the manager and provider that the home should obtain a controlled drugs register as per the guidelines from the White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 15 Royal Pharmaceutical Society, which states that records of controlled drugs should be recorded in a bound book with numbered pages. The drugs fridge is positioned in a store cupboard in the front reception. The fridge stored insulin and eye drops and had no lock attached to the door and the door to the cupboard was unlocked at the time of this visit. There were no records of fridge temperatures being recorded. This was discussed with the provider who agreed to fit a lock to the fridge, ensure the door to the cupboard is locked and monitor temperatures of the fridge daily. The provider was advised where she could obtain the revised Royal Pharmaceutical Society guidelines to the handling of medicines in social care settings. Requirement will be made from the findings of this standard. The staff were observed to have good relationships with the residents and were familiar with their preferences of how they liked things done. They were observed to knock on bedroom doors before entering and interacting with residents in a respectful manner. It was observed that all bedroom doors have locks fitted and there is an option for residents to have a key to the lock on their bedroom door for privacy and security. Residents and there relatives describe the staff as treating them with dignity and respect. The AQAA states that the resident’s privacy is upheld and staff are reminded that this is extremely important. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The home provides a programme of social activities to meet service users needs although some residents may benefit from additional activities. Service users are able to exercise choice and make decisions about their lives. Visitors are made welcome to the home and they can see service users in private. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: The home has an informal activities programme displayed on the wall and care staff undertake this role when they have time. The provider said that she had recently appointed an activities organiser but they had not taken up the post and she was now in the process of advertising this role. The home does have outside entertainers in once a month and every Monday a person attends the home for service users to participate in musical movements. Service users spoken with gave a mixed response as to if they White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 17 wish to participate in any of the activities. Surveys returned from three service users indicated that there were activities ‘sometimes’, and one commenting ‘I would like things to do sometimes’. The AQAA stated that the manager and provider have increased the social activities in the past year by holding a summer party as well as the Christmas party and relatives are invited. The manager wishes to work out more ways of getting residents involved with the social activities. Although the assessment does record likes, dislikes and preferences there is no record of social history and background that would contribute to the planning of appropriate activities for the service users. The home does have visiting clergy every week that attend the home to give communion to those service users who wish to take it. One service user goes to the community church and is transported to it by the people from the church. Outings for the service users are usually via relatives taking the residents out with the occasional trip out organised by the home. The visitor’s book demonstrated that the home does have visitors and this was supported when talking to a number of service users who said they have regular visits from family and friends who are made welcome in the home. Records are now maintained of the preferred rising and going to bed times of the individual residents and residents spoken with confirmed that they are able to exercise choice in this area and that ‘staff are very kind’. Personal preferences and religious needs are recorded. The cook was spoken with and she said that she knows the resident’s likes and dislikes in food and plans the menus around these. The kitchen was visited by us and was found to be clean and well organised with appropriate cleaning schedules in place and records of fridge/freezer temperatures and safe and correct storage of foodstuff. The chef was knowledgeable when spoken to about the diabetic diets that she caters for. There was evidence that she has record of all likes and dislikes but reports to know them well. The menus were viewed and demonstrated that they are changed on four weekly basis and the content of the menus described wholesome meals that elderly people would enjoy. There is a choice at every mealtime. The day of the visit was a Friday and most service users said they were looking forward to fish and chips. One resident said she could not tolerate fried food so the cook was preparing her a steamed fish with mashed potatoes. Residents are served breakfast in their rooms and the home has a pleasant dining room where most service users take the main lunchtime meal. We were White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 18 told that residents do have the choice of where they eat, and indeed some were choosing to eat in their rooms. The lunchtime meal was observed. The meal was well cooked and presented. The lady residents spoken to at lunchtime said they enjoyed the lunch a great deal and enjoy meeting up with the other residents at this time of the day to have a social chat. The care plans identify that weights are monitored monthly and the manager said that if a service user were loosing weight this would trigger a nutritional assessment. None of the service users have had a nutritional screening risk assessment undertaken. We discussed with the provider about how to obtain information with regards to identifying an appropriate nutritional assessment tool. Certificates evidenced that both the cooks employed at the home are up to date with the food handling and hygiene training. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which service users felt they would use if necessary. Staff do not have adequate knowledge on the procedures to follow when dealing with suspected abuse. EVIDENCE: The home has a complaints procedure. This is given to residents and their relatives in either the contract and/or the Service Users’ Guide. The feedback from several survey forms indicated that the home might need to remind residents and relatives of the complaints procedure and how they can complain. The complaints log was viewed in which records are kept of any concerns or complaints raised and of the outcome of dealing with the matter. Service users spoken with at the time of this visit said they would speak to a member of staff, the manager or proprietor, if they had any concerns. No complaints have been recorded since the last inspection. The home has a copy of the local authority social services Safeguarding procedures and also a Whistle Blowing policy. In light of a recent safeguarding issue in the home, when agreed local authority procedures were not followed, the provider has reviewed the home’s White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 20 policy on dealing with abuse. The manager said that as a result of the recent safeguarding issues in the home, it has highlighted a training need for her and staff. The proprietor told us that she is making enquiries as to where further safeguarding training for staff can be supplied. A requirement will be made from these findings. The manager said that she ensures all staff are made aware of the safeguarding procedures at the time of induction but concedes that she and staff need further training to reiterate the procedures to follow should there be allegations of abuse or witnessed abuse. Service users spoken with at the time of this visit said they would go to the manager or their relatives/friends immediately if they had any issues with their safety. One commenting that ‘the manager would act on what I said she is on the ball’. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean, safe, pleasant and well-maintained environment for the enjoyment of service users. EVIDENCE: We looked around the premises. Each resident has a single bedroom, many of which have an en-suite toilet facility. The rooms are decorated to a good standard and contain numerous personal possessions. Residents are able to bring their own furniture to their rooms. One resident describing how she really ‘loved’ her bedroom and that it had been painted in the colour she had chosen and she would not want to move from this room. Several residents have a key to their bedroom door for privacy. Residents are also able to have their own telephone line to their room. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 22 The home has a passenger lift which residents were seen to use. Hoists are available for those with mobility and lifting needs. The home has two lounges, one is called the television lounge and the other is known as the quiet lounge. Both are decorated to a good standard and have access to the gardens, which are large and maintained by a gardener. The surrounding grounds are pleasantly situated and used by the residents in the finer weather. On the ground floor the home has a wet room which has recently been converted from a bathroom and which is proving very popular with the residents. Another separate bathroom and a further bathroom on the first floor are also available. The kitchen has been refitted. The home has separate laundry, which is equipped with a domestic washing machine and tumble dryer and the flooring has been recently replaced. The provider said the home has a maintenance programme of redecoration that is viewed monthly by her. There are plans to develop the back of the home to provide more en-suite rooms and all existing rooms will be extended to provide an en-suite facility. All areas of the home, on this visit, were observed to be clean and no unpleasant odours were detected, except in one bedroom and this was discussed with the manager as to the reasons for this. Service users spoken to said they were happy with their environment and one saying that she dusts her furniture herself on a regular basis because she has so many bits and pieces. Infection control training is provided for staff. Disposable gloves and aprons were observed to be available as so were hand washing facilities in all appropriate areas. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 23 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 good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by sufficient numbers of staff who have received training, however, there are aspects of training that are not to an acceptable level to fully protect service users. Recruitment policies and practices now ensure that service users are supported and protected. EVIDENCE: The previous report identified that there were insufficient staff on duty from 7 am until 9 am to meet the needs of the service users. This has now been adjusted and three members of staff are on duty until 6 p.m and from then until 9 p.m, there are two care staff on duty. Two waking night staff are on duty each night. Two cooks cover the seven days and domestic staff work five days a week. Care staff undertake the laundry role. The provider is in the process of recruiting a weekend cleaner and extra care staff. At the time of the visit there were 23 service users in residence. There appeared to be sufficient staff on duty at the time, staff were not rushed and many of the service users had a good level of independence. Staff and service users spoken to felt there was adequate staff on duty at all times. Service White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 24 users stated ‘ the girls are very good’, and the bells are always answered promptly’. It was clear staff and service users got on well together. Staffing levels were discussed with the manager and provider and it was agreed that the staffing numbers should be adjusted as to the service user’s needs and dependency. The home’s induction programme is supplied by an outside training organisation and is based on the Skills for Care induction standards. We could not evidence a completed induction programme in a recently recruited staff member. The manager reported that she destroys them when they are completed and that the organisation does not supply a certificate of evidence of completion. This was discussed with the manager as to this evidence should be maintained in the staff members file as part of her portfolio of training. The staff training needs are identified through their twice-yearly appraisal and supervision every two months. A sample of records was evidenced of appraisal and supervision taking place, at which time training needs are discussed. Staff surveys returned to CSCI says that staff have received appropriate training and that they meet often with their manager. One survey saying: ‘We are involved with training and encouraged and supported to do training’ ‘The home does well in many areas of training’. The AQAA stated that the home wants to improve and get involved with more training to improve staff knowledge and ultimately promote the home. As stated in standard 18 texts, it has been identified by the manager and staff that more training is required to enable staff to be confident in how they report and deal with any forms of abuse or any issues associated with safeguarding. Over 50 of staff has completed their NVQ level 2 training. Staff are also able to complete NVQ levels 3 and 4. Training records show that staff have attended the following courses: first aid, dementia, health and safety, medication, infection control, fire safety, epilepsy, coping with aggression and risk assessment. The recruitment files for four staff members were looked at. Each person had completed an application form and two written references had been obtained one of which is from the most recent previous employer. The previous report identified that the home was not taking up the appropriate CRB and POVA checks before employment commenced. The improvement plan received from the provider subsequent to this requirement stated that staff do not commence employment without both the CRB and POVA check being received by the home. This was confirmed when viewing files of the most recently recruited staff. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 25 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, 33, 35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An experienced manager runs the home, although there are deficiencies in management systems. The home is run in the best interests of service users, however, there is no formal quality assurance systems to measure the outcomes for service users against that stated in the Statement of Purpose. Records are maintained in a safe environment. The health and safety of service users and staff is promoted. EVIDENCE: White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 26 The manager of the home has been in place since May 2005 and was registered in September 2005 and has many years experience in caring. She has completed a Registered Managers Award. There is a deputy manager in post to support the manager, who is also very experienced and has worked at the home for some time. The provider informed us that the registered manager will soon be absent from the home for some months and the deputy will be taking over her role whilst she is away. The provider was advised to inform the CSCI by letter of this arrangement. Service users and staff spoken to felt she was a good manager and they felt were able to talk to her about any concerns they had. Comments on surveys returned were: ‘The managers are very supportive and are always there when they are needed regarding any aspects of care’. Some areas inspected such as medication records and practices, care plans, protection and quality assurance showed deficiencies in the management of the home and are addressed in the appropriate standard. It was clear from discussions with service user the home is run in their best interests. Service users spoken to stated they would have no problem complaining if they thought something was not right and they reported to us that they ‘ are very happy and the staff cannot do enough for us’. The manager told us that she does check on records and MAR sheets and undertakes quality control on a daily basis but nothing is documented as to evidence this. The home has not distributed service user/relatives satisfaction surveys for some time and therefore there is no formal feedback system in place to demonstrate that the home is measuring the outcomes for the service users against that stated in the Statement of Purpose. Regulation 26 reports are written every month by the person who visits the home as a representative of the provider who is not always present on the premises. These were seen by us and were detailed in content. The home does not manage any of the service users finances. The home has complied with the requirement from the last inspection visit and all service users confidential information and records are maintained in a locked cupboard in the front office. Keys are stored in small key safes in the appropriate locations in the home. The previous two reports have noted that not all radiators were covered. These have been risk assessed and the previous report required a review of the risk assessments as concerns were again raised at this visit. The risk assessments have been reviewed and the action taken has been that two radiators have been covered in the bathrooms, the temperature is thermostatically set on the boiler and the temperatures of all radiators are White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 27 checked weekly and recorded, These records were seen at the time of this visit. The provider told us that she anticipates that all radiators will be covered gradually and this is part of the planned maintenance programme. Risk assessments were also seen for the upstairs windows and all residents in upstairs rooms have been assessed and will be assessed regularly. This was a requirement from the previous inspection visit and forms part of the improvement plan and has been complied with. The fire log was viewed. This demonstrated that all fire alarms are now checked weekly and other checks are undertaken of equipment at appropriate intervals with records maintained. The fire alarm system was serviced March 08. There were records that demonstrate staff receive fire training twice yearly and that fire drills take place. One of the members of staff is to attend a fire marshal training. A sample of other servicing certificates was evidenced to be up to date. White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 3 3 White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation Reg 15(2) Requirement Timescale for action 31/07/08 2. OP9 The registered person must ensure that care plans are reviewed with the service user and that they are person centred and reflect any changes in the service user’s needs and care. 13 The registered person must (2)(3)(4)c ensure that medication Reg 17 administration recording sheets (1)(a) Sch are documented for all service 3. users to accurately reflect the resident’s current prescription. The registered person must ensure that MAR sheets are recorded appropriately each time a prescribed medication is taken by the service user. The MAR sheet must also identify reasons why prescribed drugs are not taken or refused. The registered person must ensure that all service users who wish to self-medicate prescribed medication must do so within a risk management framework with documentation to support this. 30/06/08 White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 30 The registered person must ensure that service users taking responsibility for their own medication store it in a locked environment at all times. 3. OP18 Reg 12(1) Reg 13(6) The registered person must ensure that all levels of staff receive updated training in the local authority protection of vulnerable adults procedures which must include the home’s own reviewed policy and procedure. 31/07/08 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 OP8 Good Practice Recommendations It is recommended that records of all visits made by professionals and consultations with the medical professionals with any action outcomes, be recorded in the care plans. It is recommended that the home acquire a copy of the Royal Pharmaceutical Society Guidelines for the Management of Medicines in a Care Setting to guide their practices. 2. OP9 White Lodge Residential Home DS0000043778.V363473.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone 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. 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