Inspection on 22/11/06 for White Lodge Rest Home

This inspection was carried out on 22nd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

White Lodge Rest Home 26/09/07

White Lodge Rest Home 12/12/05

White Lodge Rest Home 31/08/05

White Lodge Rest Home 28/02/05

White Lodge Rest Home 19/11/04

White Lodge Rest Home 04/03/04

White Lodge Rest Home 20/01/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE White Lodge Rest Home 79-83 Alma Road Portswood Southampton Hampshire SO14 6UQ Lead Inspector Ms Jan Everitt Key Unannounced Inspection 22nd November 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address White Lodge Rest Home DS0000011852.V313633.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 Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service White Lodge Rest Home Address 79-83 Alma Road Portswood Southampton Hampshire SO14 6UQ 023 8055 4478 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) Mr Michael J Foot Mr Michael J Foot Care Home 28 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (28), Mental disorder, excluding learning of places disability or dementia (28), Mental Disorder, excluding learning disability or dementia - over 65 years of age (28), Old age, not falling within any other category (28) White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 5 service users aged 60-65 years may be accommodated. Date of last inspection 12th December 2005 Brief Description of the Service: Whitelodge is a care home situated in Southampton and is close to local facilities. The home is registered for twenty-eight service users within the categories of old age, dementia and mental health. The home provides accommodation in a range of double and single rooms and some rooms are on the ground floor. The home has two lounges, two dining areas, a kitchen and suitably located bathrooms and toilets. To the front of the house is a small garden and to the rear is a nicely maintained garden and patio, which is accessible to service users. The home is owned and managed by Mr Foot. Fees range from £359 - £410. Items not covered by the fees are hairdressing, papers/magazines, chiropody and personal toiletries. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit to White Lodge residential care home, which was unannounced, took place on the 22nd November 2006. This report details the results of an evaluation of the quality of the service provided by White Lodge and brings together accumulated evidence of activity in the home since the last key inspection on 12 December 2005. The visit to White Lodge formed part of the process of the inspection of the service to measure the service against the key national minimum standards for the year 2006/7. The judgements made in this report were made from the visit to the home, information gathered prior to the visit; pre-inspection information submitted to the commission by the registered manager, information from the previous report, the service history correspondence, registration activity, touring the home and viewing records. People who use the service have been consulted with and this has been done by questionnaire surveys sent to service users, relatives, other visiting professionals including GPs, staff questionnaires and talking to service users and staff at the time of the inspection visit. Due to the service user’s cognitive impairments comment cards were not completed and the manager reported that he considered it inappropriate for staff to support service users in completing these. The surveys had been left in the front reception hall should relatives which to complete them. There were four responses to the visiting relatives survey, five from visiting professionals and included social worker, CPN (community psychiatric nurse) and district nurses. Two GPs returned their comments and six staff completed the surveys given to them by the inspector. The responses from the surveys were, in general, very positive. What the service does well: White Lodge provides a homely welcoming environment that is clean and comfortable and is decorated to an adequate standard. The staff were observed to be interacting well with the service users and were noted to be good humoured and sensitive to the needs of confused people. The activities programme in the home is good and it was observed during this visit that activities were taking place. There was also evidence around the home of arts and crafts objects that had been made by the residents. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 6 Staff spoken with and comments from the staff surveys indicate that the staff gain a great deal of job satisfaction working at the home and comments such as: • ‘the care given to the resident is appropriate and well done’ • ‘the home provides as much care as possible to the service users and try to make it feel like their own home’ • ‘the homes ethos of friendly care is outstanding’ were made. Comments from visiting professionals were positive: • very pleasant and caring staff. • care and communication excellent and staff are friendly and helpful’ What has improved since the last inspection? What they could do better: The Home must maintain in service users’ files a signed contract drawn up between the home and themselves stating the terms and conditions of residency. Care plans must be written for new service users and reviews of the plans must taken place appropriately and be available to enable staff to have access to full information about the service user’s care needs. The storage of medication is fragmented and needs reviewing. The area in which it is stored would become very hot in the warmer weather as the roof is of Perspex. A self-medication policy must be written and risk assessments undertaken for the service user who wishes to maintain and administer medication. Errors were noted in the recording and administration of medication. A system of close monitoring would quickly identify discrepancies and enable action to be taken. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 7 There are areas around the home that need maintenance and attention and these are discussed in the main body of the report. The staff training plan needs to identify the training needs of all staff that should be identified at appraisal and supervision. The staff communicated with reported that they do not receive supervision or appraisal. The home does not demonstrate any quality assurance system to monitor the quality of the service. Service users monies are not placed in individual savings accounts and therefore cannot accrue interest. The infection control policy must be reviewed. Guidance on infection control and training for staff must be obtained imminently. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. White Lodge Rest Home DS0000011852.V313633.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 Rest Home DS0000011852.V313633.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives receive relevant information to enable them to make an informed decision about where to live. Service users have not signed a contract/statement of terms and conditions of residency with the home. Service users are assessed before admission to ensure the home can meet their needs. EVIDENCE: The home has a Statement of Purpose that details all information stated on Schedule 1 of the Care Homes Regulations. The Service User Guide is distributed to people who enquire about the home. This details information that would assist service users to make informed decisions. Owing to the White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 10 mental frailty of a large majority of the service users it was not possible for the inspector to ascertain the level of information they had received before being admitted to the home. A sample of service user’s personal files was viewed. The home could not demonstrate in service user’s files that service users or their advocates had signed contracts or/and terms and conditions of residency. This was discussed with the manager. He evidenced the contract of agreement the home has with social services for those service users who are funded. There will be a requirement made from the findings of this standard. The proprietor or manager undertakes the pre-admission assessment. The inspector viewed a sample of these. The content was comprehensive and thorough and would allow a good over view of the service user’s needs and included a social history, their physical and mental health needs and how they managed their activities of daily living. There was also evidence that family are involved at these assessments and the manager reported that the home rely on them to gain accurate information about the service user’s past life. Further information is also gathered from the care manager’s need’s assessment. A copy of this was evidenced on the file of one of the residents recently admitted. White Lodge Rest Home DS0000011852.V313633.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 at least once during a 12 month period. 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 and viewing records. Service users health, personal and social needs are set out in care plans. Service users health needs are met. Service users are not fully protected by the policies and procedures in the home for the management of their medication. Service users are treated with respect and the core values of care upheld. EVIDENCE: The inspector viewed a sample of four service user’s care plans. The care plans were audit trailed from service user’s admission. Three of the four care plans were comprehensive and covered all aspects of the service user’s assessed needs. The inspector could not evidence that any care plans had been written for a service user who had recently come to live at the care White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 12 home. The daily records were well documented and all visits by professionals attending the home, and any outcomes, were recorded. There was no evidence to suggest that the service user or/and their relative have had involvement with the formation of the care plans or the reviews, but owing to the service user’s level of mental frailty they were not able to communicate if they understood about their planned care. Four relatives indicated on the comment surveys returned to the CSCI that they are well informed about any matters that affect their relative and the home consulted them about their care. The care plans were maintained in a locked filing cabinet that also contained the night medication and were not easily accessible to care workers. The daily notes were maintained on the desk in the conservatory and these were the records used to update staff on any changes to the service users. The home is serviced by one GP practice that is geographically close to the home. Two GPs returned their comment survey cards and indicated that they have a good working partnership with the home, with one GP commenting that he found the staff ‘very pleasant, caring and co-operative’. They both indicated that the staff demonstrated a clear understanding of the care needs of the residents in their care. The community psychiatric team also visits the home regularly from the local psychiatric hospital. Four comments cards were received from this team. One CPN commenting that the ‘care and communication is excellent. Staff are friendly and helpful’ and the general comments indicate that they have no criticisms of the care of the service users. The chiropodist, dentist and optician attend the home at regular intervals to ensure the service users other health care needs are monitored. The home uses the monitored dosage system for the administration of medication and medication that cannot be put into these packs are administered from boxes, bottles etc. The inspector audited a sample of the MAR sheets and there were gaps in the recording of administration in a number of nighttime drugs. The night medication is maintained in a filing cabinet next to the metal cabinet that stores all other medication. Reasons for this were discussed with the manager who reported that this is so the night carers only have access to the medication they have to administer. The draw also held a locked tin box that contained the night sedation. It was observed that some of this medication had not been stored in the locked box the previous night, as stated in the policy. The home maintains an exercise book for the recording of this medication with a running balance. This is considered to be good practice. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 13 If the occasion ever occurs that a controlled drug is prescribed to any of the service users, the home must obtain a controlled drug (CD) register and alternative storage arrangements made, to ensure that CDs are stored appropriately. The inspector evidenced the policy for the crushing of medication and service user’s records are supported by a letter signed by the pharmacist and GP to agree for certain medication to be crushed. Also documented was the involvement with the service user or/and the relative in agreement with this practice. One service user maintains some pain killing tablets in their room. This was discussed with the senior carer who described how this is managed. The inspector advised the senior carer that a risk assessment must be undertaken for her keeping these tablets in her room and the management strategy must be recorded. The home has no self-medication policy and procedure, which must be written. The inspector observed a list of identified staff that are able to administer medication in the front of the MAR sheet folder. The room where the medication is stored is a conservatory that also houses the washing machines and laundry equipment. The medication that needs to be stored below a certain temperature is stored in the domestic fridge in the kitchen, separately. The inspector considered that the area that stored medication was not appropriate. The storage of night-time medication, if maintained in a locked filing cabinet, results in the staff not readily having access to the care plans. The inspector has, therefore referred to the CSCI pharmacy inspector to undertake an inspection of the home for further guidance. The inspector observed that there was a good relationship between carers and service users and carers were very familiar with their individual needs. Care staff were observed to show service users respect and knocked on doors before entering their rooms. Care plans identify service users preferences, their likes and dislikes. Staff spoken with confirmed that for those service users who are more physically independent, they are able to move freely around the home. Service users choose when they go to bed or get up in the morning. A visiting relative spoken with reported that she is very happy with the care her husband is receiving and that she comes weekly to take him out for the day and is supported by the home to do so. The service user himself reported that he would ‘rather be at home but that this home was fine and he would not want to move to another’. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 14 From observations of the daily routines and talking to staff members, the home demonstrates it’s understanding of the core values of care which is stated in the Statement of Purpose and forms part of the philosophy of care. Shared rooms were observed to accommodate screens to ensure service user’s privacy is respected. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users expectations and preferences to meet their social, cultural, religious and recreational interests are met. Service users are able to maintain contact with family, friends and the local community as they wish. Service users do exercise control over their lives as much as is possible. In general most service users receive a well balance diet in pleasant surroundings but attention to detail is not afforded to those on pureed diets. EVIDENCE: The home demonstrates a full and varied programme of activities and entertainment that take place in the home most days of the week i.e. quizzes, chair aerobics, bingo at weekends. The inspector observed that there were two separate sets of entertainment taking place on the day of the inspection. A visiting professional the home employs for a period of time, attended the home White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 16 to support service users making Christmas decorations and they were observed to be absorbed in their work and very pleased with the end results. Staff surveys returned to the CSCI highlight that the home provides good entertainment and activities for the residents. The home attempts to get a social history of the service user’s past life at the initial assessment or as soon as possible and entertainment and activities are planned appropriately. The clergy visit the home monthly to service communion to those who wish to attend. The home welcomes visitors at any time and this is reflected in their policy. Service users were observed to be receiving visitors at the time of the site visit, although there were not many that day. Relatives comment surveys returned to the CSCI confirm that they are made welcome to the home and there is ‘always a cup of tea or coffee on offer’ and the atmosphere around the home is friendly. A number of service users go out into the community escorted. There are two service users able to go to the local shops independently and the inspector observed a risk assessment for this. Service users are able to wander around the home freely and indeed on the day of this inspection this was observed. The front doors are alarmed should a service user open the door. The garden is secure and service users use this in the fine weather. The service users’ rooms were observed to be personalised and many of the service users had chosen to bring their own pieces of furniture for their rooms. The manager reports that this is not put on an inventory. Staff spoken to about the service user’s daily routines appeared to be so familiar with them that they did not consult the care plans on a regular basis. The inspector visited the kitchen which was found to be clean and tidy. The meals and menus were discussed with the manager. He reports that the registered manager/proprietor decides on the menus on a weekly basis. There is a cook on duty until early afternoon each day. Housekeepers or carers arrange the tea and supper meals. The inspector did not observe any advertised alternatives to the daily menu but was assured by the cook that service user could request an alternative if they chose and special diets are catered for such as gluten-free. The cook reported that she is familiar with the service user’s likes and dislikes and accommodates this. It was observed that if a service user has an alternative White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 17 menu this is not recorded. It was discussed with the manager and cook that records must be maintained of all food service users eat. The inspector observed the lunchtime meal. The menu for the lunch was egg, chips, and beans. The meal looked well presented and was an obvious favourite and was enjoyed by most service users. The inspector observed that care staff were not wearing aprons or protective clothing whilst serving the meal. One care staff served a pureed meal to a service user who was very mentally frail and unable to advocate for themselves. The egg, chips and beans had been pureed together and put into a serving bowl all mixed up. This was discussed with the manager as to the need to be more sensitive to the service user’s needs and separate the portions so that the colour and textures could be enjoyed. The mealtime was noted to be quite relaxed and service users who need support with their eating were not rushed and their dignity maintained. Service users reported that the food was good, as did a visiting relative. All service users are weighed monthly to monitor nutrition. Food preferences of the service user are documented at the assessment when the service user is admitted. The Environmental Health Officer inspected the kitchen in December 05 and the report had no recommendations documented. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service and inspection of records. Relatives and service users are confident that complaints or concerns reported to the management team will be listened to and acted upon. Service users are fully protected by the adult protection procedure. Staff demonstrate knowledge and understanding of what constitutes abuse. The home’s procedure regarding the service users financial affairs are not maintained for the benefit of the service user. EVIDENCE: The home has a complaint policy in place, which is displayed on the wall in the front entrance hallway; this needs reviewing to reflect the regulation body as being the Commission for Social Care Inspection and not the NCSC. Relatives comment surveys returned indicated that they were unaware of the complaints procedure. The procedure is clearly stated in the Statement of Purpose. Relatives may need to be made aware of this policy and be reminded where they can locate this information. A service user, when asked whom they would complain to, replied the carers or the manager. They were unaware of the exact procedure but would ‘have a moan’ if they felt it necessary. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 19 The manager has received one complaint the previous day from a recently employed carer which highlighted a short fall is areas of infection control training and the manager has now booked training on the back of this complaint. The home has an adult protection policy and procedure. The procedure was talked through with the manager and some of the care staff. They demonstrated knowledge of how adult protection was dealt with. A number of staff attended training on abuse awareness in August 06 and this was evidenced in their training file. The questionnaire surveys given to the staff all indicated that they would report any incidences or allegations of abuse to the manager. The inspector discussed with the manager how service user’s monies were stored and if they have access to it. The manager reports that it is pooled into one account in the home’s name. This is discussed further in Standard 35. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users live in a safe, clean and homely environment that is maintained to a satisfactory level. Service users do have sufficient lavatories but inadequate hand-washing facilities. The guidelines for the management of infection control are not practiced. EVIDENCE: The inspector toured the building. The pre-inspection document records that a new bathroom and toilet have been added on the ground floor and one extra room with en-suite. A small dining room has been converted to another bedroom and a double room has been made into single accommodation. One White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 21 sluice room has been added, this was noted to be partitioned off from a service user’s WC facilities. The home was clean and tidy and service users’ rooms were homely and personalised. One relative commented that the home is very clean and homely. The home employs a maintenance man who was seen about the home undertaking small repair and maintenance jobs. The manager reports that the home has no maintenance programme in place for the renewal and refurbishment of the home. On touring the premises the inspector identified that part of the floor boarding at the entrance of one room was collapsing. This proved to be the case and the maintenance man was called immediately to rectify the fault. The inspector observed that stair carpets were becoming threadbare in some areas. This was discussed with the manager and the monitoring of this should take place to ensure the safety of service users who use the stairs independently. Generally the home was pleasantly decorated although one staff member did comment that there are areas of the home that need redecorating. The infection control policy and procedures need to be reviewed in view of some of the practices observed by the inspector. The inspector observed that there were no hand washing facilities in a number of toilets and where there was a basin, no disposable hand towels were available. The home reports to use towelling hand towels but the inspector could not find one in any of the toilets, not even the staff toilet. The inspector could not identify any waste disposal bins in the toilets to dispose of either clinical or general waste. The bathroom on the first floor did not have a washbasin, hand washing facilities or waste bin. The manager reported to the inspector that the senior carer, who lives on the premises, uses this bathing facility and only the service users use the toilet. This is an encroachment on the service users communal space and must cease and be used for service users only. The inspector observed that the two toilet facilities leading off of the lounge did not have full hand washing facilities available with no towels to dry their hands should the service user choose to wash them. Carers were observed not to be wearing aprons over their uniforms they had been wearing all morning for caring, when serving food. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 22 The home demonstrated little awareness of the principles of infection control and the training matrix did not identify that staff had undertaken any training. The laundry is housed in a conservatory on the side of the home. The machines were observed to be of an industrial standard and fit for purpose. The environment also accommodates the medication cupboards, a desk and two filing cabinets in which service user’s care plans, medication and dressings are stored. Carers undertake the laundry throughout the day. The tiled flooring in this area was worn with a hole in one area that presents a health and safety risk for staff using this area and the floor is not readily cleanable. White Lodge Rest Home DS0000011852.V313633.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 at least once during a 12 month period. 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, pre-inspection information, viewing records and speaking to staff. Service users needs are met by the numbers and skill mix of staff on duty as any one time. The recruitment policies and practices are robust. Staff are trained and competent to undertake their roles. EVIDENCE: The inspector viewed the staff rotas and this demonstrated sufficient staff on duty. At the time of this inspection there were twenty-four service users in residence with one in hospital. The staff rotas identified the hours worked and the staff roles. A manager, one senior carer and two or three carers cover the home each day with two waking staff on all night. Ancillary staff on duty are a cook, two cleaners during the week and one at week ends. Carers undertake the laundry as part of their role. Staff spoken with considered they were well supported by senior staff and management. When speaking to staff they displayed an understanding of the White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 24 needs of the service users and the inspector observed that they interacted and communicated well with the service users. Comment survey cards received by the CSCI from relatives identified that they considered there was enough staff on duty at any one time. At the current time the home has 8 carers that have achieved NVQ level 2 & 3. The provider’s son, who was acting manager at the time of this inspection, is undertaking his Register Managers Award in anticipation of applying to become a registered manager. A sample of recruitment files was viewed. The files viewed contained all the necessary checks such as CRB, POVA, two references and other required information. The most recent recruited carer was awaiting a CRB check and was working under supervision. Staff spoken to confirmed their recruitment process as being robust. Six care worker surveys were returned to the inspector. Most confirmed that they had undertaken a thorough recruitment process. Four of the six reported not to have received a contract of employment. Half reported not to have received a job description. Two of the six reported not to have received an induction to the home. The newly appointed carer confirmed that he was undertaking his induction programme at that time. The training matrix was submitted to the CSCI with the pre-inspection questionnaire. This indicated that staff attend the mandatory training for health and safety issues. The records indicated that all staff have undertaken training on abuse awareness and named staff have received training in the safe administration of medication. Staff on duty spoken to confirmed that more senior carers have received this training. Training certificates were evidenced in staff files. Staff that returned the surveys stated that they have received training that was funded by the home and they were supported to meet their training needs. The home could not demonstrate how the staff training needs were identified and care staff that returned surveys reported they did not receive supervision on a regular and individual basis. The training matrix identified current training but did not indicate dates and when updates were due for the mandatory training. The manager reports that training is provided ‘in house’. White Lodge Rest Home DS0000011852.V313633.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit and viewing records. The home is managed by a person fit to be in charge and able to discharge his responsibilities fully. The home does not have an effective quality assurance system and does not seek the views of service users, relatives and other professionals to measure the effectiveness of the service. Service users’ financial interests are not appropriately safeguarded. The home promotes the health, safety and welfare of service users and staff. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager was on annual leave at the time of this visit and his son was acting as manager. He reports that the registered manager does visit the home most days. The registered manager has many years experience in the care home industry and has been the registered manager for some considerable time and is able to discharge his responsibilities and accountability for the care home. Two staff members commented in their returned surveys that they would like better communication between the management and staff and another commented on the staff meetings not being held often enough. The home does not demonstrate any quality assurance system for monitoring the quality of the service and if it meets the stated aims and objectives of the Statement of Purpose. The acting manager reported that service user/relatives surveys are not distributed but he talks to the residents and visitors on a daily basis. The inspector could not find any evidence that systems within the home were audited regularly by the manager to ensure compliance with the standards. Residents meetings are not taking place at the current time. There was no evidence that staff meetings take place but one staff survey received indicated that they had not taken place for some considerable time. The home does manage a number of service users own monies. The inspector evidenced records for each service user stating monies received and out going monies and a balance sheet stating how much money the service user has. Receipts were also evidenced in the files. The acting manager informed the inspector that only a small float of money was maintained at the home for service user’s use but all other monies were pooled into one bank account in the home’s name. This was discussed with the acting manager as to how the interest is distributed. He informed the inspector that this is an administration fee for the home managing the monies. A requirement will be made from these findings. The inspector checked a sample of certificates/invoices for the servicing of systems and equipment. These were found to be current and up to date. The PAT testing for all appliances has now been undertaken in the current year. The fire log evidenced that the system was checked at appropriate intervals. The fire risk assessment was dated January 06 and the environmental risk assessment was reviewed 06. White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 27 The accident book was viewed and completed appropriately. The inspector gave advice as to how to store these records in accordance with the Date Protection Act and that they should be treated as confidential to the person involved. There was no evidence that the manager analyses the accident reports to identify any emerging themes. The inspector did observe cleaning chemicals stored in the linen cupboard, which was unlocked. This was discussed and the cupboard was locked immediately. The infection control policy needs to be reviewed and made more specific to the home. Staff training must be provided for all staff and the home must seek guidance and information from the Public Health department. This is discussed more in Standard 26. White Lodge Rest Home DS0000011852.V313633.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 3 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 OP2 Regulation Reg 5(1)(b) Requirement Timescale for action 31/01/07 2. OP7 Reg 15(1) 3. OP9 Reg 13(2) Reg 17 (1)(a) Sch.3 Reg 12(4) The registered person is required to ensure that all service users have signed and received a copy of a contract/statement of terms and conditions of residency. The registered person must 31/01/07 ensure that care plans are drawn up with the involvement of service users/relatives and provides a basis for their care. The registered person is required 31/01/07 to ensure that all medication that is administered to service users is recorded on the MAR sheets. 4. OP15 Reg 12 Risk assessments must be undertaken on service users who wish to maintain medication in their own rooms and selfadministrate. A locked cupboard/draw must be provided for the service user and records maintained. A care plan must be written to describe how the risk is managed. A self-medication policy must be written to guide staff of this practice. The registered person must 21/01/07 DS0000011852.V313633.R01.S.doc Version 5.2 Page 30 White Lodge Rest Home ensure that all foods eaten by service users are recorded and include those service users who have eaten an alternative diet. Those service user who are assessed as needing a pureed diet, must be presented with meals where the foods have been pureed separately so that colours, flavours and textures can be appreciated. The registered person must ensure that the torn flooring in the laundry area is repaired or replaced imminently. The stair carpet identified as being worn and becoming threadbare, must be monitored for wear and be replaced in the coming maintenance planning year. 6. OP21 Reg 23(2)(j) The registered person must 31/01/07 ensure that the first floor bathroom is maintained for the use of service users only to ensure that the home maintains the correct ratio of 1:8 bathing/shower facilities. Reg The registered person must 28/02/07 12(1)(a) ensure that hand-washing Reg 13 facilities are installed in all toilets (3)(4) and bathrooms for service users Reg 23(5) and staff to use. Staff must wear appropriate protective clothing when carrying out care tasks and also when serving food. Guidance and information on the control of infection in care homes must be sought from the Public Health department or the Department of Health website. Reg The registered person must put 28/02/07 18(1)(a)(c into place a plan to ensure that DS0000011852.V313633.R01.S.doc Version 5.2 Page 31 5. OP19 Reg 13(4) 28/02/07 7. OP26 8. OP30 White Lodge Rest Home ) staff receive annual appraisals and regular supervision to enable their training needs to be identified and recorded on a training plan. This was a requirement from the inspection report of December 2005 with a timescale of 28/02/06. The dates of staffs’ mandatory update training on health and safety issues must be recorded on the training matrix. 9. OP33 Reg 24 (1)(2)(3) 10. OP35 Reg 20(1)(a)( b) Reg 13 (3) Reg 23(5) 11. OP38 The registered person is required to establish a system in the home for the monitoring of the quality of care provided in the home and for systems within the home that underpin the care. This must be undertaken with the consultation of service users, relatives and/or representatives. The registered person must ensure that monies held for the service users are done so in an interest bearing saving’s account in the service user’s name. The registered person must make suitable arrangement for the training of staff in infection control. 28/02/07 31/03/07 28/02/07 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 OP14 Good Practice Recommendations It is recommended that an inventory of service users furniture, they choose to bring with them, be recorded with their care notes. DS0000011852.V313633.R01.S.doc Version 5.2 Page 32 White Lodge Rest Home Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI White Lodge Rest Home DS0000011852.V313633.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!