Random inspection report
Care homes for older people
Name: Address: White Lodge & St Helens House 15-17 Boscombe Spa Road Bournemouth Dorset BH5 1AR zero star poor service 10/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gloria Ashwell Date: 2 4 1 1 2 0 0 9 Information about the care home
Name of care home: Address: White Lodge & St Helens House 15-17 Boscombe Spa Road Bournemouth Dorset BH5 1AR 01202395822 01202569587 wl-office@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Christine Higginson,Mr John Higginson,Mrs Karen Frances Watt,Mr Peter John Higginson,Mrs Carolin care home 54 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 54 old age, not falling within any other category Conditions of registration: 0 One named person (as known to the CSCI) under the age of 65 may be accommodated to receive care. Date of last inspection Brief description of the care home White Lodge and St Helens House are adjoining properties with an extension that links them on each level. The home is registered to accommodate fifty-four residents in the old age category. All residents have single bedrooms. The home is on sloping land and has four floors; lower ground, ground, first and second. There is a passenger lift. There are pleasant well-maintained gardens at the rear of the property, but access is limited by a steep path and steps. Care Homes for Older People Page 2 of 16 Brief description of the care home The fees for the home range from £380 to £500 per week. Up to date details of fees can be obtained from the home. Care Homes for Older People Page 3 of 16 What we found:
This focused inspection was undertaken in order to view the homes progress towards meeting the requirements of the last key inspection which took place during September 2009 and determined the quality rating that this is a 0 star service, meaning that the people who use the service experience poor quality outcomes. At the key inspection it was identified that the quality of daily life experienced by people living in the home, processes for staff employment, the standard of care practice and associated record keeping, infection control and the management of the home must be improved. This latest inspection took place over two days (17 and 24 November 2009) with both visits being unannounced and both being carried out by 2 inspectors. The duration of the inspection was 13 hours. The visit on 17 November 2009 included the carrying out of a Short Observational Framework for Inspection (SOFI), because people with dementia and/or complex needs and ways of communicating are not always able to reliably tell us about their experiences, we use this formal way to observe people and to help us understand their experience of life in the home. We observed up to five people for two hours and recorded their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. At the end of the inspection visits feedback was given to the providers, describing our findings, to enable them to develop and improve the service as necessary. During this inspection we identified serious concerns regarding the provision of care and the handling of medicines. Accordingly two Immediate Requirements for improvement were issued on 24 November 2009, and we made a referral for the safeguarding of all residents to the local Social Services office. What the care home does well:
Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Staff are kind and considerate to the people in their care. Staff have good relationships with the people living at the home and were seen to be patient and encouraging. During the end of the morning of 17 November 2009, before lunch was served, residents sat in the conservatory listening to music and during this period staff found some magazines for people to look at. There were reasonable levels of engagement whilst there were staff doing activities with people e.g. giving out magazines, putting on music and assisting residents with lunch. Care Homes for Older People Page 4 of 16 Residents using wheelchairs were given the choice of staying in the wheelchair or transferring to a dining room chair. The meal was served to a table at a time so residents ate at the same time in a companionable manner. Staff explained to residents what was for lunch and encouraged them to eat and drink independently. What they could do better:
Care records We examined records recently written for all people currently living at the home, and for 5 of these people we examined care plans and other records in greater depth. We found that the standard of pre admission assessment is frequently poor, with only minimal information being obtained in advance of the new resident arriving in the home, and some of this information was contradictory and thereby unhelpful in guiding staff in their work with the new residents. For example, for one person the pre admission assessment provided contradictory information for a number of essential aspects, including the persons mental health and hearing ability, and thereby, when the person arrived in the home staff were without reliable information upon which to base their care of the person. For another person the pre admission assessment states the person has heart disease for which no treatment is ongoing, but the risk assessment written only 9 days later states Has a history of heart conditions, ensure X receives the care required for these conditions. The care plan provides no further information to assist staff in this aspect. For both these people, it appears probable that on their arrival in the home, staff did not have enough information about their needs and circumstances to ensure they were able to properly care for them. The key inspection of September 2009 identified significant weaknesses in care planning, invariably because the plans were reviewed only annually, so failed to reflect recent changes in need and circumstance. Accordingly the home has decided to change the format of care plans and work is currently ongoing to transfer all care plans to the new format. However, during this process it nonetheless remains necessary for staff to have available to them accurate and up to date information about the people in their care, but for some of the people whose records we examined this was not the case. For example, the care plan of a person with serious wounds which receive the attentions of a visiting District Nurse does not describe the wounds, nor the necessity for staff of the home to administer pain controlling medicines shortly in advance of the planned arrival of the nurse, so that the pain incurred by treatment is minimised. The medicine record of this person also omits reference to the Controlled Drug which staff of the home told us has been prescribed for this purpose. For a different person there is no care plan reference to the pain control which was prescribed following a recent fall, and although daily records frequently describe the
Care Homes for Older People Page 5 of 16 person as being in great pain, sometimes shouting and crying with the severity of discomfort, from examination of records and discussion with the managers and senior care staff, it appears that the prescribed medicines were never received into the home, and thereby have not been administered to relieve the pain. Daily records are frequently unclear, conflicting and thereby unreliable e.g. for one person on consecutive dates there was frequently no information recorded, except to state that person was asleep, although one entry indicates concern that the resident may not be eating adequately, and is therefore to receive nutritional supplements. A record written some days later briefly states that the person has lost body weight during the past month, and therefore should receive a nutritional supplement with a record of each occasion this is given, but the records fail to address this and provide no further information in these regards. Medicines We examined recent and current medicine administration records (MARs) and identified a high level of concern. At the time of our visits 46 people were living in the home. The MARs of 30 of these people indicated that the home had recently failed to accurately administer to them all their prescribed medicines. For example, a person prescribed to receive an antibiotic 4 times each day never received it more than 3 times a day, and sometimes received it only twice a day. The MAR of a person prescribed pain control bore incorrect directions for the dose, and the managers and senior care staff were unable to confirm what the dose administered on each occasion had been. One person was prescribed a medicine to be taken once a week, on the same day each week, but records showed the medicine had been administered on 14 and 17 November 2009. At our request the managers investigated this matter and later wrote to us stating that the record had been incorrect, and the person had not received the medicine on both occasions. There were many occasions when staff had failed to sign the MAR to confirm that medicines had been prescribed as directed. On these occasions the box on the form was left blank, providing no indication for the reason for non administration e.g. the medicine might have been purposefully withheld, refused or not needed. For a recently admitted resident the pre admission assessment states the person is allergic to Penicillin but the MAR provides no allergy information with the box on the medicine chart left blank. For many people a variable dose of medicine has been prescribed e.g. Give 1 or 2 tablets. In such circumstances staff must on each occasion record the dose actually given, to ensure the home can properly account for all medicines received and used. MARs in current use frequently omitted this essential information, which also means there is no record of the amount of the medicine most usually found to be helpful to the resident. Complaints Care Homes for Older People Page 6 of 16 The daily records of a female resident included a recent statement that she had been disturbed by a male resident who had entered her room during the night. The incident should have been dealt with as a complaint, with records kept of investigation and outcome, and care records demonstrating that the home has reviewed the care of the male resident, to ensure the protection of other people living in the home. However, until we drew the attention of the managers to the incident they had not been aware of it, so no investigation had taken place. Environment On the first day of the inspection a number of concerns were apparent. We saw that on many treads of each flight of the main staircase there were holes, from the recent removal of the stair lift. These holes presented a significant trip hazard. We also saw that on the lower ground floor there was a fire exit door displaying a handwritten notice Danger, Men working overhead, falling debris, do not use. However, the door could be easily opened because it was not locked and the alarm was not operational. The door led to the rear garden but the narrow route went under scaffolding pipes and past piles of builders debris. On the top floor of the home we saw two baths with attached shower hoses, which could be placed into the bath water, and thereby presented a risk of cross infection to later users of the bath, because bath water from earlier users could be inadvertently discharged into the fresh bath water. These matters were made known to the managers and when we returned on 24 November 2009 we saw that the scaffolding had been removed and the carpet holes made good. The shower hose of one bath had been removed, but the shower head of other bath was unchanged, so continued to present a risk of cross infection. Daily Life We carried out a Short Observational Framework for Inspection (SOFI) and in so doing observed five residents in the main lounge and dining room. The two hour period included part of lunchtime. Overall residents were mainly in a passive state of being. When people were observed to be in positive state of being this was related to staff interactions. There were reasonable levels of engagement while staff were doing activities with people such as giving them magazines, putting on music and during lunch. At the times when there was no activity from staff residents became more passive and there were lower or no levels of engagement. Residents started to sit and wait for lunch, with many brought to the tables by staff from 12pm although the meal was not served until 12.30. One resident was seen to rearrange the crockery and cutlery that had been laid by staff
Care Homes for Older People Page 7 of 16 and another put out the serviettes for lunch. We feel that more could be done to encourage residents who are interested to participate in the daily living activities in the home. Residents were not given any choice of squash by staff. Glasses of juice were just put on the tables. We noted that two people asked for a different flavour of squash and feel that if others had the ability to request an alternative they may have done so. Residents were not given any choice of meal at lunchtime and we saw one member of staff standing over residents to assist them to eat instead of sitting down next to them. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall not provide accommodation to a service user unless the needs of the person have been assessed and the registered person has obtained a copy of the assessment. To ensure that the home is able to properly meet the needs of the prospective resident. 22/10/2009 2 7 15 The registered person shall prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. This plan must include all relevant information and instruction to ensure that staff have available to them the information they need to provide consistent and appropriate care. 22/10/2009 3 8 12 The registered person shall 22/10/2009 so far as is practicable enable service users to make decision with respect to the care they are to receive and their health and welfare. This means that Care Homes for Older People Page 9 of 16 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action arrangements for end of life care, including considerations regarding resuscitation, shall be properly supported by a written policy and procedure which reflects and includes the associated legal aspects. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. 4 9 13 The registered person shall 23/09/2009 make suitable arrangements for the recording, handling, safekeeping, self administration and disposal of medicines received into the care home. This means that an accurate record must be kept of the ordering, receipt, administration and stock levels of Controlled Drugs. 5 12 16 The registered person shall 22/10/2009 ensure that there is appropriate provision for the social interests and activities of service users, to minimise the distress and anxiety that boredom may lead to. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key
Care Homes for Older People Page 10 of 16 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Inspection. 6 15 16 The registered person shall 22/10/2009 ensure that food is provided to meet the needs of service users, at appropriate times and of a sufficiently appetising standard, as to encourage residents to accept adequate nutrition and enhance their quality of life by enjoyment of food. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. 7 18 13 The registered person shall 22/10/2009 make arrangements, by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. 8 26 13 The registered person shall 22/10/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. This means that a policy and procedure for the
Care Homes for Older People Page 11 of 16 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action management of commodes must be developed and implemented, to provide staff with clear guidance on the particular control of infection methods. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. 9 31 37 The registered person shall 22/10/2009 give notice to the Commission without delay of the occurrence of any allegation of misconduct by any person who works at the care home, and of any event in the care home which adversely affects the wellbeing or safety of any service user. . 10 38 13 Records of investigation, 22/10/2009 assessment and outcome should be promptly recorded with regard to all accidents involving residents of the home, to ensure that risks of recurrence are minimised. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. 11 38 13 The registered person shall 22/10/2009
Page 12 of 16 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Compliance with this requirement was not assessed during this Random Inspection; it will be assessed at the next Key Inspection. Care Homes for Older People Page 13 of 16 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 8 13 Action must be taken to 02/12/2009 ensure records are sufficiently clear to provide a reliable description of the circumstances of each resident, and thereby provide evidence that each person is receiving the care they need. . 2 9 13 The registered person shall 02/12/2009 make suitable arrangements for the recording, handling, safekeeping, self administration and disposal of medicines received into the care home. This means that an accurate record must be kept of the ordering, receipt, administration and stock levels Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 The registered person shall not provide accommodation to a service user unless the needs of the person have been assessed and the registered person has 02/01/2010 Care Homes for Older People Page 14 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action obtained a copy of the assessment. To ensure that the home is able to properly meet the needs of the prospective resident. 2 7 15 The registered person shall 02/01/2010 prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. This plan must include all relevant information and instruction to ensure that staff have available to them the information they need to provide consistent and appropriate care. There must be evidence that 02/01/2010 when complaints are received they are properly managed with records kept, and that residents are properly safeguarded from risks of harm and abuse. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 3 16 22 Care Homes for Older People Page 15 of 16 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 16 of 16 - 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!
