Inspection on 24/08/09 for White Lodge & St Helens House

This inspection was carried out on 24th August 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

White Lodge & St Helens House 29/12/09

White Lodge & St Helens House 17/11/09

White Lodge & St Helens House 20/08/07

White Lodge & St Helens House 03/10/06

White Lodge & St Helens House 20/01/06

White Lodge & St Helens House 25/08/05

White Lodge & St Helens House 02/03/05

White Lodge & St Helens House 08/12/04

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Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for older people Name: Address: White Lodge & St Helens House 15-17 Boscombe Spa Road Bournemouth Dorset BH5 1AR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Gloria Ashwell     Date: 1 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 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 old age, not falling within any other category Additional conditions: 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. The fees for the home range from £380 to £500 per week. Up to date details of fees 0 Over 65 54 Care Homes for Older People Page 4 of 35 Brief description of the care home can be obtained from the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was a statutory inspection required in accordance with the Care Standards Act 2000. Throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. This inspection took place over 4 visits, each was unannounced; the first visit was by the Lead Inspector and commenced at 13.00 on 24 August 2009. It resulted in Immediate Requirements being issued because an unrestricted upper floor window was seen to present a risk of accidental falling, and serious discrepancies were found in the Controlled Drug register. Accordingly on the following day, 25 August 2009, our Care Homes for Older People Page 6 of 35 Pharmacy Inspector visited the home, and the Lead Inspector and another inspector attended the home on 2 and 10 September 2009. During the visit on 2 September further Immediate Requirements were issued for the protection of vulnerable people accommodated in the home. During the inspection, particular residents were case tracked; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. We toured the premises and spoke to residents, staff, observed staff interaction with residents and the carrying out of routine tasks and together with the manager discussed and examined documents regarding care provision and management of the home. Since the last key inspection we have received 7 completed survey forms from service users; the comments made in these surveys have been used to inform our knowledge of the home. In advance of the inspection an Annual Quality Assurance Questionnaire was completed by the manager and returned to the Commission; the information it contained has been used to inform the findings of this inspection. For this inspection compliance with all key standards of the National Minimum Standards was assessed. The duration of the inspection was 18 hours. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not reliably record assessment of the needs and circumstances of prospective residents so is unable to establish that their care needs can be properly met. Evidence: The pre-admission records of 2 people admitted to the home since the last key inspection were examined and found to be of generally poor standard. For one of these people there was no evidence in records kept by the home that an assessment of needs had been recorded prior to their admission by staff of the home. The manager later told us that essential details had been provided in advance of the admission by Social Services. For the other person, whose needs and circumstances had been assessed prior to admission, only minimal information had been recorded and thereby insufficient Care Homes for Older People Page 10 of 35 Evidence: information was available, for example with the exception of the word Dementia there was no information about the special ways this condition was affecting the person, the associated risks and the specific care that would be needed in this regard. The record included no assessment of the persons nutritional circumstance, no body weight, did not list the medicines prescribed for the person and provided no description of the special needs regarding the persons spiritual beliefs. To ensure that they will be able and prepared to meet the needs of each new resident the home must record a comprehensive pre-admission assessment in advance of offering a place to each prospective resident and in so doing, prepares the staff and the home to minimise the persons likely stress and anxiety upon arrival and is able to meet the individual needs sensitively and fully. Care Homes for Older People Page 11 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient evidence that residents receive the care they need. Associated records and care practices require improvement to ensure staff have sufficient guidance to enable them to properly care for and protect residents from the harm and ill health that unplanned and potentially inappropriate care, risks of cross-infection, and incorrect medicine administration might cause. Evidence: Since the previous inspection the home has changed the documentation for care records, and is using a computerised system for all the assessment, care planning and records of ongoing care. This inspection was significantly hampered because the home was unable to promptly provide to us the records we requested to examine because the home has only a laptop computer with no other means of accessing the system, and the home manager was unable to operate the laptop to display the daily records of residents, and the process of printing out hard copies onto paper was very slow, so that records requested at approximately 10.30 on 2 September 2009 were not available for examination until mid-afternoon of that day. Care Homes for Older People Page 12 of 35 Evidence: We were told the home had only one laptop, from which to access records; thereby all staff use this one device and must inevitably encounter difficulties when trying to access the information they need about the care needs of residents. We noted that almost no night reports had been recorded. Since the inspection we have been told that the night reports are kept in separate records and they will be examined at the next inspection as they were not provided when requested during this inspection. We examined the care records of all currently accommodated residents. We combined the information we obtained from the documents we read, with the things we saw taking place in the home during our inspection, and with what we were told by staff and visitors. This provided us with evidence indicating that people do not always receive the care they need and that staff sometimes have a poor understanding of the needs of the people in their care. The following provides information on some of the evidence we obtained to support these findings. The plan of care of a long term resident of the home stated that the person has diabetes controlled by medicines and diet, but provided no additional information on the condition, the likely indications of a change in condition and wellbeing, and the action staff should take to monitor the person and take if there are associated concerns. The records of a recently admitted resident stated that pressure relieving stockings should be worn, but the person was not wearing them, told us that staff no longer make the stockings available, but that her legs remain swollen and painful. The daily evaluation written on 12 July 2009 for a person admitted to the home during 2007 stated that the skin on the sacral area was broken, but the care plan, although reviewed on 20 July 2009, stated that the person May have pressure sores that need to have special attention, and provided no information on the care that was necessary for the wound that had been observed only 8 days earlier. The care plan of a person admitted to the home during 2005 had been last reviewed during July 2008, and accordingly made no reference to the shingles known to have been present during July 2009, and the various creams and lotions which had been variously applied during July and August 2009. There was no evidence that the home Care Homes for Older People Page 13 of 35 Evidence: had developed a plan of care to ensure staff knew how to support and care for the person while the shingles was present. For another person admitted to the home during 2005 the care plan had been last reviewed during November 2008, stating that a nurse visited each week to dress a wound. We were informed that the wound is now long healed, so the care plan is inaccurate. The content of care plans was confusing and frequently irrelevant. For example for one person it states Xs native language is English, she is also fluent in English. Xs native language may hinder some communication with her care staff. Carers should try to assist her when communicating and be patient as this can be frustration to both parties. The standard of recording daily records is generally poor, with very little information about care provided and many of the records meaningless e.g. one resident was stated on 28 July 2009 to be Not too well, and on 24 August 2009 Not well, although no further detail was recorded to describe the apparent ill health. On 31 August 2009 a resident was reported to be Complaining about feeling skin, and on 9 August 2009 for another resident was written Do caring his friend. For another resident, the recently reviewed care plan stated that the person May suffer from hallucinations or delusions that could put her wellbeing at risk, but failed to describe the forms these disorders might take and the type of risk, e.g. falling, malnutrition, absconding. The guidance to care staff for management of the hallucinations or delusions was that the person Should be given emotional support, although this is unlikely to be sufficient to counteract the effects of significant disorders of perception. This plan did not identify clear person-centred guidance and direction to staff in how they should support this person. During the inspection the friend of a resident currently in hospital attended the home to collect the residents dentures because staff had omitted to provide them to the resident at the time of hospital admission. We saw at least 3 people being transported about the home in wheelchairs without footplates attached thereby presenting an uncomfortable position for people whose feet did not reach the floor, and increasing the risks of accidental injury to their feet. Records of at least 7 residents indicated they had wounds requiring treatment, but care plans frequently made no reference to this and there was no information Care Homes for Older People Page 14 of 35 Evidence: recorded about the wounds and condition e.g. size, appearance, treatment, review findings and staff we spoke to, including the manager, were unable to tell us the current condition of these wounds. Records of some people stated that they were not to be resuscitated, but the home has not developed or implemented a related policy and procedure for End of Life care and has not recorded the necessary assessments for mental capacity and informed consent. Records indicated that during July 2009 at least 6 residents had lost body weight, but there was no evidence that the home had done anything other than record the weights i.e. nutritional circumstance had not been reassessed, care plans had not been reviewed, records did not state if the weight loss was desirable or otherwise, food enhancement had not been considered to enable the residents to gain the lost weight and there was no evidence that the people who had lost weight had been referred to health professionals. This report includes a requirement for the improvement of care records to ensure staff have available the information they require to enable them to properly meet the needs of people in their care. On the first day of this inspection examination of the Controlled Drugs Register and Controlled Drugs at that time held by the home indicated significant discrepancies so an Immediate Requirement was issued, and on the following day our Pharmacy Inspector attended the home and identified additional discrepancies including the failure to maintain adequate records of Controlled Drugs returned to the dispensing chemist or taken out of the home by the resident for whom they were prescribed. It was noted that the Controlled Drug cabinet was insecurely fixed to the wall. This was drawn to the attention of the manager who made prompt arrangements for it to be correctly fixed. Examination of recent medication administration records (MARs) indicated that medicines are correctly administered to the residents for whom they are prescribed. During our visit we overheard some staff speaking abruptly to residents, and as stated in the Complaints and Protection section of this report, there are concerns that a particular member of staff has been verbally abusive to residents. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are few opportunities for the residents to engage in recreational and social activities; in consequence many are likely to become bored, apathetic and restless. Residents do not have sufficient choice of the meals that are provided to them and mealtimes are not an enjoyable highlight of the day. Evidence: The home does not employ a dedicated Activity Organiser, relying instead on a care worker to provide recreational and social activities but this person told us that when care staff are busy she will do care work, and the recreational activities are done only when other responsibilities permit . The manager told us that occasionally up to 4 residents at a time are taken out for a car ride, and the record of activities showed that a Keep Fit session takes place each week, and sometimes there are games of cards or quizzes, and occasional craft activities such as card making. However, this large home must do more to provide a varied programme of activities suited to the abilities and preferences of the residents, and thereby including one to one and small group events and it is unlikely that this will be properly achieved without the employment of an experienced Activity Organiser. Care Homes for Older People Page 16 of 35 Evidence: The conservatory lounge includes a dining area furnished with closely positioned tables and chairs, sufficient to seat 40 people although at the time of our inspection 51 were resident in the home. For main meals there is one sitting. Some residents told us that mealtimes involve a lot of waiting because of the high number of people requiring assistance. They said they wait to be seated, wait to be served the meal and then wait to leave the room, and we saw this to be true, with lots of people waiting in the dining area while staff moved wheelchairs and assisted people to walk, then served meals apparently at random, i.e. meals were not served to all the people at a particular table at once, with instead some people receiving meals which they ate, while people seated close to them continued to wait for their food to arrive. During the inspection we observed a midday medicine round and noted that it took place in the dining room while residents were eating lunch, thereby necessitating the interruption of their meals, additional staff activity and the accommodation of the medicines trolley in the already crowded and busy room. We saw staff putting aprons, used as clothing protectors, over residents heads without warning them they were going to do this. A resident who had not eaten any of her meal told us she wanted a cup of tea and did not like the meal staff had given to her, but said Theres no point in telling them what I would like, they wont listen when they are busy. A person seated nearby ate very little of the meal, leaving untouched the potatoes and vegetables, and staff removed the plate without speaking to the person, and without offering alternative food. Another person told us that the meal had been Very ordinary, no flavour, and said she did not know what the awaited pudding would be until it arrived. A person sitting at the same table told staff he felt sick and was given a glass of water and an empty plastic ice cream container in which to vomit, with no attempt being made to move him from the table at which other residents were eating. Shortly afterwards he vomited into the container, and thereafter staff moved him from the table. We saw that 5 residents at the lunch tables were not given the opportunity to transfer to dining chairs being instead left seated in wheelchairs. This is contrary to good practice because ordinary wheelchairs are intended for transporting people, are not suited to supporting a prolonged seated position, have armrests likely to hamper the arm movements associated with cutlery use and prevent the person being placed comfortably close to the table. We received 7 completed survey forms from service users and spoke to a number of residents during our inspection. Comments they made indicated that all are not satisfied with daily life at the home. For example one person said to us There is Care Homes for Older People Page 17 of 35 Evidence: nothing going on in the home, making for very long days, and told us there are no activities, and because staff will not bring them to her bedroom she has to wait for medicines before going to bed at night, sometimes until 9 or 9.45 pm, and because she chooses to rise early, finds this too late. Other told us they would like greater choice of meals and provision of meals suited to their needs, e.g. one said that because she has no teeth and cannot chew food she frequently receives unappetisingly thinly mashed food. There is room for improvement regarding the information provided to residents about daily life in the home and it is recommended that a large menu and activity programme be prominently displayed. The home must do more to improve residents experience of the home. During the inspection we saw people sitting for long periods with nothing to do and they told us they are often bored. Mealtimes should be carefully reviewed to ensure they are a pleasant and social part of the day, and not the hectic, noisy, overcrowded and generally undesirable experience we observed. Care Homes for Older People Page 18 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has failed to properly protect vulnerable residents from risks of abuse. Evidence: The home has a Complaints Policy and keeps records of all complaints received against the home, but these are stored as separate loose pages in folders, without index or register, and on examination were found to fail to provide a reliable record including the outcome of each complaint. It is required that a register of complaints be kept to ensure that all complaints are recorded, and recommended that the standard of records be improved to provide clear and complete details of the management and outcome of each complaint. Since the last inspection an investigation led by the local Social Services office has taken place, regarding allegations involving the safeguarding of vulnerable people. The home had failed to notify us of this matter although it is a requirement of the Regulations that we are promptly notified of any events affecting the safety or well being of any resident. The allegation was made known to the home during January 2009, and in May 2009 after the investigation had concluded, the home wrote to the member of staff against whom the allegations had been met, stating that a written warning had been issued. We examined this letter during our inspection and noted it to make reference to the alleged abuse of 3 additional residents, involving physical, emotional and verbal abuse Care Homes for Older People Page 19 of 35 Evidence: and the failure to provide prescribed medicines to one resident. The manager told us that none of these additional allegations had been notified to Social Services, nor had they been reported to us. We issued an Immediate Requirement for the home to report the matters to Social Services, and raised a safeguarding alert. Investigation has commenced and on 15 September 2009 the manager informed us that the person against whom the allegations have been made has now left the employ of the home. The home has a policy and procedure for safeguarding vulnerable people but aspects of these documents are misleading so they should be reviewed to ensure they comply with local and national guidance. The failure to report the concerns is contrary to agreed safeguarding procedures. The home has installed Controlled Circuit Televison at the two main entrances but has not implemented a policy in this regard and is recommended to do so at the earliest opportunity, to ensure that peoples rights and freedoms are not compromised. Care Homes for Older People Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parts of the home present an institutional aspect, with little evidence of personalisation in many bedrooms, and an overall impression of tired and shabby premises with poor control of infection processes. Evidence: The home consists of two properties joined together by an extension. The home is at the top of a steep incline to the rear, accordingly although some bedroom are on the lower ground floor they are situated to the rear of the building and thereby have windows overlooking the garden. A passenger lift provides access to each of the four floors of the home. Residents are provided with single bedrooms. Communal space includes a conservatory style lounge, with a dining area, and two additional separate lounges including one with a piano. At the front of the home there are car parking spaces and to the rear of the home there are well maintained gardens overlooking Boscombe Chine gardens. However, the manager said that of the rear garden Access is very poor, its not accessible to 90 per cent of the residents here. At a previous inspection it was recommended that risk assessments of uncovered radiators in the older part of the home be reviewed and action taken where any risk was identified, and subsequently the home obtained a grant to have all radiators converted to low surface temperature type. Some radiators remain unguarded and it is recommended that this work be completed at the earliest opportunity to protect Care Homes for Older People Page 21 of 35 Evidence: people from risks of accidental scalding. On 24 August 2009, the first day of this inspection a top floor bathroom window was found to be unrestricted and an Immediate Requirement issued for the home to protect vulnerable people from risks of accidental falling. The window was made safe, but on 2 September 2009 we saw an unrestricted bedroom window, so issued another Immediate Requirement. Much of the home appears shabby, institutional and generally tired. Many carpets are worn and stained, in particular on corridors and the piano lounge which also contained a vinyl covered armchair blackened with dirt at the edges and a recliner chair missing some castors and leaning heavily to one side, despite blocks of rough wood placed beneath it. Toilet and bathroom doors were seen to have blackened areas of fingermarking on the white gloss paint, bathrooms and toilets are bare and uninviting and we saw a toilet floor that had been mopped and left very wet floor, but no sign warning of the slip hazard was displayed. One bedroom in current use has only roof light windows so the resident accommodated in this room has no view except of the sky. Many bedrooms are very basic, without ornamentation, and containing old unmatched furnishings of low standard. Signage throughout this very large home is poor and thereby the various floors and many corridors present a confusing aspect, unsuited to the accommodation of people with dementia. Standards for control of infection are poor, with communal use toiletries, uncapped disposable razors, and open topped or hand operated waste bins in bathrooms and soiled clothing and household linen left on the laundry floor. At least one person uses a commode in the bedroom, but the home has no sluice facility and during the inspection the manager said there is no established procedure for the management of the commode, including safe emptying and cleaning. Since the inspection we have been told that the home has a written policy and procedure for the management of commodes and these documents will be examined at the next inspection as they were not provided when requested during this inspection. A survey form returned to us by a resident of the home stated Sometimes the home could be warmer, we old folk feel the cold. Care Homes for Older People Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure the safety of residents the home must improve aspects of employment practice. Evidence: The records of two staff employed since the last key inspection were examined and although Criminal Records Bureau (CRB) declarations had been obtained in advance of employment the records were found to lack some essential information. The application forms completed by both people provided an employment history showing incomplete dates e.g. 2005 to 2006, 2007 to 2008. There was no record of interview, and for one of the applicants the reference from the most recent employer was dated 2 days after the person commenced working at White Lodge & St Helens House. Records of the recently employed staff showed they had received induction training and training in core subjects including safe moving and handling. The manager told us that the home has not obtained a CRB for a person in the long term employ of the home who lives on the premises, nor have the CRBs or other details including references for a number of people attending the home for a variety of purposes e.g. hairdressing, chiropody and students occasionally attending to lead Care Homes for Older People Page 23 of 35 Evidence: recreational activities. An Immediate Requirement was issued for the safeguarding of vulnerable residents from potentially unsuitable people about whom the home does not possess essential background information. Formal staff supervision is not routinely carried out e.g. for a person employed since May 2005 the undated contract states that supervision will take place every 2 months, but records show that only two supervision meetings took place, on an unknown date during February 2008, and during early July 2009. Records of three other care staff were examined and were found to contain no evidence of formal supervision having taken place. The home is recommended to keep a record of the process of risk assessment when an adverse CRB is received i.e. a declaration of criminal history is received. It is also recommended that the home review night time staffing levels, because usually only 2 wakeful and 2 sleep in staff are on duty throughout the night, despite the large number of residents accommodated, and the complex layout of the premises, which extends over 4 floors. Some residents to whom we spoke expressed concern about low staffing levels, e.g. we were told that the creams that should be regularly applied to one person are often missed out because the staff are too busy, and that on a few occasions when this person had fallen during the night, she had to crawl to reach the call bell to summon assistance so has requested a pendant alarm. Via a completed survey form a resident stated Weekend staff can be very hit and miss, mostly agency they are not quite so kind and caring, and the relative of a resident told us that due to low staffing levels X hates the weekends. Care Homes for Older People Page 24 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is inadequate to the current circumstances. The registered providers have failed to reliably monitor the operation of the home and prior to the inspection had not identified the many weaknesses identified in this report. The poor management of the home means that people who use the service cannot be assured it is run in their best interests and that they are properly protected from harm. Evidence: The home is a family run business with five family members registered as providers, including one who has obtained a National Vocational Qualification in care at level 4. The management arrangements for the home were discussed at the previous inspection in August 2007 and we were then told that it was intended for one of these persons to apply to become the registered manager of the home. Care Homes for Older People Page 25 of 35 Evidence: However, to date no application has been received and the long term absence of a registered manager appears to be seriously affecting the safe and proper running of this service, as is demonstrated by the many weaknesses described in this report. The home has processes for quality assurance, satisfaction surveys are periodically issued but the effectiveness of these appears poor, in the light of the findings of this inspection. Records are kept of all accidents and for some there is evidence of subsequent investigation, but this does not involve review of the care plan and the home does not record periodic audit to identify any trends e.g. time, place, person, and activity. There have been a number of allegations of abuse and although it is required for such events to be notified to us and to Social Services most of these events have not been notified to either organisation. The home manages the finances of most residents with regard to the safekeeping of monies for personal expenditure; the processes were discussed and there appear to be appropriate arrangements in these regards. Recruitment practices do not ensure the protection of residents from potentially unsuitable staff, the necessary checks have not been carried out for all staff working at or attending the home on a sessional basis. The providers have not properly discharged essential duties of effectively monitoring the home and have failed to identify the significant failings in many aspects which were apparent during this inspection, which resulted in the issuing of 5 Immediate Requirements, for safety of the premises, protection of vulnerable people and the correct handling of Controlled Drugs. The manager told us that a Fire Risk assessment has been recorded but does not describe the means by which each of the currently accommodated people will be evacuated in the event of emergency, and although a resident smokes in her upper floor bedroom this aspect has not been subject to risk assessment. Care Homes for Older People Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 35 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 22/10/2009 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. Care Homes for Older People Page 28 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 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. Equipment must be properly 22/10/2009 used in accordance with the manufacturers instructions. This means that footplates should be attached to wheelchairs when they are being used to transport people. 4 8 13 5 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, Care Homes for Older People Page 29 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 administration and stock levels of Controlled Drugs. 6 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. 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. . 8 18 13 The registered person shall 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. . 9 19 13 The registered person shall ensure that all parts of the 22/10/2009 22/10/2009 7 15 16 Care Homes for Older People Page 30 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 hoem to which service users have access are so far as reasonably practicable free from hazards to their safety. This means that windows should have restricted opening capacity to reduce risks of accidental falling from them 10 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 management of commodes must be developed and implemented, to provide staff with clear guidance on the particular control of infection methods. 11 29 19 The registered person shall 22/10/2009 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2, to protect vulnerable people from the risks that contact with unsuitable staff may present. . Care Homes for Older People Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 12 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. . 13 38 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. . 14 38 12 The Registered Person must 22/10/2009 make proper provision for the health and welfare of the residents. Where risks of accidental scalding/burns have been identified appropriate action must be taken to minimise the risks. This means that where necessary, radiators should be covered. 15 38 13 Records of investigation, 22/10/2009 assessment and outcome should be promptly recorded with regard to all accidents involving residents of the Care Homes for Older People Page 32 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 home, to ensure that risks of recurrence are minimised. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 All staff should be instructed on the correct ways to address people to ensure their dignity and rights are not compromised. The home should develop and implement a policy and procedure for End of Life care, to ensure that the rights of people are protected and their wishes are respected. More should be done to encourage and promote residents opportunities to exercise choice and control over their lives, in accordance with their individual capacities. The living accommodation should be improved to provide an environment promoting best practice, specifically suited to the special needs of elderly people with dementia. The standard of the premises and furnishings should be thoroughly reviewed and a programme of improvement commenced at the earliest opportunity. Signage throughout the premises should be improved, to assist service users in finding their ways around the home, and thereby retaining as much independence as possible. Regular checks of bathrooms and all hygiene facilities should be carried out to ensure that standards of cleanliness are satisfactory and the rooms do not contain potentially unsafe or inappropriate items. To prevent the spread of infection soiled items should not be left on the laundry floor, but should instead be placed in receptacles provided for this purpose. Staffing levels should be carefully reviewed to ensure that at all times there are on duty in the home sufficient staff to Page 33 of 35 2 11 3 12 4 19 5 19 6 19 7 26 8 26 9 27 Care Homes for Older People 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 properly meet the needs of all residents. 10 29 A record of the process of risk assessment should be kept when an adverse CRB is received i.e. a declaration of criminal history is received. The home should develop and implement processes for the regular formal supervision of all staff. There should be a process of continuous self monitoring of the home, reflecting aims and outcomes for service users and ensuring the ongoing safety and suitability of the premises and working practices. 11 12 30 33 13 38 Periodic audit should be recorded of all accidents to identify any trends or aspects of risk and there should be evidence of appropriate action being taken to minimise identified risks. The fire safety assessment should be amended to include details of each resident currently accommodated in the home and the means by which they will be evacuated in the event of such necessity. 14 38 Care Homes for Older People Page 34 of 35 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. 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