Inspection on 15/05/08 for Whitehaven Lodge

This inspection was carried out on 15th May 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Whitehaven Lodge 15/05/09

Whitehaven Lodge 16/05/07

Whitehaven Lodge 20/11/06

Whitehaven Lodge 18/05/06

Whitehaven Lodge 16/02/06

Whitehaven Lodge 22/09/05

Whitehaven Lodge 03/02/05

Whitehaven Lodge 01/06/04

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

CARE HOMES FOR OLDER PEOPLE Whitehaven Lodge Buttermere Close Maybush Southampton Hampshire SO16 9JR Lead Inspector Mark Sims Unannounced Inspection 15th May 2008 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitehaven Lodge DS0000039153.V363169.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. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whitehaven Lodge Address Buttermere Close Maybush Southampton Hampshire SO16 9JR 023 8078 4839 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) Southampton City Council Mrs Lorraine Tew Care Home 55 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (55) of places Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of eight service users in the category DE(E) may be accommodated at any one time. Three service users in the DE category may be accommodated between 60 and 64 years of age. 16th May 2007 Date of last inspection Brief Description of the Service: Whitehaven Lodge is a large purpose built residential home providing care and support to 55 elderly persons, some who are frail and have dementia relating to their old age. The home is located in Millbrook, the west of Southampton, approximately 2 ½ miles from the city centre and is managed by Southampton City Council. The building is laid out over two floors with a passenger lift access to the first floor. It was built in 1981. Recent renovations to the home now allow residents to be accommodated in single rooms. Bedrooms are arranged in 6 separate living units. On the ground floor there is one large dining room and four smaller lounges, one of these is a smoking lounge. There are 3 separate unit-living facilities available on the first floor, each with its own kitchen and dining facilities should residents wish to prepare drinks or snacks and retain or regain their independent living skills. The home has a pleasant garden, which incorporates a raised sensory flowerbed and a lawn. Garden furniture and a handrail enable residents to enjoy the garden to the full, particularly during the warmer months. The home also has its own shop, which is open twice a week, and on request from residents, however residents when staffing levels allow are supported to go out to the local shops if they wish. There is a library area, an arts and hobbies room and hairdressing facilities. At the time of a site visit to the home on 16th May 2007, the cost of living at the home ranged from £382 - £447 a week. The cost of a short stay is £194 a week. The fees do not include the cost of chiropody, hairdressing, toiletries and newspapers. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over two days, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met service users, staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commissions surveys was poor, with four service user surveys returned, prior to the report being written. What the service does well: What has improved since the last inspection? It was established during the fieldwork visit and through the AQAA that: Staffing levels are now maintained at the same level seven days a week. The service also indicate via the AQAA that they have made the following Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 6 improvements: ‘Increased management staff profile hours to ensure two Care Co-ordinators cover 7 days a week. Appointed Peripatetic Care Co-ordinator to work across city. Developed care staff to cover relief Care Co-ordinator vacancies. Care Co-ordinators act up as manager during managers’ absence. Review areas of work and introduced changes to improve performance. Agency monitoring forms introduced to monitor performance in accordance to Working Time Directive’. What they could do better: The ‘service users plans’ in their entirety, are poorly maintained and not reflective of the current care and/or service being provided to the residents’, with charts and monitoring tools poorly maintained and plans directing staff to the completion of charts, etc, which the residents’ no longer require or are having completed. The service approach to supporting people manage their medications requires a review, as creams and lotions were observed, during the fieldwork visit, not to be properly secured and/or stored. The activities and/or entertainments programme is designed to meet the needs of those residents’ who are independent, however, eight places at the home are designated for people who suffer from cognitive impairments and during the fieldwork visit a number of people who fall into this category were observed walking around the home without any structured entertainment provided. On occasions staff and other residents’ were observed or heard encouraging people back to their bedrooms, which is unlikely to encourage them to settle or take an interest in events. Peoples right to privacy and dignity is not being promoted, as stated in the charter of rights, with people, like us (the commission), able to walk around the home and identify who suffers from an incontinence problem, as their room has become a storage area for the products they use to manage the problem. Some areas of the premise have benefited from an injection of funds, with the manager identifying areas where new carpets have been fitted, bathrooms have been upgraded, etc. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 7 However, the general environment could be improved further, with paint noticed to be peeling of the walls along corridors, the kitchen in need of immediate investment and refurbishment, additional storage areas created to prevent people’s bedrooms becoming stores for continence products and equipment. Staff designated as housekeeper / domestic staff, should not be expected to cover the care staffing shortages. During the fieldwork visit it was noted that the environment was unclean with debris on the floors and the sanitary bins in the toilets un-emptied and odorous. The shortage in care staff appears to be an on-going issue, with several staff noticed to be on long term sick and vacancies not filled. This is placing a strain on the remaining care staff team, which is being noticed by the residents’ one person asking to speak with the Commission about this situation and its impact on the delivery of care. The home’s recruitment and selection process is not being robustly operated, with last employers not approached for references, documents belonging to other applicants mixed in the other people’s records, documents for overseas staff poorly completed and/or worded and apparently, the references and applications all written by the same person. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Whitehaven Lodge DS0000039153.V363169.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 Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The service tells us, via their AQAA that: ‘All prospective service users have an assessment undertaken by the home. This maybe in the individuals home, hospital and/or in the residential home. A procedure operates within the home to gain information about the service user at the time of the initial referral. On the day of the assessment (trial visit to the home) and upon admission, once it is established we can meet the service users needs and operate within our CSCI registration criteria. This procedure operates in all Southampton City Council Older Persons homes to ensure a consistant approach. This procedure applies to all individuals whether they are self funding or not. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 10 Care planning plays an integral part of recognising individuals abilities and needs. All staff have undertaken training to ensure they understand the principles of effective Care planning. Whitehaven Lodge does not provide Intermediate Care’. A review of five ‘service user plans’ took place during the fieldwork visit, the evidence gathered indicates that needs assessments are carried out by the management team, prior to an offer of accommodation is made. The service, as part of Southampton City Council, is also able to access the Local Authority database (Paris) and review care management assessments and information. The indication from the service user surveys is that three of the four respondents recall receiving a contract on admission to the home and believe they received sufficient information about the home prior to deciding to move in. The home does not provide an intermediate care service and so this standard is not applicable. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The services’ records do not reflect that the health and personal care people, being received is based on the individual needs or that these needs are being reviewed or updated via the care planning process. EVIDENCE: Five ‘service users plans’ were reviewed during the fieldwork visit, as stated earlier in the report. The plans are largely informative documents, which are divided into different working elements, the main record used by the care staff being the ‘daily living plan’, which provides a quick overview of the day-to-day care a person requires. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 12 Overarching this document is the care plan, which is maintained by the ‘care co-ordinators’, in association with the residents’ keyworker, who is a member of the care team. The care plan generally provides a more detailed account of the support a person needs and acts as a central location for the storage of documents and information, the files containing copies of the ‘daily living plans’, ‘night plans’, contracts, care plans, risk assessments, general practitioner involvement, etc. The staff are also required to maintain monitoring tools/charts as indicated by the ‘daily living plan’ and/or care plan, these tools including bath charts, bodily function charts, fluid charts, food charts, etc. On read through the care plans and daily living plans for two residents, it made clear that their food and fluid intakes should have been being monitored, however, on reviewing the food and fluid charts their were no records available for the two residents being case tracked. During the tour of the home one of the two people being case tracked had been spoken with and no indication was given or established that this person required their food or fluid intake charted. Staff were also spoken with and they indicated that the residents being tracked no longer required food or fluid charts maintained, however, both residents’ had their care and daily living plans reviewed and neither had them updated to review this change. The review of the care plans and daily living plans also established that staff, when updating or amending a record, do not re-write the plan but add hand written entries to the pre-printed document, even when space to make an entry is limited. This leads to the documents being very confusing and difficult to read, as the hand written entries are not chronological but entered wherever a space exists, which could lead to important information being missed. The service state, via the AQAA that: ‘all care staff undertake a National Vocational Qualification (NVQ) Level 2 in Care. This enables them to work to a high level providing care from a person centred approach. All residents have a Care Plan, which reflects their individual abilities, needs and support requirements. Robust reporting and recording systems are in place to ensure any specialists care needs are responded to. All residents continue to be seen by their General Practitioner (GP) (unless the GP. is out of the area). Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 13 The AQAA statement indicates that person centred planning (PCP) is taking place within the home, however, the plans are not person centred, they contain no evidence of the residents’ direct involvement in planning and producing the plans and are written in a third party style, which direct the staff on what they must do for the person and not what and how the person might like their care provided. The records do provide a good account of the residents’ involvement with appropriate health and social care professionals and during the visit both members of the Community Nursing Service and a visiting Chiropodist were seen in the home. The care planning records contain details of the residents’ immediate medical histories as well as listing any known allergies. Correspondence, between the National Health Service (NHS) and the residents was seen on two files, which either confirmed an appointment or summarised the persons’ last visit. The residents’ surveys also indicate that people generally feel they are being appropriately supported when accessing health care services, two people ticking ‘always’ and two ‘usually’ in response to the question: ‘ do you receive the medical support you need’. The service tells us via their AQAA that: ‘Southampton City Council developed a medication procedure, all staff responsible for the administration undertakes medication training which is refreshed every 2 years. Residents are individually risk assessed on the safe administration of their medication’. Our (The Commission’s), records indicate that we have received eight medication error notifications from Whitehaven Lodge in the last fifteen months. We have also received a letter from the ‘Responsible Individual’ for the service informing us of Southampton City Council’s intention to review the medication management within the home, to which end they have arranged for a ‘Primary Care Trust’ (PCT) pharmacist to visit. During the fieldwork visit a review of the home’s medication management procedures were undertaken, with the storage and records (medication administration records (mar)) scrutinised. Generally the storage of the medications in use was considered appropriate and safe, with lockable trolleys available to the staff for the transportation and administration of medications around the home. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 14 The MAR sheet records were being accurately maintained, with all appropriate boxes filled in and each medicine received into the home signed off against the mar sheet document. A controlled drugs cabinet is available and an independent registered is maintained in respect of the controlled medications in use within the home. A medications’ fridge was also available, however, on inspecting the records of the daily fridge temperature checks, it was noticed that the fridge has been running excessively low, 0.1 to 0.2 degrees, for sometime, with records dating back to 2007 available. This was brought to the manager’s attention and the manager did increase the fridge setting, however, staff should have realised beforehand that the fridge was not operating effectively and taken steps to address this matter. The home also maintains an significant amount of stock medication, which we (The Commission) felt was excessive, one person having over twenty boxes of nebulizers, whilst another persons’ records indicated that had twenty one boxes of co-codamol available. The home maintains a stock record monitoring sheet, which is intended to account for all stock medications held, however, on checking through these records it was quickly established that they were not accurately maintained. One persons’ records indicating that they should have four boxes and/or bottles of paracetomal in stock, whilst a check accounted for six boxes and/or bottles. Another residents’ record indicated that there should be twenty-one boxes or bottles of co-codamol, although when checked there were only eighteen boxes and/or bottles in stock. Creams and lotions, which are prescribed medications, were also found not to be being appropriately stored or handled, with the Commission noticing, during the first fieldwork visit day, a blue container full of creams and lotions left unsecured and unattended in the reception office. On checking through this container, a number of the creams, etc, were noticed to have become separated from their original packaging and therefore had no application instructions, this also leading to staff being unable to know whom the cream or lotion was prescribed for with any certainty. Creams and lotions, as prescribed medicines must be treated as any other prescription medication and must therefore be kept appropriately stored. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 15 The manager during the fieldwork visit and via the AQAA stated that Southampton City Council had produced and provided staff with access to a medication management procedure, however, it may be worthwhile the manager supplementing this document with a copy of the ‘Royal Pharmaceutical Society of Great Britain’ guidance on ‘The handling of medications in Social Care’. The service tells us via the AQAA that: ‘the staff group consists of male and female carers. Resident’s choices are respected when supporting them with personal care tasks. Staff respond appropriately and sensitively in all situations ensuring residents privacy, dignity and respect at all times. The wishes of individuals about dying and the arrangements upon death are discussed sensitively during the development of their Care Plan’. The service also has a ‘charter of rights’ on display, which have been produced by Southampton City Council, which also refers to people’s rights to privacy, dignity and respect. All accommodation is single occupancy and ground floor rooms, which are over looked, have had a special one-way screening material applied to the outside to improve privacy. Communal facilities, toilets and bathrooms, were fitted with locks that were of a suitable design given some of the physical and cognitive impairments suffered by the residents. The residents preferred term of address was also document on their ‘service user plan’ and the interaction between the staff and the residents and the staff and the visitors noted to be appropriate and respectful. Information obtained from a visitor indicates that they feel the residents’ with dementia, etc, are not always given the time and support they require and that they are often left sleeping in chairs or to wander without any structured support. These comments fit with observations made during the fieldwork visit, when one particular resident seemed constantly to be being re-directed to her bedroom rather than involved in any structured or purposeful stimulation, this action seeming dismissive and to lack respect for the person. It was also evident during the tour of the premise, which residents suffer from incontinence problems, as their rooms were being used to store their incontinence products, pads, catheter or convene produced, etc. Issues of such a personal and sensitive nature, should be treated with a great deal of sensitivity and consideration and incontinence produce stored Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 16 appropriately and provided to the resident either as they demand or when being supported by the care staff. In conversation with staff the reason behind these products being left in people’s rooms on display, was attributed to a lack of storage, the City Council have created additional accommodation out the previous storage areas and the alternative storage being used to house equipment, which is waiting to be installed in the kitchen, when it is refurbished. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are generally able to make choices about their lifestyle, and are supported to develop their life skills. Social, educational, cultural and recreational activities could be improved to better meet individual’s expectations. EVIDENCE: The service tells us via the AQAA that ‘We listen to individual residents and detail their interests on their Care Plans with information about how we will support them in achieving positive outcomes’. Residents are supported to participate in activities in the community and inhouse E.g. Boat trips Pub lunches Cream teas Theatre DS0000039153.V363169.R01.S.doc Version 5.2 Page 18 Whitehaven Lodge Reminiscence Cookery Club Bingo, etc’. Notices were seen on display during the fieldwork visits advertising a forthcoming pub visit for lunch and a recent visit for a boat trip around the harbour. The latter featured as a topic of conversation during meetings with two residents’, one who had not gone on the trip and enjoyed the day the second who had not gone on the trip but new other residents’ who had. The second resident spoken with also discussed the twice weekly bingo sessions that take place and the weekly visits of the music man, although the resident again stated they did not attend this, as they could hear the performance from their bedroom. The residents also discussed the visits of a lay preacher, who is a member of the staff team with a Christian background, who in association with a resident has set up meetings within the home for the purposes of religious celebration and reflection. Generally, the views of the residents, is supportive of the day-to-day activities provided at the home with two people ticking ‘always’ and two ‘usually’ in response to the question: ‘are there activities arranged by the home that you can take part in’. However, as mentioned above there appears to be a lack of stimulation for those people suffering from cognitive impairments, with no specified activities co-ordinator employed to provide any structured activities for people within this group. During the visit one lady, as mentioned was observed on three separate occasions being escorted or told to go back to her bedroom, although clearly this is not an activity designed to promote stimulation. On one occasion this person was even asked to return to their bedroom by another resident, who proceed to inform us that she often comes into my room and I look after her, as there’s little else for her to do. During the fieldwork visits no activities or entertainments were seen being undertaken with the residents. The home does, however, provide access to the day-to-day entertainments you would expect to find in most people’s homes’ with televisions and radios, etc, in evidence both in communal areas of the home and people’s bedrooms. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 19 The home’s visiting arrangements are detailed within the ‘service user guide’ and/or ‘statement of purpose’ documentation. Copies of these documents were available within the home’s reception hall/main corridor area and notices about visiting times are on display. Access to the home is via an intercom-controlled door, which alerts staff to the arrival of a visitor and so enabling them to greet people as they enter the home. Within the entrance hallway is a register for people to sign in and out of the home, this document serves a dual purpose, as it identifies how many people are in the home in the event of a fire breaking out, it also provides a record of the people visiting the home. During our (The Commission’s) visit a number of visitors were observed arriving at the home and being welcomed by the staff prior to meeting up with their next-of-kin. Visitors were also observed coming to the reception office to discuss with the administrator, issues to do with the management and support of their relatives’ finances. As mentioned earlier in the report Southampton City Council has developed a ‘Charter of Rights’, which set out how the residents’ can expect to be treated and the philosophy behind how their care should be provided, the charter emphasising people’s rights to choice, dignity, respect, privacy, etc. The service tells us via their AQAA that: ‘Monthly residents meetings are arranged – residents set their own agenda – minutes are shared. A Care Coordinator has responsibility for ensuring agreed actions are implemented and outcomes feedback to residents’. The above statement confirmed by residents’ during conversations, who discussed their attendance at the monthly residents’ meetings. Minutes of the meetings were also during the fieldwork visit, as were notices advising people of the next meeting date, although this was eventually cancelled to due the co-ordinating staff members’ absence from work. The tour of the premise allowed us (The Commission) to observe people’s bedrooms’ and to speak with the occupants, who confirmed that the room was decorated, furnished and set out in accordance with their wishes. Observations made during the visit showed people involved in various pursuits, having their haircut / styled, in the home’s salon, visiting the garden or smoking room for a cigarette, engaged in conversation with each other or sat watching television in the lounge’s or their bedrooms. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 20 However, as mentioned above more could be done for the residents’ suffering from cognitive impairments, whose choices to engage in any meaningful activities or socially stimulating activity appears restricted due to the lack of time allocated to their care, as a result of staff shortages. The manager states via the AQAA that: ‘we offer a varied health diet catering for individual dietary needs. A statement not supported by the four service users to complete surveys, all four ticking ‘usually’ in response to the question ‘do you like the meals at the home’, one person adding ‘usually lunch soaked in gravy’. During conversations the residents also raised concerns about the meals provided, describing the food served as edible and depending on who cooks nicely presented or not. It was also felt that the home provided a lack of teatime options, although on checking the menu their appeared to be a hot and cold choice each day and the cook stated alternatives were available. The AQAA also states that: ‘the kitchen refurbishment is scheduled to be undertaken in 2008’. However, during the tour of the premise the kitchen was visited and catering staff meet. The kitchen is in a poor state of repair and is in need of the refurbishment planned by Southampton City Council, with torn and damaged flooring and faulty or unreliable equipment. In discussion with the catering and care staff it was established that so far Southampton City Council have twice postponed the refurbishment of the kitchen and at present there is no confirmed date for the essential works to be completed. The catering staff also discussed the service’s five weekly rotational menu, which they review and revamp annual after meeting with the residents’ to discuss their likes, dislikes and preferences. Each ‘service user plan’ reviewed during the fieldwork visit, was noted to contain an assessment of the persons’ dietary needs and habits, identifying likes, and dislikes, allergies, portion sizes and physical barriers to eating. As mentioned earlier, the service also maintains specific monitoring charts, food and fluid charts, for residents’ who are known to suffer from dietary problems. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 21 These documents were being poorly maintained and provided little or no information about the actual dietary habits, calorie intake or fluid intake of the residents’. The lounge/diners are spacious and comfortable and provide adequate seating for all of the people accommodated at the home, although some people do choose to dine in their rooms, as observed during the visit. Residents’ living in one of the first floor units are provided with separate kitchenettes, where they can prepare their own breakfast, snacks and drinks, main meals are still prepared by the catering staff and taken to the kitchenette in heated trolleys. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The service tells us via their AQAA that they: ‘promote an open culture within the home, which enables Service Users to ‘speak out’ and complain. Southampton City Council has a Complaints and Protection Policy to ensure complaints are responded to appropriately. Southampton City Council has an Adult Protection Policy. All staff undertake training in this area, as part of their Skills for Care, Common Induction Standards. Refresher training is undertaken regularly. All complaints are recorded, identifying actions undertaken to resolve any issues/complaints. Each Service User has a copy of the Complaints Procedure, these leaflets are available to others who use the service’. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 23 The dataset, which forms part of the AQAA documentation, confirms the existence of the home’s complaints and concerns procedure and that this was last reviewed in the April of 2007. The dataset also contains information about the home’s complaints activity over the last twelve months: No of complaints: 1. No of complaints upheld 1. Percentage of complaints responded to within 28 days: 100 . No of complaints pending an outcome: 0. The evidence indicates that people’s complaints are being appropriately handled, with written responses, where appropriate, being dispatched by the manager, a complaints logging system documents all activities associated with a complaint. Details of the home’s complaints process are on display around the home and made clear to people via the ‘service users guide’ and ‘statement of purpose’, which are also accessible around the home. The residents’ surveys indicate that people are aware of whom to speak to if they are unhappy about any element of the service, with all four people ticking ‘always’ in response to the question: ‘do you know how to make a complaint’. The service, as part of Southampton City Council, has access to the local authorities ‘safeguarding’ procedure, a copy of which was observed in the reception office during the fieldwork visit. The existence of this policy was also confirmed by the manager, via the dataset, it stated that policies on the protection of service users are in place, ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, although both policies are in need of reviewing and updating, as they were last reviewed in the June of 2006 and the January of 2004 respectfully. The dataset makes clear that over the last twelve months there have been five safeguarding issues reported and that all five have been investigated and resolved. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home ensures the residents live in a safe, reasonable well-maintained and comfortable environment. EVIDENCE: The manager has stated via the AQAA that: ‘Whitehaven Lodge is a purpose built Residential Care Home for older people. The layout of the home offers facilities to meet individual’s needs. The unit living area on the first floor enables Service Users to maintain and improve their daily living skills. A programme of scheduled works is discussed regularly with the Service Manager. Consideration to implementing the improvement is considered on a priority needs basis. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 25 Southampton City Council Property Services Department support the home in managing repairs. They respond effectively to meet the needs of the home to ensure maintenance is kept to a high standards and ensuring any Health and Safety issues are responded to without delay. Whitehaven Lodge has attractive communal grounds. The maintenance of the grounds is undertaken regularly to ensure they are attractive and safe for Service Users use. Staff recognise Whitehaven Lodge is the Service Users home. They work hard to ensure a homely, comfortable clean environment is provided. Policies and Procedures are in place to ensure Health and Safety standards are worked to. Whitehaven Lodge has a laundry service that is fitted to meet the needs of the home. Staff undertake training in the Control Of Substances Hazardous to Health (COSHH) to ensure good practice. Services and facilities comply with the Water Supply Regulations’. The tour of the premise confirmed much of the information provided via the AQAA, however, some areas of the home were noticed to need repainting, as the paint on the walls is flaking off, this was brought to the manager’s attention. Members’ of the estates or property services team were observed around the home during the fieldwork visit, as they were removing carpets in bedrooms that had been earmarked for redecoration and refurbishment. Several bathrooms were also noticed to be out of action, which the manager stated was the result of them being redecorated and refitted, the service aiming to make the bathrooms more aesthetically pleasing. Many of the bedrooms visited during the tour of the premise, contained items of an individual nature, pictures, ornaments, pieces of furniture, etc, which had been used by the occupant to personalise their room. Communal areas were spacious and offered a variety of uses, i.e. sitting rooms, hairdressing salon, smoking room, library area, dining rooms and television rooms. The home employs housekeeping staff that are responsible for the day-to-day cleaning of the home. During the tour of the premise the home was noticed to be in a poor state of cleanliness, with debris on the carpets, bins in the toilets odorous and general areas dusty, the bathrooms being the location were this was most noticeable. It was stated by the care co-ordinator that due to staff shortages members’ of the housekeeping staff had migrated across to the delivery of care, however, this left the home short of domestic staff and the resulting untidiness. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 26 However, the views of the residents’ who completed the surveys, indicate that it is not uncommon for the home to be cleaned to an unsatisfactory level, with one person adding ‘carpets could be clean better’, which mirrors our (The Commission’s) findings. The need to ensure the housekeeping staff are left to cleaning discussed with the manager during the fieldwork visit. The AQAA, as mentioned above did tells us that staff receive access to training on the management and control of infections and that policies and procedures are available, these were last reviewed and updated in the October of 2006. Communal toilets and bathrooms were noted to contain liquid soaps; paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. The laundry, which is located within the main building, is the responsible of the laundry personnel who laundering residents clothing and returning them to the clients room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home may be trained, skilled but they are not provided in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: The manager states via the AQAA that: ‘Southampton City Council offer positive Terms and Conditions which value staff. They have gained an Investors In People Award, which acknowledges its commitment to their staff teams. We have been active in recruiting staff working on the principle of the importance of recruiting the right person for the job being more important to the filling of the vacancy. Southampton City Council has a Recruitment Procedure to meet legislation and equal opportunities and CSCI requirements. All management staff undertake training in the recruitment procedure and play on active role in the recruitment of staff. We have a diverse staff team with a skill mix to meet the needs of the Service Users. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 28 Due to positive recruitment we have reduced the need for agency staff to support our service. We work closely with specific agencies to ensure agency staff that work in the home work to a good standard and are consistent. All staff received Induction, Supervisions and Appraisals. The recruitment process is worked to at all times, ensuring equal opportunities and the protection of Service Users. New staff are only confirmed in post following completion of satisfactory police CRB and POVA checks and two written references are obtained. Staff training records evidence training undertaken throughout the year’. The fieldwork visit established that the home is currently still needing to cover a large number of shifts with agency staff, four agency care staff and an agency cook all arriving at the home on the afternoon of the first fieldwork visit. In conversation with staff, including care co-ordinators and the manager, it was established that the home is currently experiencing a high level of longterm sickness, which is resulting in the use of agency staff, although where possible agency staff familiar with the home are requested. On the moring of the first fieldwork visit shortages within the care staffing team had been caused by short-term sickness and the care co-ordinator had been unable to secure any agency cover, which lead to staff from the housekeeping team being used to support the care team. However, the manager should review the practice of pulling housekeeping staff away from their duties, as the building is large and requires extensive cleaning to keep it tidy, which the staff obviously cannot manage if their numbers are reduced. Copies of the home’s duty roster were also seen during the fieldwork visit and these support the fact that the home is currently struggling to cover all of its shifts without significant agency input, however, with the aid of agency staff sufficient care staff are available to support the residents’. A view shared by the four people to complete the surveys, with one ticking ‘always’ and three ‘usually’ in response to the question: ‘are the staff available when you need them’. Although residents’ spoken with during the fieldwork visit have noticed the increased reliance on agency staff and comment on how stretched they feel the care staff are at times. During the visit the manager produced copies of the training records (kardex), which she and care co-ordinators’ maintain as evidence of the courses attended/completed by staff. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 29 On reviewing these records it was evident that the training and development needs of the staff are not always being appropriately recorded and it was necessary during the training and development review to cross reference peoples training activities with their supervision records, which are also used to review training outcomes and identify further training needs. The manager, however, advised us (The Commission) of Southampton City Councils’ plans to computerise the staff training records and the system for requesting training, which once fully operational will replace the paper based system. Overall the training and development needs of the staff are considered reasonable with the various records demonstrating that the staff have attended training on The Mental Capacity Act, Dementia, Moving and Handling, First Aid, Fire Safety, The use of Topical Medications and Adult Protection. The documents also establish that staff are awaiting confirmation of courses applied for including, COSHH and Food Hygiene. Information taken from the dataset and confirmed with the manager indicates that currently the home employs twenty-six care staff. Eight of the twenty-six staff has completed a National Vocational Qualification (NVQ) at level 2 or above and this provides the home with a rate of 69 of its care staff possessing an NVQ at level 2 or above. The dataset also indicates that six staff are completing their NVQ, which could increase the percentage of staff holding an NVQ level 2 or equivalent to 92 . The service states via the AQAA that ‘Due to positive recruitment we have reduced the need for agency staff to support our service. We work closely with specific agencies to ensure agency staff that work in the home work to a good standard and are consistent. All staff received Induction, Supervisions and Appraisals. The recruitment process is worked to at all times, ensuring equal opportunities and the protection of Service Users. New staff are only confirmed in post following completion of satisfactory police Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks and two written references are obtained. Staff training records evidence training undertaken throughout the year’. Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the manager when employing new staff and that all newly recruit staff have been subject to a rigorous recruitment and selection process. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 30 However, when the files of three staff were reviewed, two recently recruited, errors in the process applied by the service were detected. One overseas employees, application form was extremely poorly completed, with the content of the application making no sense: ‘‘I have ever attended a lot of righteouness work socities to practice on activity in the holidays, acquiring some certificate of honors also connert to get the excellent member honor of two years’. This should have prompted the recruitment team to have asked questions of the persons suitability to work in this field based on the person apparently poor English, however, there is no evidence of this having been considered or a justification for continuing to employ the person evident. It was also noted that both the application form and the references for this candidate were completed by the same person, as evidence by the hand writing, however, this also does not seem to have been questioned. A second applicant was found to have materials belonging to a third party mixed into their employment file, this third party not even working at Whitehaven Lodge. Whilst a third person employed at the home, had not had their last employer approach for a reference, despite the applicant clearly stating that this was their last employment. These issues were brought to the manager’s attention during the fieldwork visit. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 31 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home may be based on openness and respect and a quality assurance system in place but the competence of the management team is questionable. EVIDENCE: The manager states, via the AQAA: ‘I have gained an NVQ Level 4 in Management and NVQ Level 4 in Care. I am a qualified NVQ Assessor having gained a D32/D33 qualification. In 2007/2008 I have undertaken training in the Management Academy to enhance my present skills. I have many years experience working with older people both as a carer and Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 32 as a manager. I have knowledge of the organisations strategic and financial systems and the Operational Business Plan for the home links to these. I am responsible for the effective management of the home’s devolved budget. I take responsibility for the financial planning to ensure I provide qualitative value for money service. I work closely with other managers to ensure I have a clean understanding of Southampton City Council’s key principles and objectives of the service both corporately and strategically. I am committed to improving services ensuring a high quality service, recognising equality and diversity as a key component in the way I work. I am aware of legislation and Southampton City Council’s Policies and Procedures. It is my responsibility to ensure that I and the staff work within them. I take responsibility for ensuring the home is run in a manner that promotes the best interests of the Service Users and ensures they are met’. The evidence used to compile this report however, indicates that whilst the manager is both qualified and experienced, at times she and her management team are not providing effective management, with care records not appropriately updated at reviews, monitoring tools not checked to ensure they are being accurately maintained, medications poorly handled, training records not up to date, recruitment and selection not operated effectively and staffing resources not used appropriately. However, there is also evidence of some good practice by the management team, regular supervision is being provided for the staff team and records maintained of these sessions, residents’ and staff meetings are regular occurrences, outings for people are arranged and provided, the homes’ or City Councils’ management of people’s finances is good and there does appear to be good levels of support for the manager from her direct line manager, with the Responsible Individual (line manager), quick to react to the homes’ poor management of people’s medications and arrange for additional support. The general view of people spoken with during the fieldwork visit, both residents and staff, was that the manager does a good job and that she is approachable and committed to the service. The services approach to quality assurance is good, with questionnaires made available by Southampton City Council to both residents and relatives respectively. As mentioned above and earlier in the report residents meetings are arranged within the home, as are staff meetings, the staff meeting split into management and staff meetings, minutes for these meetings are available. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 33 Regulation 26 visits are also being undertaken by the provider, according to the AQAA, however, the reports of these visits were not seen during the visit. The service state, via their AQAA that ‘Southampton City Council procedures ensure Service Users financial interests are safe guarded. As the home’s Registered Manager I work to the procedure at all times. Our records evidence that this is managed well. Southampton City Council provide all service users with an opportunity to manage their finances through a special client account, which allows funds to be deposited into a large account overseen by the City Council, this is then subdivided into smaller accounts, which are specific to the resident and can provide information in relation to all transactions, account balances, etc. For service users who do not use this system, the service asks that they either manage their own financnes or are supported by representatives and/or relatives. The service tells us, via the AQAA and dataset information that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. Health and safety training is being made available to staff, with the training records providing evidence of the courses attended and those to be attended by staff, including: infection control, moving and handling and first aid. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed, as highlighted by the service’s decision to improve the ramped access at the front of the home. Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety issues. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Requirement Timescale for action 10/07/08 2. OP7 3. OP9 4. OP10 5. OP12 Regulation When reviewing the service user 15 plans, changes in the residents’ care needs must be identified and amended. Regulation The manager must make sure 15 that staff accurately maintain all of the monitoring tools/charts currently being used with the residents. Regulation The manager must ensure the 13 home’s medication handling, recording and storage processes are effectively implemented and maintained. Regulation The manager must take steps to 12 ensure the storage facilities within the home are improved, so people’s dignity can be respected and items required for the delivery of their personal care not stored in their bedrooms. Regulation The manager must ensure the 12 leisure or social care needs of people with dementia are identified, planned and meet by the home’s social activities programme and care planning process. DS0000039153.V363169.R01.S.doc 10/07/08 10/07/08 10/07/08 10/07/08 Whitehaven Lodge Version 5.2 Page 36 6. OP15 7. OP26 8. OP27 9. OP29 10. OP31 Regulation The Manager needs to secure a 16 date for the completion of the work on the kitchen planned by the City Council. Regulation The manager must ensure that 13 & 16 sufficient housekeeping staff are on duty at all times to ensure the home is maintained to a suitably hygienic level. Regulation The manager needs to work with 18 Southampton City Council to ensure the staff shortages are appropriately handled and managed and that staff allocated to other roles within the home are not used routinely to support the care staff team when short. Regulation The manager needs to ensure 19 the recruitment and selection process is robustly operated and that employment files are accurately maintained. Regulation The manager and the 24 management team need to ensure records are appropriately updated and maintained at all times. 10/08/08 10/07/08 10/09/08 10/07/08 10/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP30 Good Practice Recommendations Records should be kept in a neat and orderly manner to ensure accuracy and there easy use by staff. The management team should ensure the training and development records of the staff are accurately maintained and updated. Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Whitehaven Lodge DS0000039153.V363169.R01.S.doc Version 5.2 Page 38 - 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!