Inspection on 02/06/06 for Whitestone Lodge Residential Care Home

This inspection was carried out on 2nd June 2006.

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

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

Other inspections for this house

Whitestone Lodge Residential... 28/09/09

Whitestone Lodge Residential... 14/07/09

Whitestone Lodge Residential... 28/04/09

Whitestone Lodge Residential... 05/06/08

Whitestone Lodge Residential... 03/08/07

Whitestone Lodge Residential... 21/02/06

Whitestone Lodge Residential... 05/07/05

Whitestone Lodge Residential... 24/01/05

Whitestone Lodge Residential... 20/10/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP Lead Inspector Mrs Claire Lee Unannounced Inspection 9:30am 2nd June 2006 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 Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 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. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Whitestone Lodge Residential Care Home Address 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP 0151-480-4237 0151 489 9505 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Caulton Mrs V Caulton Mrs V Caulton Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 20 OP and up to 20 PD(E) Date of last inspection 21st February 2006 Brief Description of the Service: Whitestone Lodge is located in the Roby area of Liverpool, close to Huyton Village. Mr & Mrs Caulton own the home and Mrs Caulton is also the registered manager. The home can have up to twenty residents who are of old age or with a physical disability. The home is pleasantly decorated and is situated over two floors. Single accommodation is provided and there are two double bedrooms for couples or for those who wish to share. There are three bathrooms, one is equipped with a walk in shower. One bathroom is currently not in use as this is being decorated and furnished with a hoist to assist less independent residents. There is a large enclosed garden to the rear of the home with a ramp and handrail and car parking space to the front. The home is situated in a residential area within access to public transport to surrounding areas, Prescot and Liverpool. The fee rate is £400.00 a week. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day for approximately eight hours and seventeen residents were accommodated at this time. It was an unannounced inspection (site visit). A partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussions were held with six residents, three staff, the home’s management consultant and care manager. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. There were no visitors to the home at the time of the site visit. All the key standards were inspected and also previous requirements and recommendations from the last inspection in February 2006 discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection. Comments included in the report are taken from the survey forms and also during the site visit. The registered manager was not present for the inspection. What the service does well: The Statement of Purpose/ Resident’s Handbook provides good information for residents prior to and on admission. It is very helpful and assists residents and their representative in both choosing and settling into the home. The information has recently been updated and a copy of the new document was forwarded to the Commission. Completed survey forms refer residents and relatives receiving sufficient information when choosing the home and a relative said, “Very pleased with our choice”. The home offers long term care and respite (short term) care also. All residents are encouraged to come and spend some time at the home prior to taking up residency. The home had a pleasant, relaxed atmosphere and areas seen are decorated to a good standard. Residents interviewed were pleased with the overall appearance of the home and comments included, “Comfortable”, “Homely”, “Attractive” and “Well cared for”. A relative reported, “The home is spotless, bright and airy. Beautiful gardens. Regularly decorated and carpeted”. Bedrooms are decorated to individual taste and those seen had evidence of personal items and own furniture. The home has two pleasantly decorated lounges, one of which also has dining space. The garden is attractively landscaped and has garden furniture. A number of resident were sitting in the garden during the site visit and one resident commented, “The garden is just perfect”. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 6 Residents were complimentary regarding the food and how meals were served by staff. A resident said, “The food is just great”. The menu was displayed in the dining room to enable residents to choose what they would like. It was evident that there is effective communication between staff and residents. Staff were observed offering assistance with personal care to residents in an unhurried fashion and also spending time sitting with them in the lounge and garden. Residents and their families are asked to complete a Journey of Life when arriving at the home, which records social details and past history of the resident. This is a good way of finding out the resident’s preferred lifestyle. Residents interviewed were pleased with the care they receive and the following comments were made: “Really good staff” “Very kind and caring staff” “There are always staff to help” “The staff are my friends” The care manager has implemented changes with regards to the routine for the residents. Staff interviewed spoke positively regarding this as they felt the changes are enabling them to give more individual care based around the residents’ wishes and needs. The staff are also becoming more involved with the care plan process and are being encouraged to record in more detail the care and support they give. This demonstrates good practice. It was evident through direct observation that residents and staff get on very well together and a trusting relationship is apparent. What has improved since the last inspection? What they could do better: The home must assess the needs of the residents prior to taking up residency. This must be carried out to ensure the home can meet their needs in full. The home has introduced a new assessment tool for this purpose however this had not been completed for a recent admission. The assessment process remains an outstanding requirement from the last inspection, dated February 2006. Residents have an individual plan of care however more detail must be recorded to ensure all health care needs are addressed. Residents who have limited mobility must be reassessed to ensure their health care needs can be Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 7 met by staff and this must include the provision of manual handling equipment if needed. Residents are able to self medicate if they wish and they should be asked to complete a consent form for this practice. Staff responsible for medicine administration should undertake some form or training and/or the manager should complete a competency assessment for staff responsible for this practice. Activities are well managed and residents can take part in a good social programme. Social activities should however be recorded within a plan of care thus ensuring residents can continue with their preferred interests where possible. To enable residents and/or their relatives to view the home’s complaint procedure, a summary should be displayed in a prominent position in the home. There has been no adult protection training for staff and the abuse policy has not been updated since 1996. The policy requires an urgent review and training for staff must be provided to ensure they are aware of the role of the statutory bodies such as the police, social services or the Commission for Social Care Inspection (CSCI) and what to do should an allegation occur. The refurbishment of a bathroom must be finished as soon as possible as residents currently only have the use of one bathroom fitted with a walk in shower. With regards to recruitment a staff files viewed lacked recording of criminal record checks (CRB) and a protection of vulnerable adult (POVA) check being carried out. Staff have also not received any training for approximately two years. This is now a priority for the organisation to get right. A training plan for staff is required and discussion with the care manager confirmed that this is a priority to ensure the staff have the knowledge to meet the needs of the residents. This remains an outstanding requirement from the last inspection, dated February 2006. Only one member of staff has an NVQ in care therefore further NVQ studies must be accessed for staff. The induction for new staff is a checklist only at present and this must be developed further for the staff and include details of care and safe working practices in the home. Policies and procedures are in the process of being reviewed and will be to be circulated to staff to sign on acceptance and understanding. The home must also introduce a formal quality assurance system to obtain residents’ views of the service and care provision. The manual handling hoist must be serviced to ensure it is fit to use. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, and 3 (Standard 6 was not assessed as Intermediate Care is not provided) The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Detailed information is available to residents, relatives and visitors in the form of the home’s Service User Guide/Resident’s Handbook and residents’ contract (terms and conditions of residency). A resident was admitted without a pre admission assessment, which is required to ensure the service can meet their health and social needs in full. EVIDENCE: The home has recently updated their Statement of Purpose and Resident’s Handbook, a copy of which was forwarded to the Commission. It was noted that the summary of the complaint procedure did not include details of the twenty eight day response required to a complainant; the document was amended to include this at the time of the visit. Residents are provided with the Service User Guide and this document was also seen in a number of residents’ bedrooms. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 11 Residents are provided with terms and conditions of residency, a copy of which was also forwarded to the Commission. The contracts are not kept in the main office however one was made available and this had been signed by the resident and evidenced the fee rate. The home has also designed a small pocket size handbook, which outlines the history of the home. A copy of this was also forwarded to the Commission. Three residents were care tracked and the home is in the process of introducing a new assessment tool to assess residents’ needs prior to admission. The old style assessment form remains in a number of care files however a resident who had recently been admitted had not been assessed using the old or new format. The home must complete an assessment of need for all residents to ensure the service can meet their care needs in full. The new assessment includes information regarding health and social care needs. This will assist care staff with the drawing up of the plan of care. The new assessment tool was amended at the time of the site visit to include details of religion, any history of falls and details of medication usage. A resident interviewed made reference to the kind and caring welcome they received when moving in to the home. Whitestone Lodge does not provide intermediate care. The care is long term or residents may take up residency for respite care following a stay in hospital or with a view to taking up permanent residency. All residents are encouraged to come and spend time at the home prior to deciding whether Whitestone Lodge is suitable for them. A number of residents have lived at the home for a long period and made reference to being very settled. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ have care plans however not all care needs are recorded in sufficient detail so that there is a risk that problems and care needs are missed. There is also no evidence that the plan of care has been agreed by the resident and/or their representative. Residents are able to self medicate if they wish and staff administer medicines according to the home’s policy and procedure. Staff were observed as being respectful their manner and approach with residents. EVIDENCE: Three residents were case tracked and their care files examined. Care plans include basic information including a risk assessment element for falls, mobility and nutrition. It is recommended that they include more details to ensure all aspects of the resident health and social care needs are met. This was discussed in relation to mobility (including use of aids), risk of falls and diet. At present resident and/or their representative are not involved with the care plan process. Residents must give their agreement and consent to the plan of care whenever possible and be involved with the review process. This will ensure they are fully aware of the care provision arranged by the staff. Care plans are Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 13 now being reviewed and care staff are becoming more involved with the completion of care records. In the past residents have had their weight monitored however care files examined did not evidence any recent record of residents’ weight. The care manager confirmed that weighing scales need to be acquired. One file evidenced a form for nutritional screening completed earlier this year but there was also no record of weight for a resident who had recently been admitted. A number of care files contained details of continence management however these had not been completed to date. There was evidence of a health professional form, which is completed when GPs or other health professionals visit the home. One record sheet did not however evidence any recent appointment. Residents interviewed confirmed that they can seen their own GP, dentist or optician and access community based services. District nurses visit the home and this was discussed in relation to a resident who is receiving this input. District nurses leave their own notes at the home and these are kept secure in residents’ rooms. Residents who have limited mobility must be reassessed to ensure their health care needs can be met by staff and this must include the provision of manual handling equipment. Medicines are administered according to the home’s policy and residents may self mediate if they so wish. A consent from and risk assessment for this practice should be completed by the home and the resident. Three MAR (medicine administration record) sheets were viewed as part of the case tracking process and these evidenced staff signatures following administration. A photograph of the resident is available for verification purposes. Blister packs are used for medicine administration and a list is kept of staff signatures for those responsible for this practice. Medicine awareness training has not been provided for staff for approximately two years. It is strongly recommended that this be arranged and/or the care manager complete an assessment of competency for each staff member who administers medication. Staff were observed as being polite and respectful towards the residents and comments included: “The staff are all very polite” “Have only lived here a short time but is it is excellent and the staff are first class” Staff were observed providing assistance to residents with their meals in a sensitive fashion and also have time to undertake activities with them over morning coffee. Staff were helping residents with various aspects of personal care and this was carried out in an unhurried manner and with a gentle approach. It was evident from direct observation that the residents and staff get on very well together. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 14 Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are able to exercise choice and control over their lives and are offered a choice of well balanced and nutritional meals. EVIDENCE: The home offers a varied programme of social arrangements and the day before the site visit musical entertainment and a buffet was arranged for the residents. Residents interviewed stated that this was very good. In house entertainment includes quizzes, beetle drives, music, word search, cards, cake decorating and making cards. Social activities should be recorded within a plan of care for each resident to ensure they can continue with their preferred interests where possible. An outing was arranged at Christmas however nothing has been planned as yet for the summer months. Religious services for two denominations are held at the home, this enables residents to continue to practice their faith. At present not many residents go out due to frail health however visitors are welcome at any time. A resident was out for the afternoon with a family member for shopping. Completed survey forms make reference to residents and relatives usually being pleased with the social arrangements in the home and also that birthdays are celebrated. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 16 Staff interviewed understood the need for residents to exercise choice and this was discussed in relation to clothing, food and personal care. A resident said, “The staff are very good and understand how I like to spend my time”. Details of advocacy services are available in the office however this information should also be on display for the residents. The home offers a two week menu and a copy of this was available in the dining area of the lounge. To avoid repetition of meals a four week menu may be beneficial. A questionnaire seeking residents’ views regarding this would be a good idea. One comment made referred to the diet as being ‘monotonous’ however other comments regarding the food include: “The meals are very good and Pat in the kitchen is an excellent home cook” “Meals and service are like a 5 star hotel. Excellent variety” “Excellent food” The home has two cooks and inspection of the kitchen confirmed that it was clean and there was a good supply of fresh, frozen and dry produce. Meals are generally served in the dining area of the lounge or meals can be served in residents’ rooms if preferred. Dietary preferences are noted in the care plans and this information should also be made available to the cooks. A small record book could be used to record these details in the kitchen. Fridge and freezer temperatures were seen for the month of May. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents know how to make a complaint and feel their views are listened to. The home provides a caring environment but there needs to be more awareness amongst the management and staff regarding the local adult protection procedures so that residents are fully protected from abuse. EVIDENCE: The home has a complaint procedure which is kept in the office and a summary can be found in the Statement of Purpose. The complaint procedure was amended at the time of the visit to include details of the twenty eight day response required to a complainant. A complaints’ log is in place and this included details of any concerns or ‘grumbles’ raised by residents and staff. A resident interviewed stated that they had no worries and would speak to Paula (care manager) if they did. The Commission has not received any complaints regarding the service since the last inspection. Staff spoken with have had no training in abuse awareness and were unable to comment on the procedures should be followed. The care manager agreed that training is required as within the home there was little understanding of the role of the statutory bodies such as the police, social services or the Commission and that the home should not take on the role of full investigators without reference to the Adult Protection process. The home has an abuse Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 18 policy and procedure however this is dated 1996 must be reviewed urgently to ensure the information is in line with current legislation. It is recommended that the home acquire Knowsley’s local procedure. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents live in a comfortable well maintained home however the home must ensure residents are offered sufficient bathroom facilities. EVIDENCE: The home offers accommodation over two floors and the areas viewed were pleasantly decorated, bright and clean. A number of bedrooms were seen with the residents’ permission and these were decorated individually and had personal items, including ornaments, pictures and electrical equipment. It was noted that the carpet in bedroom 22 was rucked and this should be corrected to minimise the risk of injury to the resident. Residents interviewed commented on the cleanliness of the home and the pleasant décor. The home is well maintained and every day maintenance jobs are carried out to ensure the building is kept to a good standard. The home has two bathrooms however one is not generally used, as residents are required to access it by a small staircase. The other is being altered to accommodate a bath hoist as the existing bath is domestic in style. A present, residents only have the use of a Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 20 walk in shower room and therefore work to the bathroom must be completed as soon as possible to ensure the correct number of washing facilities are available. The temperature of hot water to baths is recorded however this record was not available at this time. The home is equipped with handrails and a raised toilet seat for one WC. A hoist is used for a resident on the first floor however this cannot be brought down to the ground floor as it does not fit in the lift. There is ramp to the garden. The home has two lounges; one has dining room tables and overlooks the rear garden. The garden is accessed via a patio door and has a ramp with handrails for the residents to use. The garden is spacious, very prettily landscaped and has patio furniture. A number of residents were sitting out in the sunshine during the site visit and commented on how much they enjoy the garden. The laundry room was organised and staff have a good provision of gloves and aprons. Care staff take care of this service. COSHH data is in the process of being obtained on all products used however staff have not received any infection control training. This is discussed further under the heading ‘Staffing’. Emergency lighting is provided throughout the building and subject to a monthly test in house and by the home’s external contractor. Records seen were up to date. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Sufficient numbers of staff are employed to care for the residents however due to the lack of evidence of staff training and poor recruitment procedures, residents are vulnerable and at risk. EVIDENCE: The day of the site visit the home was fully staffed. The care manager was in charge and was being supported by a management consultant who has been brought in to assist with reviewing policies and procedures in the home. The staffing rota for the month of May was viewed and this evidenced sufficient numbers of staff on duty. Changes have been made to the staffing rota to ensure there is more continuity of care and staff gave positive feedback regarding this. Care staff are also becoming more involved with the residents’ plan of care and are now taking part in the review process. Staff meetings are held and staff confirmed they are advised of any proposed changes in the home. Two staff records were viewed and these evidenced completed job application forms and referees had been contacted for two references prior to commencing work at the home. A member of staff requires the necessary checks with the Protection of Vulnerable Adults (POVA) register as well as the Criminal Records Bureau (CRB). A photograph is also required for verification purposes. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 22 Residents interviewed were complimentary regarding the standard of care they receive, comments included: “Staff are at hand” “The staff are always available” “Staff are very kind” “Very dedicated staff” “Paula (care manager) and the staff are excellent, always willing to listen, nothing it too much trouble” Through direct observation it was evident that staff provide a good standard of care however the home has not provided any form of training for approximately two years (evidenced through discussion with staff and looking at staff files). This matter must be addressed urgently. A training plan for staff is required and discussion with the care manager confirmed that this is a priority to ensure the staff have the knowledge to meet the needs of the residents. This must include –manual handling, fire safety, first aid, food hygiene and infection control. The cook requires food hygiene training. Further training is also recommended to be included in the training plan, for example abuse (as previously stated under the heading ‘Complaints and Protection’). Staff have a personal development plan, which can be developed in line with the training. Staff interviewed are eager to undertake a variety of courses including dementia care. Only one member of staff has an NVQ in care therefore further NVQ studies must be accessed for staff. The induction for new staff is a checklist form only and the induction process must be more detailed to ensure staff are fully aware of care and safe working practices. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home benefits from a stable management team however the lack of staff training, poor recruitment practice affects the health, safety and welfare of the residents. EVIDENCE: The registered manager, Mrs Caulton, was not present at the time of the site visit. The care manager Mrs Allen was on duty and she is now working with the management consultant regarding the general management and administration of the home. Mrs Allen is taking on more responsibility in this area and residents and staff commented on her good leadership skills. It is essential that the home urgently addresses the lack of training for staff and also ensures the recruitment practices are robust. Through observation it was evident that the management team and staff support the residents and have a good understanding of their individual needs. This however should be reflected Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 24 further within the care plans. Completed survey forms referred to residents and their relatives being pleased with the home. A resident said, “The home is managed well”. Residents can manage their own finances and two financial records seen were up to date and included staff signatures for recent transactions. Residents pay for chiropody and hairdressing visits. The home does not have a quality assurance system, which incorporates attaining feedback from residents and/or their representatives, for example, arranging residents’ meetings or sending out regular satisfaction questionnaires regarding the service. A questionnaire was sent out regarding the routine in the home and this should be followed up with a more general questionnaire regarding the overall care provision. Policies and procedures must be reviewed and the home are now in the process of undertaking this. Policies and procedures are being circulated to staff to sign on acceptance and understanding. The policy regarding abuse must be reviewed with urgency as this is dated 1996. Staff are not receiving supervision and therefore this must be introduced to ensure staff are supported in their role. Staff now take part in handovers at each shift change to discuss the care of the residents. A selection of safety contracts for equipment and services in the home were viewed. The gas, electric and fire prevention certificates were in date. Portable appliance testing is due this month. There has been no service of the manual handling hoist since it was purchased. Fire alarms are tested weekly and the fire log book evidenced the most recent tests. As previously stated staff have not received any fire training for approximately two years. Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The home must ensure residents’ are admitted following a full assessment of their individual needs. This remains an outstanding requirement from the last inspection dated February 2006 The home must ensure residents are consulted regarding their plan of care and be advised of any change in care provision The home must review health care provision with emphasis on nutrition and manual handling needs for residents with limited mobility The home must ensure that the policies and procedures are updated regarding the management and reporting of Adult Protection / abuse issues and that all staff are aware of these and receive training The home must ensure the work is completed to the bathroom to enable residents to use this facility The home must access NVQ courses for staff DS0000021473.V291718.R01.S.doc Timescale for action 03/07/06 2. OP7 15 03/08/06 3. OP8 12/16 03/07/06 4. OP18 13 03/09/06 5. OP21 23 03/09/06 6. OP28 18 03/09/06 Whitestone Lodge Residential Care Home Version 5.1 Page 27 7. OP29 19 8. 9. OP29 OP30 Schedule 2(19) 18 10. OP30 18 11. 12. 13. OP33 OP36 OP38 24 18 16 The home must ensure staff do not commence employment until a relevant POVA and or a Criminal Records Bureau enhanced disclosure has been attained. The home must keep a photograph of all staff for verification purposes The cook must undertake Food Hygiene training. This remains an outstanding requirement from the last inspection dated February 2006 The home must implement a training plan and keep a record of all staff training undertaken including full induction training for new staff. Staff must receive training in safe working practice areas. This remains an outstanding requirement form the last inspection dated February 2006 The home must introduce an effective monitoring system for the service The home must introduce supervision for staff The manual handling hoist must be serviced 03/07/06 03/07/06 03/08/06 03/08/06 03/09/06 03/08/06 03/07/06 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. 3 Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Care plans should be completed in more detail and health professional records be maintained accurately The home should ensure residents’ weight is monitored The home should ensure staff should receive formal DS0000021473.V291718.R01.S.doc Version 5.1 Page 28 Whitestone Lodge Residential Care Home 4. 5. 6. 6. 7. 8. 9. 10. 11. OP9 OP12 OP14 OP15 OP16 OP18 OP19 OP33 OP33 medicine awareness training or the manager should complete an assessment of competency for each member of staff responsible for this practice. A consent form should be used for residents who wish to self-administer their own medications. The home should complete an individual risk assessment for this practice Care plans should record preferred social interests Advocacy details should be displayed for residents to view A four week menu may should be considered and a record should be kept of dietary preferences The complaint procedure should be displayed in the home The home should acquire Knowsley’s local adult protection procedure The rucked carpet should be straightened out in Bedroom 22 The home should send out questionnaires to resident and relatives to obtain their views of the home The home should hold residents’ meetings Whitestone Lodge Residential Care Home DS0000021473.V291718.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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