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Inspection on 03/08/07 for Whitestone Lodge Residential Care Home

Also see our care home review for Whitestone Lodge Residential Care Home for more information

This inspection was carried out on 3rd August 2007.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Whitestone Lodge presents with a very warm, caring and friendly environment and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents` individual care needs and the level of support each person required. Care was seen to be given in a discreet, sensitive manner andstaff were patient and gentle in their approach. There was plenty of laughter and good interaction was noted between the staff and residents. Comments from residents and relatives regarding the service include: "They make residents and their family and friends feel at home. Create a welcoming and friendly atmosphere, therefore you feel you can trust them in their care of the residents" (relative) "I like it at the home" (resident) "Nice people" (resident) "A good home" (resident) "We get good care" (resident) Residents have a plan of care, which gives good detail of individual care and social needs. Care documents evidenced that residents` health care needs were being met appropriately and staff aware of the need to maintain and promote independence where possible. Residents confirmed that the routine was flexible with regard to personal care and that were willing to accommodate individual wishes where possible. A resident said, "The girls are very good if I want to stay in bed later or have a rest in the afternoon". Residents also said that sufficient numbers of staff were on duty to assist them and that the staff were polite and helpful. This was evidenced through general observations during the site visit. The entrance hall is welcoming and the front lounge has information regarding the service on display for residents and relatives to view. The accommodation is maintained to a good standard, areas seen were pleasantly decorated, spotlessly clean and `homely` in appearance. Staff receive a good standard of training to ensure they have the skills and knowledge to undertake the care and support residents need. Training is centred on delivering improved outcomes for residents.

What has improved since the last inspection?

The registered manager is currently in dispute with Knowsley Metropolitan Borough Council over contracting agreements and therefore the requirement regarding provision of contracts for residents cannot be met at this time. Residents who are privately funded however are provided with conditions of residency when they are admitted. Care documentation for residents has greatly improved to reflect individual care and social needs. A requirement was not raised regarding this at the last inspection however the care manager has made more improvements to ensure staff deliver care in a flexible, consistent and reliable way.

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 09:00 3 and 6th August 2007 rd 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.V342370.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. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 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 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.V342370.R01.S.doc Version 5.2 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 2nd June 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, which are equipped with aids 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 for accommodation is £418.00 a week. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced inspection over a two day period for a duration of approximately ten hours. Seventeen residents were accommodated at this time. A partial tour of the premises took place and a number of the home’s care, staff and health and safety records were viewed. Discussion took place with eight residents, two staff, the care manager, Mrs Paula Allan and the registered manager, Mrs Caulton. Mrs Caulton was not present for the first day of the site visit. 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. Interviews also took place with two relatives. All the key standards were inspected and also previous requirements and recommendations from the last inspection in January 2007 were discussed. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents, relatives and GPs prior to the inspection. Comments included in the report are taken from the survey forms and also during the site visit. Two relative surveys and three resident surveys were returned. Telephone contact was made with one relative. No surveys were returned from residents’ GPs. An AQAA (Annual Quality Assurance Assessment) was completed by the care manager prior to the site visit. This provides details of the service provision including the staff employed and improvement made since the last inspection. Evidence from the AQAA is incorporated in the report. What the service does well: Whitestone Lodge presents with a very warm, caring and friendly environment and residents appeared relaxed and comfortable with the staff. It was evident through interviews, general observations and discussions that staff had a good knowledge of the residents’ individual care needs and the level of support each person required. Care was seen to be given in a discreet, sensitive manner and Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 6 staff were patient and gentle in their approach. There was plenty of laughter and good interaction was noted between the staff and residents. Comments from residents and relatives regarding the service include: “They make residents and their family and friends feel at home. Create a welcoming and friendly atmosphere, therefore you feel you can trust them in their care of the residents” (relative) “I like it at the home” (resident) “Nice people” (resident) “A good home” (resident) “We get good care” (resident) Residents have a plan of care, which gives good detail of individual care and social needs. Care documents evidenced that residents’ health care needs were being met appropriately and staff aware of the need to maintain and promote independence where possible. Residents confirmed that the routine was flexible with regard to personal care and that were willing to accommodate individual wishes where possible. A resident said, “The girls are very good if I want to stay in bed later or have a rest in the afternoon”. Residents also said that sufficient numbers of staff were on duty to assist them and that the staff were polite and helpful. This was evidenced through general observations during the site visit. The entrance hall is welcoming and the front lounge has information regarding the service on display for residents and relatives to view. The accommodation is maintained to a good standard, areas seen were pleasantly decorated, spotlessly clean and ‘homely’ in appearance. Staff receive a good standard of training to ensure they have the skills and knowledge to undertake the care and support residents need. Training is centred on delivering improved outcomes for residents. What has improved since the last inspection? The registered manager is currently in dispute with Knowsley Metropolitan Borough Council over contracting agreements and therefore the requirement regarding provision of contracts for residents cannot be met at this time. Residents who are privately funded however are provided with conditions of residency when they are admitted. Care documentation for residents has greatly improved to reflect individual care and social needs. A requirement was not raised regarding this at the last inspection however the care manager has made more improvements to ensure staff deliver care in a flexible, consistent and reliable way. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Whitestone Lodge Residential Care Home DS0000021473.V342370.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 Whitestone Lodge Residential Care Home DS0000021473.V342370.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 1,2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a contract and information regarding the service to help them to decide whether to take up residency. Assessments are carried out prior to admission to ensure the staff can meet the needs of the residents. EVIDENCE: The Statement of Purpose was reviewed in February 2007 to ensure the information contained was accurate. A copy of this document can be found in the lounge and also in resident’s rooms for their referral. A brochure on the service was also available. Sufficient information is therefore available for residents to help them in choosing a care home. The manager is presently in dispute with Knowsley Metropolitan Borough Council regarding contracting agreements however residents who are privately funded receive a contract stating terms and conditions of residency. These Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 10 details are kept separately and secure. Four contracts were viewed and were signed by residents /or their representative. A letter has recently been sent out by owners to inform the relevant person of the fee increase for this year. Surveys completed confirmed that contracts had been received. The care manager undertakes a full needs assessment with the resident, their relative/representative and with the relevant health care professional where possible. All residents have an individual care file, which outlines their needs and wishes. An assessment seen recorded good detail of current health and social cares needs to enable staff to provide the care and support required. Key areas include personal hygiene, mobility, diet, continence, sleep, communication, risk of falls and social care. Basic care needs such as optical, dental, foot care and hearing are assessed, as they are important to the care of an older person. Medication is listed on admission and residents are asked if they wish to administer their own medicines as part of maintaining their own independence. The initial assessment is followed up with a dependency assessment and this gives a good summary of care to assist with writing the plan of care. A resident said, “I like being here, everyone is very kind indeed”. Standard 6 was not assessed, as intermediate care is not provided. Whitestone Lodge Residential Care Home DS0000021473.V342370.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. Residents may be placed at risk due to poor medicine administration. EVIDENCE: Three residents were case tracked and their care files examined a part of this process. The care files were easy to read and the information clearly recorded care and social needs. Care plans seen were based upon individual need with information on how staff need to given the appropriate standard of care and support. Key areas include, mobility, risk of falls, sleep, eating and drinking, communication, sight, dental care, medication usage, mental state, personal safety and risk, social involvement and personal well being. Care plans seen had been reviewed monthly and changes made where needed. There was no evidence of the resident and/or relatives’ agreement and consent to ensure they were aware of the care provision. Supporting care documents include risk assessments for skin, moving and handling and nutrition. The risk assessments address safety issues whilst aiming for better quality of life for the residents with the support of the staff. Falls risk assessments should contain more detail Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 12 regarding the preventative and control measures required to protect the residents. This was discussed in relation to falls. Staff sign a day book to evidence personal care, such as bathing and daily record sheets are completed at the end of each shift to report on the care and support given. A record is maintained of GP visits and also letters to external professionals for their input when required. The health care needs of residents unable to leave the home are managed by visits from local health care services. Residents and relatives reported positively on the care via direct conversation or surveys received. Comments include: “We get good care” (resident) “I can see my GP at any time” (resident) “Very pleased with the care” (relative) “Very good care” (resident) “Staff help me with washing and dressing when I ring for help” (resident) Medicines are administered from blister packs and the medicine trolley is kept locked inside a lockable cupboard. There was no list of sample signatures for staff responsible for administering medicines. The keys are kept by the care manager or senior care staff however on one occasion the keys were found to be in the kitchen. Medicines were not administered safely. Not all medicine administration sheets (MARs) evidenced staff signatures for medicines administered and there is therefore a risk that the residents did not receive them. There was no evidence of a referral to the relevant health professional for residents who refuse their medication for a long period of time. There is a risk that this will affect their general health. The day staff administer a number of bedtime medicines early and there is a risk that medicines are not being given at the time prescribed. There was no evidence that checks were undertaken to ensure staff follow the procedure for safe handling, recording and administration of medicines. This meant that the manager could not guarantee the medicines were given out in a safe and appropriate manner at all times. Staff who administer medicines receive annual training however there was no evidence of an assessment of competency for staff responsible for this task. A risk assessment is completed for residents who wish to administer their own medicines to ensure they are able to undertaken this practice safely. The temperature of the medicine fridge is not recorded for the safe storage of medicines. Staff have access to a medicine policy for referral. Interviews with residents and general observations confirmed that staff are respectful in their approach and have sufficient time to spend with residents on a one to basis. Staff were see talking to residents in a quiet manner and also assisting with various aspects of personal care in a sensitive fashion. A resident Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 13 said, “The girls are always polite”. Staff are advised of the importance of privacy and dignity during their induction and through regular supervision. Residents have the choice to remain in their own room or sit in the lounges to watch TV, take part in activities or chat with staff and other residents. Some residents had chosen to sit in the garden and staff accommodated this wish. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to decide how they wish spend their day and are offered well balanced meals. EVIDENCE: Visitors were seen popping in and out throughout the day and offered refreshments by the staff. With regard to the service a relative reported, “They (the staff) pay a lot of attention to each individual person by listening to them and keeping them occupied by doing different kinds of activities. They also listen to the relatives”. The staff help residents complete ‘The journey of my life’, which provides details of residents’ preferred interests and routine, social background and religion. Those seen had been completed in good detail to enable staff to get to know the residents better. With regards to the routine several residents commented on the fact that staff do not mind what time they go to bed or get up and they can have their meals later if preferred. A staff member said, “We make sure the residents decide what they want to do”. Care plans contain Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 15 information about residents’ wishes, choices and decisions that affect their welfare. The majority of residents were complimentary regarding the standard of food however several residents felt that the menu could be improved, as it was repetitious. Comments include: “Lovely food” “Nicely served food” “The staff always ask us what we want” The care manager and registered manager stated that special foods are purchased when requested and every effort is made to provide a varied menu. A review of the menu and food purchased would be beneficial this will ensure residents are able to enjoy the food they prefer and like. The menu should also evidence all meals prepared to enable resident to choose what they wish to eat. The fridge and freezers were well stocked and there was plenty of fresh fruit and vegetables available. Environmental health records were not up to date for the week of the site visit. This may pose a health and safety risk to residents. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 16 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. Residents feel their complaints will be listened to and acted upon. Abuse and policies and procedures are in place to protect the residents. EVIDENCE: A complaints procedure is in place and residents are provided with this information within the Service User Guide, which is made available to them. The complaints procedure is also displayed in the entrance to the home and no complaints or ‘grumbles’ have been received since the last inspection. Relatives and residents spoken with and surveys returned confirmed that they are aware of how to make a complaint should they need to. Residents’ rights are respected and information pertaining to this is displayed in the main hall. A resident said, “I have no complaints at all and would speak to Paula (care manager) if I needed to”. Staff receive adult protection training and have access to an abuse policy and also the local guide for the protection of vulnerable adults. Staff interviewed were able to describe the concept of abuse and when incidents need external input who they talk to. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 17 It was evident that residents with happy with the service provision and felt safe and supported. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 18 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 20,21,22,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers comfortable, clean, well maintained accommodation. This contributes to a good quality of life for the residents. EVIDENCE: The accommodation is based over two floors and areas seen were well maintained and clean. Residents can access all areas by the use of a staircase or passenger lift. Bedrooms viewed were attractively decorated and residents had brought in personal items to make the rooms ‘homely’. A number of bedrooms did not have call bell extension leads as beds were placed next to the call point. The care manager stated that the residents were able to use the main call point however call bell extension leads should be available to ensure residents can ring for assistance in the case of an emergency. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 19 There are two lounges and one lounge has designated dining space. Both rooms are bright and airy with comfortable furniture. The front lounge is often used for private meetings, consultations or ‘quiet’ time. Residents tend to sit in the lounge, which overlooks the garden as they have their meals here and the view is very pleasant. The lounge door opens in to the garden and there is easy access to the grounds for less mobile residents. The garden is attractively laid out and provides a pleasant environment for residents to enjoy. There is also a patio area, which can be used for barbeques. Residents spoken with were complimentary regarding the standard of accommodation and the cleanliness of the premises which they said is maintained at all times. Bathrooms are fitted with aids including a walk in shower to assist residents who are less independent and the hot water is checked prior to bathing to ensure it is maintained at a safe temperature. Emergency lighting is provided throughout the building and subject to regular service checks to ensure it is working correctly. There is an ongoing maintenance programme and decoration includes the purchase of new curtains for some bedrooms. The laundry room is equipped with hand washing facilities and an infection control policy provides guidelines to staff to minimise the risk of infection. Staff were seen to use gloves and aprons where needed. Laundry is well organised and each resident has their own clothing basket for the return of their personal items. Residents’ comments include: “I have a nice bedroom” “Everywhere is always really clean” “The bathrooms are clean” “The garden is lovely” Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 20 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. Recruitment practices for new staff are not robust to protect the residents. Not all staff have received an induction to enable them to have the skills and knowledge to carry out their role. EVIDENCE: The staffing rota evidenced sufficient numbers of staff on duty to care for the residents. A number of care staff hold a senior role and support the care manager. It was noted that the care manager was working every day over a three week period. This is not effective management and will not assist in delivering outcomes for residents. Many of the staff have worked at the home for a number of years and residents commented that they like the continuity this offers. Residents reported that the staff were helpful, polite, cheerful, kind and caring in their attitude. Good interaction was noted between staff and residents and everyone appeared relaxed throughout the day. Resident and relative comments include: “The girls are really good” “Paula (care manager) is excellent” Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 21 “The staff are lovely” “The staff are good” (relative) Poor recruitment practices place residents at risk. Three staff files were viewed and these evidenced that not all staff commenced employment prior to the necessary police checks or references being obtained. Staff must not commence employment prior to a POVA (protection of vulnerable adult) check and/or CRB (criminal record bureau) disclosure are received. Two references are required for all staff and they should be obtained prior to employment. NVQ (National Vocational Qualifications) are ongoing for staff, as a ratio of 50 of trained care staff needs to be achieved. The AQAA reported that two staff have an NVQ qualification and that twelve staff are working towards Level 2 or above. Staff interviewed and records examined confirmed that a wide range of courses in safe working practices is available. This includes moving and handling, first aid, health and safety, fire prevention and food hygiene. Infection control training is booked for later this year. The good standard of training ensures the staff are equipped with the skills and knowledge to carry out their roles. There was evidence of an induction in two files however evidence of this was lacking in one file. An induction is required to provide the employee with details of the organisation, care practices, needs of the residents and training requirements. The induction should be given in line with Skills for Care Induction Standards, which are new national standards. These standards will help staff know all they need to know and to enable them to work safely. A staff member said they were shown round the building when they started and advised what to do in the event of a fire. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 22 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 31,32,33,35,37,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed for the benefit of the residents and their health and safety is protected. EVIDENCE: The registered manager, Mrs Caulton, was not present the first day of the site visit but was present for the feedback on the second day. The care manager Mrs Allen was on duty for both days and she assisted with the inspection process. Mrs Allen is in the process of applying to the Commission for Social Care Inspection for the position of Registered Manager. The Central Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 23 Registration Team will process her application. Mrs Allen takes on responsibility for overseeing the completion of care documents, staff training, supervision and general management in preparation for her new role. Mrs Caulton is present in line with her position as registered manager and supports Mrs Allen and the staff. Mrs Caulton and Mrs Allen are aware of the need to promote equal opportunities for all staff and to provide residents with care based on their needs. Outcomes for residents are monitored through quality assurance processes. Residents and relatives complete surveys to enable them to give their view of the service and these were last distributed in July 2007. None have been received as yet. Residents do not wish to attend meetings at present but Mrs Caulton is looking to introduce a newsletter regarding various aspect of life at the home from a staff and resident perspective. At the time of the site visit staff were observed to spend time with the residents getting to know them and making sure they were happy with arrangements in the home. There is no annual development plan however information recorded from the AQAA is going to be used to help formulate this document. Staff have been asked to review a national minimum standard and reflect on the service provision. This raises staff awareness on what they achieving for the residents and areas of improvement. A staff member reported that this was a very good idea and helped her to get to know more about care standards. Staff now receive a good standard of training and their skills and knowledge is based around continuous development to provide person centred care in a safe manner. A staff member said, “The training is much better now and we can ask to go on all sorts of courses”. Staff meetings are held and staff receive supervision and an annual appraisal as part of their development. Recruitment and induction for new staff must be improved to protect the welfare of the residents. Residents can manage their own finances and three financial records seen were up to date and included staff signatures for recent transactions. Policies and procedures are being reviewed with the assistance of an external quality assessor to ensure they are in line with current legislation. A policy was seen for confidentiality, abuse, privacy and pressure relief. Care records are currently being stored in small lockable filing cabinets, which are heavy and not easily accessible or transportable for staff and residents. A more permanent secure place is being found for the care records so that staff and residents can view them at any time. A number of care records were not dated or signed on completion to evidence their accuracy. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 24 Accident records had been completed for incidents that affected the welfare of the residents. Care files did not always record the incident and there is a risk that staff will not be aware of the incident and any treatment needed. A selection of safety contracts for equipment and services in the home were viewed. The gas, lift and fire prevention certificates were in date. The electrical certificate could not be located; a letter only was on file stating the date of the test in 2004 and renewal in 2009. It was agreed that a copy of the certificate would be forwarded to the Commission to ensure the ongoing protection of the residents. Fire alarms are tested weekly and the fire log book evidenced the most recent tests. Staff receive fire training every six months to ensure they are aware of the procedures to be followed in the event of a fire. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 3 3 3 3 X 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 3 3 x 3 3 3 3 Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 24(1) Requirement The registered person must ensure there is an effective system in place to audit medicines management within the service in order to ensure that people who use this service are receiving the correct medication. The registered person must ensure staff administer medication in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. The registered person must obtain two written references for new staff employed to protect the residents The registered person must ensure staff do not commence employment prior to a POVA first and/or CRB check is obtained. This will protect the residents. The registered person must keep a record of induction training for all staff to ensure they have the skills and knowledge to undertake the work. The DS0000021473.V342370.R01.S.doc Timescale for action 12/09/07 2. OP9 13(2) 12/09/07 3. OP29 19 (1) (c) Schedule 2 19 (1) (c) Schedule 2 17 (2) Schedule 4 12/09/07 4. OP29 12/09/07 5. OP30 12/09/07 Whitestone Lodge Residential Care Home Version 5.2 Page 27 registered person must provide an electrical certificate for the service to ensure the ongoing protection of the residents. 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 Good Practice Recommendations Agreement and consent to the plan of care should be obtained from the resident and/or their relative/representative. Risk assessments should record sufficient information relating to the preventative and control measures required to minimise the risk to the resident. Staff should have their competence checked prior to undertaking medication administration and recording in order to protect residents. The temperature of the medicine fridge should be recorded to ensure medicines are stored at the correct temperature. A list of sample staff signatures should be obtained for those staff who administer medicines. A review of the menu and food purchased should be undertaken to ensure food is to the liking of the residents. The menu should evidence all meals prepared to enable resident to choose what they wish to eat. Environmental health records should be maintained to ensure the health and safety of the residents Call bell extension leads should be placed in resident bedrooms for them to access in an emergency. The staffing rota should be reviewed to ensure the care manager is not working every day over a three week period. A minimum ratio of 50 trained member of care staff with NVQ Level 2 and above is required in a care home. References for new staff should be obtained prior to commencing employment. Induction for staff should be given in line with Skills for Care Induction Standards so that staff know all they need to know and can work safely. Care records should detail any untoward incident that DS0000021473.V342370.R01.S.doc Version 5.2 Page 28 OP8 OP9 4. OP15 5. 6. 7. 8. 9. 10. 11. OP15 OP22 OP27 OP28 OP29 OP30 OP37 Whitestone Lodge Residential Care Home 12. OP38 affects a resident’s welfare. Care records should be dated and signed on completion; be stored appropriately and accessible for staff and residents. A copy of the electrical certificate for the service should be forwarded to Commission. Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Whitestone Lodge Residential Care Home DS0000021473.V342370.R01.S.doc Version 5.2 Page 30 - 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. 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