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Inspection on 05/06/08 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 5th June 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.

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

The home presents as friendly and relaxed. Residents said they were happy with the standard of care and that staff were kind, polite and willing to help them in all ways. Staff were seen spending time with the residents either on a group basis or on an individual basis. Residents were enjoying playing card games and also taking walks around the garden.The accommodation is maintained to a good standard. The bedrooms are individually decorated and residents can bring in items from home to make their rooms feel special to them and `homely`. The lounges have comfortable armchairs and visitors can use these rooms or meet residents in the privacy of their own bedrooms. The garden is currently being landscaped for the residents to enjoy during the warm weather.

What has improved since the last inspection?

Medicines are being administered to residents in safe manner. Recruitment of new staff is now robust to protect the residents. This includes two written references and a police check prior to staff starting work. New staff also receive an induction and a written record is being kept of this training to evidence their learning. A number of recommendations made at the last inspection have also been actioned to help improve the service.

CARE HOMES FOR OLDER PEOPLE Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP Lead Inspector Mrs Claire Lee Key Unannounced Inspection 5th June 2008 09:20 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.V363240.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.V363240.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) whitestonelodge@btconnect.com Mr Caulton Mrs V Caulton Paula Allen 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.V363240.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability, over 65 years of age - Code PD(E) The maximum number of service users who can be accommodated is: 20 Date of last inspection 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 the registered manager is Ms Paula Allen. The home is situated in a residential area within access to public transport to surrounding areas, Prescot and Liverpool. 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 fee rate for accommodation is £418.00 a week. Whitestone Lodge Residential Care Home DS0000021473.V363240.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. A site visit took place as part of the inspection and this was carried out for a duration of one day for approximately nine hours. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading service records and looking at different areas of the building. All of the key standards were inspected and also previous requirements and recommendations from the last inspection in July 2007 were discussed. Case tracking’ was used as part of the site visit. This involves looking at the support a resident gets from the manager and staff including their care plans, medication and financial matters. This was not carried out to the detriment of other residents who also took part in the inspection process. Time was spent meeting with residents, visitors and staff to gain their opinions of the overall service. Interviews were conducted with four residents and two family members. ‘Have your Say’ Survey forms were distributed to residents, relatives, staff and health care professionals as another means of gaining their views. A number of comments included in this report are taken from interviews conducted and also survey forms received. An AQAA (annual quality assurance assessment) was completed by the manager prior to the site visit. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager had completed the AQAA in good detail prior to the site visit. What the service does well: The home presents as friendly and relaxed. Residents said they were happy with the standard of care and that staff were kind, polite and willing to help them in all ways. Staff were seen spending time with the residents either on a group basis or on an individual basis. Residents were enjoying playing card games and also taking walks around the garden. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 6 The accommodation is maintained to a good standard. The bedrooms are individually decorated and residents can bring in items from home to make their rooms feel special to them and ‘homely’. The lounges have comfortable armchairs and visitors can use these rooms or meet residents in the privacy of their own bedrooms. The garden is currently being landscaped for the residents to enjoy during the warm weather. What has improved since the last inspection? What they could do better: A number of care plans did not reflect the care and support residents needed. This was noted in relation to two incidents that affected residents’ welfare. The manager and staff had not recorded the relevant health issues within the plan of care to reflect the change in their condition following the incidents. There is therefore a risk that staff are unaware of the care needed and that residents do not receive the care they need. More attention is needed to meet the changing needs of residents to maintain their health and provide good outcomes for them. This includes information regarding any risk identified and the necessary measures staff need to consider and record to keep the resident safe. The manager and staff require moving and handling training to ensure they can move residents in a safe manner. The training was arranged at the time of the site visit as current certificates had expired. The manager and staff must inform the Commission for Social Care Inspection (CSCI) of any incident that affects a resident’s welfare. This is in accordance with Regulation 37 of the Care Homes Regulations. It is a form that is submitted with details of the incident. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 7 A number of good practice recommendations are made in the main report to help improve the service. They should be given serious consideration. 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.V363240.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.V363240.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given information regarding the service to help them choose a suitable home. Residents are assessed before they are admitted to the home. This gives an assurance to everybody that a person is only admitted if the staff can meet their needs. EVIDENCE: The Service User Guide provides good information regarding the service however this needs to be updated with the new manager’s name and qualifications. Ms Paula Allen previously worked as a care manager at the home and in the autumn of 2007 became the registered manager. There was also a small brochure with details of the service and both documents were kept in the lounge for people to see. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 10 Before any resident is admitted to the home the manager undertakes an assessment of their needs. An assessment looks at what help and support the prospective resident needs in all aspects of daily life. Two assessments were seen for residents recently admitted. They were completed to satisfactory standard and gave a clear indication of the residents’ needs and what they could and could not do for themselves. This included areas such as mobility, eating and drinking, sleeping, communication, medicine and social background. The assessment detail is then used to form the plan of care. Standard 6 was not assessed, as intermediate care is not provided at Whitestone Lodge. Whitestone Lodge Residential Care Home DS0000021473.V363240.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 health care needs of the residents are not set out in a plan of care to ensure staff provide the necessary support and care required. EVIDENCE: Individual care plans were in place for each resident. The care plans cover areas such as, mobility, sleep, communication, social background and washing and dressing. The care plans of four residents were looked at as part of the case tracking process. One of the residents had extensive care needs and the care plan had not been reviewed following a serious incident (a fall with hospital admission) to reflect the resident’s general state of health and well being. The care plans were inaccurate and did not provide staff with information on how best to care for the resident. This was noted in relation to the resident’s reduced mobility, poor dietary intake and a deterioation in their general condition on return from hospital. The care files showed that staff complete risk assessments in relation Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 12 to eating and drinking, mobility and risk of developing problems with skin. The two residents who had suffered falls had not had any update to their risk assessments to evidence the change in their condition and control measures needed to keep them safe and in good health. The CSCI had not been advised of the incidents, this is discussed further under Standard 38 of this report. District nurses are currently visiting one resident to provide clinical care and to help the staff. A resident said they could see their doctor when they wanted and that the manager arranged any outside appointments. A continence advisor was visiting at the time of the site visit to offer advice for continence management. Discussion with staff supported the fact that they are aware of the importance of helping residents to stay well. There was no resident and/or relative agreement to the plan of care and this should be obtained where possible to ensure everyone is aware of the care needed and decisions being made by the staff. A general ‘grumbles’ book is maintained on behalf of the residents along side the complaint log and complaint policy. It was noted that the book was being used for recording aggressive incidents by residents towards staff. These should be noted on incident forms and monitored on a more formal basis. Incidents of this nature have the potential to affect residents’ care. The staff were seen to help residents with various tasks throughout the day and the residents appeared comfortable and well dressed. A staff member was observed to provide an aspect of personal care to a resident in the lounge and this was brought to the manager’s attention. This could have compromised the resident’s right to privacy and should have been carried out in a bedroom or bathroom. This was however only one incident. Staff made sure residents had their reading glasses and offered everyone regular drinks. The staffs’ approach was gentle, kind and polite. A resident said, “Everyone is always polite to us.” Aids and equipment were in place to ensure resident comfort. Bed rails should have protective covers over them to reduce the risk of injury to the resident. The majority of medicines were packaged in a blister system supplied by the pharmacy and this helps staff administer medicines in an organised safe way. A spot check of a number of medicines evidenced that they were given as prescribed. Records of medicines received into the home, administered to residents and disposed of were clear, accurate and complete. Staff had signed for medicines administered. Staff have received training in medicine management and the manager has undertaken a competency assessment with them to ensure they have the skills and knowledge to carry out this practice. A quality check of medicine Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 13 administered each month is also recommended to ensure medicines are given in accordance with the medicine policy and procedure. Whitestone Lodge Residential Care Home DS0000021473.V363240.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 have a choice in how they spend their day and find enjoyment from the activities available. The choice and variety of the food provided ensures that the nutritional needs of the residents are met. EVIDENCE: There was a pleasant relaxed atmosphere in the home and residents’ routine and preferred choice of daily living and their social interests were recorded in their care plans. This was noted in relation to foods, sleep patterns and social activities. The AQAA reported that the manager has developed a flexible schedule for the residents’ bed and rising times. Two residents were chatting in a bedroom rather than coming to the lounge and others were listening to music in the lounge. Visitors were seen arriving at various times of the day. A resident reported the staff were always welcoming and polite when their family member visits. The activities in the home were displayed on a board in one of the lounges. These are carried out on an informal basis and include gentle exercise, music, birthday parties, card games and walks out accompanied by staff. A ‘journey of Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 15 life’ had been completed for residents and this has details of family, social background and preferences (for example daily routine and foods) in order for staff to get to know the resident in more detail. During the inspection a staff member played cards with two residents and also accompanied them for a walk around the garden. Both activities were well received and there was lots of laughter. With regard to social arrangements in the home a relative said, “Very regular events, super birthday parties arranged without prompting.” Holy Communion is offered at the home to enable residents to continue practice their chosen faith. A weekly hairdressing service is also available. A resident reported they could bring in pictures, photographs and ornaments to make their room special and a change of bedroom for one resident had been well received. The bedrooms that we looked at were personalised to help the residents feel at home. The menu was displayed in one of the lounges. The residents are offered a choice of food at breakfast, lunch and teatime with snacks and hot/cold drinks at other times of the day. The kitchen was well stocked with food supplies and the manager regularly goes out and buys ‘special’ foods on request. This was confirmed during a resident interview. A discussion with the cook and residents showed that they could always have something different if they wanted. The rear lounge has an allocated dining space, which was very pleasant and the tables were nicely set for lunch. There has been some negative comments regarding the standard of the meals at previous inspections however at this time residents spoken with said the food was good. Comments included, “Nice meals”, “Mum has a good appetite and seems to enjoy her food”, “You can eat what you want.” Whitestone Lodge Residential Care Home DS0000021473.V363240.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. Policies and procedures are in place to protect people using the service. Staff however, need to be fully away of local contact details to ensure full understanding of the processes involved so that residents are protected. EVIDENCE: A complaint procedure was in place and was displayed in the reception area. A record is kept of any complaint made and a more formal system of recording complaints was discussed with the manager to evidence the investigation and outcome of complaint. The AQAA reported that no complaints had been received over the last twelve months. The CSCI have received none. A concern raised by a family member through a CSCI survey prior to the site visit had been dealt with by the manager to the satisfaction of all parties. Residents and visitors interviewed had no worries at this present time and said they would always speak to the manager and if they had a problem it would be sorted. Staff have access to a safeguarding adults policy and also a copy of Knowsley’s safeguarding procedures. Staff spoken with knew where these documents were located. Staff files evidenced the fact that staff had received training on the recognition of abuse but not all interviewed were clear about the role of outside agencies such as CSCI or Social Services. They were unsure about the ‘Careline’ contact for the reporting of abuse but said they would always refer an incident to the manager. Perhaps contact details for reporting an alleged incident can be advertised more readily and further safeguarding training be given to staff. Everyone must be conversant with these procedures. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 17 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 19,20,21,22,22,24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in safe, clean, well maintained suitable accommodation. EVIDENCE: The home is based over two floors and it is maintained to a good standard. Areas seen were attractively decorated and clean. The home has lots of flower arrangements, pictures and pleasing colour schemes. There are two lounges, one of which can be used for private consultations or ‘quiet’ time for the residents. The other lounge has been decorated, new armchairs purchased and a supervisors’ station built for the safe keeping of resident care records. This lounge has dining room tables and residents enjoy their meals overlooking the garden. The lounges and bedrooms were clean and suitably furnished. Bedrooms were ‘homely’ in appearance and a number have been decorated recently. There were enough toilets and bathrooms to meet the needs of the residents. Toilets Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 18 were close to bedrooms and living areas. Locks were available for privacy on bathroom/toilet and bedroom doors. A number of bedrooms did not have a call bell extension leads as beds were placed next to the call point which residents can use. The manager said the call bell extension leads have been purchased and are now being fitted. A resident who wished to stay in her room had a call bell lead next to her to press for staff assistance if needed. Lockable cupboards had been provided for residents and this is arranged when requested on admission. Residents and visitors said that the home was kept clean and in a good condition. A relative said, “There are never any nasty smells” and a resident confirmed that their room was cleaned regularly. Bathrooms had equipment to assist residents with bathing, for example, a bath chair and a walk in shower. Staff check the hot water to ensure it is delivered at a safe temperature. Records seen were satisfactory. Liquid soap and paper towels are provided in the laundry room and bathrooms to reduce the risk of cross infection. One WC requires these to be fitted. The manager said this would be rectified as soon as possible. The laundry room was organised and care staff were seen to use gloves and aprons. As previously stated the rear lounge overlooks the garden. The garden is being landscaped and there is a new patio area with garden furniture. This area is lovely for the residents to sit out during the warm weather. There is some car parking space to the front of the premises. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. A lack of moving and handling training for staff places residents at risk. EVIDENCE: Talking with the manager, staff and residents and visitors confirmed that there were sufficient number of staff on duty to provide the necessary care and support to the residents. The duty rotas seen also provided evidenced of this. During the inspection the staff were kept busy helping residents with various aspects of care and also chatting to them on an individual or group basis. The staff were caring and respectful in their approach. Comments from residents and relatives included: “My step grand mother could not be better cared for” (relative) “They are very helpful on giving us advice on needs and health” (relative) “I like the staff” (resident) “We are very satisfied with the care and attention” (relative) The manager now has supernumerary hours for administrative work and the owners and also a deputy manager support her in her role. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 20 The AQAA reported there is a low turn over of staff. When new staff are appointed they are asked to complete a job application form with previous employment details. Evidence was seen of this and also two written references and a Protection of Vulnerable Adult (POVA) first check and a Criminal Record Bureau (CRB) enhanced disclosure. These checks were received prior to appointment to help protect the residents. The AQAA provided details of National Vocational Qualifications (NVQ) for staff. Fifteen staff are employed and nine have an NVQ in Care, four are working towards it. NVQ certificates were available in staff files seen. New staff have an induction with a senior member of staff. A newly appointed staff member said they had been shown round the building when they started and had worked along side a supervisor (senior care role). Induction records were seen and the Skills for Care Induction Standards were available. The manager said that these are read by the staff however they should be incorporated in the induction as they contain good detail regarding care practices to enable staff to work safely. Staff receive training in safe working practices and dementia care. It was noted however that the moving and handling training for all staff is out of date. Their moving and handling certificates were due for renewal in January 2008. Two new staff also require this instruction. Residents and staff are therefore being placed at risk. A date for this training was arranged at the time of the site visit due to the urgency of the matter. An external training company is giving the training this month and following this a list of attendees should be forwarded to the CSCI. Staff interviews confirmed that residents do need help with their mobility and the practice of ‘lifting’ was referred to rather than use of hoist for a resident who is not able to stand unaided. The manager is also required to undertake this training as her qualification as a moving and handling trainer has expired. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 21 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 31,32,33,35,36,37 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 of the service must be improved to protect the health and well being of residents. EVIDENCE: The registered manager is Ms Paula Allen. Ms Allen was appointed last year. Ms Allen has completed NVQ Level 4 in Management and is waiting for her certificate for the Registered Manager’s Award, which she finished in February 2008. Residents, relatives and staff were complimentary regarding Ms Allen’s management style and her enthusiasm. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 22 To ensure good outcomes for residents, work is needed to improve the care plans and risk management. This is particularly important where an incident has occurred that affects a resident’s health. Care plans must be person centred and where possible agreed by the resident and/or a relative. Equality and diversity is looked at through the initial assessment by respecting a resident’s right to choice, privacy, dignity and promoting independence. At the time of the inspection there were no residents of any ethnic minority. There was nobody who needed any special diet due to his or her religious or cultural beliefs. With regards to monitoring the health and well being of residents the CSCI were not notified of two incidents where residents needed hospital treatment. This notification is required in the form of a Regulation 37 form. This is important, as there may be a need for the inspector’s input and follow up for the resident in terms of review. The manager must ensure senior staff in charge of the home are aware of the need to complete this form. Residents and relatives’ views are gained for the service. They completed satisfaction questionnaires last year asking what they think about the care and services provided. The manager said these would be given out again this year. Residents and relative meetings are not requested and in the past have not been attended. Residents said they could meet with the manager at any time to discuss anything they wanted. Good communication was evident between the staff and residents during the site visit. The systems for the safekeeping of residents’ money was looked at. This was found to be safe however it is recommended that two staff signatures or resident/relative signature be obtained for any monies received or given out. The care staff write up the daily care they give the residents. A daily evaluation of the care was not recorded in all the documents seen. The care staff should write up the care they give to provide a progress report for the residents. Staff receive supervision to help them with their care practices and development. Staff have access to a good number of polices and procedures to help protect the residents and to support staff in their work. Information from the AQAA demonstrated that safety checks of services and equipment are current. A spot check of the electric, fire prevention and moving and handling equipment evidenced this. The gas certificate could not be located however a phone call to the company responsible for the annual contract confirmed that it was in date. A copy of the certificate is to be forwarded to the CSCI. Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 23 The fire alarms were being tested each week and a fire risk assessment of the premises was on file. Fire training has been arranged for July 2008 as not all staff have received this Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 25 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 15 (1) (2) (b) Requirement The health and personal care of the resident must be recorded in a plan of care. This will ensure staff are aware of their current needs and will provide the necessary care and support. Risks to residents must be identified in their plan of care. This will promote their health and well being and minimise the risk of injury to them. Staff must receive moving and handling training to ensure they transfer residents in a safe manner to protect their health and well being. A Regulation 37 form must be submitted to the Commission for Social Care Inspection for any serious injury to a resident or an event which affects their well being or safety. This is a notification of death, illness any other events. Timescale for action 05/07/08 2. OP8 12 (1) (a) 13 (4) (c) 05/07/08 3. OP30 18(1) (c) (i) 05/07/08 4. OP38 37 (1) (a-g) 05/07/08 Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 26 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 OP1 OP7 Good Practice Recommendations The Service User Guide should reflect details of the service provision in relation to the manager Ms Paula Allen and her qualifications. Residents and relatives should be consulted regarding the plan of care and their agreement sought to any decisions made. Incident forms should be completed for all incidents that affect a resident’s welfare. Bed rails should have protective covers in place to minimise the risk of injury to the residents. A quality check of medicines administered should be carried out each month to ensure medicines are given in accordance with the medicine policy and procedure. A more formal record should be kept for any complaint received and their subsequent investigation. Contact details for ‘Careline’ should be advertised in the home to ensure all staff are aware of the details. Call bell extension leads should be placed in resident bedrooms for them to access in an emergency. Hand washing and drying facilities should be placed in the ground floor WC. 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. A list of attendees for moving and handling training should be forwarded to the CSCI. Two staff signatures or resident/relative signature should be obtained for any monies received or given out. The staff should complete a daily evaluation of care for the residents. Fire training should be given to all staff to ensure they are fully aware of fire procedures in the home. OP8 4. 5. 6. 7. 8. 9. OP9 OP16 OP18 OP22 OP26 OP30 10. 11. 12. OP35 OP37 OP38 Whitestone Lodge Residential Care Home DS0000021473.V363240.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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.V363240.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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