Inspection on 04/07/07 for Wilson Lodge

This inspection was carried out on 4th July 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wilson Lodge 11/06/09

Wilson Lodge 26/02/07

Wilson Lodge 26/09/05

Wilson Lodge 13/04/05

Wilson Lodge 24/08/04

Wilson Lodge 22/04/04

Wilson Lodge 17/12/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Wilson Lodge 16 Augusta Road East Moseley Birmingham West Midlands B13 8AJ Lead Inspector Sarah Bennett Key Unannounced Inspection 4th July 2007 09:30 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 Wilson Lodge DS0000024909.V339546.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 Adults 18-65. 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. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilson Lodge Address 16 Augusta Road East Moseley Birmingham West Midlands B13 8AJ 0121 449 1841 0121 449 2926 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) www.wilson-care.com Wilson Care Resources Ltd Mr Malcolm Wright Care Home 36 Category(ies) of Learning disability (36), Mental disorder, registration, with number excluding learning disability or dementia (36) of places Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th February 2007 Brief Description of the Service: Wilson Lodge was purpose built in the 1970’s and commenced operating as a residential home. The registration status changed at a later date to nursing care for up to 36 adults suffering from mental health problems. People living there may also have a learning disability but mental health illness is the primary reason for admission. As well as the registered manager the home employs a nurse manager. The ethos of the home is encouraging and supporting independence of the people living there. The home is situated within a residential area, close to the city centre and within walking distance of local shops and other amenities. The building is located at the end of a cul-de-sac and provides turning facilities at the front of the home but no off road parking for visitors. Car parking facilities for staff are situated at the rear of the property. The home has ramped access, which enables disabled people or visitors to easily access the premises and a passenger lift is available inside the home. Accommodation is spread over two floors offering a mixture of single and shared rooms. One bedroom has an en suite toilet. Communal areas include two lounges, a dining room, a smoking room and two small-secluded gardens. The home has two baths and three showers which meet the needs of the people living in the home. There are dedicated kitchen and laundry facilities on the premises. Corridors are wide and have handrails, which would enable the people living there to mobilise independently. A hoist and a stand aid are available and pressure-relieving equipment is available for people living there who may require this equipment to prevent skin sores. Copies of previous inspection reports are available from the office and a notice is displayed to inform the people living there and their representatives that the reports are available, so that they have information about the home if required. The current scale of charges for the home is £437 - £865 and this includes the nursing determination contribution. Additional charges include aromatherapy, massage, toiletries, chiropody, hairdressing and outings. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by one inspector over one day and was assisted throughout by the Registered Manager and the Deputy Manager. The people living in the home, two relatives and the staff on duty were spoken with. Care, staff and health and safety records were looked at. The management of the medication and a partial tour of the premises were undertaken. Information was gathered from talking to people and from observing staff interacting with the people who live there. What the service does well: Before people move into the home detailed assessments are completed to make sure that the needs of the person can be met there. Each person has a care plan and risk assessments so that staff know how to support them to meet their needs and achieve their goals. Other health professionals are involved in the care of the people living there to make sure that all individual’s health needs are met. Various activities are available inside and outside the home and staff support the people who live there to pursue their interests. One person said to the Manager, “ Thanks for giving me a chance and letting me come and live here.” One person said, “ The food is good and the cook is a good cook.” There is a relaxed and happy atmosphere in the home. Even though there are a lot of people living there people seem to get on well and the staff also get on well with the people living there and each other. Relatives said that the home is wonderful and their relative’s life had improved so much since living at the home. Bedrooms are individual and well decorated and where people have to share a room effort had been made to make sure that people’s privacy had been respected. The home was clean and there were no unpleasant smells making it a nice place to live. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to help them decide whether or not they want to live there. Before a person moves into the home their needs are assessed to ensure they can be met there. They have an opportunity to visit to help them decide if they want to live there or not. EVIDENCE: The statement of purpose of the home included all the relevant and required information so that people who may be looking to move there know what is provided and if the home can meet their needs. Since the last inspection there had been a notice put up to let people know that the inspection report is available for those who wish to read it. One person had lived in the home for a few weeks. Their records showed that before they moved there an assessment was completed to ensure that their needs could be met and staff would be able to support them to achieve their goals. A person who wants to live there visited for lunch and stayed for the afternoon so they could spend time meeting with the staff and the other people who live there before they move in. Staff said that the person had visited before and plans to visit again before they move in. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have the information about individuals so they know how to support them to meet their needs and achieve their goals. It is not evident that the people living there are always consulted on what goes on in the home. The people living there are supported to take risks within a risk assessment framework to ensure their safety and well being. EVIDENCE: Three records of the people living in the home were sampled. These included an individual care plan. These stated how staff are to support the individual to meet their health needs, take their medication, maintain their personal hygiene, keep in contact with their family and friends, manage their behaviour, meet their religious and cultural needs, their dietary needs and manage their finances. Care plans had been reviewed regularly and updated where there had been changes. One person’s records had been misfiled so it appeared that their care plan had not been reviewed recently. Since the inspection the Manager had Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 10 rectified this and introduced a monthly care plan audit to be completed by the Manager or Deputy Manager to ensure all care plans are regularly reviewed so staff know how to support people. The last record of a meeting with the people living in the home was dated September 2005. At this meeting people discussed activities, trips, smoking, day centre and meal times. The Deputy Manager said there was a meeting a few days before about smoking but this was not recorded. Often there are meetings held at coffee time when most people are in the dining room to talk about things but they are not recorded. The Deputy Manager recognised that a record of these should be kept so it is clear that the people living there are involved in the decisions made in the home and how they spend their time there. They said that there used to be a residents committee and one of the people living there chaired this but when they were ill they resigned and the committee folded but this is something they will look at again. Records included individual risk assessments so staff know what support to give individuals to minimise the risks to their health and well being as much as possible. These included the risks of self - harm, going out on their own, their behaviour, smoking, staying out all night and the risk of being exploited or abused due to their vulnerability. One person’s daily records showed that there had been some incidents where they had gone missing from the home. This had not been reported as required to the CSCI under Regulation 37. The Manager said that often people go missing and are found soon after. However, there had been occasions when people had been missing overnight and therefore had been very vulnerable and at risk of being harmed. It was agreed that if a person is missing overnight then the CSCI would be notified to ensure that all steps to minimise the risks to the person had been taken. When people go out staff make a note of the time they left, the time they are expected to return, where they plan to go and what clothes they are wearing. Staff give the person a slip of paper that stated the name, address and telephone number of the home, which if the person was at risk would help the public or police to identify them and seek help from the staff at the home. Throughout the day people were observed following this procedure and accepted that it was important to maintain their personal safety. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. The people living there are offered a healthy and varied diet and enjoy their meals. EVIDENCE: Staff said and records showed that some people go to local day centres during the week. Throughout the day people were observed going out when they wanted to and to the places they wanted to go. Some people went for walks locally or to local shops, some people went shopping in the city centre and two people went out for a curry. People said that staff arrange day trips and last year they went to Walsall Illuminations. Records sampled showed that people go out when they want to and for some people this is most days. Staff said that the Activity Co-ordinator is on maternity leave. However, arranged activities that they had previously set up had continued. The Deputy Manager said that the role of an Activity Co-ordinator is important and if they Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 12 do not return from maternity leave they will look to recruit another one. Activities include bingo, board games, art and painting. Staff said that some people do not like joining in with group activities. The Deputy Manager does 1:1 anger management sessions with people and runs an anxiety management group for four people who live there. There is also a yoga group who meet weekly and a women’s group led by one of the nurses. They said that recently the women’s group organised a sponsored walk and raised money for a cancer charity. A massage therapist comes in regularly for those people who want this. A hairdresser also visits regularly and there is a hairdressing and beauty room. One person said they had been to Lourdes and to Knock on holiday with the Deputy Manager and had enjoyed these holidays that were important to them because of their religious and cultural background. Records sampled showed that people have visits from friends and relatives and may go out with them or they may visit their friends and relatives. A payphone is available so that people can keep in contact with their friends and family. One person’s relatives visited and they went out shopping with them to the city centre. Staff said that one person was away on holiday with their relative. Records showed and people were observed to be supported to be as independent as possible. People living there were not restricted but could come and go, as they wanted to. Measures were in place to ensure people’s safety but this was not restrictive to their independence. People living in the home said the food is good and one person was observed telling the cook he is a good cook and he had enjoyed his meal. There are two sittings for lunch, the first sitting is for people who need more support and the second for people who are more independent with eating and drinking although if they want to they are not stopped from going to the first sitting. The first sitting was about 12.50pm and the second about 1.30pm so people were not rushed. There were two choices of lunch- chicken with rice or potatoes and vegetables or sausage rolls, mash potatoes and vegetables. One person had an egg salad. During the meal staff interacted well with the people living there, there was lots of laughter in the dining room and the atmosphere was relaxed. Staff said there is a cooked breakfast three days a week and a choice of two main meals and desserts. Staff said that some people are vegetarian, one person has West Indian food when they want it and some people are on a diet because of their diabetes. Fresh fruit and vegetables were available. Staff supported the people who needed it appropriately. There was a choice of cold drinks on the table and a choice of hot drinks after the meal. There are eight small tables with a maximum of four chairs around each in the dining room so that people do not all have to sit together but they can sit in small groups. It was observed that this aided the relaxed atmosphere and people interacted well with the other people on their table so making it a social occasion. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the personal care and health needs of individuals are met so ensuring their well being. The management of the medication systems had improved to ensure people receive the medication they are prescribed. EVIDENCE: All the people living there were well dressed and dressed appropriately to their age, gender, the weather and the activities they were doing. In the laundry each person’s clothes were separated and all had been ironed. Attention had been given to individual’s personal care, which helped to raise their selfesteem. The Deputy Manager said that toiletries are bought out of the home’s budget but people can also buy extra toiletries for themselves if they want to. If a person does not have the money to pay for hairdressing or the chiropodist this is also paid for as it is important to the individual’s well being. People who lived there said that staff go out with them to buy their clothes if they want support. Records sampled included individual moving and handling assessments so that if people need support with moving around this is given with the risks to them Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 14 and staff supporting them minimised. These had been regularly reviewed and updated where there had been any changes in the individual’s need. Records sampled showed that staff monitor the weight of individual’s to ensure they are not gaining or losing a significant amount that could be an indicator of an underlying health need. An assessment of each person’s pressure areas and nutritional needs is completed. These are reviewed regularly depending on the individual’s need e.g. one person was not at risk so they were reviewed every six months but another person was reviewed monthly as they could potentially be at risk. Each person is registered with a local GP. Records and observations showed that staff at the home liaise with the GP and follow up any results of tests or investigations undertaken to ensure that the individuals’ health needs are met. Other health professionals are involved in the care of individuals and records showed that staff follow the advice given to ensure the well being of individuals. The person is involved in all their appointments and their agreement is sought before treatment is given. At the last inspection the management of the medication was judged to be poor and did not ensure that medication was safely administered. Following that inspection the Manager and Deputy Manager completed a comprehensive audit of the systems for managing medication. From this they made changes to ensure that medication could be safely administered. The week before this inspection a pharmacist from the Primary Care Trust (PCT) completed an audit of the medication. They did not make any recommendations and stated, “the new system was working well including carried forward which would make any errors easier to spot.” The qualified nurses give the medication to the people living there. Medication that people are prescribed to take regularly is kept in individual boxes in a locked trolley. This helps staff to identify which medication belongs to which person. Some people are prescribed as required (PRN) medication and this is kept in a separate medication cabinet. Separate records are kept for PRN medication and individual protocols are in place that state when, why and what dosage of the medication should be given to the person. When a person has been given PRN medication staff calculate the amount of medication left so it is clear how much is given to the person. Daily records sampled recorded the mood of the person, when PRN medication had been given and why it was given. Some people who have asthma or breathing conditions self-administer their inhalers. Since the last inspection this had been recorded on the Medication Administration Records (MARS) so it is clear that the person is able to do this and are taking their medication as prescribed. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 15 Some people are prescribed injections that are for their mental illness and the qualified nurses administer these. These are recorded on the MARS but there is also a separate record that included what side the injection was given on so this can be alternated and a record of what is left in the stock to make sure the right amount is given. All but one of the numbers of medication in boxes or bottles sampled crossreferenced with the stock total on the MARS indicating that medication had been given as prescribed. One sampled had less tablets in the bottle than was stated on the total on the MARS. It was not clear how this had happened and the Manager said they would investigate it. Following the inspection the Manager informed the inspector of their findings. The person had been admitted recently from another home and another pharmacy had provided the medication. Staff had failed to count the actual stock in the bottle but merely took the quantity from the label. The Manager has reminded all nursing staff to physically count all stock received and check against the stated quantity on the label. The Manager said that he had previously discussed with the CSCI Pharmacy Inspector if it would be possible to devise their own MARS so medication that is not received by the pharmacy but by the Community Psychiatric Nurse (CPN) could also be included on the MARS. This is currently handwritten on the MARS, which could increase the risk of errors. It would link in with a database of each person’s medication and include a running total of each medication. There is not enough room to record this on the pharmacy generated MARS. The MARS proposed by the Manager also provided space for PRN medications so these do not have to be recorded on a separate sheet. Injections included the date when the next one is due and a reminder to staff to put the date due in the diary. This MARS had addressed all the necessary areas to ensure that medication is managed safely and showed that the Manager is committed to ensuring that medication is given to individuals as prescribed. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the views of the people living there and their representatives are listened to and acted on. The people living there are protected from abuse, neglect and self-harm so ensuring their well being. EVIDENCE: There had been no complaints made to the home or the CSCI in the last 12 months. The complaints procedure was displayed on the notice board so that the people living there had the information they needed to make a complaint if they were unhappy. It included details of how to contact the CSCI. The Deputy Manager said that there had not been any compliments but thank you cards had been received from student nurses that had been on placement there and a letter of thanks had been received from a relative. It is recommended that these be recorded as compliments and included as part of the home’s quality assurance process to evidence that the views of representatives of the people living there are sought. Staff records sampled showed that staff had received training in adult protection and the prevention of abuse. The Deputy Manager said that most of the nursing staff had received training in a recognised form of physical intervention. This is to ensure that if a person who is displaying behaviour that is putting them and others at risk of harm can be restrained safely. Records sampled did not show that the use of restraint was necessary. The Manager said that the amount of money that people get is different for each person depending on their individual needs. The Manager is the appointee for some people who live there. Each person has a bank account that their Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 17 benefits are paid into and is given an amount of personal allowance each day to help them to budget their money and not spend it all when they receive their benefits. Some people manage their own money but it is kept safe for them if they want this. The Manager said that they buy cigarettes from the wholesalers for the people who smoke, as this is cheaper but they each have the ones they prefer. One person who had been recently admitted is not yet in receipt of their benefits and had few personal possessions. The Manager had ensured that they had clothes to wear and they are given money from the home budget to buy cigarettes. In the past they had been involved in criminal behaviour as a result of not having money for cigarettes so the Manager is ensuring that the risks of this happening are reduced as much as possible. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements generally ensure that the home is homely, comfortable and safe for the people who live there. EVIDENCE: The home is on two floors and there is a lift provided. On the ground floor there are two lounges, one of which is used as a quiet lounge and staff said that at times there are religious services held which people can go to if they want to. In the both of the lounges the carpet was uneven in the middle of the rooms, which could be a trip hazard. In the lounge where there was a TV some of the paintwork on the walls was worn and needed redecorating to make it more homely and comfortable. There is access from this lounge to an enclosed garden where there were pleasant seating areas, a gazebo, plants and shrubs. Some people have their own bedrooms and some people have to share a bedroom. The Deputy Manager said that they try to match people who share bedrooms as sensitively as they can. For example in one shared room one person spends a lot of their time in the room but the other person only uses it to sleep in and spends their time in the communal areas of the home. One Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 19 person has an en suite toilet. Each person has a key to their bedroom door and a locked area in their bedroom. All bedrooms had a front door with the number on so they looked like individual flats with their own entrance. Bedrooms were personalised and had been decorated to individual tastes. In one bedroom there was a fan on and this was very dusty. The Manager said these needed to be replaced with a tower fan so that the room could be ventilated without putting the health of the person at risk from the dust. Some people who are able to have their own fridges and kettles in their bedrooms so they can make their own drinks when they want to. There was a bathroom on the ground floor with an adapted bathing facility that could be accessed by a person who has mobility difficulties. It had recently been redecorated making it homely and comfortable. On the first floor there was a bathroom that was not adapted so would not be suitable for a person who had mobility difficulties. A smoke room is provided for the people who live there to smoke in. This had a TV and had metal garden furniture and flooring not carpet so as to reduce the risks of there being a fire. It was a room that the people living there seemed to enjoy spending time in and the atmosphere was relaxed. A maintenance person is employed part-time. There is a maintenance book which records when anything in the home needs attention or repair and a weekly maintenance checklist is completed. This helps to ensure that the home is well maintained and kept safe for the people living there. The home was very clean throughout and there were no offensive odours making it a pleasant place for people to live in. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing, their support and development are variable, which could impact on their ability to meet the needs of the people living there. Generally the homes recruitment practices protect the people who live there. EVIDENCE: The Manager said that more than a third of staff have NVQ level 2 or above in Care and that some staff had just started this training. The Manager also said that some people have a City & Guilds certificate in Mental Health. This is relevant to the needs of the people living there. The Manager should ensure that this qualification ensures that staff have the necessary skills and knowledge to meet the needs of the people living there. The Manager said that they are currently recruiting for staff. Staff said that they enjoyed working at the home and many staff had worked there for several years. On each shift there are two qualified nurses working and this sometimes includes the Deputy Manager. The Manager does not work as part of the rota so they can spend time on management tasks. There are four to five care assistants on each shift as well as laundry, domestic and catering Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 21 staff. At night there is one qualified nurse and three care assistants. The Manager and Deputy are also on-call at night so can be contacted in an emergency. The Manager said there are a number of bank staff that work there regularly so that they know the people who live there well. They do not use agency staff but use bank staff or regular staff work overtime to cover any vacancies and absences. There are often student nurses on placement at the home, which helps to ensure that staff are kept updated with current good practice. The Deputy Manager said that there had not been formal staff meetings for a while although informal meetings are held each day at the handover of each shift. Where staff had been informed of a change in practice, changes in needs of the people living there or an organisational change this should be recorded so that it is clear that staff have been notified of these. Staff records included the required recruitment records. These included evidence that a Criminal Records Bureau (CRB) check had been undertaken to ensure that suitable people are employed to work with the people living there. The Personal Identification Number (PIN) of one of the qualified nurses had expired. The Manager said that they have got a copy of the nurses’ latest PIN and they need to put this in their records. Staff training records sampled did not show that staff had received the required training so that they have the skills and knowledge to meet the needs of the people living there. The Manager said that these are mixed up and needed organising. They said that they had just started a new training programme and at the moment they are concentrating on all staff completing moving and handling training. Some staff said they had completed this recently. All staff had received regular training in fire safety. Staff had completed Health and Safety and Infection Control courses. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living there benefit from a well run home. Arrangements are improving to ensure that the views of the people living there underpin all self-monitoring, review and development by the home. Arrangements ensure that the health, safety and welfare of the people living there is promoted and protected so ensuring their safety and well being. EVIDENCE: The Registered Manager is a Registered General Nurse and a Registered Mental Nurse who has a number of years of experience at management level. He has also completed the Registered Managers Award. The people living there said that the Manager is good and if they have a problem he gets it solved. The owner had visited regularly as required under Regulation 26 and had made a report of their visit. Their visits included speaking to the people who live Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 23 there and staff and seeking their views. The Manager said that the owner had visited the day before. One person living at the home said, “The owner is a lovely man and makes sure it is a nice place to live in.” Regulation 26 visits included the required areas to look at to ensure that the quality of the service is being monitored. The Manager said these would link in with the homes quality assurance system. Separate audits are completed regularly to monitor infection control and fire safety. There were questionnaires available to seek the views of the people living there. The Manager said that people had not been asked to complete these for a while but they would ensure these were done in the future. One person living there is going to be involved in interviewing for new staff so their views are represented. Fire records showed that staff tested the fire equipment regularly to make sure it was working. Staff had regular training in fire safety. The last record of a fire drill was in November 2005. The Manager thought there was a fire drill just before the last inspection. The diary stated that there was a fire drill on February 14th this year. These should be recorded in the fire records and should take place every six months to ensure that staff and the people living there know what to do if there is a fire. An engineer regularly services the fire equipment so that it is well maintained and working properly. The Manager said that staff were testing the water temperatures every three months. They then found out that guidance from the Health and Safety Executive said they should be tested weekly. Due to the size of the home this would take a long time. Thermostatic valves are fitted to each tap so that the temperature of the water is regulated. The last test showed that all the temperatures were within the safe range so that people were not at risk of being scalded. Therefore, the risk of people being scalded had been minimised so it was agreed that so many water temperatures are tested each week so that in the period of a month all temperatures are tested. A Corgi registered engineer completed the annual test of the gas equipment in October 2006 and stated that it was in a satisfactory condition. An electrician completed the five yearly test of the electrical wiring in July 2006 and stated that it was in an unsatisfactory condition. The manager said the remedial work had just been completed to ensure that the wiring was satisfactory. The Manager agreed to send a copy of the electricians report to the CSCI once it is received. An engineer services the passenger lift regularly to make sure it is working properly. At the last inspection a requirement was made for the report of the visit of the Environmental Health Officer to be available. This was seen and stated that all systems and procedures for food hygiene and infection control were satisfactory at the time of their inspection. Wilson Lodge DS0000024909.V339546.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 Adults 18-65 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Wilson Lodge DS0000024909.V339546.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 YA24 Regulation 13(4), 23 (2) (b, d) Requirement The flooring in the lounge must be free from hazards to ensure the people living there are safe. Timescale for action 02/08/07 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. 4. 5. 6. Refer to Standard YA8 YA20 YA22 YA24 YA30 YA32 Good Practice Recommendations Evidence of meetings and consultations with the people who live there should be available to ensure that they are consulted on their life in the home. Nursing staff should count all medication received and check this against the stated quantity on the label to ensure that medication is managed safely and given as prescribed. Compliments should be recorded and included as part of the home’s quality assurance process to evidence that the views of representatives of the people living there are sought. Some areas of the lounge should be redecorated to ensure it is a homely and comfortable place for people to spend time in. An audit should be completed of the fans and where these are dusty they should be cleaned or replaced to ensure they do not affect the health of the people living there. The Manager should ensure that the City and Guilds in DS0000024909.V339546.R01.S.doc Version 5.2 Page 26 Wilson Lodge 7. YA33 8. YA34 9. YA35 10. YA42 Mental Health ensures that staff have the necessary skills and knowledge to meet the needs of the people living there. Where staff had been informed of a change in practice, changes in needs of the people living there or an organisational change this should be recorded so that it is clear that staff have been notified of these. The Manager should ensure that the current PIN of all the qualified staff are kept in their records to evidence that the nurse has maintained their registration to protect the people living there. The training records should be organised to evidence that staff have received the necessary training so they have the skills and knowledge to meet the needs of the people living there. All fire drills should be recorded in the fire records to ensure that people know what to do if there is a fire. Wilson Lodge DS0000024909.V339546.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Birmingham Office First Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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