Inspection on 11/05/06 for Wilton Lodge

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

Other inspections for this house

Wilton Lodge 19/10/07

Wilton Lodge 27/11/06

Wilton Lodge 24/04/06

Wilton Lodge 17/01/06

Wilton Lodge 31/08/05

Wilton Lodge 11/12/04

Wilton Lodge 30/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 77-79 London Road Shenley Hertfordshire WD7 9BW Lead Inspector Marian Byrne Key Unannounced Inspection 11th May 2006 10:00 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 Wilton Lodge DS0000019621.V295148.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. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton Lodge Address 77-79 London Road Shenley Hertfordshire WD7 9BW 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) 01923 854623 01923 850019 Wilton House Limited Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Wilton Lodge is a care home providing personal care and accommodation for 36 older people who may also have dementia. It is owned by Wilton House Limited, which is a private company. The home was opened in 1990 and consists of a purpose built two-storey building. It is adjacent to Wilton House Nursing Home, but the two homes operate independently. The home is located in the village of Shenley, approximately 1½ miles from Radlett. It is within walking distance of local shops, and several pubs and churches are close by. All the homes bedrooms are single and all have en-suite facilities. The first floor is accessed by a passenger lift. A sun lounge forms part of the homes entrance. There is an enclosed front garden with a lawn and seats that is well maintained and easily accessible. A car park is available at the back of the building. Information about the current range of fees was not available. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a random inspection carried out by two inspectors over five and a half hours on the 11th May 2006. It was a follow up inspection to concerns this Commission had been alerted to. In April 2006 this Commission received information indicating that three named service users were being locked in their rooms. An unannounced inspection by three inspectors at 20.00 hours on the 11th April 2006 did not find any evidence of this. This inspection was to further ensure that the health and safety of all service users was protected. The inspectors had concerns regarding the staffing levels and the long hours worked by care staff in the home. The acting manager was unable to assure the inspectors that there were indicators in place to protect the health and safety of very vulnerable service users and to ensure their quality of life is maintained and enhanced . The ratio of staff on the unit where service users with dementia are cared for, is the same staffing levels as the downstairs unit where there are more able service users. This must be reviewed. What the service does well: What has improved since the last inspection? What they could do better: The home has very low staffing group who work very long hours. In the main staff work 12 ½ hours per shift some working six days a week. Seven staff are on duty from 07.30 until 13.45 where it drops to five staff as indicated by rotas the inspector took away from the inspection. The number of staff available for work is very limited. There were no risk assessment or guidelines in place to ensure the safety of service users who are being cared for by this staffing group, other areas of concern relating to staffing was the high turnover of staff. Of the current day staffing group one member of staff had been in post over one year, seven having been employed in the last six months. The home was unable to demonstrate how staff can be released for training or holidays giving the current staffing levels. Two members of staff were working despite not having had a POVA first check. An immediate requirement was left Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 6 to ensure they did not work again until the clearance has been received depleting staffing levels still further. During lunch the chef appeared in the dining room to demand why they needed another pizza as he had sent through the correct number. This was done in - what was considered by the inspector – an aggressive manner, leaving the service users who had wanted the pizza confused and the service users in the dining room generally upset. No additional pizzas were available she had to settle for a fried egg. Lunch was beef stew even though the day was very hot. Most of the residents did not eat much, staff were not observed to make notes on who did not eat lunch. Some of the food served at lunch was not kept on the hot plate resulting in it being served cold. The inspector was unable to identify one vegetable being served even after tasting it. The management of the home was found to be poor, the acting manager was unable to offer answers to issues put to her by the inspectors. In many cases no answer whatsoever was forthcoming for some of the questions. Some staff’s command of English was so poor that the inspector could not make herself understood. Care staff were overheard speaking in their own language. One service user whose care plan identified that he needed the assistance of two staff members to mobilise had fallen and received facial injuries when walking alone. 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. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 7 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 Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10. Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. Care plans contained some detail but were not always followed. Service users were not always treated with respect and dignity. EVIDENCE: Care plans where inspected contained good detail, however there were instances where needs identified in care plans or daily records were not carried out. For instance on male service user who had been having falls was identified as needing the assistance of two care assistants for mobilising. On the day of the inspection he had bruises on his face obtained form a fall where he was walking unassisted. Another service users care plan had the aim of ‘to prevent GS from dinking lots of alcohol’ also to keep him safe, calm and not to harm other residents’ action included ‘talking slowly, calmly, politely to him, do not shout back at him’. One member of staff was heard to call a service user ‘darling’ rather than that person’s name. Staff were also heard to speak in their own language in the dining room where service users were having lunch. While observing lunch it was noted that one member of staff who was assisting a service user with lunch did not converse or communicate with the service users in any way. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. Service users were not served a wholesome, appealing balanced diet in a convivial setting. EVIDENCE: The day of the inspection was hot and sunny. Beef stew was served and while this was tasty and served at an appropriate temperature there was little appetite for it from the service users and plate upon plate was returned uneaten. The inspector did not see any evidence that this was being noted on nutrition charts. One service user wanted pizza for lunch – there had been some mix up on numbers - and the chef a very large man in comparison to the service users stormed into the dining room to demand to know who wanted the pizza that hadn’t been ordered the previous day. This was done in a very aggressive manner and was very off putting for those vulnerable service users and staff who were trying to assist them to eat. Not all the food was kept on the heated trolley and was cold and unpleasant when tasted by the inspector. Staff who assisted service users to eat did so without involving the service user in any kind of conversation, encouragement or communication of any kind. On the day of the inspection this member of staff was being assessed for her NVQ 2 qualification. Staff were heard to communicate in their own language. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. EVIDENCE: Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The environment was clean, fresh and odour free. EVIDENCE: On the day of the inspection the home was clean fresh and odour free. Rooms were nicely decorated and personalised. Service users were sitting in the garden at the front of the home. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 13 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. Staffing needs in the home were not met. Two staff were working unsupervised despite not having a POVA first check. Staff turnover is very high. EVIDENCE: Staff turnover is very high. In the afternoon the staffing ratio on the unit where service users with dementia are cared for is the same as the unit with service users with lesser needs. The acting manager was unable to tell the inspector why. In fact there is one less service user on the lesser need unit. The acting manager was unable to explain why this was and how she ensured that service users needs were being met. Some staff work very long hours, starting at 07.30 and finishing at 20.00, and starting again at 07.30 for as many as six days without a break. The acting manager was unable to inform the inspector how she insured service users needs were being met by staff who worked such long hours. When asked why she had such a rota she informed the inspector that the staff wanted to do the overtime. Staff were observed to assist service users mobility in a manner that could cause them an injury. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 14 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36. Quality in this outcome is poor; this judgement has been made using available evidence including a visit to this service. The home is not managed in a manner that is in the best interests of the service users. EVIDENCE: The acting manager while friendly and welcoming to the inspectors, displayed little knowledge of how the needs of very vulnerable service users are met and managed. The Deputy Manager is on maternity leave and has not been replaced, she left in March 2006 and the acting manager informed the inspector that the post was advertised prior to her going, no appointment has been made and the post had yet to be re-advertised. The low staffing levels and long hours worked by staff leave the service users very vulnerable. The acting manager did not convince the inspectors that she was aware of the implications of this. She also seemed to be unaware of the responsibilities of a registered manager and on several occasions when asked why she did something she said that it was like that when she joined the home. The acting Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 15 manager made no attempt to answer some of the questions asked by the inspector, for example what was the impact of the high turnover of staff on the home and the service users, again when asked how she ascertained if the staff were delivering good care to service users while working such long hours she didn’t answer the question but stated that the staff asked for the overtime. There were supervision notes to indicate that formal supervision takes place regularly. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 2 X x Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 17 Are there any outstanding requirements from the last inspection? 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 OP28 Regulation 18(1)(a) Requirement Only two members of staff have NVQ qualifications. The registered person must provide a schedule for ensuring that the numbers of qualified staff are increased to the recommended level of 50 . The high turnover of staff prohibits achieving this standard. Previous timescale of 31/03/06 was not met. 2 OP10 OP15 12, 16(2)(i) The registered person must ensure that the dignity of service users is maintained through the choice of food, and that food is taken in a congenial setting and assistance is provided with feeding in an appropriate manner. The registered person must be able to demonstrate that staff who work long hours are fit to carry out their duties to service users safely. Communication between staff and service users must be clear and in the service users language. DS0000019621.V295148.R01.S.doc Timescale for action 11/05/06 11/05/06 3 OP27 18 11/05/06 Wilton Lodge Version 5.2 Page 18 4 OP29 19 The registered person must ensure that all staff have a POVA first check prior to starting work at the home. An immediate requirement was left on this. The registered person must ensure that there is a sufficient number of trained and experienced staff on duty at all times. The staffing levels in the unit where people who have dementia are cared for are reviewed. The registered person must ensure, that the home is managed by an experienced and competent manager. The registered person that details set out in care plans for the welfare of service users are followed by staff. 11/05/06 5 OP30 18 11/05/06 6 OP31 OP32 OP33 OP7 8 30/06/06 15 11/05/06 7 Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 19 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. Refer to Standard OP8 Good Practice Recommendations The staff were observed to carry out good practice in wound care which follows the guidance given by the district nurse, but the procedures are not written in the care plan. The actions taken following weight loss were not recorded It is recommended that care plans should include the guidance of the district nurse on procedures for wound care, and any actions taken in relation to weight loss. 2. OP10 Staff entered one resident’s bedroom without knocking, and the call bell for another resident was placed out of her reach. Action should be taken to ensure that the home’s procedures for respecting the privacy and dignity of the residents are followed at all times. Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wilton Lodge DS0000019621.V295148.R01.S.doc Version 5.2 Page 21 - 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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