Inspection on 13/06/08 for Wilton Lodge

This inspection was carried out on 13th 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.

Other inspections for this house

Wilton Lodge 21/06/07

Wilton Lodge 14/02/06

Wilton Lodge 08/09/05

Wilton Lodge 03/02/05

Wilton Lodge 07/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 402 Holderness Road Hull East Yorkshire HU9 3DW Lead Inspector Beverly Hill Key Unannounced Inspection 13th June 2008 09:15 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 DS0000000876.V365682.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 DS0000000876.V365682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton Lodge Address 402 Holderness Road Hull East Yorkshire HU9 3DW 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) 01482 788033 01482 788120 Humberside Independent Care Association Limited Manager post vacant Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2007 Brief Description of the Service: Wilton Lodge provides personal care and accommodation for a maximum of 48 older people some of who may have memory impairment. It is owned by Humberside Independent Care Association Ltd (HICA) which is a not for profit organisation. The home is located on Holderness Road, which is to the eastern side of the city of Hull. The homes location provides people with easy access to a variety of shops, pubs, public transport etc. The home was rebuilt in 1999 and is a two-storey building with access to the upper floor via a passenger lift or stairs. All of the homes bedrooms are single with forty-two having en-suite facilities. A number of these single rooms do have a lockable interconnecting door which means couples are able to share a bedroom whilst using the other as a lounge area. The home has various well equipped communal areas on both floors that include, lounges, dining rooms, a sitting room for people that smoke and smaller quieter areas to sit with visitors. The home has two bathrooms downstairs and three upstairs. In addition there is a shower room on each floor. The homes theme of decoration reflects its location with old photographs of East Hull and memorabilia from Hull Kingston Rovers. Central to the home is a garden and courtyard area with patio tables and chairs, which people are able to access safely. According to information received from the home the weekly fees are between £375 and £480. This includes a top up fee of £15 for a basic room and £20 for an en-suite room. Additional charges are made for hairdressing, chiropody, clothing, toiletries, transport, newspapers, personal television licence, nametapes, holidays, outings, alcohol and cigarettes. Information about the home and services can be located in the statement of purpose and service user guide available in the reception. Copies of the most recent inspection reports are also on display. Wilton Lodge DS0000000876.V365682.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 that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 21st June 2007, including information gathered during a site visit to the home, which took approximately nine hours. Throughout the day we spoke to people that lived in the home and two relatives to gain a picture of what life was like at Wilton Lodge. We also had discussions with the deputy manager and four care staff members. Information was also obtained from surveys received from seven people that live at the home, six relatives and seven staff members. Comments from the surveys have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We checked how staff monitored the food and fluid intake of those with nutritional risks. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. The providers had returned their annual quality assurance assessment, (AQAA) within the agreed timescale. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We would like to thank the people that live in Wilton Lodge, the staff team and management for their hospitality during the visit and also thank the people who completed surveys. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A manager has been appointed will which provide support and consistency to the staff team. There has been an improvement in the care support plans and it was clear that staff had worked hard to improve them. There was still some work to be done ensuring they contained all the needs identified in assessments. See below. The home had employed an activity coordinator, which may help to resolve shortfalls in this area. The home reported to the Commission and the local authority, incidents between people that lived at the home. This enabled the home to recognise Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 7 more quickly when they were unable to meet their needs and provided the local authority with information about the people they funded in the home. There had been a recruitment drive and most vacancies had been filled. When this is completed and the new staff members are established it should address perceived shortfalls in this area. Staff retention appears to have settled, which helps in the consistency of care and less agency staff have been used. Training needs of the staff team are in the process of being identified and steps will be taken to meet them. The deputy manager has produced a new staff supervision structure so staff know who will be supervising them. This now needs to be implemented. The home has made sure that bedrails comply with manufacturers instructions and risk assessments take into consideration health and safety guidance. There is now a system to monitors the safety of the bedrails. What they could do better: The assessments completed by the home prior to peoples’ admission should be comprehensive enough to give staff a picture of the persons needs so they can decide if they can meet them. Care plans must really include all assessed needs or care could be missed. When managers feel that monitoring charts for food and fluid intake or pressure relief are required, or health professionals request them, they must be filled in accurately and consistently. They can give an accurate picture of the care provided when completed fully and can help to plan treatment. The way medication is managed must be improved to ensure people receive the medication as prescribed for them by their GP’s. The bedrooms of some people with dementia were quite sparse with very few pictures and ornaments. The manager and staff could rectify this by talking to the persons’ family if possible and helping to decorate their bedroom in a way that remains safe for them but offers some stimulation. Staff members have told us they are short staffed at times, although rotas suggest there is sufficient staff. The manager should check out with staff why there is a perception of being short staffed. Now that refresher training for staff has been identified the home should make sure that it is completed. The new manager should apply to be registered with the Commission. This will help the home to have some stability with regards to management. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 8 Now that staff supervision structure has been formulated the home must make sure that it is carried out. Staff also told us that communication and the way information is passed on to the different levels of staff could be improved. 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. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home ensures that peoples’ needs are assessed prior to admission. The home could make sure in-house assessments contain more comprehensive information about peoples’ needs and how they affect them. EVIDENCE: We examined six care files during the visit: two recent ones in relation to the assessment process. Most contained assessments of need and care plans produced by the local authority for people funded by them. Of the two people recently admitted both had a local authority care plan and one had a full community care assessment. The second had some assessment information, for example a previous physiotherapy and occupational therapy assessment from the previous year and a brief care management contact assessment. The management team had also completed the homes own assessment to check there had been no change in need and to assess whether Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 11 they were able to meet the persons needs. Neither of the homes own assessments were dated or signed by the person completing them so it was difficult to audit when they had been completed. Both had very basic information that didn’t give a full picture of the persons needs. The deputy manager explained that both people had been admitted as an emergency and the information they had was all that was available at the time. As the home had not received the community care assessment for one person until the day after the admission and the other person not at all to date, it was important that the homes assessments gave them sufficient information to enable them to make a decision about whether they can meet presenting needs prior to admission. The homes assessment had scope to cover all areas of physical, social and psychological needs. The company had routine documentation used throughout all the homes. After admission the staff completed strengths and needs assessments, which related to people’s activities of daily living and these informed care plans. They also completed personal profiles and fact files which identified diverse needs, routines and preferences. Surveys indicated that people had sufficient information about the home prior to admission to help them decide but generally families were instrumental in choosing the residential home for their relative. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were provided with support in ways that promoted their privacy, dignity and independence. However some gaps in care planning and recording means that staff may not have full information about specific tasks and care could be missed. The management of medication was not sufficiently robust to ensure all people received the medication as prescribed for them by their physician. EVIDENCE: We examined six care files during the visit. The care files were well organised into sections and easy to read. They had usually good personal profiles and fact files detailing preferences and likes and dislikes. Care support plans had been formulated for each person but they varied in whether important information from the assessment stage was included in them. For example one care support plan was comprehensive and had all needs planned for. To improve these further staff could make better reference to district nurse Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 13 support and the potential for soreness that required monitoring. Two care support plans did not reflect continence and pressure area care needs and another had no reference to monitoring epilepsy. Some of the issues may be to do with the risk assessment documentation. These were completed for a range of situations such as moving and handling, nutrition, tissue viability and specific safety issues. The outcome score on some guided staff to complete certain actions. For example the risk assessment for pressure areas was the waterlow scoring system and a score of 14 was described as, ‘at risk’ of developing pressure sores and therefore there would be a need to plan for this or staff should record why the plan wasn’t required. In two files seen this had not occurred. Similarly the nutritional risk assessment score of 15 indicates staff members need to assess whether to, ‘monitor food intake and weigh at least monthly’. In one of the files examined for a person with very poor short-term memory loss, this was not happening. Some of the weight records did not give an accurate reflection of whether the person had gained or lost weight. Some care support plans had been completed well in regards to recognising the persons’ strengths and what they were able to do for themselves to aid the promotion of independence. We checked one care support plan to ensure that a specific behavioural issue had been addressed and it had been completed appropriately with clear tasks for staff. There was no evidence of care support plan evaluation in one file and another had not been evaluated for the last two months. Care support plans had been audited once by seniors and actions highlighted for staff. However in one examined the audit took place in March 2007 and stated that the person was to be weighed monthly. When checked weight had not been recorded for eight months between August 2007 and May 2008. There had been a substantial weight gain during this time and the person had diabetes, which requires close monitoring in this area. There did not appear to be a system of checking that audit actions had been followed up. A later discussion with the area manager and acting manager indicated that the weight gain had not been substantial but the recording had been inconsistent. Some entries were recorded with the person sitting in a wheel chair. Some aspects of daily recording were good, for example in most individual daily shift records, but other areas required attention. For example specific monitoring charts, such as food and fluid intake, pressure relief and bathing, as they were not recorded consistently. Because of this we were unsure whether people had received the appropriate amount of personal care, pressure relief and food and fluid intake. This area must be improved and management must be proactive in ensuring monitoring charts, obviously put in place for a reason, are completed fully with accurate information to ensure peoples needs are met. One relative spoken with did express concerns about this and the home is currently investigating them as a complaint. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 14 Family members generally signed agreement to their relatives plan if the person was unable to. The home ensured that people had access to a range of professionals for advice and treatment such as GP’s, district nurses, dentists, chiropodists and opticians. The deputy manager confirmed they had obtained food supplements for one newly admitted person and also made a referral for them to the falls coordinator. People spoken with described care provided to them that respected their privacy and dignity, ‘the attendants are very kind, they learnt me how to get in and out of bed’, ‘I’m doing more walking since I came here’, ‘its mainly women carers – they keep me covered up’ and ‘they always knock on the door and wait’. One person told us they, ‘loved’ the home and that he was well looked after. Six of the surveys received from people that lived in the home stated they received the care and support they needed either, ‘always or usually’, one person stated this was, ‘sometimes’. Staff had a good understanding of how to promote privacy and dignity and covered this in induction Comments from relatives were, ‘they have genuine care and compassion for the residents that they care for’, ‘they are patient, polite, welcoming and informative’, ‘overall I am happy with my mothers care’ and ‘he believes he is well looked after’. However other comments referred to a lack of continuity of care due to staff changes and one person expressed dissatisfaction with personal care tasks on occasions. There were some areas in the management of medication that required attention. • Medication was stock controlled and safely stored but the temperature of the medication room was often recorded between 26° and 28°C. Most medication must be stored below 25°C so as not to affect the efficacy of the medication. Medication requiring refrigeration was stored at the correct temperature. During the writing of the report the home fitted an air-conditioning unit to address the problem. • On checking controlled drugs it was noted that what was recorded in the controlled drugs book as the remaining stock for a Fentanyl patch for one person, did not match the actual stock. Staff could not locate the missing patch nor receipts to confirm it had been returned to the pharmacy. The pharmacy had no record of its return to them. • One persons medication for bowel care was required to be administered on a regular basis but from 19.5.08 to 13.6.08 staff had recorded twelve times when the medication was not given with codes of ‘NR’ or ‘R’ meaning not required or refused. Similarly one persons’ important nocturnal medication had Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 15 eleven recorded ‘R’s in a month. Staff had not consulted with the GP that prescribed the medications to inform them this was happening and to seek their advice. • When medication was prescribed, as 1-2 to be taken, staff did not always indicate how many had been given to the person. • Another person had three occasions of missed medication that was recorded ‘O’ but the code did not specify the reason. Staff confirmed the person often declined medication because of their memory impairment. The GP should be contacted so they can decide what action to take and whether an order of priority is required to be documented for staff guidance. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking. The home provided well-balanced meals, which met peoples’ nutritional needs. EVIDENCE: The home provided a range of in-house activities such as bingo, ball games, quizzes, reminiscence, hand and nail care, dominoes, karaoke sessions, birthday and other seasonal parties and visiting entertainers. Outings were organised to places of interest such as East Park and local shops. Clergy visit monthly for church services and the library exchanges books three monthly. One person receives talking books on a regular basis. The home had access to a minibus as often as they required. Fact files were produced about people’s preferences, interests and previous hobbies, although it was noted that two people had not had theirs fully completed yet. One person stated in a survey that their relative complained to them they were bored sometimes. One person stated in a survey they had Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 17 activities, ‘always’, five said this was ‘usually’ and one person said it was, ‘sometimes’. Activity records were maintained of who had participated and there appeared to be something each week for each person even if the activity was sitting down with people and chatting to them –very important for people. Some people joined in more than others and there was evidence that choice was respected. One person stated in a survey, ‘since coming here I have been very happy and made friends with all the staff’. Existing staff had, in recent months, tried to compensate for the lack of an activity coordinator but they found this difficult when completing their own daily tasks. A new activity coordinator has recently been employed which should address minor shortfalls in this area. People spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussions with staff and a relative, and surveys received from them. We observed visitors coming and going freely. Relatives commented in surveys that staff kept them informed, ‘ I’m always well informed with what goes on’ and ‘if there has been a problem the home always rings one of her sons’. People spoken with generally enjoyed the meals provided by the home. Out of seven surveys received six people stated they liked the meals, ‘always’ or ‘usually’, one person stated this was ‘sometimes’. Comments were, ‘they suit me; plain and wholesome’, ‘there’s plenty, you get extra when you want it’, ‘I like it’, ‘its alright, you get two choices at lunchtime’, ‘yes its good’ and ‘the food is good – the chef is leaving at the end of the month and we have a new one starting. They will have to be good to match up’. One person said they liked the food but stated, ‘it depends what’s on the menu’. Special diets were catered for and staff were observed checking with people if they had enjoyed their lunch or if they required any more. Three staff members were observed supporting people to eat their meals in a patient and sensitive way, however one was standing up next to the person rather than sitting down and making eye contact. The home had gained the Healthy Heartbeat Award and gained an, ‘A’ in Hull City Council’s ‘scores on the doors’ assessment system of food management. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 18 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): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to provide an environment where service users and relatives feel able to complain. Vulnerable people are protected from abuse by staff training and adherence to policies and procedures. EVIDENCE: The homes complaints policy was on display and via surveys staff indicated they were aware of how to record and action complaints. A complaint form was available that had space to detail the complaint, how it was investigated and what the outcome was. The AQAA document completed by management indicated that seven complaints had been received by the home and all had been resolved quickly. The Commission had recently received one complaint about care issues, which was referred to the provider to investigate. The investigation is still underway. In surveys five out of seven people stated they knew how to complain and generally they knew who to speak to if they were unhappy about something. Relatives knew how to complain and one stated, ‘I have never had a reason to complain’. However another relative stated complaints had been dealt with for them but on some occasions they had to raise the issue again. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 19 Staff members received training in the protection of vulnerable adults from abuse during their induction and were knowledgeable about the different types of abuse and the need to alert the local authority to any allegations. The deputy manager was aware of the multi-agency policies and procedures regarding alerting, referral and investigation. Since the last inspection there had been an improvement in staff completing safeguarding alert forms to the local authority when there were significant incidents between people that lived in the home. This enabled the local authority to be aware of the incidents so they could monitor them more effectively. Senior management took advice from the local authority regarding a potential safeguarding issue and dealt with it within the homes disciplinary system. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 20 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): 19, 24 and 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to provide a well-maintained, clean and comfortable environment for people. People have the opportunity to personalise their bedrooms, which made it homely for them. EVIDENCE: The home is laid out over two floors with access to the upper floor via a passenger lift and stairs. All forty-eight bedrooms are single with forty-two having en-suite facilities. A number of the rooms have a lockable interconnecting door which means couples are able to share a bedroom whilst using the other as a lounge area. There are five bathrooms and two shower rooms, and sufficient toilets throughout. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 21 The home has various well equipped communal areas on both floors that include, lounges, dining rooms, a sitting room for people that smoke and smaller quieter areas to sit with visitors. All are nicely decorated and furnished and there is an ongoing system of re-decoration. The home also has a hairdressing room. Corridors were wide, had handrails and were decorated with old pictures of the surrounding area. Central to the home is a garden and courtyard area with patio tables and chairs, which people are able to access safely. Bedrooms had been personalised to varying degrees and service users confirmed they were able to bring in small items to decorate their room. Five of the bedrooms viewed lacked a personal touch and could be made more homely and stimulating for people. Each bedroom had a photograph of the persons’ allocated key worker to aid recognition for both the person living in the room and relatives. All bedrooms had privacy locks and lockable facilities. People spoken with during the day were happy with their home, ‘I love the home – the place is clean’, ‘I have my own room and have brought in my television, pictures and some ornaments – I like it, especially having my own toilet’, ‘it’s kept clean and tidy’ and ‘nice and tidy rooms’. All seven of the surveys received from people living in the room confirmed the home was fresh and clean either ‘always’ or ‘usually’. Surveys received from relatives also indicated a general satisfaction with the environment although one person stated that they could improve by cleaning rooms more. One person commented, ‘it’s a warm, clean, comfortable, friendly environment and atmosphere’. During the visit it was noted the entrance had an initial odour but this was rectified throughout the day, and staff were aware of and attempting to address, an ongoing odour in one of the bedrooms. The home had sufficient laundry and cleaning equipment. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recent improvements in staffing levels should address a lingering perception of being understaffed at times and enable peoples’ needs to be fully met. The company has good induction and training opportunities for staff to ensure they are equipped to complete their role. However gaps in refresher training should be addressed quickly. EVIDENCE: Discussions with care staff members indicated that there were two care staff and a personal care manager/senior downstairs to support nineteen people and three care staff and a personal care manager/senior upstairs to support twenty-six people. The manager was supernumerary and the deputy manager completed some shift work and other administration activities. In discussions with staff it was clear that staffing numbers had been a major issue in the past months but was slowly being resolved, ‘it’s a good company to work for and when we are fully staffed things run smoothly’ and ‘we are still understaffed now and again’. They described the situation as, ‘resolving’ rather than, ‘resolved’. New staff members were in post but were naturally taking time to settle in and get up to speed. This was confirmed in surveys received from staff members and relatives, Comments were, ‘we need more staff’, Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 23 ‘there is a high staff turnover’, ‘they could improve continuity of care’ and ‘there’s not enough done or time spent for people with disabilities’. One staff member stated there was enough staff, ‘always’, three said, ‘usually’, one person said, ‘sometimes’, and two people stated, ‘never’. However all seven surveys from people that lived at the home stated staff listened to them and acted on what they had to say, four stated staff were available, ‘always’ and three said this was, ‘usually’. The AQAA documentation stated that the home had stopped using agency staff in November 2007 and staff turnover had definitely improved. This showed us that managers were aware of the need for consistency and were addressing it. Generally people commented positively on staff attitude and approach, ‘I’m looked after well’, ‘the staff always listen to you’, ‘they are excellent and kind’, ‘the staff are very supportive’, ‘they cheer dad up when he is down’ and ‘very friendly staff’. One person stated they had to wait a long time sometimes when they call to staff and a relative felt that sometimes comments about issues could be taken too personally by staff rather than them being seen as an expression of concern for their loved one. The block induction for new staff covered a range of mandatory training such as moving and handling, first aid, health and safety and infection control. New staff also completed skills for care induction booklets over a period of time to help consolidate their knowledge. These were overseen by senior staff and signed off on completion. Management were in the process of auditing training and confirmed there were some shortfalls, which tended to be in refresher training. The deputy manager is to plan for the identified shortfalls and some courses have been identified. The training plan evidenced that mandatory and service specific training was covered. Each staff member had a personal training plan that recorded the training completed and booked. The gaps should be addressed throughout the year. According to information received from the AQAA documentation the home had 36 of care staff trained to national vocational qualification (NVQ) level 2 and 3. Further staff members were progressing through the course. This is good progress and the home is aiming for 50 of care staff trained to this level. The company provided a one-day introduction to dementia during the block induction week and a further two-day consolidation course. Those staff spoken with and surveys received from them commented that the company continued to provide good training opportunities, ‘I get any training I ask for’. Records showed that staff usually had annual appraisals to look at training needs and set goals. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 24 Generally the home continued to operate a robust recruitment process. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. Of the five new staff files examined two had started after the povafirst check but prior to the return of the criminal record bureau check. Only one of these had any personal care contact with people that lived in the home and staff confirmed they always worked in pairs until the CRB was returned. It appears this was an exceptional circumstance and not a routine occurrence. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36, and 38. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally the home was well managed. The system in place to monitor that specific personal care tasks have been completed needs to be fully implemented to ensure peoples needs are met as their care plan indicates. EVIDENCE: The home has had some management changes in recent months with the departure of the registered manager at the end of last year, a temporary manager in place from Jan to the end of March 2008 and the acting manager taking up their post on 1st April 2008. The process has been managed smoothly and the company have kept the Commission informed. The acting manager has been a deputy manager at another home in the company for three years and has many years experience in the care sector. She has Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 26 completed a national vocational qualification (NVQ) in management at level 4 and is an NVQ assessor. She has completed relevant training to equip her with the required skills for the management role, such as, local authority safeguarding of adults training, staff supervision, sensory awareness, and mandatory training. The company provides the acting manager with a good structure of support, which includes an area manager, a health and safety officer and a deputy manager. Staff have the opportunity to meet with the area manager during their visits. Staff spoken with felt supported by the acting manager and deputy manager and surveys commented on their supportive and approachable manner, ‘the service manager is approachable and listens to any concerns particularly work related’, ‘staff are supported well’, ‘there has been a great deal of improvements’, ‘it’s a good company to work for’ and ‘they listen to concerns and we wouldn’t hesitate in taking things to them’. Staff did feel that the way information is passed between them could be improved and in surveys some stated they had not had the opportunity to meet with their line manager. The deputy manager had just completed a new staff supervision plan to ensure people had an identified supervisor and that they received supervision on a regular basis in line with national minimum standards. Currently staff supervision is not consistent. When four random records were checked regarding supervision over the last twelve months, people had between one and six sessions. Staff confirmed this inconsistency in discussions. They did confirm they had annual appraisals, which identified training needs. The company has a good quality assurance system in place, which consists of audits and questionnaires to seek the views of all stakeholders. The company produces an annual development plan, which looks at the organisation as a whole as well as each individual home. The quality audit tool focuses on all areas of service provision with different tasks each month. Results of audits and questionnaires are usually analysed and plans produced to rectify any shortfalls. One residents survey about key worker input in April resulted in issues that needed to be discussed at the next key worker meetings but when checked this did not appear to have been followed through. The audits should incorporate documentation relating to personal care tasks as monitoring charts such as bathing, fluid monitoring and pressure relief failed to provide an accurate picture of the care provided. The care plan audits also need to have a system of follow up when issues have been identified. The AQAA does state that ongoing care programme and key worker training is in place for all staff to ensure that they, ‘understand the importance of accurate recordings’. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 27 The annual quality assurance assessment (AQAA) requested by the Commission was provided within the timescale. Meetings continue to be held for people that live in the home and staff, and suggestions were listened to. There was evidence that residents meetings and staff meetings had both taken place in April and May. At the last site visit peoples’ finances were well managed with individual records maintained on a computerised system. Receipts were obtained for money deposited into the personal allowance system and when staff members assisted service users to purchase items from local shops and on outings. Administration staff audited finances regularly and the company audited them on an annual basis. Finances were not assessed at this visit The AQAA detailed that moving and handling equipment was serviced and since the last inspection safety checks on bed rails have been completed. Staff complete training in health and safety and infection control. The home has a designated health and safety representative and the company has a health and safety officer available for guidance and advice. The AQAA stated that extra policies and procedures had been distributed throughout the building to ensure all staff members have access to them. It was noted that one bedrail had a protector on that was too small and left some bars exposed. The deputy manager was to attend to it as soon as possible. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 28 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 29 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 Requirement Timescale for action 31/08/08 2 OP9 13(2) 3 OP9 13(2) 4 OP36 18 Care plans must detail all needs identified at the assessment stage or following risk assessments, They must be evaluated by the care staff and updated to reflect any changing needs. This will ensure care is not missed. People must receive the 31/07/08 medication that is prescribed for them. This will promote their health and wellbeing. Medication must be stored at the 31/07/08 temperature required by the manufacturer and the home must take action when records demonstrate it is not. Care staff members must receive 31/08/08 formal documented supervision so the home is sure they are completing their roles effectively. Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 30 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 OP3 Good Practice Recommendations The homes own in-house assessments should be completed thoroughly covering all aspects of need and how conditions affect people. This will help staff to make a decision as to whether they are able to meet needs. They need to be signed and dated by the person formulating them. Accurate information on the amounts of food and fluid consumed should be recorded when using monitoring charts for this purpose. Monitoring charts should be completed consistently to give an accurate picture of the care provided. The manager should liaise with the community pharmacist to rectify the controlled drugs book. The manager should seek advice from a GP regarding an order of priority for one person’s medication. To avoid confusion consistent codes should be used when detailing why medication has been omitted. The manager should ensure some bedrooms are more personalised to provide stimulation for people with dementia care needs. In view of some staff comments regarding staffing numbers, this perception of understaffing should be discussed with them to see how it can be resolved. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. Refresher training should be carried out in good time to ensure staff have updated skills. In light of staff comments in surveys and discussions about the need for improvements in staff communication, management should reflect on how these issues can be improved. The registered person should ensure that the manager applies for registration with the Commission to ensure stability for the home. The manager should review the way specific personal care tasks are monitored and audited to ensure they are carried out in line with care plans. 2 3 4 5 6 7 8 9 10 11 OP8 OP8 OP9 OP9 OP9 OP24 OP27 OP28 OP30 OP31 12 13 OP31 OP33 Wilton Lodge DS0000000876.V365682.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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