Inspection on 17/01/06 for Wilton Lodge

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 11/05/06

Wilton Lodge 24/04/06

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 Claire Farrier Unannounced Inspection 17th January 2006 10:10 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.V278642.R01.S.doc Version 5.1 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.V278642.R01.S.doc Version 5.1 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.V278642.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st August 2005 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. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection, and including preparation time it took a total of 8 hours. During their time in the home the inspectors spoke with eight residents, one visitor and five members of staff, and feedback was given to the manager. The Operations Manager from Wilton House Limited also visited the home during the inspection, and spoke to the inspectors. The interaction between residents and staff was observed. The records were checked of residents’ care and residents’ money, and further information was provided in the pre-inspection questionnaire that was completed in November 2005. 31 residents were in the home at the time of the inspection. Two residents were in hospital and there were three vacancies. This was a positive inspection, and the majority of the standards inspected on this occasion were met or partially met. All the residents spoken to were happy in the home. One new requirement was made concerning qualifications for the care staff. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: All the residents who took part in the inspection said that they are happy in the home and that the staff provide a good quality of care. One said, “They’re very good here,” and another asked the inspectors to give them a good report. All the care staff spoken to were enthusiastic about their work. They said that there is a good atmosphere in the home and they enjoy working there. The staff were observed to have a good relationship with the residents and to treat them with courtesy and respect. They spent time talking to individual residents. Care plans have a format that provides clear and easily accessible information on all the residents’ needs, and good recording of the care given and the activities that each person has taken part in. A visiting district nurse said that she is very happy with the care that the staff provide. However medical guidance on wound care and pain relief should be included in the care plans. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 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. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 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.V278642.R01.S.doc Version 5.1 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 on this occasion. EVIDENCE: Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 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, 8 and 10 The care plans are arranged in a format that provides up to date and easily accessible information on each resident, so that the care staff are able to meet the resident’s needs. The home monitors and addresses all the residents’ personal care and health needs. Residents said that staff treat them with respect. The policies and practice in the home promote privacy and dignity for the residents, but on a few occasions they are not put into practice. EVIDENCE: Detailed case tracking was carried out through the files of three residents. They contain clear and easily accessible information on the resident’s health and personal care needs, with comprehensive procedures for meeting the needs. The procedures for dementia care have good detail related to each individual’s behaviour and needs. For example, one care plan states, “Talk to *** slowly, clearly and simply. Remind *** of what she used to do, also about family and friends. Tell *** what and why you are doing things. Always maintain *** dignity and privacy.” Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 10 Each person’s assessment and care needs are reviewed every month. The care staff complete a daily record with comments that are relevant to the person’s care plan needs. A lot of care has been taken in compiling a personal history for each resident. In one case there was a detailed letter from a relative, and in others the resident had provided their own information. A detailed personal history is useful information for the staff to have for all residents, and for residents with dementia it provides vital information to help the staff to communicate effectively with them. Each part of the care plan is signed by the resident or a relative. The care plans contain good information on the residents’ health care needs, with appropriate monitoring of specific health concerns and recording of all contacts with medical practitioners. The pressure care for one resident was checked. Good procedures are carried out, including monitoring the skin condition and the use of equipment such as appropriate air mattresses and cushions to prevent pressure sores from developing. A visiting district nurse said that the staff carry out all health care, including pressure care, very well. The district nurses provide active management of red areas and guidance to the staff. The nursing notes are very detailed and record all the pressure care that is provided. There is very little detail about management of wound care in the care plan. However the district nurse confirmed that she is very happy with the care that the staff provide. It was clear from observation and discussion with staff that action is being taken in line with the district nurse’s advice, but guidance on wound care and pain relief should be included in the care plan. The weight record showed that one resident has been losing weight. It was reported that the GP was informed on the loss of weight, but the actions taken were not recorded in the care plan. All falls in the home are monitored, with a monthly record of where and when the fall occurred, any pattern noticed and any action that should be taken. Appropriate risk assessments are in place for each resident, including a falls risk assessment, moving and handling assessment and pressure area assessment, and these are reviewed every month. The residents spoken to confirmed that the staff respect their privacy and treat them with respect. Several people said that the staff are kind and gentle when providing personal care, and one requested that the inspectors should give them a good report. The home has policies and procedures to protect the residents’ privacy. Notices were seen on several doors stating, “ Please lock the door when not in use”. One care plan stated that the staff should knock before entering the bedroom. However, when a GP arrived they were observed to enter the bedroom without knocking. One resident had to call out for help because her call bell had been placed out of her reach. When she did use the call bell, the staff arrived very promptly to assist her. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 11 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): 12 The home provides a stimulating environment for the residents in which they can continue to practice their religious, cultural and recreational activities. EVIDENCE: A new activities co-ordinator has recently been appointed. She was previously a care assistant in the home. She knows all the residents well, and she was observed to have a very good relationship with them and to give a lot of attention to the individual needs of the residents. A detailed activities programme is now in place. On the day of the inspection there was a church service in the morning, and four residents went to the pub across the road for a lunch of soup, hot roll and egg and chips. Several residents mentioned this as a highlight of their week. The residents spoke of other activities that they enjoy, including quizzes, draughts, carol singing and hairdressing. The manager has started monthly coffee mornings for the residents and their relatives. One resident likes to spend most of the day in his room. This is recorded in his care plan, and any special events are offered to him. Another resident also likes to stay in her room. She enjoys knitting and looking out at the view, and her patio has bulbs and ornaments and a bird table. The activities organiser spent some time talking to individual residents in the lounge and in their bedrooms, and she ensures that all residents are given the Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 12 opportunity to take part in their choice of activities. A detailed record is kept for each resident of the activities they take part in. The recording provides good details for each person, for example, “Had a discussion about the headlines in today’s papers. Some interesting facts came up.” “ *** came for a walk with me to post a letter. She said she enjoys going out and having fresh air.” “ *** called out the numbers today when we played bingo.” The activities provided in the home have greatly improved since the last inspection. The new activities co-ordinator would benefit further from some training in activities specifically for people with dementia. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 13 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): 18 All staff have appropriate training on prevention of abuse, and robust polices and procedures are in place to ensure that the residents are protected. EVIDENCE: The home has comprehensive procedures for prevention of abuse. Training in the prevention of abuse is included in the induction programme. Most of the staff spoken to were aware of the home’s procedures and of the whistle blowing policy, and training is currently taking place for all the staff. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 14 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): These standards were not inspected on this occasion. However the home appeared to be clean and well maintained throughout. EVIDENCE: Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 15 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 and 28 Staff numbers in the home are sufficient to ensure that all the residents’ needs are met. The staff receive appropriate training, but the number of qualified staff is below the recommended level. EVIDENCE: The home has a good level of staffing, with six or seven care assistants and a duty officer on the early shift, five care assistants and a duty officer on the late shift and two waking night staff. The home is fully staffed. Many of the staff are recruited from abroad, and the staff spoken to during the inspection were from Pakistan and Poland. The home provides accommodation for them. All the staff spoken to said that there is a good atmosphere in the home and they enjoy working there. Only two members of staff have NVQ qualifications, and three more have enrolled for the course. Several of the care assistants are registered nurses in their own countries, and they have come here hoping to do conversion training. The company used to offer only short term contracts to their staff form overseas, but they now offer long term contracts. The company must address the need for 50 of the staff to take NVQ qualifications. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 16 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, 35 and 38 Adequate records are maintained for the effective management of the home and monitoring of heath and safety procedures. The acting manager has maintained the good atmosphere in the home. EVIDENCE: The registered manager left in August 2005, and an acting manager was appointed. The acting manager was previously assistant manager at another of the company’s homes, and she has completed the Registered Managers Award. The arrangements for management of residents’ money were inspected and appeared to be accurate. Money is stored safely and adequate records are maintained in order to protect service users from financial abuse. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 17 The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. No health and safety concerns were observed during this inspection. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 19 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 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 . Timescale for action 31/03/06 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. Wilton Lodge DS0000019621.V278642.R01.S.doc Version 5.1 Page 20 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.V278642.R01.S.doc Version 5.1 Page 21 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. 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