Inspection on 21/06/07 for Wilton Lodge

This inspection was carried out on 21st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 13/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 402 Holderness Road Hull East Yorkshire HU9 3DW Lead Inspector George Skinn Key Unannounced Inspection 21st June 2007 09:00 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 DS0000000876.V334562.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.V334562.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 Lynda Clarke 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.V334562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 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 service users 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. All of the homes bedrooms are single with 42 having en-suite. 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 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; all service users are able to access these areas safely. The home was designed so as to take full advantage of the bustling community life; lounge areas are located in such a position to ensure service users feel part of the community. The current scale of charges are: Privately funded Standard £395.00 to Ensuite £405.00 EMI Standard £430.00 to Ensuite £440.00 Local Authority funded Standard elderly £327.50 to EMI £368.50 Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken over 10 hours. Prior to the site visit questionnaires were sent to all of the service users, their relatives and staff to complete. The responces from these helped to form some of the judgments made in the report. During the site visit service user were spoken with, records were looked at, staff were interviewed, and the building was inspected. What the service does well: What has improved since the last inspection? What they could do better: The home needs to make sure that the service users personal care needs are met. The home needs to make sure the service users can exercise choice and control over the times of personal care and ensure these times are convenient to them. The home must make sure that the service users can participate in activities of their choosing and which suite their needs at times which are convenient for them. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 6 The home must make sure there enough staff on duty at all times to meet the needs of the service users and to provide a flexible service. 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.V334562.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 DS0000000876.V334562.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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use this service experience good quality outcomes in this area. The home provide information which is up to date so prospective service users can make an informed choice. Service user needs are assessed prior to moving into the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous random inspection made to the home as result of concerns received revealed that the home statement of purpose contained information which was no loner applicable and misleading information about the manager. The home were require to update the statement of purpose to reflect the current position of the home within a given time scale. The statement of purpose was looked at and this had been updated; it contained information about the manager and listed her qualifications. The statement of purpose included information about staffing and their qualifications it also made it clear there is now a third party top up arrangement regarding fees. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 9 The files of those recently admitted service users were looked at, these contained evidence of assessments being undertaken by the placing authority and the home. From these assessments the home had devised care plans. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 10 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): The people who use this service experience adequate quality outcomes in the area. Service user needs are set out in an individual plan of care however needs are not always met. Service users health needs are monitored. The service user are protected by the homes medication procedures. Service users are treated with respect and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 5 service users files were looked at, these contained evidence of comprehensive assessments being undertaken this included risk assessment around mobility, pressure area care, falls and nutrition. There was written evidence that the care plan had been agreed and signed by either the service user or their representative. There was evidence of best interests meeting taking placed one example was a serviced user had refused to have bed rails fitted to his bed and meeting involving relevant health care professionals recorded that this had been discussed and a way forward agreed. The daily recording was separated into categories and detailed recording of daily activities were made. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 11 One care plan did not have any information about the service users past life or history. The deputy manager stated that the service user had declined to provide any of this information when asked; she was intending to ask the relatives of the service user to gain any information they may have. The records indicated that the home monitor the nutritional intake of the service users and their fluid intake. The fluid charts of one service user indicated the amount of fluid intake as a cup or beaker but the output was measured in millilitres. A cup or beaker is an arbitrary amount and it did not equate with the output, it would be better if the amount being drunk were measured in millilitres so proper calculations can be made. The service users files indicated that they had regular contact with health care professionals and regular reviews take place to ensure the right care is provided. The home now undertakes risk assessment around the use of bedrails and daily checks are made to ensure these are fitted properly and conform to current health care guidance. The manager monitors the care plans regularly and any short falls in recording is identified and time scale given for updating. The home record the bathing of service users, one care plan indicated that the service user had not had a bath for 6 months speaking with the service user confirmed this and he could not understand why he had not been asked. When asked the staff stated that they do not have the time to ensure the service users are bathed regularly but do ensure they have regular full body washes. The homes procedure for handling medication protects the service user. All the staff have received both HICA’s medication training and accredited; there were clear audit trails for medication. The company have a comprehensive procedure to use if service users want to self medicate. Evidence of agreements with service user about the administration of medication was seen in service users files. The staff were observed to respect the dignity of the service users and all personal tasks were undertaken in private; the staff commented on receiving training on respecting individual needs during the weeks block training which HICA provide. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 12 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): People who use this service experience adequate quality outcomes in this area. Service users opportunity to participate in social activities is limited. Service users community contacted is limited and is dependent on staff availability. Service users ability to exercise choice is severely limited. Service users receive a wholesome balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user files had evidence of activities undertaken with the service users, however observation made during the site visit indicated that service user are sat for long periods of time un-stimulated and sleeping. An example of this was observations made in the morning in the dining room; service user were seen to be spending time sat at the table and not moving from breakfast to lunch time with staff setting the tables for lunch around them. The deputy stated that some of the service users choose to spend time in the dining room; evidence seen indicated that some of the service users in the dining room could not make an informed choice, none of the care plans seen recorded that service users wish to spend time sat in the dining room. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 13 The interaction between staff and service users was seen to be good and there were lots of examples of staff speaking with service users sensitively, calmly and respectful. There is a list of social activities displayed around the home, however service users spoken with commented on there being a lack of activities one service user said that “the activities co-ordinator is on sick and since then no alternative activities had been offered” another one said “I spend a lot of time in my room watching TV”. Staff spoken with commented on being frustrated that they do not have the time to spend with the service users and had to fit this in with completing care plans in the lounge. There was evidence of service user visiting the local community and shopping and staff were heard arranging this with the service users; staff commented that this again is restricted and many undertake this in their own time. There is no restriction on visiting and visitors are welcome at any reasonable time. Service users files indicated that one service user had not had bath for 6 months this he confirmed; when asked why he said that the staff were too busy at the time he wanted a bath and so it got missed. He also commented on the bed linen not being changed for over a week again when he asked the staff they said they were too busy. He felt he had to fit around the staffs working routine. Service users likes and dislikes are recorded in the care plans and also amount of food preferred there was an example of one service user only liking small amounts of food. The main meal of the day was observed, this was presented well and service user commented on enjoying the food one service user commented, “the food could not be faulted” another one said “its simple just how I like it” another said “there is always plenty of choice”. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 14 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): People who use this service experience good quality outcomes in this area Service user and relatives know who to complain to and are confident these will be taken seriously. Service user are protected form abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random inspection was undertaken on the 18th January 2007 during this inspection it was identified that the home recording of complaints was good with regard to general complaints but the recording did not indicate the outcomes of more complex complaints was not as thorough. The complaint record was looked at and the issues had been addressed all outcomes for all complaints received was thorough and indicate the outcome. The preinspection questionnaire indicated that the home had received 8 complaints since the last inspection and 6 were substantiated. The home has a comprehensive complaints procedure and this is included in the homes statement of purpose and the service user guide. Service user spoken with knew whom to complaint to and had confidence that this would be taken seriously by the management of the home. One served user said he “would see the boss” if he had any complaints. Staff questionnaires received as part of the inspection process indicated they had a good understanding of the homes complaint procedure and were aware of the procedure for reporting any instances of abuse which they may witness. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 15 Those staff interviewed during the site visit stated that they had received safeguarding adults training during the block induction training. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 16 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): People who use this service experience good quality outcomes in this area Service users live a well maintained and clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random inspection undertaken on the 18th January 2007 identified that action had to be taken to ensure there were no malodours around the home. A tour of the building was undertaken as part of this site visit and no malodours were apparent. The home is currently undergoing refurbishment and the corridors have been redecorated. The general upkeep of the building was good and all areas were clean and tidy. All maintenance certificates were up to date. Staff were seen to using protective clothing when helping service users with personal tasks.. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 17 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): People who use this service experience adequate quality outcomes in this area. Service users are not supported by staff in adequate numbers to ensure their needs are met. The company offer appropriate training to staff employed Service user are protected by the homes recruitment and selection procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are well trained and HICA offer a range of training for the staff to access. Staff receive developmental opportunities and specialist training is offered so the staff can meet the more complex needs of service user. All staff had undergone the block induction which HICA provide for all new staff. The companies recruitment procedure protects the service users; there was evidence of application forms which addressed any gaps in employment, references being sought and Criminal records Bureau (CRB) checks being undertaken prior to staff commencing employment at the home. Prior to this site visit and as part of the inspection process some concerns had been raised regarding the amount of staff on duty at the home and this was resulting in some of the needs of the service users not being met. These concerns were raised via service users surveys, relative surveys, and staff surveys. Comments made were “we don’t have enough time to sit and talk to Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 18 the service users”, “I have to wait for the staff to come to me as they are very busy and they often seem to be short staffed”. The service users and staff confirmed these comments during the site visit. Staff were frustrated that they could not spend more time with the service users and some of them commented that they did not have enough time to meet the basic needs of some of the service users and felt they expected the service users to fit around the working practises of the staff. One service user said “I don’t like to bother the staff too much as they always seem to be very busy”. During the site visit there was an example of a service users who had not had a bath for six months, this was attributed to a lack of staff and staff not being able to meet the service users needs. The manager has provided information that the service provides 861 care hours per week; calculations done using the residential staffing forum guidelines indicate that the home should be providing 893.36 according to the dependency levels of the service users provided by the manager. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 19 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): People who use this service experience good quality outcomes in this area. Service users live in a home which is managed by some one who is fit to in charge. Service users are involved in the functioning of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is registered with the CSCI and is fit to be in charge of the home. The company provide developmental training for the manager. She has the registered manages award qualification. Both service users and staff commented that the manager was approachable and dealt efficiently and professionally with any requests or issues raised. The home operates the company quality assurance system which seek the views of all the stakeholders who have interest in the home and the care of the service users, results are published and goals set for improvement. Service Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 20 users confirmed they were consulted on a regular basis about the functioning of the home. The company representative completes the visits required by virtue of regulation 26 of the Care Homes Regulations 2001. The equipment in use at the home is regularly maintained; contracts are in place to ensure this happens within the required time scale. The home have policies and procedures in place to ensure the health and safety of the service user and the staff these are updated and the company employ a health and safety officer to ensure the training the staff receive is up to date and based on current guidance and legislation. All staff have received health and safety training during their block induction and this is updated as required. Risk assessments are undertaken regarding the safety of the building and the equipment being used, the home undertake weekly checks on bedrails used on the service users beds. This assessment is based on guidance issued by the department of health. The service users money is kept in a communal business account which accrues no interest. Service users or representatives can maintain their own accounts and finances but are offered the facilities operated by the home. the company have introduced a third party top up system which is made clear in the homes statement of purpose so potential service users are aware of the arrangement. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 22 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 OP8 Regulation Requirement Timescale for action 30/09/07 2 OP12 3 OP14 4 OP27 12, 13, 18 The registered person must & 19 ensure that the personal health care needs of the service users are fully met at all times. 5, 12, 16 The registered person must 30/09/07 & 23 ensure that the service users are offered opportunities to participate in meaningful activities based on their assessed needs. This will ensure the service users lead a more fulfilling life style. 12, 15, 17 The registered person must 30/09/07 & 20 ensure that the service users can exercise choice over their daily lives, especially with regard to maintaining choice around personal care tasks. 18 The registered person must 30/08/07 ensure that there are enough staff at all times to ensure the service users needs are being met effectively and their choices are not compromised. Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wilton Lodge DS0000000876.V334562.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!