Inspection on 22/05/08 for Wilton Lodge

This inspection was carried out on 22nd May 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 27/04/09

Wilton Lodge 05/02/08

Wilton Lodge 23/08/07

Wilton Lodge 13/06/06

Wilton Lodge 31/10/05

Wilton Lodge 24/06/05

Wilton Lodge 21/12/04

Wilton Lodge 29/06/04

Wilton Lodge 29/01/03

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX Lead Inspector Debbie Calveley Unannounced Inspection 22nd May 2008 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 DS0000021290.V364469.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 DS0000021290.V364469.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton Lodge Address 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX 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) 01424 216250 wilton@angelhealthcare.co.uk www.angelhealthcare.co.uk Angel Healthcare Ltd Vacant Care Home 12 Category(ies) of Dementia (12) registration, with number of places Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That the maximum number of service users to be accommodated is twelve (12). That service users accommodated will be aged 65 years, or over on admission. That service users accommodated will have a dementia type illness. That a maximum of two (2) service users between the ages of 55 and 65 years, who would otherwise fall within the main category, may be accommodated at Wilton Lodge at any one time. The home is not registered to accommodate service users with primary symptoms of drug or alcohol abuse, or acquired brain injury. 5th February 2008 5. Date of last inspection Brief Description of the Service: Wilton Lodge is a Victorian terraced property set close to the seafront and town centre in Bexhill-on-Sea. There are bus routes and a mainline railway station, within a short distance. The home, one of four care homes owned by Angel Healthcare Limited, is registered to provide residential and social care for twelve older people with dementia type illnesses. Accommodation is provided on three floors. Stair lifts are fitted, providing assisted access to rooms on the first and second floors. There is a staff sleep-in room on the fourth floor that doubles as the managers office. At the rear of the premises is a small, private courtyard for use by residents. Potential service users find out about the service via word of mouth, Angel Healthcare website, brochure, contacting the home direct, through care managers and placing authorities. The ranges of fees charged (at the time of this report) were £410 to £560 per week. Extras are charged for hairdressing (£6.50 - £20 dependent on treatment), chiropody (£8 - £12) and toiletries (varied). Wilton Lodge DS0000021290.V364469.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 the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Wilton Lodge will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 22 May 2008. There were nine residents living in the home on the day, of which six were case tracked and spoken with. The purpose of the inspection was to check that the statutory notices served on the 13 March 2008 had been met within the given timescales and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Three members of care staff were spoken with in addition to discussion with the Manager. Telephone contact was made with visiting professionals following the visit and one relative was spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment was received completed in full prior to this key inspection and received 14/03/08. What the service does well: There is now a fully comprehensive statement of Purpose and Service Users Guide that gives prospective residents and their families the information required to enable them to make an informed choice about where they live. The menus evidence a well thought out balanced diet with a varied choice of food in line with resident’s preferences. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 6 Quality assurance systems are in place, which enables the service to monitor and improve their service. There is an open-house policy, which welcomes visitors at all reasonable times. Satisfactory arrangements are in place to safeguard residents’ finances. Staff provision is well maintained with a robust recruitment practice being followed and appropriate numbers of suitably qualified staff working in the home. The atmosphere of the home is pleasant with good interaction seen between residents and staff. People who use the service have access to an efficient complaints procedure. Whilst the homes processes and staff training should protect residents in the event of an allegation of abuse. What has improved since the last inspection? Statutory notices were served on the home on 13 March 2008 and this key inspection also served as the compliance visit. The Statutory requirements notices had been met by the home in respect of: Developing a service Users Guide that gives the information required regarding fees, of how people may pay the fees. A copy of the improved Service Users Guide was sent to the CSCI as requested and all residents and/or their families have received a copy. The care plans of all existing residents have been reviewed and revised where appropriate after consultation with the resident or a representative (if possible). They have introduced a more comprehensive daily care plan, which detailed a good level of information regarding the residents and clear directions for staff to follow in how to meet that residents needs. The home have ensured that appropriate systems are in place to regularly check, service and maintain the Home’s gas and electrical systems, in line with current legislation by suitably qualified and competent professionals to ensure the safety and welfare of residents, staff and visitors. Residents and their families are now consulted regarding their needs and preferences regarding their social life and these are put in to a suitable programme of activities, which addresses their social, and leisure needs. This included documented evidence of activities and arrangements for residents to participate in activities inside the Home and in the local community with appropriate support from staff. The management team have ensured there are sufficient numbers of suitably qualified and competent care staff working at the home each day and night to ensure that the individual and collective needs of the service users are met. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 7 The staffing rota identifies staff roles and the staff are pleased with this new way of working as they can spend more time with the residents. It was evidenced that all staff receive regular, appropriate supervision with written records maintained on their recruitment file. Quality Assurance systems have been introduced that formally monitors the quality of service the home provides. This includes obtaining the views of service users, relatives and stakeholders. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 8 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 DS0000021290.V364469.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission although people are not assured in writing that their needs will be met. EVIDENCE: Since the last inspection, the management team have worked together to produce a comprehensive Statement of Purpose and Service Users Guide, which now contains clear information about the home, the range of fees charged and the services it provides. Copies of these have been sent to the all the residents and their families as requested in the Statutory Enforcement Notices. It was confirmed that the contract arrangements are now clear and have been updated. There is a copy of the terms and conditions of residency included in the Service Users Guide and all residents care plans evidenced that the terms Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 10 and conditions of residency have been renewed to reflect the actual fees charged. A review of the care documentation confirmed that pre-admission assessments are completed by the registered provider. The format of the pre-admission document was seen to be thorough and relevant. However, there have been no new admissions to the home since the last inspection and so no new documentation was viewed. From discussion with the manager the preadmission assessments contain all the information required to ensure that new admissions to the home are suitable and that the home have the staff and environment to meet the care needs of their needs. This is especially important for mobility needs, as the layout of the home is not suitable for residents who are restricted to wheelchairs at this time. It was also confirmed that prospective residents’ are seen either in their home or hospital before admission and the manager confirmed that wherever possible the family or representatives are involved. A recommendation of good practice is that the venue and all the people involved in the assessment are documented. The manager could not confirm if the residents receive written confirmation that their needs can be met by the home and staff and this needs to be clarified. The manager was able to verbally demonstrate his knowledge and awareness of the different specialities required in the home and ensures that the carers employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases. Trial visits to the home can be arranged; this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at Wilton lodge Care Home. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 11 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 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst residents are offered a good provision of health care and personal support by the home. The care plan documentation is difficult to follow and does not always provide clear guidance for staff to follow in managing everyday risks. All care is delivered in a way that protects residents privacy and dignity and promotes their independence. EVIDENCE: The care documentation pertaining to six residents was reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated as required at the last inspection and in line with meeting the statutory enforcement notices. However as discussed there have been many additions to the care plan format and this makes it difficult and time consuming to follow. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 12 Whilst areas of the care planning process has improved, it does highlight that it would be beneficial to review the whole care planning documentation and this was discussed in full with the manager. Risk assessments for health needs are included in the care planning systems used by the home, and whilst some individual risk assessments were found to be completed, not all were followed through with an appropriate plan of action when identified as required and there is a need for further development of risk assessments in the following areas: managing a resident with epilepsy, inappropriate behaviour management and moving people safely in the dining area, This was discussed in full with the senior staff. It was confirmed that the manager has recently attended a three-day risk assessment course and acknowledges that the risk assessments need to be developed further. The manager produced up to date gas, equipment and electrical wiring safety certificates and this statutory requirement has been met. Residents are registered with a GP from the local surgery. Resident’s are supported to attend the GP surgery if appropriate, home visits are conducted when necessary. Referrals to the Optician, Occupational Therapist, Physiotherapist, Dietician and Audiologist are made via the GP or the hospital. Residents access private dental surgeries, where able, and access to a domiciliary dentist is also available. A visiting Chiropodist attends residents six weekly, with additional appointments being arranged if necessary. The records in the home evidence that the health needs of the residents are met. It is acknowledged that a significant amount of work has been undertaken by the staff to improve the records and documentation and that training in care planning will be on-going. Staff spoken with confirmed that they received a report on each resident daily and read the daily care documentation that is kept in the dining room. They felt that their views were taken into account when planning resident’s care. A relative spoken with at the home was satisfied with the care provided at the home saying ‘no problems’ ‘my relative receives good care and the care workers are kind, considerate and supportive.’ Residents spoken to expressed satisfaction, comments included ‘I have my own room and the people are nice ’ ‘ The food is good, and I go for walks on the sea front’. There is no designated clinical room and medications are stored in a lockable cupboard in the dining room. The cupboards were clean and well organised. The home has clear policies and procedures in place for staff to refer to Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 13 regarding the safe administration, storage, disposal and recording of medication. A monitored dose box system is in place for the majority of medications prescribed. There are systems in place for the recording and checking of controlled drugs when required. Medication Administration Charts (MAR) were found to be competently completed. However the comparison signatures of staff able to administer medication were not available and are to be produced to provide a clear audit trail. Some areas of poor practice were identified and discussed with the manager during the inspection and these include ensuring that all MAR identity photographs of residents are in place and dated and then updated regularly and that all verbal orders are signed and dated to provide a clear audit trail. Medications that are kept in the kitchen fridge need to be appropriately risk assessed so as too ensure its safety and that of the residents. It was also discussed that the topical creams in use and found in residents are only used for those who it is prescribed for. It was confirmed that all staff receive medication training to ensure that that they are competent, regular assessment of competency and refresher training is to be provided. Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs and the interaction observed was open and friendly. There is a Privacy and Dignity policy in place and this reviewed regularly. The protection of residents privacy and dignity is highlighted as one of the main aims of the home in its Statement of Purpose and Service User Guide. Each of the residents were addressed by their preferred term and dressed appropriately in well-laundered clothing. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 14 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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides various activities on a daily basis, which enables residents to enjoy a stimulating lifestyle. Residents are supported and enabled to maintain contact with friends and relatives. Meals remain good in respect of both quality and variety that meets the majority of residents’ tastes and choice. EVIDENCE: The activity programme was displayed on the notice board and demonstrated a variety of daily activities which are popular with the residents and include, singing, reminiscence, walks out along the seafront, shopping trips, helping with household chores and bingo. The staff confirmed that the residents have responded really positively to the introduction of activities. Discussion with the registered provider confirmed that further plans for activities are being planned. The staff have introduced a social life care plan and record the residents interaction daily. There is evidence that a designated member of staff is responsible daily for activities and the staff spoken with were enthusiastic about the sessions and discussed how the residents enjoy them. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 15 Resident’s religious wishes are taken into consideration and arrangements are made for residents to receive Holy Communion if they choose to. Residents are facilitated to maintain their independence for as long as they are able. There are no restrictions on visiting times as long as consideration is shown to all the residents. Many of the residents have individualised their bedroom with items from home to make it homely and the furniture was of a good quality. It was observed during the inspection that the routines at the home are flexible; residents were seen choosing where they sat and where they spent their time during the visit. The home has an advocacy policy in place and the information regarding this is available to all residents. Residents are treated with respect and there was a good rapport observed between staff of the home and residents. The dining room is situated at the rear of the house next to the kitchen. It is furnished with good quality domestic furniture and simple décor with plenty of natural light. The access to the dining room is not ideal for less mobile residents due to the steps and narrow doorway and advice should be sought from an occupational therapist team. Residents positioning at the table needs to be assessed to ensure it is suitable for encouraging independence. One resident was seen struggling with her meal due to poor positioning. Staff assisted residents with their meals in a dignified manner, however a recommendation of good practice is that the use of blue plastic aprons as bibs be reviewed. The menu evidenced a well-balanced nutritious diet, which rotates 4 weekly. The midday meal is normally cooked at the sister home and then transported down and served by the home staff. The midday meal was observed and residents enjoyed a roast chicken with fresh vegetables and roast potatoes followed by jam roly-poly and custard. Whilst the menu does not offer an alternative, records demonstrated alternatives are offered and these are listed for each resident. Mealtimes can be varied upon request and residents guests are also welcome to have meals at the home. Medical, therapeutic or religious diets are provided as needed. Drinks and snacks are available at all times. A recent Environmental Health Inspection 23/04/08 identified areas for improvement, which will be checked for compliance by the Environmental Health Officer. From discussion with the manager it is confirmed that these have been attended to. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 16 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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a clear, uncomplicated formal complaints system, which is accessible to both residents and visitors to the home. Staff receive training to protect residents from abuse and the home have clear policies and procedures in place for staff to follow. EVIDENCE: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The home has not received any complaints since the last inspection. Relatives and residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. The home has relevant guidelines on the protection of vulnerable adults and staff have received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 17 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, 20, 21, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Wilton Lodge provides a comfortable, clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room, and rooms are homely and reflect the resident’s personalities and interests. EVIDENCE: The home is generally well maintained, furnished and decorated to a good standard. The layout of the home is not totally suitable for those residents who are not independently mobile due to narrow entrances to the dining area and narrow steps. The home does not have a shaft lift but does have a stair lift to the first floor. This needs to be clearly reflected in the Service Users Guide and Statement of Purpose. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 18 The lounge and dining room areas are fairly small, but are pleasantly decorated and well furnished. The majority of the furniture in the home is of a good quality. The rooms visited evidenced residents personal possessions, pictures and ornaments. The outside area is accessible to residents and furnished with garden tables and chairs. Plants have been placed on the walls and brighten up the patio. There are adequate communal bathrooms and a wet room in the home with specialist equipment, which enables frail residents and those with a physical disability to enjoy the facilities available. However one bathroom was found not to be attractive and inviting and is in need of redecorating. Specialised equipment to encourage independence is provided e.g. handrails in bathrooms, hoists and wheelchairs if required. Call bells are provided in all areas. The lighting in the home is of domestic quality and there are above bed lights as well as the main ceiling lights. Water temperatures are controlled and monitored monthly and a record kept. Random temperatures were taken and the majority were of the recommended level, one was found to be running cold. There are systems in place for monitoring safety issues such as fire checks, fire drills, PAT testing, electrical tests and gas and boiler checks and all the rooms are routinely checked for safety and maintenance issues. The records in the home confirmed they were up to date. The tour of the home confirmed that staff are aware of the fire safety policies, no doors were found inappropriately wedged open. Polices and procedures for infection control are in place and are updated regularly. The home was clean, but odours were apparent in identified areas on the day of the inspection. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. The laundry area is in the cellar of the premises was well organised, but it was noted that the floor is not impermeable and therefore is not cleanable and this needs to rectified. Resident’s clothes were seen to be well looked after. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 19 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 this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: Since the last key inspection in February 2008, the management team have reorganised the staff deployment in the home. At present there are nine residents living in the home and two staff are deployed to support and care for staff whilst the third carer organises the meals, cleaning and laundry chores. The staff on duty all stated that this worked much better than the previous way of working. The rota evidenced that staffing was alternated and that staff were not stuck on the ancillary work. The staffing levels of the home needs to be reviewed regularly against the documented needs of the residents and adjusted as required to ensure residents receive a consistent approach to their care. The staffing rota confirmed that the home has a permanent staff team of ten carers and a supper assistant. Five staff have completed a National Vocational Qualification (NVQ) level 2 in care with further carers due to commence the NVQ level 2 in care training in the near future. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 20 A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. The induction programme is now in place and has been introduced for all staff. Files seen confirmed this. A sample of individual staff training files were viewed and it was evident that staff had received training in English (for overseas staff), Food hygiene, Fire safety, Moving and Handling, POVA, medication, challenging behaviour, Health & Safety and induction. As discussed the refresher dates for training undertaken need to be checked with the training provider. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 21 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 and 38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management structure of the home has been formalised by the appointment of a manager, who is now able to take ownership of the day to day running of the home which is beneficial to both staff and residents. The management approach at Wilton Lodge is open and encourages residents, relatives and staff to be actively involved in the lifestyle provided in the home. The health and safety of residents are promoted through an ongoing training and supervision programme for staff and up to date policies and procedures. EVIDENCE: The management structure of the home has been formalised and strengthened by the appointment of a manager. An application has been received from the Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 22 organisation by the CSCI for the registration of a manager. The manager was previously the deputy manager and has a good knowledge of the residents and staff. The staff confirmed that they felt supported and that they felt the improvements made to the running of the home benefited the residents. Currently the manager works two shifts a week alongside the staff caring for residents and three days in the office attending to the managerial tasks. He is supported by the organisation management structure in his role. The quality assurance systems in the home have been introduced and include questionnaires sent out to residents and relatives and other visitors to the home. The introduction of this formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The quality assurance results have recently been audited and action taken to address any suggestions of improvement. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. Staff supervision was discussed and staff supervision has been commenced. Staff spoken with confirmed that they receive supervision and it is suggested that a plan of the year’s supervision sessions is developed. In the main good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents. Residents are appropriately supervised when entering the kitchen, but advice should be sought in respect of the use of a rope in the kitchen door to deter residents from walking in to the kitchen. A different route to the patio area would benefit the residents. Staff were seen transferring a resident in a wheelchair from the dining area to the lounge and due to the narrow doorway and tight turn with steps, it was not an easy manoeuvre and advice needs to be sought from a specialist agency to protect both staff and residents from harm. All windows were seen to be appropriately restricted and no doors wedged open. Staff were vigilant in protecting residents who do wander from harm and doors to the cellar and cupboards were locked. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 N/A 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 3 3 3 3 3 3 2 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 2 X 3 X 3 X X 2 Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14(1) Requirement Timescale for action 22/08/08 2. OP7 15 (1) 3. OP8 12 (1) (a) That the registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. That the registered person 22/08/08 ensures the care plan system in use is reviewed to ensure that it is provides a consistent and clear approach to meeting the needs of the residents. That the registered person 22/08/08 ensures that suitable risk assessments are completed in all areas of risk and cover the use of high beds, risk of bathing, epilepsy and risk of falls to promote resident safety. That appropriate risk assessments are in place with an action plan for those residents that do not have the capacity to ring the call bell. The registered person shall make 22/06/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of DS0000021290.V364469.R01.S.doc Version 5.2 4. OP9 13 (2) Wilton Lodge Page 25 medicines received into the care Home. In that: Specimen signatures are in place to identify staff administering medication and provide an audit trail to follow if required. That photographs of residents for identification purposes are in place, dated and updated regularly. That all verbal orders regarding changes to medications are signed by staff and dated to provide an audit trail. The registered person ensures that all parts of the Home are kept free from offensive odours. 5. OP26 23 (2)(d) 22/08/08 6. OP31 9 (2) (b) (i) 7. OP38 13 (4) (a) (c) (5) That the laundry floor be impermeable and cleanable for infection control measures. That the registered person 22/08/08 ensures that the person in day to day charge of the home has the necessary qualifications, experience and support to meet the aims and Statement of Purpose of the home. That the registered person 22/08/08 ensures that specialist advice be sought from an appropriate agency in respect of the entrance and steps between the dining room and lounge. That the rope used to deter residents from using the kitchen is reviewed and advice sought from the fire services and occupational therapists. That appropriate environmental risk assessments are put in place to protect the residents. Wilton Lodge DS0000021290.V364469.R01.S.doc Version 5.2 Page 26 To include; Use of call bells Stair lift Stair gate at top of first flight of stairs 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 DS0000021290.V364469.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000021290.V364469.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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