Inspection on 23/08/07 for Wilton Lodge

This inspection was carried out on 23rd August 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wilton Lodge 27/04/09

Wilton Lodge 22/05/08

Wilton Lodge 05/02/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 55 Wilton Road Bexhill-on-sea East Sussex TN40 1HX Lead Inspector Andrea Leverett Unannounced Inspection 23rd August 2007 03:00 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.V345604.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.V345604.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 www.angelhealthcare.co.uk Angel Healthcare Limited Vacant Care Home 12 Category(ies) of Dementia (12) registration, with number of places Wilton Lodge DS0000021290.V345604.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. 30th October 2006 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. The scale of charges as of August 2007 are: Lowest fee £ 420.00 Highest fee £ 530.37 Cost of item (£) Items not covered by fee Hairdressing Chiropody Various Various Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 23rd of August 2007. Four people who use the service were spoken with as well as 2 staff members, and the assistant manager. Some judgements about quality of life and choices were taken from direct discussions with and observations of people who use the service on the day of this site visit, followed by discussion with support staff and evidencing records held at the home. The inspector concluded that on the whole staff work hard to try and meet peoples needs but poor management practices and inadequate staffing levels are undermining this. During the site visit staff were observed interacting with people who use the service in a respectful and dignified manner. Staff responded sensitively to people’s needs and feedback from people who use the service and who were able to express a view, were positive about the staff support provided. Wilton Lodge is still without a registered manager and has failed to meet requirements from the last three inspections regarding this. Although feedback from people who use the service and staff suggested they felt supported by the assistant manager and some improvements have been noted in key areas, the lack of appropriate management is continuing to undermine the health, safety and well being of people who use this service. The home has not made sufficient improvements and many requirements in key areas such as risk assessments care plans, staffing levels, staff recruitment, staff supervision and induction, and the maintenance of the environment remain outstanding. What the service does well: During the site visit staff were observed interacting with people who use the service in a respectful and dignified manner. Staff responded sensitively to Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 6 peoples needs and feedback from people who use the service was positive about the staff support provided. What has improved since the last inspection? What they could do better: More needs to be done to ensure that people who use the service have their needs fully assessed and the Home can demonstrate they can meet those needs before they move in. More needs to be done to ensure that the homes service user guide includes information about the scale of charges and people who use the services contracts have up to date information regarding fees. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 7 More needs to be done to ensure that people who use this service benefit from care plans that give sufficient information about their needs and how these should be met. Appropriate health records need to be maintained to evidence that people’s health needs are properly monitored and met. More needs to be done to ensure that people do not share rooms unless they have made an informed decision to do so and it is in keeping with their needs and wishes. On the whole a varied balanced diet is provided but people are not being properly supported to ensure that individual nutrition and specialist dietary needs are met. More needs to be done to ensure that the homes kitchen is kept clean and facilities and equipment are maintained appropriately. The environment for people who use this service is not appropriate for people with dementia and mobility needs, as there is no space for them to wander. A recommendation has been made that an Occupational Therapy assessment is undertaken of the premises and facilities to explore possible ways of improving the environment in terms of lay out and aids and adaptations. Staffing levels must be sufficient to meet people who use the services needs and all staff training records should evidence that Food Hygiene, first aid and infection control had been undertaken Although POVA and Criminal Record Bureau checks are in place an inspection of the homes staffing rota showed that the two most recently employed staff members had been allowed to work in the Home prior to POVA checks being undertaken. This shows that the homes recruitment practices are still not adequate to protect people. More needs to be done to ensure that staff receives appropriate guidance and support in terms of supervision and staff induction. Although some improvements have been made, overall the Home is not being managed properly and poor management practices are undermining the health safety and wellbeing of people who use this service. A requirement was made at the last inspection that the Home must produce a development plan, based on a systematic cycle of planning –action-review, reflecting the aims and outcomes for people who use this service and that the registered person maintains a system for evaluating the quality of the services provided at the Home. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 8 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.V345604.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 People who use the service experience adequate quality outcomes in this area. On the whole the homes statement of Purpose and Service User Guide provides sufficient information to ensure that people who may wish to use this service can make an informed decision to do so, but more needs to be done to ensure that people have up to date information about scales of charges. People who use this service do not have accurate and up to date contracts. People who use this service cannot be confident that their needs will be fully assessed and met before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home now keeps copies of the homes Service User Guide and statement of Purpose in each persons file. An inspection of this document showed that it Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 11 has been updated and now includes most of the information required to enable people to make an informed choice about using the service. It was noted however that the document did not include the scale of charges and people who use the services contracts did not have up to date information regarding fees. The Home has been required to ensure that this information is provided in the guide and accurate information regarding fees are included in people who use the services contracts. Three assessments of people who use the service were inspected as part of case tracking. Although all three assessments were in place these did not include sufficient information to enable the Home to formulate a comprehensive plan of care. The assessments did not give enough information regarding risk assessments, particularly around moving and handling and environmental risk assessments. The assessments did not give enough information regarding people’s social and recreational needs. Requirements have been made that the Home ensures that assessments provide sufficient detailed information to enable a full plan of care to be put in place. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience Poor quality outcomes in this area. People who use this service do not benefit from care plans that give sufficient information about their needs and how these should be met. People who use this service cannot be confident that their health needs are fully met. On the whole people who use this service are protected by the homes medication practices but more needs to be done to ensure that the Home can evidence staffs competency to administer medication. On the whole people who use this service can be confident that they will be treated with respect but more needs to be done to ensure their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 13 EVIDENCE: Three care plans were inspected as part of the case tracking process. Although it was clear that improvements had been made in some areas, information was still limited. Risk assessments still need to be improved upon for example moving and handling care plans and risk assessments are not specific about how a person should be moved and what equipment should be used. Although people who use the service were observed having access to the homes kitchen, risk assessments and care plans are not in place to give information about possible risks and areas that the person may need guidance and support. Care plans inspected did not include social, recreational and therapeutic plans of care and so it was not clear how activities and support provided was in keeping with peoples needs. Records showed that care plans are being reviewed more regularly but these are still not being done every month in keeping with good practice. There are outstanding requirements from previous inspections regarding risk assessments and the need to review care plans monthly and these remain outstanding. Although the assistant manager stated that some people were supported to access dentists and opticians and information in people’s daily notes showed that they had access to Doctors a record of routine and specialist health input was not being maintained for each person. A requirement has been made that the Home evidences that people who use this service have regular access to specialist and routine health services in keeping with their needs. Records also showed that people are not being weighed regularly and nutritional risk assessments are not undertaken. A further requirement has been made regarding this. A requirement was made at the last inspection regarding the need to ensure that all staff that administers medication are trained to do so. An inspection of staff training records and the homes staffing rota showed that this requirement has been complied with. However the Home does not have a system in place to evidence staff competency to administer medication. Discussion took place regarding the need to evidence that medication is covered as part of an induction process and that a system is in place to evidence ongoing competency of staff. During the site visit staff were observed interacting with people who use the service in a respectful and dignified manner. Staff responded sensitively to peoples needs and feedback from people who use the service was positive about the staff support provided. Improvements have been made to the homes bathroom since the last inspection. The bathroom door now closes Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 14 properly and so protects people’s privacy. It was noted that two people with learning disabilities and dementia share a room and assessments were not in place to evidence that this was appropriate. Information gathered at the site visit suggest that this arrangement is not in keeping with their needs. A requirement has been made that the Home review this arrangement and ensure that people do not share bedrooms unless they have chosen to do so and it is in keeping with their needs. Typical comments included: “The staff are nice and treat me respectfully, I go to bed and get up when I like.” “ It is nice here.” Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15 People who use the service experience adequate quality outcomes in this area. People who use this service can not be confident that the lifestyle experienced in the Home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. People who use this service are supported to maintain contact with family and representatives but access to the local community is not consistent. People who use this service are not given sufficient support to exercise choice and control over their lives. On the whole a varied balanced diet is provided but people are not being properly supported to ensure that individual nutrition and specialist dietary needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 16 The homes activity record book and discussion with staff and people who use the service showed that activities are provided including walks and shopping trips. The Home also has some input from an activities co coordinator. However activities are not consistent and there is no planned programme of activities in place. As stated previously assessments and care plans do not reflect peoples social, recreational and therapeutic needs and so it is not clear how activities provided are in keeping with their needs and wishes. Staff spoken to confirm that activities are not consistent and said that they do not always have time to do things with people. There is an outstanding requirement from the last two inspections regarding the appropriate provision of recreational activities and this remains outstanding. A requirement has been made in the staffing section of this report regarding the need to review staffing levels to ensure that needs are consistently met. An inspection of the homes menu’s and food stocks was undertaken and although menu’s seemed varied and balanced information about peoples dietary needs and preferences are not included in their care plans and assessments. For example both the assistant manager and the owner informed the inspector that several people had eating and drinking assessments in 2002, but eating and drinking care plans are not in place to reflect these assessed needs. The assistant manager told the inspector that one person who has to have their food blended has all their meal blended together. Discussion took place regarding the fact that this is not good practice and that the different food groups should be blended and presented individually on the plate. A requirement has been made regarding the need to include dietary needs and preferences in care plans and a recommendation that advice and training are sort to ensure that soft diets are prepared and presented in line with good practice. Feedback included: “I would like more choice of food, I like roast dinners but don’t get many, and I like fish and chips but don’t get those much” “Staff come and take me down the shops, I like going down the shops.” Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 17 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience good quality outcomes in this area. People who use this service can be confident that their complaints will be listened to and acted upon. People who use this service can be confident that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home has updated its complaints procedure since the last inspection and now includes accurate information required by this standard. Discussion with the assistant manager showed that complaints received within the last 12 months have been managed appropriately by the Home. Information regarding a resent adult protection issue showed that the Home responded appropriately to protect vulnerable people. Training records showed that most staff has received adult protection training and the assistant manager informed the inspector that more is being planned. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 19 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): 19,26 People who use the service experience poor quality outcomes in this area. On the whole the Home is clean, pleasant and free from offensive odours but some improvements are needed in key areas. People who use this service are being put at risk because of lack of maintenance of essential equipment and facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the Home was undertaken at the site visit and a sample of maintenance records was seen. On the whole the Home was clean, reasonably Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 20 decorated and free from offensive odours and the homes lounge area has been redecorated and a new carpet was being fitted on the day of the site visit. As stated previously the homes bathroom door now closes properly and window restrictors have been fitted. Although the homes kitchen was tidy the fridge, cooker, storage areas and some plastic food containers are in need of a deep clean and a requirement has been made regarding this. It was also noted that in addition to the direct care of people who use the service staff are required to undertake laundry, cleaning and cooking tasks and feedback from staff suggest that staffing levels are not sufficient to enable some tasks to be done effectively. Maintenance records showed that an appropriate gas safety certificate was in place but there was still no evidence that an electrical wiring certificate is in place as required at previous inspections. It was also clear that the Home was not carrying out annual electrical equipment safety checks and a requirement has been made regarding the need to do this. The homes mobile hoist and fire equipment showed that they are maintained and inspected regularly. The door to the basement of the Home leads to a very steep set of stairs and was found unlocked on several occasions during the site visit. The basement of the Home accommodated the laundry facilities and so is accessed regularly by staff. However the door does not lock from both sides and so presents a hazard to peoples safety. A requirement has been made that this is addressed. As stated at previous inspections the environment for people who use this service is not appropriate for people with dementia and mobility needs, as there is no space for them to wander and also there are three flights of stairs to the office. A recommendation has also been made that an Occupational Therapy assessment is undertaken of the premises and facilities to explore possible ways of improving the environment in terms of lay out and aids and adaptations. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 People who use the service experience poor quality outcomes in this area. The homes ability to meet people’s needs is being undermined by poor staffing levels. Improvements have been made to the homes recruitment practices but these are still not robust and do not offer protection to people living in the Home. People who use this service have benefited from improvements in staff training but significant improvements are still needed in key areas such as staff induction. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is an outstanding requirement from previous inspections that staffing levels must be sufficient to meet people who use the services needs. Since the last inspection the Home has reduced staffing levels further and now only have two care staff in the mornings and afternoons and one waking and one sleeping in staff during the night time period. In addition to this the Home has an assistant manager and some input from an activities co coordinator. People who use this service have a combination of needs including dementia, learning Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 22 disability and mobility needs and in addition to the direct care of people staff are required to undertake laundry, cleaning and cooking tasks. Domestic duties are being carried out to the detriment of giving care. Care must be given the priority so that the assessed care needs and dependency of people are met and also the services aims and objectives and Statement of Purpose. Although it is acknowledged that the Home is currently supporting one less person, feedback from staff, activity records and observation on the day of the site visit evidenced that staffing levels are not sufficient to meet peoples needs and therefore the requirement regarding this remains outstanding. An inspection of the homes training records and discussion with staff evidenced that staff training has improved. Records showed that staff are trained in moving and handling, emergency first aid, fire, medication administration, infection control and an introduction to dementia training. There was also evidence that some staff has completed NVQ level two in care and others are currently undertaking it. Some staff training records did not evidence that Food Hygiene; first aid and infection control had been undertaken although the assistant manager thought that most staff has undertaken these. A requirement has been made that the Home is able to evidence training undertaken by all staff. An inspection of staff files showed that significant improvements have been made to the homes recruitment and selection procedures and practices, although the outstanding requirement from previous inspections has still not been fully met. An inspection of the records of the two most recently employed staff members showed that appropriate references and employment histories are now being sought. Files also had staff photos and proof of identification. Although POVA and Criminal Record Bureau checks are in place an inspection of the homes staffing rota showed that the two most recently employed staff members had been allowed to work in the Home prior to POVA checks being undertaken. This shows that the homes recruitment practices are still not adequate to protect people who use the service and the requirement regarding this therefore remains outstanding. Although the assistant manager stated that the Home is trying to work towards the new induction standards there are no induction records to evidence this and a requirement has been made. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 23 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 the service experience poor quality outcomes in this area. Although some improvements have been made, overall the Home is not being managed properly and poor management practices are undermining the health safety and wellbeing of people who use this service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Home continues to be without a registered manager despite previous requirements to provide one. The assistant manager who is supported by the owner is currently managing the Home on a day-to-day basis. The assistant Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 24 manager has no previous management experience or a management qualification. He has recently completed his NVQ care level 2 and has undertaken a range of mandatory training including a medication foundation and assessors course, emergency first aid, moving and handling, adult abuse, food hygiene, fire training and risk assessment training. Despite an outstanding requirement to provide appropriate staff supervision staff records showed that most staff have only received one supervision this year, most of which had not been undertaken until the month of August. Although feedback from people who use the service and staff suggested they felt supported by the assistant manager and some improvements have been noted in key areas, the lack of appropriate management is continuing to undermine the health, safety and well being of people who use this service. The home has not made sufficient improvements and many requirements in key areas such as risk assessments care plans, staffing levels, staff recruitment, staff supervision and induction, and the maintenance of the environment remain outstanding. The assistant manager informed the inspector that the Home does not look after any money for people and that families or other representatives manage this. The inspector was concerned that a lack of appropriate access to their money and support to manage it may be undermining their right to make choices about how their money is spent. A requirement has been made that financial assessments and care plans are put in place for all people who use the service. A requirement was made at the last inspection that the Home must produce a development plan, based on a systematic cycle of planning –action-review, reflecting the aims and outcomes for people who use this service and that the registered person maintains a system for evaluating the quality of the services provided at the Home. This information was not available in the Home at the time of the site visit. Although the owner did forward a development plan to the inspector at a later date, the document did not give sufficient information about Wilton Lodge and how it was meeting people’s needs. It was a concern to the inspector that the document did not refer to any of the issues and requirements that have been made at previous inspections or what the service planned to do to meet people’s specific needs in the future. Although the assistant manager informed the inspector that the Home did use questionnaires to seek the views of people who use the service and their representatives, no evidence of this was seen at the site visit and was not included in the homes development plan. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 25 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 26 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 2 2 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X X 1 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP31 Regulation Reg8(1) & 9(2b,i) Requirement 1) The Organization is required to appoint a manager that they have recruited and retained that has the appropriate experience, qualifications and competencies to manage the service and be in day-to-day control. 2) That the manager when they are appointed makes an application to be registered in respect of the service so that they are in compliance with the Care Standards Act 2000 and the associated legislation. (This has been a previous requirement over the past three inspections, last timescales of the 01/08/06 and 01/02/07) 2 OP1 Reg 4(1), 5(1)(a)(b) (c) (d) (e)(f)& (3) That the home has a Statement of Purpose and Service User Guide that is up to date and provides accurate information about the home and the service it provides. (This was a previous requirement 01/08/06 and 16/12/06) DS0000021290.V345604.R01.S.doc Timescale for action 14/11/07 14/10/07 Wilton Lodge Version 5.2 Page 28 This requirement is still not fully met in that the documents do not provide information about the scale of charges 3. OP2 Reg 5(1)(b) That each service user is provided with a copy of terms and conditions which meets NMS 2 and evidence of this is kept in the home. ( this was a previous requirement. The last time scale was 16/12/06. This requirement is still not fully met in that contracts were not being kept up to date and did not reflect actual fees being charged. 14/10/07 4. OP7 Reg 15(1)(2)( a)(b)(c)(d ) 14/11/07 Unless it is impractical to carry out such consultation, the registered person shall, after consultation with the service user, or representative of his, prepare a written plan( the service user plan)as to how the service users needs in respect of his health and welfare are to be met. The registered person shalla) Make the service user plan available to the service user: b) Keep the service users plan under review: c) Where appropriate and unless impractical to carry out such consultation, after consultation with the service user or a representative of his, revise the service user plan: and d) notify the service user of any such revision. Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 29 In that care plans must include mobility, health, nutrition and dietary needs, communication, financial, social, recreational and therapeutic needs. Also review service users needs in terms of sharing rooms and ensure that people do not share bedrooms unless they have chosen to do so and it is in keeping with their needs. (Previous requirements relating to this regulation not met. Last time scales 01/08/06 and 16/12/06 ) 5. OP8 Reg 13(4)) The registered person shall 14/10/07 ensure thata) All parts of the Home to which service users have access are so far as reasonably practicable free from hazards to their safety: b) Any activities in which service users participate are as far as reasonably practicable free from avoidable risks: and c) Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In that full and comprehensive risk assessments are undertaken for each service user covering all aspects of care and safety. In that equipment and facilities in the Home are maintained to a safe standard including electrical wiring and electrical equipment. (Previous requirements relating to this regulation have not been fully met. Last time scales were 01/08/06) Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 30 01/12/06 and 16/12/06) 6. OP9 Reg 13 (2) The registered person shall make 14/10/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care Home. In that the Home must ensure that it has a system in place to evidence staff competency to administer medication as part of a medication induction and on an ongoing basis. (Previous requirement relating to this regulation was not met. Last time scale was 01/12/06) 7. OP12 Reg 16(2)(m)( n)Reg 43 The registered person shall having regard to the size of the care Home and number and needs of service usersm) Consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communication with their families and friends. n) Consult service users about the programme of activities arranged by or on behalf of the care Home, and provide facilities for recreation including having regard to the needs of service users, activities in relation to recreation, fitness and training. In that the Home evidences through service user assessments and cares plans that activities being provided are in keeping with their needs and wishes and are consistent. 14/11/07 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 31 (Previous requirements relating to these regulations have not been met. Previous time scales 01/08/06 and 16/12/06) 8. OP27 Reg 18(1)(a) That at all times suitably qualified and experienced persons are working in the home, in the capacity of carers, in numbers that are appropriate for the safety and well being of residents. In that the number of staff on duty on each shift must be reviewed using the Guidance document issued by the DOH Care Staffing in Care Homes for Older Persons. Also the number of staff rotered for each duty must be based on the dependency of each person rather than the number of people currently accommodated, (Previous requirements relating to this regulation have not been met. Previous timescales 01/08/06 and 16/12/06) 9. OP29 Reg The registered person shall not 21/09/07 19(1)Sche employ a person to work in the dule 2 care Home unlessa) The person is fit to work in the care Home: b) Subject to paragraph (6) he has obtained in respect of that person the information and documents specified in(i) paragraph 1 to 7 of schedule 2. This requirement has still not been fully met in that satisfactory CRB and POVA checks are still not in place for all care staff prior to their DS0000021290.V345604.R01.S.doc Version 5.2 Page 32 14/10/07 Wilton Lodge commencement of employment at the home. (Previous requirements relating to this regulation have not been met. Previous timescales were 01/08/06 and 16)12/06 10. OP33 Reg 24 (1)(a)(b) (2) & (3) The registered person shall establish and maintain a system fora) Reviewing at appropriate intervals: and b) Improving, The quality of care provided at the care Home. (2) The registered person shall supply to the commission a report in respect of any review conducted by him for the purposes of paragraph (1) and make a copy of the report available to service users. (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representative. That there is a development plan for the home, based on a systematic cycle of planningaction-review, reflecting the aims and outcomes for residents, and that the registered person maintains a system for evaluating the quality of services provided at the home. (A previous requirement made in relation to this regulation has not been met. Previous timescale was 01/01/07 11. OP36 Reg 18(2) The registered person shall ensure that persons working in the care Home are appropriately supervised. A previous requirement made in DS0000021290.V345604.R01.S.doc 14/11/07 14/10/07 Wilton Lodge Version 5.2 Page 33 12 OP30 Reg 18(1) (C)(i) relation to this regulation has not been met. Previous timescale was 01/12/06 The registered person shall, 14/11/07 having regard to the size of the care Home, statement of purpose and number and needs of service usersEnsure that the persons employed by the registered person to work at the care Home receive training appropriate to the work they are to perform: and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work; In that all staff must receive appropriate induction training and that records are maintained to evidence that all staff have undertaken appropriate training in all areas as needed. 13 OP26 23(2)(d) The registered person shall have regard to the number and needs of the service users ensure that all parts of the Home are kept clean and reasonably decorated. In that the Home must consult with the EHO and ensure that the standards of cleanliness in the kitchen are in keeping with regulations. 14/10/07 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 34 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 OP16 Good Practice Recommendations That improved reporting mechanisms are introduced in cases where external agencies are to be informed, or involved in handling matters of complaint. That a cleaner is employed, who may also carry out carpet cleaning and laundry tasks, to ensure that consistently satisfactory standards of cleanliness and hygiene are maintained, also to free up care hours in meeting the levels agreed by the National Residential Forum. That the manager’s office base be suitably sited on the ground floor of the building, where there may be regular contact with residents and staff, indicative of a more ‘hands-on’ approach. That there is a development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for residents. That the required target ratio of 50 care staff trained, or in training to the required NVQ standard is achieved. That advice and training are sort to ensure that soft diets are prepared and presented in line with good practice. 2. OP26 3. OP31 4. OP33 5. 6 OP28 OP15 Wilton Lodge DS0000021290.V345604.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Maidstone Local 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.V345604.R01.S.doc Version 5.2 Page 36 - 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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