Inspection on 24/04/06 for Wilton Lodge

This inspection was carried out on 24th April 2006.

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

The inspector 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 19/10/07

Wilton Lodge 27/11/06

Wilton Lodge 11/05/06

Wilton Lodge 17/01/06

Wilton Lodge 31/08/05

Wilton Lodge 11/12/04

Wilton Lodge 30/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wilton Lodge 77-79 London Road Shenley Hertfordshire WD7 9BW Lead Inspector Mrs Sheila Knopp Unannounced Inspection 24th April 2007 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wilton Lodge DS0000019621.V336017.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 DS0000019621.V336017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton Lodge Address 77-79 London Road Shenley Hertfordshire WD7 9BW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 854623 01923 850019 Wilton House Limited Mrs Ruta Starkute-Nahani Care Home 36 Category(ies) of Dementia - over 65 years of age (36), Old age, registration, with number not falling within any other category (36) of places Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2006 Brief Description of the Service: Wilton Lodge is a care home providing personal care and accommodation for 36 older people who may also have dementia. It is owned by Wilton House Limited, which is a private company. The home was opened in 1990 and consists of a purpose built two-storey building. It is adjacent to Wilton House Nursing Home, but the two homes operate independently. Wilton Lodge is in the village of Shenley, approximately 1½ miles from Radlett. It is within walking distance of local shops, and several pubs and churches are close by. All the homes bedrooms are for single occupancy and have en-suite facilities. A passenger lift provides access to the first floor. Each floor has a lounge and dining area. Residents are able to sit in the front garden, which has a covered seating area and is enclosed by a low wall. There is level access to the front entrance from the main road but access from the car park at the back of the building is via a steep flight of stairs. Details of the latest inspection report are available in the home and copies can be obtained from the manager. The current fees for the service range from £546 - £576 per week. Contractual arrangements may differ for service users funded by local authorities. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information in this report is based on an unannounced inspection by 2 inspectors who spent a total of 16 hours in the home. Information received by the Commission since the last inspection, including a visit to the service on 13th April 2006 to obtain information following an incident, has been included in this report. Survey forms were sent to 12 people who live at Wilton Lodge and 6 health & social care professionals so that they could give their views on the service provided. At the time of writing this report only one survey had been returned from a resident. Where residents were unable to complete them they were forwarded on to their relatives. Three surveys have now been received from health & social care professionals who are currently in contact with residents. On the day of inspection the inspectors had discussions with residents, visitors and staff. Relevant care, management and health & safety records were examined. The inspectors also joined the residents for lunch, which provided the opportunity for more conversation in a relaxed setting. The Registered Manager, Mrs R Starkute-Nahani and the Director who is taking a leading role in the home, Dr G Selimyan, were present at the inspection. What the service does well: The residents who live at Wilton Lodge were positive about the staff that supports them. One resident said the staff are ‘wonderful I couldn’t wish for better’. They reported that they enjoyed their meals. There was a calm atmosphere and residents were relaxed. The laundry service provides residents with smartly laundered clothing to wear. Visitors feel welcome in the home. Three visitors present on the day of inspection were positive about the service and kindness of staff. One person commented that their relative was well cared for and peaceful since coming to stay. All three people confirmed that staff kept them informed of any changes. A relative who received a survey telephoned the Commission to say the home was very good. A healthcare professional said this was a small friendly home. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The company need to review their approach to the provision of dementia care so that it meets current professional guidance. Adopting a person centred approach to care planning, that builds on the life experiences, preferences, skills, strengths and needs of each person, will enable individuals to retain their personal identity and abilities. While there is evidence that the Registered Manager and Directors are challenging poor practice brought to their attention, this inspection identified numerous concerns that could affect the health & safety of residents, which go unrecognised because staff are not translating the information received on training courses into their everyday practice. The lead Director has advised that the company are currently reviewing the training to look at how better learning outcomes can be achieved. The quality of the mealtime experience could be improved by ensuring staff are knowledgeable about the meals being served and residents are encouraged to maintain their independence. The company need to ensure that there are enough care, domestic and maintenance staff to be able to respond to the changing needs of residents and their environment. The company needs to ensure their recruitment practices support the rights of residents to be cared for by staff who are able to converse fluently with them and understand their social and cultural needs Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 7 People who use the service are being put at risk because staff do not understand or apply the required safety standards consistently in relation to fire safety, food hygiene and infection control. Robust quality monitoring systems need to be put in place to ensure the home is being run in the best interest of the people who use the 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 DS0000019621.V336017.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 DS0000019621.V336017.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): Standard 3 & 4 (standard 6 does not apply to this service) People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who are looking to use this service cannot currently be sure that a thorough assessment of their needs will be carried out so that a plan of care setting out how they wish to be supported will be put in place. EVIDENCE: Following notification of a serious incident the Commission reviewed the records of the resident concerned to check the quality of the assessment and admission processes used to ensure staff could meet their needs. A thorough assessment process was not followed which meant staff did not have clear instructions on how to manage specific areas of risk. As the risks increased the care plan was not reviewed to identify any preventative action required. A Statutory Requirement Notice has now been served on the service to ensure the safety and well being of all residents. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 10 The current assessment process does not provide staff with the detailed information required to develop a person centred care plan for those with dementia. Wilton Lodge DS0000019621.V336017.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): Standards 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. While residents who are able to express their views are positive about the support they receive from staff, there needs to be a clearer approach to meeting the needs of residents with dementia so the quality of their lives is improved. The safety of residents is being put at risk by inconsistent practices and poor assessments that lack the detail and rigour required to identify risks and respond to changes. EVIDENCE: Residents confirmed staff were gentle when they provided support with their personal care. One person described how nice they felt after their bath. A relative and a health care professional used ‘content’ and ‘peaceful’ to describe their observations of residents. The care records reviewed showed that residents have regular access to chiropodists, opticians and dental hygienists. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 12 Residents were wearing smartly laundered clothing. Overall the personal hygiene of residents was good and supported their dignity. However staff need to monitor residents who have been identified as self-caring to ensure they are looking after themselves appropriately. Several toothbrushes seen early in the morning were dry and caked. One resident had put their toothbrush back in a mouldy sponge bag. Each resident has a care plan but these are largely generic and are not used to deliver care based on the wishes of the individual. Routines at the home are task based and not person led. Residents are regularly weighed to check if their nutritional needs are being met. There are systems for reporting changes to the resident’s GP for a review but this was not happening in all cases. Residents generally have access to drinks in their rooms and the lounge but they were late being put out on the day of inspection. Two people who had been ill confirmed staff encouraged them to take fluids to keep hydrated. Food and fluid intake was being monitored for several residents who were considered to have problems. However, staff were not filling in the records at the time food or fluids were given but at the end of their shift, which could reduce their accuracy. It was not clear what action had been taken on days when no food had been recorded, or whether staff had clear instructions on the level of fluid required for each person. A recent review of an incident raised questions about whether records are being completed at the time events occur or at the end of a shift. No residents were reported to have pressure sores at the time of this inspection and aids to prevent sores developing were in use. Two health care professionals have raised concerns regarding the varying quality of assessments carried out by staff when deciding if someone needs to go to hospital or requires medical attention. They felt staff could be more proactive in seeking advice and language difficulties could sometimes be a problem. Various issues were identified which could affect the safety of people who use the service. Variable practice in relation to moving residents safely was observed. However, a good transfer from chair to wheelchair was observed. Staff consistently used the footplates on wheelchairs to protect the resident’s feet while the chair was moving. However staff were also seen using an out of date under arm lift, which can cause injury. A health care professional said that moving and handling was an area, which needed improvement. The manager needs to ensure that detailed moving and handling assessments, as well as the tick lists of the action required by staff, are carried out by a person who is trained to do so. For example to assess those who need a lap belt in place when they are being moved in a wheelchair to prevent them falling forward. Where residents are using equipment such as electrically adjustable beds there needs to be a risk assessment in place to ensure the competency of Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 13 that individual to continue to use the controls safely, is reviewed and the safety of the equipment is checked. Prescribed food supplements were being stored past their use by date. A blood glucose-monitoring machine was being shared between residents, which can spread infections and has been subject to recent guidance from the Medicines & Health Care Regulatory Agency (MHRA) since 2004. The latest guidance was issued to care homes on 6/12/06 (MDA/2006/066). It was advised that where staff are monitoring blood glucose levels that they have clearly recorded guidelines, from the GP or community nurse, on the acceptable range for each service user and the action required when the reading is outside this. The box used to dispose of used syringes and blood lancets was kept in the medicines trolley, could also spread infection. The systems for ensuring residents receive their prescribed medication and it is kept under review were found to be in order. To ensure medicines are stored at the correct temperature and therefore clinically effective the temperature of the storage area should be measured when temperatures are at their height rather than first thing in the morning. A maximum/minimum thermometer would enable staff to assess the range of temperatures and take appropriate action. Wilton Lodge DS0000019621.V336017.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 the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live at Wilton Lodge have opportunities to attend activities arranged within the home and local community but this needs to be developed further to provide a service that can respond to the individual needs and preferences of each person. Residents enjoy their meals but the mealtime arrangements but improvements to make them less institutional and encourage independence should be made. EVIDENCE: The activity organiser arranges activities and events for residents at home and in the local community. Recent trips include visits to local pubs and garden centres. Further training is being organised to provide a stronger focus on meeting the needs of people with dementia. All staff need to be involved in providing meaningful activities as residents said they were bored when the activity organiser was on leave. Making resources available around the home to provide sensory stimulation would also be helpful. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 15 The people who use the service confirmed they enjoyed their meals. There was a choice of lunch with plentiful helpings and opportunities for residents to change their minds or have second helpings. Pictorial menus are available to assist residents in making choices and were being used to good effect for a resident who does not speak English. The quality of the mealtimes would be improved for the residents if staff were able to discuss the options available and were familiar with the names of dishes and vegetables served. Great confusion was experienced when pureed tomato was offered when the care worker actually meant mashed potato. A resident jokingly said they were saving up for salt as the saltcellar on the table had been empty for three days. One tomato sauce bottle was taken around to the tables in turn. Making condiments, vegetable dishes, gravy boats and jugs of drink available on each table would encourage greater independence. Table clothes and linen napkins could be considered where appropriate. Matching vases are placed on each table but the effect is diminished as one is held together with sticky tape. For residents with dementia not choosing to or able to use cutlery, a range of range of suitably nutritious finger foods should be made available to support their dignity at meal times. Wilton Lodge DS0000019621.V336017.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): Standards 16 & 18 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Areas have come to light where residents have been put at risk because of unsafe practice. However, the company have demonstrated a willingness to work with the Commission and local authority representatives to improve standards. EVIDENCE: The manager reported no complaints had been received since the last inspection. No complaints have been made directly to the Commission. Recent letters & cards complimenting staff on their patience and kindness were seen. It was suggested staff keep a record of compliments received along side the complaints record. Relatives confirmed they were kept informed of changes and a health care professional said staff took action to address issues brought to their attention. The manager is encouraging relatives meetings as a forum for sharing their views. An incident reported to the Commission, which resulted in a serious injury to a resident who fell from a first floor window is currently subject to investigation under the Hertfordshire County Councils Safeguarding Adult procedure and the Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 17 Environmental Health Department under the Health & Safety at Work Regulations. The Commission has served a Statutory Requirement Notice on the company in relation to poor admission procedures and inadequate response to changes in the individual’s condition. Hertfordshire Adult Care Services have also been holding meetings with the company and other professionals who have contact with residents in the home to review the quality of service provided to the people it funds. Wilton House Ltd directors have been represented and have provided details of an action plan to improve services. Issues regarding the attitude of staff observed at the previous inspection, which resulted in a requirement being made were not seen on this occasion. There is evidence that the manager is challenging staff when an inappropriate approach to residents is identified, such as a brisk approach or a tone of voice, which can sound sharp. Keypad door locks on the first floor restrict the movement of residents around the home and access to outside. The manager needs to ensure any restrictions placed on individual residents are fully assessed and recorded in their care plan so that each person’s rights are fully considered and reviewed. There is limited office space and on occasions information about individual residents was left unattended in public areas of the home. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 18 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): Standards 19 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The safety, comfort and dignity of service users is compromised because of the poorly maintained environment and concerns about infection control practices. Residents are able to maintain their autonomy and independence by adding personal possessions to their rooms and having their own door key. EVIDENCE: Residents are able to personalise their rooms and many have their own key. The manager reported that assistance has been given to a relative to install a satellite dish to enable a resident to view channels in their own language. The premises are shabby and in need of decoration. Furniture and fittings need to be upgraded. The bedroom furniture is some rooms is worn and damaged. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 19 The baths are stained. Tiles are missing from various bathrooms. There is a stain on the corridor carpet outside the ground floor lounge. The automatic self closing device in use had torn a carpet in the doorway of a resident’s room. Staff are not recognising the action they need to take to support the dignity and safety of residents. The manager was requested to remove a broken footstool, which was hazardous. A bench residents sit on outside while they have a cigarette had a crack in it and there was an old piece of equipment lying next to it. A tin can was being used to dispose of cigarette butts. Following a recent inspection of health & safety standards by Hertsmere Environmental Health Department the company have been asked to address a number of concerns including the safety of a low level parapet, the external steps leading to the lower level garden and car park, paving around the building and checks on window restrictors. The Company Directors have reported that a review of the premises is in progress and a copy of the action plan with timescales will be forwarded to the Commission. Defective window restrictors have been replaced. The dependency of residents being admitted has increased since the home first opened and as part of the review the company should consider updating bathing aids, disability equipment and provision of seating and beds to accommodate people of varying heights. There are concerns regarding the prevention of infection in the home. Information from the Health Protection Unit (HPU) and Environmental Health Department (EHO) indicates there was a delay in reporting a recent outbreak of diarrhoea and vomiting which could place residents at risk if the cause goes undetected. There were similar seasonal outbreaks in other care homes at the time. The manager has since put an outbreak log in place to alert staff to any emerging issues and is going on training run by the HPU. The HPU advise that cassette liquid soap containers are used rather than refillable ones as contamination can occur during filling. Care staff need to ensure they are inviting people to wash their hands before meals to reduce the risk of infection. The domestic staff do not appear to have an in-depth knowledge of the cleaning products they are using or the products that should be used where there has been an infectious outbreak and disinfection is required. There is not currently a clearly defined cleaning schedule in place setting out the frequencies with which areas should be cleaned. Cleaning issues were identified on 13/4/07 but had been rectified by the time of the second visit. The domestic staff are also allocated to manage the laundry and go between cleaning and laundry duties on the same shift. Access to the laundry sink for staff to wash their hands was blocked by clutter. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 20 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To protect residents the suitability of staff to work with vulnerable adults is checked before they are employed. However inconsistent approaches to care practices and health & safety issues indicate there needs to be further training and monitoring of staff and allocation of resources to ensure residents are cared for safely by enough staff to carry out the tasks allocated to their role. EVIDENCE: Residents are supported by a relatively stable group of care workers, of whom they speak positively. It was reported that no new staff have been appointed since the last inspection, which confirmed appropriate recruitment procedures were in place to ensure suitable people are employed. A spot check of the records of an existing member of staff confirmed the required checks including a Criminal Records Bureau (CRB) check had been carried out. Minimum staffing levels are being applied across the staff groups, which means they are not able to respond to changes in routines without it having a knock on effect on residents. For example residents didn’t have access to drinks in their rooms until 11.30 am because staff were busy bathing people. Residents in the ground floor lounge were dependent on another resident to pull the call bell if they needed assistance. Residents on the upper floor are limited in their Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 21 access to the garden. Currently 17 care assistants are covering day and night shifts. For the week beginning 23/4/07 8 staff worked 52 hours. Staff regularly work 12 hour shifts with split days off which could affect the approach to residents if staff are tired. The rota indicates there are days during the week when all the staff on the late shift have been at work since 7.30 am. However the majority of staff live on the premises so commuting time does not add to this. Two full time and one part time domestic are employed to carry out cleaning and laundry duties. The company need to look at whether the current establishment of domestic staff can achieve the standards of cleaning required on their current hours as there was evidence the home is not always clean and staff struggle to complete deep cleaning such as taking curtains down. As detailed under Standard 26 of this report, putting a cleaning schedule in place will enable the company to determine whether adequate resources are allocated to this area. Similarly a review of the availability of maintenance staff should be carried out to address maintenance and safety issues in a timely manner. Staff are given the opportunity to have one to one supervision with the manager so that their views on the running of the home can be obtained and their own performance discussed. Although a planned induction programme is available and 65 of staff have achieved care qualifications at NVQ level 2 this inspection identified concerns about the quality of training being provided. This has been identified by the company who are looking beyond the current reliance on video training. While individual training records are maintained the manager would benefit from having access to a computer to put an overall training plan in place to identify any gaps. Gaps in the frequency of fire safety training were identified. A member of the night staff last received fire training in 2004. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 22 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): Standards 31, 32, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The company directors and management team need to demonstrate that they are improving standards in the home for residents who are currently being put at risk because staff are not applying consistent safety standards. The number of issues identified in this report would indicate that the quality assurance system in place is not robust enough to measure and review the quality of service provided to residents. EVIDENCE: Wilton Lodge has recently been through a period of unstable management. The new manager, Mrs Ruta Starkute, was Registered by the Commission on Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 23 23/2/07 following an assessment against criteria set out under The Care Standards Act. The Commission met with 5 representatives of the Wilton House Ltd board of directors on 27/2/07 to discuss the role and responsibilities of the board in ensuring improvements took place. The company should consider ways of making Internet access available to the manager as this is the route professional practice and guidance is being issued and would allow her access to the most recent publications/guidance/good practice guidelines. The company received 24 responses to a survey sent out in February. It was recommended that details of the points raised and action being taken by the company are put into a user friendly formulated and circulated to residents & their relatives. Appropriate records of money kept on behalf of individual residents are maintained so that residents are confident it is being kept securely. Accidents to residents and staff are recorded and reported to the Commission and under health & safety legislation (RIDDOR) as required. The records indicate four people have been admitted to hospital with fractures as a result of falls since the inspection in December. The manager carries out a monthly audit to identify any further preventative action is required. A care plan provided evidence that for one resident the number of falls had decreased following a review. Staff do not currently have access to a community falls coordinator to provide advice in line with government guidance (NSF). Breaches in food safety standards, which could affect the health of residents, were identified. Food was found to be inappropriately stored. Hazardous chemical products were left unattended by staff in areas used by residents. The Environmental Health Department who are the enforcing authority for food standards & health & safety in care homes have been notified of these concerns. The health & safety of staff was put at risk because a fire exit in the laundry was blocked by chairs on both sides and the crash bar was being used to hang clothes on. The Hertfordshire Fire Safety Service has notified the company that they are due to carry out a planned inspection of the premises. The location of the laundry down a steep flight of stairs has safety implications for staff carrying containers of laundry up and down. Routine gas, lift, hoist, fire safety and Legionella checks had been carried out. The manager reported staff carry out checks on the security of window restrictors but no records were being kept. The hot water temperatures were Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 24 found to be within the required safety range. Records of hot water safety checks were available but were not set out to ensure that each bath was tested within a specific time period. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 1 x x x x x x 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 x x 1 Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 26 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 OP3 Regulation 14 15 Requirement You are required to ensure: a) Service users are only admitted to Wilton Lodge following a comprehensive assessment that identifies the action required to meet any known risks. b) Service user care plans details the action, which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of service users are met. c) Service users care plans must be reviewed and updated as their condition changes. d) The assessment and care planning process must demonstrate that service users and or their representatives are fully involved in decisions about how their care needs are to be met. Requirements under these Regulations are subject to a Statutory Requirement Notice. Timescale for action 05/05/07 2 OP4 4 12 A review of the service provided 21/08/07 to people with dementia needs to be carried out to ensure it meets DS0000019621.V336017.R01.S.doc Version 5.2 Page 27 Wilton Lodge 3 OP8 13 4 OP9 13 5 OP9 13 6 OP18 13 7 OP19 23 current professional guidance and this is reflected in the home’s Statement of Purpose. To protect people who use the service from infection, MHRA guidance on the safe use of blood glucose monitoring machines must be followed. Each service user should be provided with their own equipment where required. Subject to an immediate requirement on the day of inspection. To protect people who use the service from infection the sharps disposal box must be removed from the medicines trolley to an alternative locked space. Subject to an immediate requirement on the day of inspection. To protect people who use the service staff must ensure that prescribed food supplements past their use by date are disposed of. Subject to an immediate requirement on the day of inspection. To protect the rights of people who use the service restrictions placed on them by the use of keypad door locks and whether they can have access to the code should be fully recorded in their care plan, kept under review and include details of the person who has made the decision, where the person lacks capacity to consent. To provide people who use the service with a safe dignified home to live in a full audit of the premises needs to be carried out and a programme of replacement and renewal must put in place. DS0000019621.V336017.R01.S.doc 24/04/07 24/04/07 24/04/07 21/08/07 21/08/07 Wilton Lodge Version 5.2 Page 28 8 OP26 13 9 OP27 18 10 OP33 24 Torn or stained carpets must be replaced. Worn and damaged furniture must be replaced. Broken tiles must be replaced. Baths must be stain free. To protect people who use the 08/06/07 service from infection an auditing system should be introduced. • Outbreaks of infection must be referred to the HPU & EHO departments when they are identified. • Cleaning schedules must be put in place. • Clear guidance on the products used for cleaning and disinfection must be available to staff. Carry out a review of the staffing 21/08/07 establishment and allocation of resources to ensure matters affecting residents can be met in a timely manner. To ensure all aspects of the 21/08/07 service are being run in the best interests of service users a robust quality assurance systems must be put in place. Previous requirement NMS 33 (20/12/06). Further breaches may lead to enforcement action being taken. To protect people who use the 24/04/07 service, staff and visitors fire exits must remain clear from obstruction at all times. Subject to an immediate requirement on the day of inspection. To protect people who use the 24/04/07 service regular safety checks on the integrity of window restrictors should be carried out and records maintained. DS0000019621.V336017.R01.S.doc Version 5.2 Page 29 11 OP19 OP38 23 12 OP38 13 Wilton Lodge 13 OP38 13 14 OP38 13 15 OP38 13 To protect the safety of people who use the service: • A qualified first aider should be available at all times. • Moving & handling assessments must be completed by a competent person. • Staff must use approved moving & handling techniques. • All staff must have fire safety training in line with the requirements of the fire safety service. • Risk assessments must be in place where residents are using electrically operated equipment such as adjustable beds and recliner chairs. Safe moving & handling has been subject to a previous requirement (20/12/06). Further breaches may lead to enforcement action being taken. To protect the safety of people who use the service substances such as cleaning products, which could be hazardous to their health, must not be left unattended and kept locked away when not in use. Subject to an immediate requirement on the day of inspection. To protect the safety of service users staff need to ensure that, in consultation with the Environmental Health Department, food is correctly stored and labelled. Subject to an immediate requirement on the day of inspection. 21/08/07 24/04/07 24/04/07 Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP26 Good Practice Recommendations Review refillable liquid soap containers in light of HPA guidance that using cassette containers reduces the risk of contamination. Wilton Lodge DS0000019621.V336017.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000019621.V336017.R01.S.doc Version 5.2 Page 32 - 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. 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