Inspection on 27/11/06 for Wilton Lodge

This inspection was carried out on 27th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wilton Lodge 19/10/07

Wilton Lodge 11/05/06

Wilton Lodge 24/04/06

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 Marian Byrne Unannounced Inspection 10:00 27 November 20 December 2006 & th th 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.V327303.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.V327303.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 Manager post vacant 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.V327303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 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. The home is located in the village of Shenley, approximately 1½ miles from Radlett. It is within walking distance of local shops, and several pubs and churches are close by. All the homes bedrooms are single and all have en-suite facilities. The first floor is accessed by a passenger lift. A sun lounge forms part of the homes entrance. There is an enclosed front garden with a lawn and seats that is well maintained and easily accessible. A car park is available at the back of the building. Information about the current range of fees was not available. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over three visits two by a regulation inspector and one by a pharmacy inspector. The report by the Pharmacy inspector is published separately. Information received in the office regarding the care of service users in the home was used as part of the inspection planning. What the service does well: What has improved since the last inspection? What they could do better: The inspector observed staff using techniques to assist service users move that could cause them injuries. One senior carer was observed to ‘tease’ a service user to the extent that the inspector concluded that the service user was made to feel frightened. Another incident, again with a senior carer, observed to assist a service user with lunch in a manner that was outpacing her and lacking in dignity. The home is now run for the convenience of staff and is task led. This means that service users were often outpaced by staff, in moving and handling and assisting with eating and changes were made to the lunch time serving of lunch without consulting the service users. The new Manager is aware of this and in conjunction with the Area Manager is determined to change the culture of the home. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 6 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.V327303.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Service users have their needs assessed prior to admission to the home. EVIDENCE: Four care plans were inspected and all had the details required by the standard. This includes details of physical health, medication and any input from health care practitioners. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10. Quality in this outcome area is poor. This would have been adequate except that the actions of two senior carers indicates that the home is not run in the best interests of the service users. This judgement has been made using available evidence including a visit to this service. Care plans were good. Health care needs were met. Medication was in the main administered appropriately. Senior cares were observed to treat service users without dignity or regard for their feelings or abilities. EVIDENCE: Care plans contained good information, were clearly set out and were reviewed regularly. Since the last inspection there was an suspected incident of TB in the home. All the appropriate guidelines were followed, including reporting it to infection control health care professionals. On the day of the inspection health care professionals were present in the home testing service users and staff for TB. On the day of the inspection none of the service users had pressure sores. Service users on the ground floor have access to the outside and regularly use the pub across the road. Care must be taken to ensure that service users on Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 10 the top floor have access to fresh air on a regular basis. The requirements left at the visit where administration of medication was inspected were in the main met. There was one gap in the medication administration record, this had not been addressed. The inspector observed a service users requesting assistance to use the toilet. A senior carer joked with the service user saying that she would leave her locked in the ‘loo’. The female service user was not amused, the staff while joking was unable to read the situation and continued to ‘joke’ the service user said that she would ask another member of staff. The senior staff member then said that she would tell her colleagues to lock her in the loo. The service user then said that she would not use the toilet. The senior staff member appeared to be totally unaware of the intimidating effect she was having on the service user and appeared to think the incident amusing. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The daily life of the home is task led and operates for the convenience of the staff rather than ensuring the inclusion, dignity and comfort of the service users. The inspector was unable to judge the quality of the food due to the lunch time being changed. EVIDENCE: Staff on duty on the day of the inspection appeared to be task led and were unaware of the effect that it was having on service users. For example the inspector wanted to observe lunch and was given the time lunch was to be served. When the inspector got to the dining room at the given time only two service users were eating. The reason for this was that one male service user had to have an early lunch due to a hospital appointment one staff member made the decision to serve lunch early. There was no evidence that service users had been consulted. Of the two service users left in the dining room one was facing the wall sitting alone, the other was also sitting alone. Staff were clearing away and washing the floor. The inspector asked what the usual routine was and was told the dining room was cleared when the service users had finished. The staff appeared to be unaware that two service users were Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 12 still eating. The service users facing the wall had not eaten much of her lunch, a senior carer sat beside her and started to ‘feed’ her with a desert spoon. The member of staff did this in a manner that outpaced the service user and appeared to be impatient. She left the table twice while assisting the service user not telling the service user she was going or when she would be back. The new manager was aware that this practice is not acceptable. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some senior cares staff do not understand their obligations to protect to vulnerable service users. EVIDENCE: See previous standard. The manager had booked Protection of Vulnerable Adults training for the week following the inspection. There is one complaint where the investigation and correspondence is ongoing. On a day to day basis one member of staff did not appear to understand what listening to service users meant. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main the environment was adequate. Some of the rooms had odours that could be associated with incontinence. EVIDENCE: On the day of the inspection the home was with a few exceptions clean, fresh and odour free. Two rooms had odours that could be associated with incontinence. The manager undertook to change the floor covering in those particular rooms. The manager should review the lay out of the sitting rooms to ensure the optimum life style choice for service users. The home is well maintained. All rooms inspected had been personalised to reflect the personality of the service user. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Senior staff do not have the knowledge or training to meet the needs of service users. EVIDENCE: The skills of the staff must be improved to meet the needs of the service users in relation to dignity and moving and handling. Staff must realise that the home should be run to meet the needs of the service users and not the staff. Care is task led rather than led by the needs and abilities of the service users. The inspector observed staff outpacing service users when assisting then to walk and to eat. The inspector also observed what could be described as ‘mockery’ and ‘intimidation’. The inspector did not feel that this was done deliberately but through a lack of training and insight into the needs of very vulnerable service users. Staff did not show any understanding of service users who have dementia. Staff who were observed assisting service users to move did so in a manner that could cause injury and in a manner that could be seen as infantilazation – leading service users by the hand. Staffing rotas have been reviewed and are now drawn up to meet the needs of the service users rather than the staffs’ needs. This inspection highlighted training needs for staff this include assisting service users to eat in a dignified manner, moving and handling and the care of service users who have dementia. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35&38. Quality in this outcome area is adequate. A new manager has been recently appointed making it difficult to make an informed judgement. EVIDENCE: This last inspection indicated that this home has been badly managed. The Commission did not register the last manager. Some senior observed by the inspector and mentioned earlier in this report do not act in the best interests of the service user and there appears to be a culture of running the home in the best interests of staff and not the service users. The new manager has made some progress and is aware of what must be done to improve the care of vulnerable service users. She is well supported by her line manager who was also present at the inspection. The manager informed the inspector that staff had had moving and handling training but continued to assist service users in the way that had been established in the home. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 17 The inspector checked the finances of four service users and found them to be in order. The moving and handling procedures in the home must be reviewed and training put in place to ensure service users are not put at risk through poor practices in moving and handling as observed by the inspector. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP28 Regulation 18 Requirement The registered person must ensure that staff are trained to carry out their duties of care to service users. This includes maintaining dignity and ensuring their physical and emotional welfare. The registered person must ensure that the dignity of service users is maintained by ensuring food is taken in a congenial setting and assistance with feeding in carried out in an appropriate manner that does not compromise the service users dignity. The registered person must ensure that all service users are free from abuse and neglect by staff. The Registered Person must ensure that the home is run in the best interests of the service users. The Registered Manager must DS0000019621.V327303.R01.S.doc Timescale for action 15/02/07 2. OP10 OP15 12, 16 15/02/07 3. OP18 13 15/02/07 4. OP14 OP33 12 15/02/07 5. OP26 23 15/02/07 Page 20 Wilton Lodge Version 5.2 ensur3e that the home is free of offensive odours. 6. OP38 13 The Registered Person must ensure that the health and safety of service users is protected through the use of safe moving and handling techniques. The registered person must ensure that medication is administered as prescribed and any indication that an error may have been made is investigated e.g. a gap on the MAR chart. 15/02/07 7. OP9 12 15/02/07 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. 2. Refer to Standard OP12 OP26 Good Practice Recommendations The registered Person should ensure that service users on the top floor have regular access to fresh air. All parts of the home should be free from offensive Odours. Wilton Lodge DS0000019621.V327303.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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.V327303.R01.S.doc Version 5.2 Page 22 - 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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