CARE HOMES FOR OLDER PEOPLE
Wilton Lodge 402 Holderness Road Kingston upon Hull HU9 3DW Lead Inspector
George Skinn Unannounced 8 September 2005 9:30 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 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 J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Wilton Lodge Address 402 Holderness Road Kingston upon Hull HU9 3DW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01482 788033 01482 788120 Humberside Independent Care Association Position Vacant Care Home 48 Category(ies) of OP Old Age (48) registration, with number DE(E) Dementia - over 65 (48) of places Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 03/02/05 Brief Description of the Service: Wilton Lodge provides personal care and accommodation for a maximum of 48 older people some of who may have memory impairment. It is owned By Humberside Independent Care Association Ltd (HICA) which is a not for profit organisation.The home is located on Holderness Road, which is too the Eastern side of the city of Hull. The homes location provides service users with easy access to a variety of shops, pubs, public transport etc.The home was rebuilt in 1999 and is a two-storey building with access to the upper floor via a passenger lift. All of the homes bedrooms are single with 42 having en-suite. A number of these single rooms do have a lockable interconnecting door which means couples are able to share a bedroom whilst using the other as a lounge area. The homes theme of decoration reflects its location with old photographs of East Hull and memorabilia from Hull Kingston Rovers. Central to the home is a garden and courtyard area with patio tables and chairs; all service users are able to access these areas safely.The home was designed so as to take full advantage of the bustling community life; lounge areas are located in such a position to ensure service users feel part of the community. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken over 9 hours. Resident records were inspected, staff were interviewed and residents spoken with. The environment was inspected. What the service does well: What has improved since the last inspection? What they could do better:
The home was not functioning very well on the day of the inspection, and it revealed that a lot of the extremely high standards, which are set and normally achieved by the home, were not being fulfilled at Wilton Lodge. The staff were doing their best to care for the residents on the day of inspection in, what appeared to be, quite difficult circumstances. The residents’ records were in a poor condition and some showed that basic care needs were not being met. These are important and instruct the staff on how to care for the residents so that their needs can be fully met. Residents commented on not having baths for a number weeks. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 6 The home has had a lot of new staff since the last inspection, and very few experienced staff remain at the home; the working practises at the home appeared muddled and disorganised with residents saying they are not able to choose when they do things like taking a bath. They said they felt that the home was run more for the convenience of the staff rather than the residents. It is company policy not to employ agency staff unless as a last resort, however, staffing levels at the home have been maintained recently by the use of more agency staff than is usual. The residents were not happy about the amount of agency staff that had been employed over the past few months and thought that this had lead to inconsistency and things being missed which they felt were important like basic care needs. 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. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All of the residents’ needs are assessed prior to moving into the home. EVIDENCE: Those files inspected were consistently maintained and had a copy of the Community Care Assessment. However, the home had not updated their assessments as the needs of the residents had changed. The files were in disarray and very difficult to access the relevant information. This was confirmed by the staff who were unsure whose responsibility it was to maintain the records and found the records impossible to use. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 Resident’s health and personal health needs are not being appropriately met as a result of inadequate case records and poor communication. EVIDENCE: Those files inspected did not contain adequate information to enable the care staff to meet the needs of the residents as their care needs had changed for example one file indicated that a resident was mobile, independent and liked to visit her husband as they lived on separate floors; in reality the lady now has poor mobility, has some dietary needs, and needs far more personal support than indicated in the assessment. The content of the files was found to be extremely muddled and disorganised to the extent that it was impossible to find or to follow any plan of care. This was confirmed by the staff who were unsure whose responsibility it was to maintain the records and found the records impossible to use. The files were badly organised and the daily recording did not give any indication that the needs of the residents were being met. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 10 The record of baths indicated that the residents had not been bathed since April or May this was confirmed by the residents and some commented on not having a bath for about 4-5 weeks; residents also commented on having no key worker and the inability to undertake daily tasks at times convenient to them because of the attitude of some of the agency workers which are being used in abundance at the home to cover the short fall in staffing numbers. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 14 The residents are not being provided with opportunities for stimulation, or are being enabled to lead a lifestyle of their choosing. EVIDENCE: Residents were observed to be sat for long periods of time unstimulated and bored, this resulted in a lot of disruptive behaviour and arguments occurring between residents. Some commented on the recent changes made to the social activities and how these were not to their liking. Some residents commented on not being enabled or supported to undertake tasks at times of their choosing. They felt pressured to do things at the staff’s convenience, and that there was a lack of consistency amongst the staff, saying it depended on who was on duty as to whether things got done or not. They felt that these inconsistencies amongst staff were due, in part, to the amount of agency staff and them not knowing their particular needs or preferences. Observation made around the home indicated that there was an air of disorganisation and lack of leadership. Staff were seen running along the corridors to complete tasks and assisting 3 residents at a time; this is impersonal and puts the residents at risk of harm.
Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 12 The staff commented on feeling rushed and overwhelmed because of the lack of information to help them meet the needs of the residents. The staff were relying on knowledge gained from the now limited numbers of staff who have worked at the home for a long time due to high staff turnover. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home has policies and procedures to protect residents from abuse and staff understand these, however, pratices within the home are abusive in that they deny people their rights. EVIDENCE: The staff have been trained in POVA and did know what to do if they suspected any abuse was taking place and felt it would be dealt with accordingly. Due to the lack of leadership at the home, direction and clarity of roles, there is a potential for situations to arise which could put the residents at risk. An example of this was observed during the inspection which involved a resident being found on the floor by the inspection team, appearing to have fallen, alone in a lounge at the end of a corridor. It was not clear how long she had been there. The staff did attend to her needs appropriately and professionally, once it was brought to their attention, however, the staff were unaware of when she had last been seen by them or how long she had been in that area of the building. As a result of the way the home is currently functioning and residents’ needs not being met then the situation could be considered abusive by denying people their rights and wishes. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 The residents are protected by the homes recruitment protocols. EVIDENCE: Those files inspected contained the appropriate information this included CRB checks and references. The company has undertaken a recruitment drive in Poland and, as a result, many of the new staff are polish. Several residents said that as much as they enjoyed bingo they had stopped going because they could not understand what the entertainments officer who was calling out. During the inspection, the inspector experienced difficulty communicating with one member of staff when enquiring about the eating arrangements. The inspector was informed that staff were relying on each other to translate into Polish when difficulties arose. Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The organisation has the appropriate policies procedures and protocols for the staff to follow, however, it was evident during the inspection that the staff were unclear about roles and responsibilities and lacked direction and leadership, which was having a detrimental effect on the wellbeing of the residents. EVIDENCE: An acting manager is now in post, however, since the departure of the previous registered manager there has been a dramatic deterioration in the running of the home, care records not updated, care staff unsure who is responsible and care needs not being met. Staff were unclear about their responsibilities, the home’s aims and objectives and the organisations mission policy statement and the policies and procedures. However, they were doing their best to care for the residents in, what appeared to be, quite difficult times for the home.
Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 17 Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 3
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x 1 Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 19 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation Requirement Timescale for action 28th February 2006 2. 7 3. 12 4. 14 5. 18 6. 38 12, 13, 14 The registered person must & 15 ensure that service user files contain a full assessment of the service users needs and these are updated as residents needs change. 15 The registered person must ensure that the service users files contain up to date and accurate information and are well organised, so that the health and welfare of the service user can be maintained. 5, 12, 16 The registered person must & 23 ensure that service users find the lifestyle experienced at the home matches their expectations and prefences and satisfies their social, cultural, religious and recreational interests and needs. 12, 15, 17 The registered person must & 20 ensure that the service users are helped and enabled to exercise choice and control over their lives. 5, 13, 17, The registered person must 18, 19, ensure that the working 20, 22 & practises at the home do not put 37 the service users at risk. 10, 12, The registered person must 13, 16 17 ensure that the health, safety
J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc 28th February 2006 28th February 2006 1st December 2005 1st December 2005 1st December
Page 20 Wilton Lodge Version 1.40 & 37 7. and welfare of the service users and staff are promoted and protected. 2005 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 Good Practice Recommendations Wilton Lodge J54_s876_Wilton Lodge_v228790_080905_Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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