Inspection on 17/07/06 for Woodside Lodge Resource Centre

This inspection was carried out on 17th July 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

Woodside Lodge Resource Centre 17/04/07

Woodside Lodge Resource Centre 06/04/06

Woodside Lodge Resource Centre 11/10/05

Woodside Lodge Resource Centre 01/06/05

Woodside Lodge Resource Centre 17/11/04

Woodside Lodge Resource Centre 27/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Woodside Lodge Resource Centre Wimpson Lane Maybush Southampton Hants SO16 4PS Lead Inspector Mr Richard Slimm Unannounced Inspection 17th July 2006 10:00 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 Woodside Lodge Resource Centre DS0000039181.V297955.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. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Woodside Lodge Resource Centre Address Wimpson Lane Maybush Southampton Hants SO16 4PS 023 8077 6141 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) Southampton City Council Mrs Janet Harris Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27) of places Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th April 2006 Brief Description of the Service: Woodside Lodge is a registered residential care home with a day centre that uses some areas of the home that used to be solely for residents. The home provides long stay or short stay residential services to older people (65 plus) living in the west and central areas of Southampton City. The home is registered to look after people with specialist older persons care needs, who have dementia, also caring for people with progressing dementia and/or physical frailty. The stated purpose of the service is to provide a person centred care approach, that will also focus on using the physical environment and multi-sensory methods to enable positive interactions and communication with people. All service users are accommodated on the ground floor in single room accommodation. The home has the resources to enable service users to live on separate wings in smaller groups, but currently this is not very effectively achieved. The home is situated approximately 2 miles from Southampton City centre on main bus routes and adjacent to local shops. The day centre operating from within the unit, is not managed by the provider, but by the Southampton Care Association and is used to support users and carers living in the local community. Service users have only limited access and use of the facilities of the day centre based on when there are vacancies. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site inspection visit to the home took place between the hours of 09.30 and 17.00 hrs on the 17th July 2006 and the 19th July 2006. This site visit was the culmination of pre-field work activities including – • A full review of the history of the service since the last inspection • Gathering information from a variety of professional sources, including • The Commission’s database • Pre-inspection information provided by the home • Contacts with families and social workers and other external stakeholders • Linking with previous inspectors who have visited the service This was a key inspection, being part of a new inspection programme, which measures the service against the core and/or key national minimum standards. Two regulation inspectors carried out the visit, Richard Slimm as lead inspector, and Clare Hall as second inspector. While in the home the two inspectors were able to meet 22 of the residents currently accommodated, carrying out case tracking with a number of service users. Additional paper work where necessary was reviewed, a tour of the premises took place, and the former manager, new manager, staff members, visiting professional and relatives were interviewed. What the service does well: The home does well to provide a relaxed environment for the residents to live in. A sense of calm was evident throughout the course of the two days, even at times, that are considered busy such as meal times. Staff members were observed to interact positively with the residents when supporting them via care interventions. Residents were observed sitting in the garden, or alternatively in the communal lounge areas. Residents are free to spend time in the personal rooms if they so wish, and can choose where they eat their meals. The home does well to provide an environment that assist residents to orientate around the home and meet their sensory and cognitive abilities. Colour coded areas, visual adaptations and pictorial documentation is available to assist residents to make choices, such as menu plans, complaints procedure and the Service User Guide. The degree to which these tools are used to full potential was unclear. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 6 The home does well to provide healthy nutritious meals for the residents, made with fresh foods stuffs. The inspector was advised that fresh fruit was available as a choice at every mealtime. However concerns regarding meeting individual nutritional needs are detailed in “what the home could do better” and in the body of the report. What has improved since the last inspection? What they could do better: The service fails to ensure the changing assessed needs of the residents are reviewed as required and reflected in the residents’ plan of care. The service fails to adequately ensure that all the residents’ personal plans are detailed and include how their support needs will be carried out. Contact sheets are not being used to monitor the outcomes for service users in sufficient detail to ensure staff across all shifts know what is the current situation with individual residents. The service fails to fully ensure all relevant staff are made aware of the changing needs of the residents, such as dietary requirements, dependency and palliative care needs. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 7 The service and management fail to adequately ensure all care staff are aware of information they need from residents plans of care. There is insufficient supervision to ensure staff members are following the actions needed as stated in plans of care. The system fails to enable care staff to report changes to residents needs promptly, as identified in use of contact sheets above. Staff need increased training in how to maintain accurate chronological records of care interventions, and management may benefit from training in monitoring, review and updating plans of care. The service fails to fully respect individual residents rights and wishes, and provide support in accordance with this. For example, with the issue of day service staff and day service clients having unrestricted access to the home. Arrangements were not in place to adequately ensure the residents have access to fluids as they need/wish through out the day and night. The service is not maintained externally to either an adequate or valuing appearance. The service fails to ensure that staff members are enabled and supported to fully respect the need for confidentiality when discussing or keeping personal records of residents, making phone calls and updating or reviewing records. The location of the care coordinators office is still a particular issue and must be addressed in order to protect the rights of service users to have their privacy and confidentiality respected. The service fails to ensure the staffing levels are sufficient to meet the assessed needs of the residents. While the registered organisation has taken action to ensure the home and the organisation follows the correct procedures when recruiting staff, the service fails to demonstrate that it protects service users in their care fully. Procedures in the home were found to be inadequate to protect service users in respect of a recent adult protection investigation. Staff who are not employed by the registered provider have regular unsupervised access to residents, and the provider is unable to keep evidence that these staff have been adequately checked with records kept for inspection of such documents as applications, checks on employment history, ID, credible references and CRB checks. There was evidence of one highly dependent service user not being cared for to the degree she required, with inappropriate equipment, and conflicting information in different care plans. Woodside Lodge Resource Centre DS0000039181.V297955.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. Woodside Lodge Resource Centre DS0000039181.V297955.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 Woodside Lodge Resource Centre DS0000039181.V297955.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The service still fails to make adequate arrangements to ensure that service users needs and wishes are fully assessed prior to being admitted to the home. The service was unable to provide clear evidence that the assessed needs of all service users are being met. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspectors were advised that all service users admitted to the service are assessed via the Southampton City Council Social Services Department (SCC SSD) community care teams. However, there would appear to be some weaknesses in how the home staff assesses prospective residents to be admitted to the home. Too great a reliance on assessments carried out by SCC staff who work externally to the home places the service at risk of admitting residents outside of the service categories of registration and committing an offence under the Care Standards Act 2000. Care managers also unlikely to be able to say whether the home can meet a prospective service users needs. It Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 11 was evident that the arrangements at the time of the visit were not fully adequate. This was evidenced by the content of one complaint that could have been avoided if the service had assessed the needs of a short stay resident effectively. There was further evidence of gaps in how the changing needs of service users are monitored and action taken to meet those changing needs. An immediate requirement was made in respect of this issue as the needs of one service user were clearly not being met adequately during the site visit. (See “Health and Personal Care” section of this report). There had been some improvement in respect of the development of personal profiles/life histories that were being developed with service users. While the service provides respite care there is no intention to provide intermediate care. Woodside Lodge Resource Centre DS0000039181.V297955.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 While service users health, personal and social care needs are identified, these are not currently planned in a clear and understandable fashion, that enable staff to provide a consistent or accountable level of service and support. Plans of care are not adequately monitored or reviewed, and consequently some plans are out of date. Service users need additional support to enable them to be more involved in decision making about their lives, and to be more involved in the running of their home. Arrangements for the administration of medication at busy times of the day and/or evening needs to be reviewed. Staff members giving out medications must be enabled to do so without distraction or interruption. The privacy and dignity of residents could and should be further promoted on a daily basis at the home. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 13 EVIDENCE: While some work had been done since the last inspection in April 2006 to further develop care planning, there was still evidence that current arrangements continue to fail to meet the national minimum standard (NMS). The pro-formas in place appeared to enable a person centred approach, but the reality of care planning still fell a long way short of being truly person centred, with any clear emphasis on quality of life outcomes. Care plans in a number of instances failed to adequately capture the needs and wishes of service users in a clear or holistic manner. The service user for who inspectors had to leave an immediate requirement (see below) is just one example of failures in developing adequate and pro-active systems of planning. Other shortfalls were evident in the maintenance of chronological daily records, known as contact sheets, which are supposed to monitor the outcomes for service users plans and general quality of life on a daily basis. It was clear that staff were not fully aware or adequately trained around the exact purpose of contact sheets, how to complete these sheets and how they fit into the overall process of assessment, care planning, monitoring and review. Managers had appeared to fail to keep essential care records up to date and relevant to the current needs of the service user. The inspector case tracked one lady in depth who was being supported by district nursing services and was considered to be requiring nursing care. The care records identifying this ladies needs and outcomes were discussed with the registered manager and the newly appointed manager and the following areas of improvement in care recording were noted. There was a good personal history identifying the service users contacts in the community, significant people involved in her/their life and noted important relationships including a note regarding a recent death of a family member. The dates for these reviews regarding this information were noted. It had been recorded recently that the service user had become unwell and was being nursed in bed. The supporting risk assessments for service sure “A” described this ladies interests and needs as; a) “A” likes to join in with the homes activities, b) “A” needs to eat little and often following a nutritional risk assessment with instructions for staff to complete daily all food and drink input records and record if refused. The nutritional risk assessment on file indicates that service user “A” scored 8 which identifies she is at high risk. The outcome on the risk assessment states,” Check weight fortnightly, encourage eating and drinking, encourage between meal snacks, milky drinks and enrich foods”. In the contact notes there were neither notes to identify what diet and fluids service user “A” had received nor when it was noted the service users had not Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 14 had adequate nutrition or fluids were there records of what action had been taken in respect of this. Diet and fluid records were being undertaken haphazardly and did not therefore reflect service user “A” was receiving a good nutrition and hydration. The plan of care recently developed was very informed but the supporting risk assessments did not reflect up to date issues. Despite the service user requiring nursing care and being nursed in bed the risk assessment continued to state that service user “A” chooses to sleep in an arm chair at night, that she may become lost and disorientated and that she is reluctant to sleep in her own room. This had not been updated to reflect current risks /needs. Further risk assessments in respect of this clients mobility i.e walking, transferring, standing, sitting, sleeping, also had not been updated since 12.04.06 and so were not reflecting the service users current ill health and current needs of nursing care. Overall it was clearly identified that the staff are adjusting to the new documents and are trying to keep them updated but the information is repetitive and fragmented information is not being audited for outcomes and staff are not recording up to date information in a chronological order of events. It was raised at the last visit that care records identified service users not eating or drinking adequately and this remains a concern despite nutritional risk assessments being undertaken and charts to record diet and fluids put in place. Record case tracking identified that these records are not being completed nor the outcomes for nutrition audited. It was also noted that risk assessment records identified that at least one service user was at risk of developing pressure sores. One statement on the risk assessment stated that equipments were being arranged by district nursing services but on the same service users care plan it stated staff to wait until the service user showed signs of skin breakdown then to seek district nursing input. The care records of service user “A” were fragmented and records did not correlate. The night plan stated the service user is very poorly and bed bound but then further records stated service user “A” prefers to sleep with the door open or has started to sleep in the main lounge. It also stated service user “A” likes to be stimulated and this can be done just observing others, doing activities or just sat in the garden enjoying the sunshine. It also stated that two carers’ are needed to assist the service user into a chair where it has been established in another record that she requires a hoist. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 15 When this was discussed with the manager she stated the service user had a propad (low risk) mattress and staff were not recording turns to prevent skin breakdown, as this was a “nursing task” but it was further identified that in some contact sheets it states she is turned but this is not reflected consistently and appears to relate to who is caring for her rather than on a plan of meeting her needs for the prevention of pressure sore development. On visiting the service user in her room the bed was observed to be up against the wall on one side and was not a nursing height adjustable bed and is considered not appropriate to meet the current needs of this lady. It was documented that the service user was still at risk of falling and the staff had placed an alarm mattress on the floor next to her bed. The staff explained if the service user got out of bed it would alarm despite it being identified that she was unwell and appeared very frail. The service user was seen propped up in bed, without bed rails. The night care plan states “ X now has a pressure alarm mat in place on the floor next to her bed. This is to alert staff if X is trying to get up and reduces the risk of falling.” The lady was seen with an injury to her face and the district nurse stated she also had an injury to her arm from falling. Serious concerns were raised at the previous CSCI site visit to the home that this particular resident had sustained numerous injuries in respect of repeated falls .The district nurse was now attending this lady to dress an injury to her arm and head that the nurse stated were the result of falling. The district nurse stated she did not understand why the service user, if it was established previously that she wanted to sleep in her chair, wasn’t provided with one in the privacy of her own room rather than be sat in the main lounge with night staff. The manager was asked regarding turning records of this lady but these had not been completed/recorded. Care records identify that since the last visit the manager has now ensured nutritional screening is undertaken and this is reflected in the plan of care but has not been audited to ensure outcomes are managed and needs are fully met. The service user visited being nursed in her room did not have fluids available. The fluid chart in her room indicated on the 15/06/06 the service user received a total of two half cups of tea fluid in 24 hours despite the care plan stating “carers to complete daily input and output and also record if refused. The contact sheet stated “A” has been sleepy this am. Ate a bit of lunch. Enjoyed a drink of black current, which has no correlation to the fluid chart. A further Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 16 concern was the care plan stated the Occupational Therapist had undertaken the nutritional risk assessment. The care plan document also states the carer is to use a hoist to get “A” in and out of bed. There was no detailed moving and handling risk assessment to describe the necessary details of how this should be done safely and with what type of sling/aids or adaptations. There was evidence of the misuse of risk assessments, with clear evidence that service users were being limited in such areas as decision-making about their lives. The level of assistance service users were receiving needed to be improved in many respects. There was evidence in at least one case that the service was failing to take adequate action to ensure the health care needs of one service user were being met. An audit of the records kept of all medicines administered showed they were on the whole completed in full .It was identified that when a service user refuses or doesn’t receive a prescribed medication notes were being made in respect of the omission. A concern raised at the previous visit that the duty officer is solely responsible for giving medications even when she is on a two-day shift pattern remains unchanged. The duty officer retires at 10.00pm and is then woken during the rest period to give medications. The care co-coordinator was observed administering medications safely and eliciting from clients their need for analgesia. Effects of medication given were also observed being monitored. Medication care plans were also seen describing the assessment of pain for clients unable to verbalize their needs, which have been considered good practice on previous inspections. Medication administration record (MAR) sheets were completed and reasons for omitting medications stated .A discussion with staff identified that when care management staff are administering the 20.30 hours medication the remaining three care staff are usually busy, two assisting clients to bed etc and one care staff member writing up care notes in the office. It was explained that as the care manager tries to administer medications she becomes “center of attention by the clients who then tend to gather round her and this can be very distracting.” She also stated that sometimes the needs / demands of the clients cause her to have to abandon the medication round until further staff can assist. When this was discussed with the manager in view of recent medication errors occurring at this time the manager stated that it had been recognized that the staffing between the hours of 8-10 pm are inadequate but that this has not yet been addressed by the provider due to financial issues. The manager implied a number of issues raised at the last visit, which required financial investment from differing departments of the corporate body had not been dealt with due to the funds not being made available. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 17 It was reported to the commissions link inspector on a previous occasion that the home is not staffed adequately to meet the needs of the service during this time of the evening and that staff had previously reported that they are distracted by the service users as they are usually left alone on the floor whilst giving out medications. Although medication practices appeared to have improved, a number of incidents of maladministration had arisen recently, and this was looked at in some detail. The findings were that errors arising during the evening period may be due to a number of factors – staff shortages; staff members administering medications being disturbed or interrupted; shift changeovers with staff members coming on duty while medication rounds were in the process of being done, and the general issues around supervising residents who are so frail, while trying to perform tasks like medication administration without being distracted. It was evident that many of the staff observed and spoken to throughout the site visits cared deeply for those people they helped and supported at the home. It was also evident that many residents felt great affection for the staff, and confirmed that they were always treated with kindness. Visitors to the home also confirmed that they felt confident about leaving their vulnerable loved ones in the care of the home staff. However, there was also evidence of poor practices that need to be addressed in order to further promote and protect residents’ rights to privacy and dignity. One service users risk assessment indicated to staff that they would have the right to search her handbag. This resident was also being subjected to restrictive practices that were not clearly identified in her plan of care or having been negotiated with the resident concerned or her advocate. One resident was observed receiving chiropody treatment in a cupboard that had insufficient room so the chiropodist could not close the door to provide privacy for the resident. This was also confusing as this area was designated as a treatment room, even though it was not suited or an appropriate size for these purposes. There is a day centre that has been developed at the home, taking over communal space that used to be available to residents. Staff, who are not employed by Southampton City Council, from this day centre appear to access the residential areas of the care home with no consideration to the right of the residents to have privacy. The site of the hairdressing area is within the care co-ordinators office where all confidential records are kept, and staff are also discussing private care matters with managers in front of day care and residential clients who are having their hair done. Service users from this day centre were also observed using residential facilities, once more with a lack of consideration to the rights of the residents accommodated at the home. The home does support and encourage visitors to the home, visitors spoken to confirmed they were always made welcome and felt their relatives were being well cared for. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 12-13-14-15 The service does not actively plan to provide daily opportunities to residents that will meet their needs or match their expectations, satisfying social, cultural, religious or recreational interests or needs. The service does support residents to maintain contact with their families and/or friends within the local community and the home itself. Residents could be supported more to journey out from the home. The service fails to exploit all relevant opportunities to support and encourage residents to exercise as much choice and control over their daily lives as possible. The service needs to review how service users with short-term memory loss are enabled to make informed choices about the food they eat. Asking them the day before the meal is served is not meeting their needs or promoting choice and control. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 19 Inspectors carried out a number of case tracking exercises that enable them to track evidence and collate this evidence with regard to the quality of life and the outcomes for service users living at the home. Given the degree of impairment of service users memories, it is sometimes difficult to assess residents’ experiences so the inspectors spoke to staff, visitors and external professionals, as well as the residents themselves. One service user shared his view that while he did not want to be living at Woodside, he had nowhere else to go. Another service user was found to be very upset, and crying. Staff advised that the GP has been alerted to the potential problem of depression. Other service users appeared to be generally content and relaxed, but many were showing signs of being distracted, probably due to the high temperatures and the lack of activities available throughout the two-day site visit. There was evidence of assessment that acknowledged issues of diversity, and care plans that tried to accommodate difference in a positive way. However, there was also evidence of a lack of structured and meaningful daily activity at the home. Some staff were trying to involve residents in such activities as dusting and folding laundry, and there were regular visits by entertainers and the like. But there did not appear to be a pro-active or programmed approach to providing residents with opportunities to pursue interests, have outings from the home or become involved in new activities that may interest them. In short there was a lack of real therapeutic interventions that could promote and provide good outcomes for service users. The environment had been adapted to take account of the needs of residents, with good use of pictorial media to support residents with memory and communication problems, and there were other positives such as tactile wall hangings and bright murals on the walls. Each resident’s room was identifiable by both picture and name of the resident concerned, and residents seemed happy with these arrangements. There was however, little evidence of staff using these resources to the full benefit of the resident group, due in part to the poor staffing levels and also a culture in the home where staff seem to gravitate to the care co-ordinators office in the lobby area. Consequently it was not a surprise that many residents also congregated in this area as this was the only area of the home where there was any stimulation available, or passing contact from staff and visitors. Inspectors floor walked over ten times on the first day, and this provided observed evidence of poor outcomes for service users across the day. There were no activities and very little quality time spent with residents by the staff team. On the second day the second inspector carried out a series of floor walks and recorded the outcomes again finding the quality of outcomes for residents to be poor. On the first day a resident approached the manager and asked for ice cream, staff were sent out and a box of ice cream was distributed around the home. On entering the home on the second day the temperature in the home was over 30* centigrade. Six residents were found sitting in a communal lounge with no drinks and no water jugs available. A staff member was observed walking along a corridor with a drink. The manager was reminded of the need Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 20 to ensure that all residents had access to drinks at all times during such hot weather. One service user who was being supported in bed was visited half hourly throughout the morning and early afternoon by the inspector. It was evidenced throughout this time that this service user was not being supported by staff by having regular checks, change of position and fluids offered. The service user remained on her back throughout the time observed and this was relayed to the homes senior management during the feedback. By 10.30 the inspector intervened and spoke with the manager with regards to the provision of fluids and it was observed that these were finally given out at 11.45am. Later some service users asleep and in their rooms still remained with out fluids and staff were observed having to walk long distances to get the drinks that the service users requested. It was also evidenced that service users nutritional needs were not being met The manager had ensured that nutritional risk assessments had been carried out but the identified intervention in respect of the risk was not being followed. One service users risk assessment identified she needed regular food in between meals and special supplements. Staff had failed to record the offers of food and had not taken any action in respect of the service user having not eaten enough calories. Fluid and food charts were being filled in inconsistently and not being audited or summarized in case the needs had changed. The inspector observed that the necessary outcomes in relation to the service users nutritional needs were not being achieved. Visitors to the home were interviewed and all said they were always made to feel welcome, and confident in the support provided to the residents. One visitor said that if he had any concerns he could speak to staff and they would deal with the matter for him. He was aware of the complaints procedure but had not needed to use it. A District Nurse said she felt the staff were very caring and doing the best they could with very limited resources. A local GP was spoken to who said she was generally satisfied with the support her patients get at the home from a health perspective. A local social worker said the home does as well as it can with such poor staffing levels given the high dependency of the service user group. These comments are both interesting and useful as they confirm CSCI observations in a number of respects. The home is not adequately staffed given the dependency and needs of the client group. The lack of staffing means that staff are not available to support residents with age related mental health problems. The service fails to provide the level of support needed by the service users to exercise choice and control over those areas of their lives where with support they could enjoy greater autonomy. There was some Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 21 evidence of over protection and limitation in some areas and also evidence of failure to adequately protect residents in other areas. The residents are asked what they would like to eat the day before the food is served. This does little to meet the needs of people with short-term memory problems. On the first day residents were given a choice of corned beef or cheese salad. On the second day when temperatures were over 30* centigrade residents were given minced meat with assorted cooked vegetables, while a staff member was observed to be enjoying a salad. Three residents said they would have preferred a salad, but had forgotten the choice they had made the day before. The cook had worked at the home for a number of years and appeared to have a good grasp of the kinds of foods the residents enjoyed. She had daily contact with the residents, as she is involved in dishing out lunch meals with the other staff. The kitchen area appeared to be well organised and food stocks were well maintained, with bulk orders being delivered and fresh foodstuff shopped for more locally. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 22 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 the following standard(s): 16-18 The home has a written complaints procedure. The home investigates complaints in line with the complaints procedure. The service fails to fully protect service users from potential harm. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff working in the day centre, who are not directly employed by the registered body have regular and unsupervised contact with vulnerable residents living at the home, contrary to best practice. One day centre staff member was observed holding hands with a service user in the lobby area of her home. Day centre staff were observed to walk through the residents communal lobby at regular intervals to access an office area elsewhere in the residents’ home. Relatives had complained and the home had investigated and resolved the concerns of the complainant. No complaints had been referred to the CSCI since the last inspection. There had been seven complaints made to the home in the last year. More lucid residents felt they could complain and knew who to speak to if they were dissatisfied. The contact sheet of a resident case tracked identified an incident of minor molestation/sexual assault perpetrated by one male service user on the female Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 23 service user being tracked. This matter was looked into in some detail and it was identified that another female service user had also been subjected to similar assaults by the same perpetrator. Contact sheets for the resident being case tracked where checked from the date of the incident to 2 weeks after the event, and there was no evidence of any monitoring or action being taken to protect the resident or other residents concerned or of any action taken to alert that resident’s next of kin. The local social services held a meeting to devise a strategy and the outcome of this meeting appeared to fail to address the issues raised by the events, or to put in place adequate protection of the residents concerned or other female residents living at the service, as the perpetrator continued to remain living at the home for a further 5 months. The inspector reviewed four of the last seven complaints made to the service as declared in the pre-inspection questionnaire. One complaint provided clear evidence of failures on the part of the home to adequately assess a short stay resident, failures to adequately or accurately clerk in medications for this person, and there was a failure to give him his medication over a period of two days, as well as failures to provide the resident with his preferred breakfast cereal. However, it should be noted that the complaints procedure was followed and the matter appears to have been resolved. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 24 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 the following standard(s): 19-22-26 Externally the home is not well maintained and appears to be neglected. The service does not provide adequate or make use of appropriate aids and adaptations that will promote service user independence and/or safe moving and handling practices at the home. The home was cleaned to a good standard, and domestic staff consult and involve residents as much as possible in the running of their home in this area of the service. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service had replaced worn bedding and towels. Windows were not cleaned inside and out frequently and there was evidence of dirty windows at the time of the visit. Peeling paintwork was still evident on windows and windowsills externally. The external brickwork needs attention to remove old growths and Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 25 dead climber plant material. The service was adequately painted and maintained internally – however, the service needs to give consideration to the redecoration of the smoking room in consultation with the people who use this area. Bedroom floors are currently not provided with carpets in a choice of colour made by the service user. Linoleum / vinyl floor coverings to bedrooms are normally provided as the exception not the rule, as is the case at Woodside Lodge. The external appearance of the home is devaluing, appearing to the eye as shoddy and unkempt. The service provider needs to make arrangements to paint handrails and other painted areas where paint is flaking, such as woodwork, handrails and fascias. The service was failing to provide the correct type of equipment to enable staff to support high dependency service users safely at the home. Some efforts had been made to adapt some aspects of the environment to reflect the needs of older persons suffering from dementia and memory/communication deficits. One-service user discussed the home and the accommodation with the inspector. When discussing the garden she stated, “When you want to relax you can go out there and meet some friends. These friends have said how good it is here and that’s why I came here.” The staff were observed adhering to good practices for infection prevention. Housekeepers were observed wearing gloves and described to the inspector how the cleaning equipments were colour coded for different tasks dependent on risk. This was also confirmed by the practices in the laundry and staff confirmed the colour coding of soiled items, cloths from the kitchen and the service users laundry. One member of the domestic staff reported to the inspector how she manages the risk when taking the cleaning trolley around the home. She stated she “always keeps the trolley near as the clients tend to wander and never let the cleaning agents be out of sight. “She also stated she never fills the trolley up with too many items so she knows exactly what she has got and what to keep an eye on. It was further explained of what to do incase of spillage and splashes. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The service fails to ensure at all times that the needs of service users’ are met by the number and skill mix of staff. The provider organisation needs to improve the quality of staff and management supervision and support at the home. The percentage of staff trained to NVQ level 2 exceeds 50 national target. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Inspectors questioned why drinks were not readily available across the home. They were advised that risk assessments prevent this as the residents accommodated would spill the drinks, drink each other and do other things that were unacceptable. Equally it could be argued that such risk assessments simply indicate poor staff supervision of the residents’, and poor staffing levels. Other forms of risk assessment in areas such as smoking and general activities also indicated poor staffing levels, and inadequate supervision/support for residents. Throughout the inspection staffing costs were sited on numerous occasions as the reason for poor quality outcomes at the home in such areas as poor levels of supervision – poor levels of activities and stimulation – errors in medication Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 27 administration – the inability to meet the palliative care needs of one service user leading to the issuing of an immediate requirement notice on the service provider. Staff members are being provided with regular support and supervision, however, the quality of supervision and support of the manager must be drawn into question, as must the efficacy of the monthly monitoring visits carried out by the owner of the service and the quality of the reports provided about the conduct of the service and the home’s ability to meet the needs of service users and the national minimum standards. Staff were observed mainly to gather in the care co-ordinators office that is shared with the hairdressing area. Comments from relatives provided to the CSCI prior to the inspection included – “I rarely see any staff” “ maybe I visit at the wrong time of day” “I don’t know what the staffing levels should be?” Comments from external professionals also included concerns about the level of staffing at the home given the high dependency of the residents. A number of responses to surveys sent to residents to the question “Are the staff available when you need them?”, included sometimes, and usually. Over 50 of staff are trained to NVQ level 2 or higher. The most recently registered manager has moved from the service. A new manager has been appointed, but has not yet made an application to be registered. However, the new manager is a registered social worker with the GSCC. Two of three staff files audited identified that the staff had received regular supervision. It was discussed with the manager that relief staff are not having the training and supervision of regular staff. It would be considered just as important to monitor the relief staff especially as they may not have the opportunities to receive regular updates and information. It was also evident that supervision is considered an event rather than a process. Audit of staff roles and responsibilities, record keeping, and note writing and assessments must be included in the process for on going supervision so that issues of poor practice can be addressed. It was very evident that fluid charts, care records, and risk assessments were not regularly audited for quality. Feedback needs to be given to staff to reflect their training needs should they be unable to risk assess appropriately. It would also be considered a concern that previous requirements made to the registered person have not been included in the managers supervision by her manager as it was clearly stated by the manager that she felt unsupported regarding the areas of concern raised at the previous visits which needed to be addressed. She felt these issues were out of her Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 28 abilities and seniority to change .The provider will need to address what measures are in place to support the manager and monitor compliance with the outstanding requirements made under regulations. Three staff files were audited, one older member of staff with a long history of employment with the organization, and two relatively new members of staff. In view of requirements it was identified that the necessary references had not been sought. References on file did not indicate they were sought from the staff member’s last employers and were also sought from the home addresses of referees. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 29 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33-35-38 The service is not managed or run to fully benefit of the service users. As the new manager has not applied to be registered as required, it is not possible to assess standard 31 in respect of the proposed new management arrangements. However, there was evidence that over recent times the service was not being run or managed by persons who were able to discharge their responsibilities fully to the benefit of service users accommodated. There was no evidence that service users are seriously considered in the context of how the home is run or how the service is to develop. This will need to be addressed by the new manager who will need significant support from senior management and indeed the registered body to achieve the change needed at the home. Arrangements for handling short stay residents monies are wholly inadequate and potentially leave both staff and service users vulnerable. The CSCI has been advised that arrangements for the management of permanent residents Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 30 monies were dealt with via a system that enables each resident to have a separate interest baring account. The health, safety and welfare of service users and staff are not fully promoted and protected. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of poor management of the service. The provider had put in place a temporary management arrangement, that finished on the first day of this site visit (17/7/06), which was supposed to be the handover to the new manager. (As a consequence this handover did not take place). All of the above evidence would indicate management arrangements at the service have been inadequate for some time, the provider organisation would appear to have failed to support the temporary manager, or identify the clear failings arising at the home over a significant period, via professional supervision and Regulation 26 monthly visits, and the reports provided by the CSCI. The new manager is now in post, but no adequate handover has been provided as identified above. No action has been taken to apply to register the new manager, even though the provider has known they would be taking over the role for some time. Given that the new manager was on her own on the second day of the site visit, inspectors asked her to arrange for more senior managers to be available at the feedback for day 2 in order that she was supported in her new role, and through what was going to be a difficult process. The service has recently focused some quality assurance activities toward respite and short stay service users, but there was little evidence of any real commitment to the consultation or empowerment of long stay residents living at the home. The impression one gets is that the permanent residents are not considered fully. This was evident from such practices as day centre service users using residential facilities with no consultation; day centre staff using communal areas of the residential care home as a thorough fare to get to an office elsewhere in the building; people with short term memory loss being asked to choose their meal a day before they eat it; at the end of the second day inspectors noted that an air conditioning unit had been provided to the lobby area, and when they congratulated staff, the staff member explained the unit did not belong to the home but had been borrowed from the day centre as they were now closed, and the air conditioner would have to be returned to the day centre the next day. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 31 It was further identified that service users are not encouraged to use the home sensory garden as they would need to be supervised in case they walked into the day centre. Staff were over heard asking the manager if they could use her office as their own was too noisy as it had been taken over by day care service users and support staff helping them to have their hair done. A staff member responsible for administrating resident personal allowances said the home’s management of short stay service users monies is “complicated and chaotic”. The inspector looked at a sample of the arrangements for the administration of short stay and respite residents’ allowances, and found them to be in need of review. The service does not have the necessary equipment to support those accommodated clients with nursing needs. The lack of appropriate manual handling equipment i.e slide sheets, height adjustable beds is not only putting the service users at risk but also the staff. Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 32 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X 1 X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X 3 1 Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 33 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(1) Requirement The manager must ensure thorough recorded assessments are undertaken on all prospective residents, specific to the home. This is an outstanding requirement, wit a timescale of 1/9/06 On the 20/7/06 requirement was only partially met. 2. OP32 14(2) The manager must ensure the changing needs of the residents are reviewed and reassessed as required and reflected in the residents’ plan of care. This is an outstanding requirement, wit a timescale of 1/9/06 On the 20/7/06 requirement was only partially met. 3. OP7 OP12 15(1) 12(1) The residents’ personal plans must reflect their assessed strengths, health and welfare needs, routines, hobbies and interests and wishes. DS0000039181.V297955.R01.S.doc Timescale for action 01/09/06 01/09/06 01/09/06 Woodside Lodge Resource Centre Version 5.2 Page 34 This requirement has been repeated. A further failure to comply may result in further action being taken by the CSCI. This is an outstanding requirement, wit a timescale of 1/9/06. On the 20/7/06 the requirement was only partially met. 4. OP7 15(1) All the residents’ personal plans must detail how their support needs will be carried out. This requirement has been repeated. A further failure to comply may result in further action being taken by the CSCI. This is an outstanding requirement, wit a timescale of 1/9/06. On the 20/7/06 requirement was only partially met. 5. OP7 15(1) 14(2) The manager must ensure all relevant staff members are made aware of the changing needs of the residents, such as dietary requirements. Staff must be trained in how to record changing needs in the contact sheet system, and managers must transfer this information when needed to update care plans. On the 20/7/06 requirement was only partially met. 6. OP7 15(1) 14(2) The manager must ensure all care staff are aware of the information provided in residents plans of care. And follow this. The system must enable care staff to report changes in residents needs promptly and DS0000039181.V297955.R01.S.doc 01/09/06 01/09/06 01/09/06 Woodside Lodge Resource Centre Version 5.2 Page 35 action taken to meet those changing needs. On the 20/7/06 requirement was only partially met. 7 OP12 OP18 12(3) 13(6) The staff must respect individual residents rights and wishes, and provide support in accordance with this. 20/7/06 – not met 8 OP7OP8OP 15 12(1) 13(1) 15(1) 16(2) The manager must ensure all residents have a nutritional assessment undertaken and address individual dietary needs as required. It is essential that action is taken to meet nutritional needs that have been assessed, and full records maintained. On the 20/7/06 requirement was only partially met. 9 OP8OP10O P12OP7 12(3) 16(4) The manager must ensure the 01/09/06 residents have access to fluids as they wish through out the day and night. Staffing levels must be adequate to monitor this area of need. On the 20/7/06 requirement was only partially met. 10 OP19 23(1) 23(2) The registered provider must provide the Commission for Social Care Inspection with an action plan including a clear schedule of works identifying exact timescales to arrange repairs and improvements to be made to the external environment, as well as how the provider intends to comply with the requirements of this report as detailed in the body of the DS0000039181.V297955.R01.S.doc 01/09/06 01/09/06 01/09/06 Woodside Lodge Resource Centre Version 5.2 Page 36 report. On the 20/7/06 requirement was only partially met. 11 OP19OP37 12(4) 17(1) The registered providers must ensure that staff members respect the need for confidentiality when discussing residents, making phone calls and updating or reviewing records. The location of the care coordinators office is a particular issue and must be addressed. On the 20/7/06 requirement was only partially met. 12. OP27 18(1)(a) The registered persons must ensure there are appropriate numbers of skilled, competent and experienced staff to meet the needs of the residents. The service must provide the Commission for Social Care Inspection by the stated times scale an action plan detailing how they are going to meet the shortfalls in staff. This requirement has been repeated on three occasions further failure to comply will result in enforcement action. This is an outstanding requirement, wit a timescale of 1/9/06. On the 20/7/06 requirement was only partially met. 13 OP29 19(1)(a)( b) The registered persons must ensure that only staff who they employ, or are legally working in the home to provide care to residents have unsupervised access to service users. 01/09/06 01/09/06 01/09/06 Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 37 The practice of staff members who do not work at the home using any part of the registered premises, as a thoroughfare must cease. 14 OP31 The newly appointed staff member to the role of manager Care must make application to the Standards Commission for Social Care Act 2000 Inspection to register as the Section 12 manager. 12 and 13 The registered person must review practices in the area of adult protection. Residents must be protected from all forms of abuse, including - harassment, molestation or unsolicited sexual advances from any source at all times. An immediate requirement was left at the home on the 19th July 2006 and followed by letter on the 20th July 2006 – the requirement was made to ensure the health care needs of a service user with palliative nursing care needs were met. The registered person must respond to this immediate requirement as identified in the follow up letter. 8 and 9 01/09/06 15 OP18 01/09/06 16 OP8 12 and 13 19/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Woodside Lodge Resource Centre DS0000039181.V297955.R01.S.doc Version 5.2 Page 39 - 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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