Inspection on 06/04/06 for Woodside Lodge Resource Centre

This inspection was carried out on 6th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 17/07/06

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 Christine Hemmens & Clare Hall Unannounced Inspection 6th April 2006 09:30 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.V288638.R01.S.doc Version 5.1 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.V288638.R01.S.doc Version 5.1 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.V288638.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Woodside Lodge is a resource centre that provides a range of services to older people (65 plus) living in the west and central areas of Southampton City. The home is a specialist unit for older persons who have dementia, caring for people with progressing dementia, physical frailty and other functional difficulties. The purpose of the service is to provide a person centred care approach, one that will focus on using the physical environment and multi-sensory methods to enable positive interactions and communication with people. The home is able to provide both long and short-term care. All service users are accommodated on the ground floor in single rooms. The home is situated approximately 2 miles from Southampton City centre on main bus routes and adjacent to local shops. It has a day centre operating from the unit, which is managed by Southampton Care Association and is used to support users and carers living in the local community. Service users can access and use the facilities of the day centre on the same site when there are vacancies. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced visit to the home this year and was carried out over one day by two inspectors. The registered manager assisted the inspectors. The purpose of the visit was to review the eighteen requirements issued following the previous inspection of the home in October 2005, and to seek the views where possible of the residents and staff. The home has been issued with twenty-nine requirements on this occasion. Nine requirements have been repeated and a decision will be made in respect of what further action to take to address continued non-compliance. The inspectors met with residents, staff and a visiting relative to seek their views of the service. Due to the nature of their cognitive ability, some residents had difficulty expressing their views, therefore a significant part of the inspection process was undertaken through observation. What the service does well: What has improved since the last inspection? Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 6 The home has done well in part to improve some areas of the home, especially residents’ bedrooms and bathrooms. New furniture, pictures and borders provide a more pleasing environment. A relative with whom the inspector met. “my wife has a very nice bedroom and it is kept very clean”. Other visitors to the home said they thought the home was very clean and bright, “a nice place to live”. This is very good progress, however further improvements are required and these are detailed in the body of the report. The home has done well to improve the security of the external building to prevent residents leaving the home unnoticed and placing themselves at risk. The home has made some improvements to four residents’ personal plans. This demonstrates in part that it is working towards a person centred approach in meeting the needs for the residents, however further work is required is detailed in “what the home could do better” and the body of the report. What they could do better: Despite some areas of good work there remains a significant number of concerns as to the residents personal, health and emotional needs, and wishes and preferences are met. The home could do better to appropriately and thoroughly assess, monitor, and record the needs of the residents ensuring that changing needs are promptly reported and shared with those that need to know and ensure care plans are promptly changed to reflect the changes to the needs of the residents. The support provided at Woodside Lodge is not underpinned by good care planning. All personal plans must be developed within stipulated timescale, currently four out of twenty seven have been completed, however the service must ensure the manager and staff are provided with the appropriate tools, skills and time to complete the personal plans that must be specific, detailed and provide clear information for staff, and must be in accordance with the stated purpose of the home. The home could do better to address the nutritional needs of the residents, ensure all residents are assessed and address the identified needs promptly; the home could do better to ensure residents are kept hydrated to assist in the prevention of unnecessary illness. The home could do better to safeguard the residents from potential risk of abuse or harm by following correct adult protection procedures, ensuring residents needs are appropriately met, proactively, effectively and efficiently and by ensuring appropriate action is taken in respect of residents who are risked assessed as at risk if they undertake an activity unsupported such as administering their own medication and running their own bath. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 7 Some improvements have been made to the environment, however a considerable amount of work is still required to provide a home that meets the needs of the residents, provide a safe environment and provide a comfortable home to live in. Consideration should be given to improve group living, providing pendant alarms for residents when accessing the garden and wandering the home and upgrading the home’s interior through redecoration and thorough cleaning. The home could do better to ensure all staff including ancillary staff are provided with the training and skills to appropriately meet the needs of the residents such as diabetes training for catering staff, infection control for laundry and domestic staff and moving and handling for ancillary staff. The home could do better to increase the numbers and current skills of the staff, providing staff with the appropriate level of supervision to ensure they are equipped to meet the complex needs of the residents and manage the layout of the building to provide a safe and stimulating environment and to enable them to manage the residents specific needs, wishes and preferences. The home continues to fail to comply with minimum standards and requirements, each inspection continues to highlight repeated concerns and raise new concerns. The home is failing in some instances to meet the basic needs of the residents and therefore must take immediate action to address shortfalls in their provision of care for elderly residents with dementia. 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.V288638.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home must ensure it fully undertakes a thorough assessment process to ensure it can fully meet the needs of the prospective and current residents. EVIDENCE: The home has pre assessment documentation to record the strengths and the needs of prospective residents and the home will obtain assessment information from the placing authority. The pre assessment documentation asks for specific detail in respect of the residents physical, medical, dietary care needs, allergies, and medication etc. However the inspectors observed for two of the residents tracked for the purpose of the inspection the pre assessment documentation had not been fully completed and in respect of another resident an assessment was not undertaken as the resident was known to the home. Through the tracking process it was identified that important specific detail had not been Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 10 documented on the assessment forms, which related to the current concerns with regards to the residents’ needs. One resident known to be a diabetic and allergic to a specific medication did not have this recorded on the pre assessment documentation, the form did not indicate who had carried out the assessment, what the residents physical needs were and if the residents required further assessments such as a medical assessment and nutritional assessment. As the resident is diabetic then a medical history and a nutritional assessment should have been carried out. A newly admitted resident already known to the organisation and transferred from another Southampton City Council home did not have up to date assessment documentation but had a copy of the assessment undertaken by the previous home which supports residents who are more able and independent. The needs of the resident in question had changed significantly that they had to be admitted to an EMI home. Therefore the assessment documentation was inaccurate and did not reflect the resident’s current needs. It is important that a pre-admission assessment is undertaken for potential residents as this is assessing whether the individual needs can be met at Woodside Lodge. The home must also ensure that it regularly reviews and undertakes up to date assessments when the needs of residents change significantly that the home may no longer be able to support the resident. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home has made some progress in adopting a person centred approach through its care planning process, however a considerable effort is required to complete all personal plans to reflect the actual needs and changing needs of the residents. The home must improve its approach to meeting the changing physical, mental, and medical health needs to ensure residents are appropriately cared for. The home now demonstrates better standards in its medication procedures, however the home must ensure residents’ health is maintained by monitoring refusals and seeking advice on what medication can be crushed. EVIDENCE: The home has produced evidence that they have in part adopted a person centred approach to meeting the needs of the residents through their care planning process. The inspectors viewed four residents’ personal plans, Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 12 observed interactions between residents and staff and tested staff’s knowledge of the residents. However a significant number of concerns were raised in respect of the care planning process and meeting the residents’ health and welfare needs. The manager could confirm that out of twenty-seven personal plans four had been completed and improved upon since the previous inspection. An example of one had been sent to the Commission for Social Care Inspection office following previous concerns raised in respect of the quality and standard of the care plans, specifically for one resident. The plans provide an interesting history, identify the resident’s strengths and needs in everyday life skills, their residents likes and dislikes and describes the assistance required. Further information provided details on the residents’ daily activity, morning afternoon and a nighttime. In addition guidance has been produced to advise staff how to support the resident when he becomes aggressive, including using diversion. The manager informed the inspectors that these had been devised using a multidisciplinary approach and that there is evidence to demonstrate that minimal restraint could be used when applicable. The home uses ”Team Teach” a recognised training programme in preventing, managing and dealing with aggression. The staff with whom the inspectors met with were able to describe clearly the philosophy of “Team Teach”, how it is used and what they need to do following an event. Although there is evidence to demonstrate the home has undertaken some good work to detail the residents individual needs and the approaches to be taken when supporting the resident, there was little evidence of the plans being reviewed. This was evidenced in three other personal plans seen by the inspectors who established through observation and discussion with staff that the plans need significant improvement to ensure the residents’ needs are being appropriately met. The inspector viewed the personal plan of a resident with diabetes. This did not describe how care for the resident’s feet should be undertaken, only stating that a chiropodist visits. Dietary information held by kitchen staff indicated the resident is insulin controlled where as now the resident has tablets. The daily plan describes the resident as becoming confused and disorientated in the afternoon, which conflicted with staff who said the resident was more confused in the morning. This clearly demonstrates that the home is not updating and reviewing personal plans, and it demonstrates either that staff are not fully aware of the residents current needs or have not fed back changes to the manager. Information held for another resident stated the resident liked to wear suspenders, stockings and cotton pants, however on the day of the visit it was Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 13 established that the resident was wearing an incontinence pad with net knickers and no stockings on her legs. Cotton pants and one stocking were found in the resident’s chest of drawers. Again this suggests that either the staff are not aware of the residents preferences or have dressed the resident for their convenience. In some plans seen by the inspector there was evidence to demonstrate that residents are receiving regular check ups for their eyes, teeth, feet and visits by the GP when the resident is unwell and reviews and changes to medication. The inspectors’ case tracked an elderly frail resident who had been reported to have had a number of falls. The Commission for Social Care Inspection had recently received notification of one of the falls resulting in a visit to A & E. However it was established that the resident had had a significant number of falls and had fallen out of bed on several occasions. Details in daily notes reported hat the resident has a fear of going to bed and is sleeping in a chair in the lounge, that the resident is currently not eating or drinking and has recently suffered a chest infection and has been prescribed a thickener for drinks. The care plans stated the resident needs a soft diet however a member of staff informed the inspectors that the resident had a liquid diet. The significant changes to the current needs of the resident were not reflected in their personal plans or detail what steps had been taken to safeguard the residents’ health and wellbeing. The resident was found asleep with her head on a table after lunch. It was highlighted in the previous inspection report that it is not acceptable to allow residents to fall asleep at the table but they must be made comfortable on their bed or in a comfortable chair. This demonstrates a very poor approach to meeting the health and welfare needs of this resident, there was no evidence to demonstrate that the home had taken steps to seek advice from health care professionals in respect of the physical needs including mobility, medical, psychological and nutritional needs. Following the inspection the responsible was asked to look into this situation. The home assists residents with their medication following a risk assessment to establish if they are able to do this for themselves. However the inspectors observed that a resident had at his disposal a maintenance dose of medication when he had been risked assessed as not being able to administer his own medication. The resident was observed to be using the medication inappropriately and other residents were observed to pick the medication up off the table. The manager was informed of this and advised to address the situation immediately. The member of staff administering the medication was observed to follow very good administration procedures and was respectful and encouraging in her approach and ensured the medication records are correctly signed. “As required” medication such as analgesics have recorded guidance on when to give, this is seen as good practice. The member of staff administering the medication did not automatically give PRN medication Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 14 without seeking if the resident required it. This is an improvement to previous inspections where concerns have been raised in respect of not signing medication given and errors made by staff. The manager has implemented a recording and monitoring system and has a recorded meeting with staff when errors are made. A recording sheet to record when medications have been refused has been implemented and there is evidence that staff are regularly completing this, however recorded evidence identified that some residents have a tendency to refuse or spit out medication regularly, sometimes on a daily basis, staff could confirm what they would do to encourage the resident to take their medication, however there was no evidence to suggest what had been done to ensure the resident took their medication. The inspectors also established that the home was crushing medications, the manager stated this had been agreed by the GP however there was no evidence to back this up. The manager is advised to ensure she obtains written confirmation from the GP or Pharmacist when crushing medications. The home keeps a copy of The Royal Pharmaceutical Guidance. However the homes policies and procedures could not be located. The manager informed the inspectors that it is usually displayed in the care coordinators office. The home must ensure it has available at all times the appropriate polices and procedures to provide guidance for staff when required, such as repeated refusal of medication. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, and 15 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home does well to encourage residents to maintain links with family and friends and assists them to exercise choice over their lives. There is some evidence to indicate that the home is trying to meet the wishes and preferences of the residents however further development is required in this area as identified in “Health and Personal Care” to ensure abusive practices are not being undertaken. The home provides well-balanced and nutritious foods, however the home must ensure the residents’ individual nutritional needs are assessed and appropriately met. EVIDENCE: The inspector met with a relative at the time of the visit who confirmed that regular contact was maintained and that staff were very good at informing him of the residents well being. The relative said he was always made to feel very welcome and said the staff were always very friendly and helpful. The inspectors were informed that a close friend had taken out another resident and there was evidence that family and friends visit regularly. Volunteers to Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 16 the home said they felt the home was warm and welcoming and nice place for the residents to live. The manager informed the inspectors that she is currently trying to trace a relative as the needs of their family member living at Woodside had significantly changed. This demonstrates that the home ensures residents maintain links with family and friends. The home has done some good work in assisting the residents to make choices and express their preferences by developing an accessible menu plan and providing them information about their home such as an accessible Service User Guide and complaints procedures. However the inspectors found evidence in personal plans and by receipt of a regulation 37 notification that not all residents’ preferences are being considered. The home has made some improvement to the level of activity for the residents, the manager informed the inspectors that some residents have expressed an interest in cake making, staff were observed interacting positively with residents such as hand massage and walking in the garden and another lady was supported to visit the local shops. The relative with whom the inspectors met with said he felt his wife was kept busy and another resident said he liked to play cards. However on viewing the admission check list for one resident the term not applicable (N/A) was used repeatedly against preferences such as, “Would the resident like a Newspaper?” N/A. “Would the resident like a Sunday paper?” (N/A), “would the resident like a cup of tea on waking?”(N/A) “Would the resident like a key to their room?” (N/A). This is a concern as individual references should be considered for all. The same resident has recently had a number of falls one of these was reported to the Commission for Social Care Inspection as the resident had to be taken to A&E suffering a cut to their eye. The regulation 37 stated action taken to minimise the risk was the resident was told they must not get out of bed at night, and to remove her chocolates from her bedroom at night. The resident suffers with dementia and is unlikely to understand the concept of having to stay in bed and secondly the resident was being denied the right to eat her chocolates in bed if she wished. The inspectors observed that two residents had identified in their personal plans that they have a preference to have a shower, however the shower is currently out of action as it is currently being used as a storage room. The inappropriate use of the shower room has been subject to requirements following previous inspections. In order for the residents to have a shower the shower room must be cleared of unnecessary items without delay. The home provides freshly baked home made meals that appear wholesome and nutritious, the catering staff said they were made aware of the specific likes and dislikes of the residents and were provided with information on Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 17 residents dietary requirements, however the records held in the kitchen regarding residents needs were out of date for some. During discussion with the cook it was identified that she would like further training in the provision of providing special diets. It was identified that when discussing food provision with kitchen staff the guidelines given for managing diabetics was to not give them too much fat or sugar or consider the supplement of sugar for sweetener as the only consideration required to achieve a diabetics diet. Staff do not recognise that an individuals needs may range in not only calorie requirements but also the management of appropriate amounts of fat, protein and even fruits and milks. The catering staff said they felt they would benefit from training in meeting the nutritional needs of the elderly, dementia and diabetes. The manager has obtained off the Commission for Social Care Inspection internet new guidance on maintaining healthy diets for the elderly. The inspectors joined the residents for lunch and observed a calm and relaxing approach to meal times, residents requiring assistance are supported to eat their meals. However there was evidence to suggest care staff were not adequately monitoring individuals at risk. Through the case tracking process the inspectors observed that one resident was not eating or drinking very well and this had not been reflected in the resident’s care plan. In the plan of care it stated the resident required a soft diet, however a member of staff said the resident required a pureed diet and that the resident had been prescribed a thickening agent to assist the resident to swallow safely. The manager stated she was not aware that the resident had been prescribed the thickener, however senior staff were aware but had not updated the care plan. There are no records to identify that any of the individuals with diabetes have a plan to best identify food sources and the quantity or number of servings from each food group. When discussing diversity issues the cook could not identify any understanding of or training in special diets. Nutritional risk assessments are not undertaken, placing vulnerable residents at risk from malnutrition. It was relayed to the manager that service users were observed throughout the visit being provided only with drinks from the trolley at set times. There was no evidence of drinks in residents’ rooms and on the day of the visit it was very warm. Nor was there access to fluid in the lounges or by the resident’s bed who is described in her care plan as liking a glass of water at night. This further demonstrates that the preferences of the residents are not considered. Residents are unable to seek a drink from the kitchen as a day service is situated between the kitchen and the main building. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The home has made progress in ensuring the views of the residents and relatives are heard. The home does well to train staff in abuse awareness however there is evidence to suggest that the residents are still at risk from abuse such as neglect. EVIDENCE: The home has produced a very good accessible complaints procedure, unfortunately the inspector did not gain an opportunity to test this out with the residents, however the residents with whom the inspectors met with appeared happy and did not express any concerns. A visiting relative said he had seen the complaints procedure and thought it to be very good and said he had nothing but praise for the home and the staff. “They do a very good job and I don’t have any complaints”. The home has not been subject to abuse allegations since an allegation of abuse was made in June 2005. The procedure for managing the alleged abuse was poorly handled by the home and by the service, to date the inspector has not received a full statement to outcome of the investigation. The manager agreed to obtain the information and forward it to the inspector. The manager and staff with whom the inspectors met with said they had received training in Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 19 abuse awareness and some care staff had gone on to undertake training in the investigation process, however the staff need to be aware of every day practices that result in unintentionally abusive action, such as removing resident’s chocolates from her room at night and not appropriately tending the residents health and welfare needs. These are tantamount to psychological abuse and neglect. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 20 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, 21, 24, Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Some improvements have been made to residents’ bedrooms and bathrooms, however the links between the style of home, its philosophy of care and its size and design in relation to staffing do not adequately meet the needs of residents with dementia and further work is required to enhance the decoration and cleanliness of the home. EVIDENCE: The manager and staff have demonstrated they are making every effort to provide a warm and welcoming home to live in, this is evidenced by the purchase of new furniture, adjustable beds, new vanity units, lockable bedside cabinets and boarders and pictures in bedrooms. The staff have made considerable effort to improve associated signage, which aid the residents to maintain a level of independence and improvements have been made to bathrooms with the purchase of bathroom furniture. A relative with whom the inspectors spoke with said he felt his wife’s bedroom was very nicely Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 21 decorated, homely and clean. Other visitors to the home felt the home was bright, welcoming and clean. The home has been specifically designed to provide small group living dependent on level of need and support of the residents. The home has two small lounges/dining rooms and one larger communal lounge and dining room, which is bright and sunny, this room was very warm on the day of the visit. However in practice the home does not to operate smaller personal units each with its own communal focus due to the lack of staff, which has a direct effect on supervision of residents. As the purpose of the home is to support and care for residents with dementia further consideration must be made to the staffing, décor and layout of communal space. This must also be considered in relation to minimizing the number of accidents and incidents within the home. Portable devises such as pendants are needed, as residents do not have access to a call bell in all areas including the gardens. The décor of the home has been designed with the needs of the residents in mind with coloured coded areas, tactile symbols, symbols on bathrooms and toilets and coloured door frames to lead residents into specific areas of the home. The home has a sensory room and hairdressing room. However sadly the sensory room is very rarely used despite staff receiving training from Southampton University approximately eighteen months ago whilst the university were carrying out a study of the benefits of sensory stimulation. The hairdressing room doubles as the care coordinators office. Following the last inspection the home was required to move the care coordinators office, as it was not practical nor a place where confidential discussions could take place. This was evidenced on the day when discussion with staff was observed to be taking place in the office with the hairdresser tending to a resident’s hair. The registered manager informed the inspectors that a feasibility study was taking place to see where the care coordinators office could be moved to, however the requirement has exceeded its timescale. The numerous notices displayed around the home regarding personal care and cleaning issues do not give a homely image. Other areas of the environment the manager must address are: 1. 2. 3. 4. Replace worn bedding and towels. Clean windows inside and out more frequently. Repaint peeling paintwork on windowsills. Repaint and repair areas of the home where paintwork is peeling or damaged i.e. large lounge and corridors. 5. Repaint walls where old vanity units have been removed and replaced by new. 6. Redecorate the smoking room. 7. Thoroughly clean or replace carpets in corridors. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 22 8. Consider the external appearance of the home and make good the paintwork on woodwork and fascias. A risk assessment in one resident’s plan identified the need for water temperatures to be checked prior to bathing to prevent the risk of scalds and the door to the bathroom in question to be kept locked as another resident was at risk is allowed to enter the bathroom unsupervised. The inspectors established that weekly recording was undertaken on the hot water outlet and the key to the bathroom could not be found to lock the bathroom after it had been cleaned. Therefore the routine measure of checking water temperatures once a week must be increased to daily checking and recording and the key to the bathroom kept safe at all times with the person in charge of the shift. The home was free from offensive odours however the home could be kept cleaner with attention to light shades to remove flies and cobwebs. The programme of routine maintenance provided by the manager does not address the concerns regarding the renewal of the fabric and decoration within the home. A timescale will be set for compliance to improve the above listed areas of concerns. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 23 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, 29 and 30 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The staffing levels and skill mix of staff are not appropriate to meet the assessed needs of the residents and to fulfill the aims of the home as detailed in the SIOP for the home. The homes repeated failure to comply with correct recruitment polices and procedures does not adequately protect the residents placing them at potential risk of harm. Ancillary staff have not been provided with the appropriate training to deem them trained and competent to do their jobs. EVIDENCE: The home has a small number of dedicated staff that have worked in the home for many years and have experienced many changes in terms of the philosophy of the service, the building and management. Some staff were observed to work hard in carrying out day-to-day tasks and there were positive interactions with some of the residents. The environment, complexities, numbers and high support needs of the residents’ places pressure on staff to do their job to the best of their ability especially when the home is working on minimum staffing levels. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 24 A high number of compliance issues have already been identified through the body of the report that demonstrate the home does not have sufficient numbers of staff on duty at any one time. The manager has done her best to deploy her staff the best way she sees fit to ensure residents are not left for long periods of time without supervision. However on the day of the inspection the inspectors observed further practices that raise concerns with regards to the numbers of staff on duty. Residents were observed leaving the building to the garden and setting off alarms. A member of staff in close proximally with the tea trolley was reluctant to leave the trolley with the safety of other residents in mind, however was forced to leave it to check on the residents who had left the building, another member of staff appeared shortly after having come from the other side of the building, this member of staff was wearing disposable gloves and said to the other member of staff that he was in the middle of attending to the personal needs of another resident. A further example earlier in the day was observed when the alarm was ringing for a long period of time, again activated by a resident opening an external door. The response to deactivate the alarm was very slow. The manager was observed to address this staff that had remained in the office and not responded to the alarm because they were discussing another resident. In view of the detrimental effect staffing levels have for service users the home must address its staffing ratio according to the assessed needs of the residents and employ sufficient numbers of ancillary and domestic staff to ensure that the standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state and free from dirt. The service continues to fail to comply with recruitment policies and procedures, this places the residents at potential risk of harm. The inspectors’ viewed four staff files, which lacked terms and conditions of employment, photo identification, application forms, employment histories, audit trail of references, job descriptions, interview notes and screening. One file did not identify the staff members’ nationality or details of identification, the application had been poorly completed and the history of employment did not detail gaps, there was one poor reference and no training and supervision records. However the manager could demonstrate that criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks had been undertaken and the manager informed the inspectors that all existing staff were being rechecked. The service has persistently failed to comply with recruitment procedures and has already received a statutory notice in respect of failing to check staff, therefore a view will be taken as to what further action will follow. Through discussion with ancillary staff the inspectors established that the staff lacked training in relation to health and safety, infection control, COSHH, food and diets and manual handling. The staff with whom the inspectors met said Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 25 they enjoyed their jobs, showed enthusiasm and were keen to do training which related to their roles such as diabetes, food nutrition and infection control. One member of ancillary staff said she was very keen to do an NVQ and had been promised this approximately four years ago, yet to date had not been nominated to do it. Identified through the body of the report are concerns relating to residents’ dietary needs, and the cleanliness of the home, therefore the manager must ensure all staff are adequately trained to undertake their roles and responsibilities. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 26 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): 31,36 and 37 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to this service. The newly appointed registered manager has done her best to address requirements issued following the previous inspection, however the home needs to make significant improvements to meet the required minimum standards. The home fails to fully comply with the supervision of staff and the homes record keeping. EVIDENCE: The newly registered manager was appointed to the post of acting manager in October 2005 and in total has worked in the home in the capacity of an acting manager for approximately two years off and on. The purpose was of the appointment was to cover the long term absence of the previous manager. The Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 27 home has been subject to other acting management appointments that have had a considerable impact on the smooth running of the home and the homes capacity to meet requirements. The current acting registered manager confirmed that a permanent appointment has been made and the new manager will commence at the end of April 06.within three months of taking up post. The Home requires a robust management structure with skilled and experienced staff to meet the required needs of the residents and the philosophy and purpose of the home. The inspectors sampled supervision records for staff and established that not all staff were recieving six formal supervision sessions a year in discussion with the manager she said that this was being addressed and that she was aware of the gaps. However the requirement issued following the previous visit to the home has not been addressed and therefore will be repeated. There was evidenced provided throughout the inspection process that residents records are not adequately maintained and kept up to date placing residents at risk of potential harm and risk of unconscious abuse as detailed in the body of the report. Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 1 X 2 X X 2 X X STAFFING Standard No Score 27 1 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 1 2 X Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 29 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. The manager must ensure the changing assessed needs of the residents are reviewed as required and reflected in the residents’ plan of care. The residents’ personal plans must reflect their assessed strengths, health and welfare needs, routines, hobbies and interests and wishes. This requirement has been repeated. A further failure to comply will result in further action being taken. 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 Woodside Lodge Resource Centre DS0000039181.V288638.R01.S.doc Version 5.1 Page 30 Timescale for action 08/05/06 2. OP32 14(2) 08/05/06 3. OP7 OP12 15(1) 12(1) 30/06/06 30/06/06 comply will result in further action being taken. 5. OP7 15(1) 14(2) The manager must ensure all relevant staff are made aware of the changing needs of the residents, such as dietary requirements. The manager must ensure all care staff are aware of the information provided in residents plan of care. And follow this. The system must enable care staff to report changes to residents needs promptly. The management of individualised medication must be based on the residents’ individual assessment. The manager must ensure there is recorded agreement with the GP or pharmacist that medications can be crushed. 08/05/06 6. OP7 15(1) 14(2) 08/05/06 7. OP7OP9 13(2) 13(4) 30/04/06 8. OP10 13(2) 12(1) 08/05/06 9. OP7OP10 13(2) 12(1) The manager must ensure advice 08/05/06 is sought for those residents who repeatedly refuse or spit out their medication and take appropriate action. The manager must ensure the staff have access to the medication policies and procedures at all times. The staff must respect individual residents rights and wishes, and provide support in accordance with this. The manager must ensure all residents have a nutritional assessment undertaken and address individual dietary needs as required. DS0000039181.V288638.R01.S.doc 10. OP10 13(2) 30/04/06 11. OP12 OP18 12(3) 13(6) 08/05/06 12. OP7OP8OP 15 12(1) 13(1) 15(1) 16(2) 31/05/06 Woodside Lodge Resource Centre Version 5.1 Page 31 13. OP8OP10O P12OP7 12(3) 16(4) The manager must ensure the 30/04/06 residents have access to fluids as they wish through out the day and night. The manager must remove all unwanted furniture from the shower room so that this is usable. This has been required previously. 30/04/06 14. OP19OP12 OP21 23(2) 15. OP12OP21 12(2)(3) 23 The manager must ensure residents can be supported to use the assisted shower if they wish. The registered provider must provide the Commission for Social Care Inspection with a schedule of works identifying when further repairs and improvements will be made to the environment as detailed in the body of the report. The manager must ensure worn bed linen and towels are replaced. The manager must ensure all residents have access to call bells at all times. This requirement has been repeated. A further failure to comply will; result in further action being taken. 30/04/06 16. OP19 23(1) 23(2) 08/05/06 17. OP19 16(2) 31/05/06 18. OP38OP22 13(4) 08/04/06 19. OP19OP37 12(4) 17(1) The registered providers must ensure that staff 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 DS0000039181.V288638.R01.S.doc 31/05/06 Woodside Lodge Resource Centre Version 5.1 Page 32 addressed by the given date. 20 OP21OP38 23(2) 13(4) Daily checks must be undertaken 30/04/06 on hot water outlets in all bathrooms and shower room. Temperatures exceeding 43 centigrade must be immediately reported, and appropriate action taken. The bathroom risked assessed as needing to be locked when not in use must be kept locked. The manager must ensure the staffing levels are sufficient to meet the assessed needs of the resident. Please confirm in writing the action you have taken to address this. Concerns’ regarding staffing levels has been repeated on four occasions, a decision will now be considered to what further action will take place. 23. OP18OP29 19(1) The manager must ensure the home and the organisation follows the correct procedures when recruiting staff. The home must demonstrate that it has obtained all appropriate documentation and information on new staff such as applications, checks on employment history, ID and credible references. The manager must ensure all staff including ancillary staff receive training so they are competent to do their jobs. The manager must ensure all staff receive a minimum of six supervisions a year. DS0000039181.V288638.R01.S.doc 21. OP7 P21 OP38 OP3 OP38OP7 OP12OP27 23(2) 13(4) 18(1) 30/04/06 22. 31/05/06 08/05/06 24. OP30 18(1) 31/07/06 25. OP36 18(3) 31/05/06 Woodside Lodge Resource Centre Version 5.1 Page 33 This requirement has been repeated. A further failure to comply will result in further action being taken. 26. OP7 13(5) 14(1) The manager must ensure all residents who require assistance to mobilise have a moving and handling assessment carried out on them. 31/05/06 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.V288638.R01.S.doc Version 5.1 Page 34 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. 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