Inspection on 01/07/08 for Worsley Lodge

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Poor service.

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

Worsley Lodge 10/11/08

Worsley Lodge 15/02/08

Worsley Lodge 08/11/07

Worsley Lodge 06/08/07

Worsley Lodge 11/05/06

Worsley Lodge 16/02/06

Worsley Lodge 18/08/05

Worsley Lodge 13/10/04

Worsley Lodge 20/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Worsley Lodge 119 Worsley Road Worsley M28 2WG Lead Inspector Elizabeth Holt Unannounced Inspection 1st July 2008 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 Worsley Lodge DS0000006733.V366574.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. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Worsley Lodge Address 119 Worsley Road Worsley M28 2WG 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) 0161 794 0706 0161 794 7715 worsleylodge@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of people who can be accommodated is: 48 15th February 2008 Date of last inspection Brief Description of the Service: Worsley Lodge is a care home that provides personal care and accommodation for up to 48 older people. The Registered Provider is Southern Cross Care homes Limited. A driveway leads from the main road to a car park and the main entrance to the home. The home is a two storey, detached, purpose built property set in its own grounds. All of the bedrooms are single. Thirty-three of the rooms have an en suite facility; sixteen rooms have a shower en-suite and seventeen rooms have a toilet en suite. Assisted bathing facilities are available on both floors. There are lounges on both floors. Adaptations and aids are provided, including a passenger lift and hoists. The current weekly fees range from £317.00 to £475.00 dependent on the package of care required. Additional charges are made for hairdressing and other personal requirements. More information is available from the home and a statement of purpose and brochure are made available pre admission. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This key inspection took place on Tuesday 1st July 2008. The manager of the home was not told beforehand of this inspection, which included a site visit. A random inspection was carried out on the 1st May 2008 to follow up the requirements of the key inspection carried out on the 15th, 19th and 27th February 2008 and to check compliance with the statutory notice requirement issued on the 27th March 2008. An improvement plan, completed by the manager and Operations Director, was submitted to the Commission on 21st May 2008. This described the action being taken to make improvements and address the requirements made following the inspection in February 2008. The administration of medication at Worsley Lodge has also been a concern and the company Southern Cross was served with a statutory requirement notice in December 2007 in relation to poor medication administration practices. A further visit by us to monitor compliance with the statutory requirement notice identified no improvement in medication practices and the company Southern Cross Care Homes No 2 Limited accepted a Simple Caution in relation to this. There had been some progress made in relation to the recording and administration of medication at the inspection in May 2008. All key National Minimum Standards for Older People were assessed at the site visit and information was taken from various sources including observing the staff, talking with residents who live at the home, the staff team and the new manager. Resident’s care files were looked as part of the inspection and other documentation. A tour of some areas of the building including resident’s bedrooms also took place. We sent the manager an Annual Quality Assurance Assessment (AQAA) form before the inspection for her to complete and tell us what they thought they did well and what they need to improve on. Service user surveys were returned to the Commission in May 2008 from residents, relatives, staff and health professionals. At the time of writing the report three residents, two relatives, two staff members and two health professionals returned surveys. We considered the responses and other information gathered during the visit and have referred to this in the report. As part of this inspection an expert by experience assisted the inspector for part of the visit. The phrase “expert by experience” is used to describe people Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 6 whose knowledge about social care services comes directly from using social care services. This person talked to various residents about their quality of life and she also spoke with some visitors. She completed a report after the inspection and some of her written comments are included in this report. Since the last key inspection there have been changes to the management arrangements for the home, the home had a new manager in place during this visit who was on her second day in post at the home following her induction. It was evident that action by senior managers to improve the quality of service in the home was being undertaken and improvements were noted in a number of areas, however further work is still required. At the time of writing this report the concerns/allegations being investigated under Salford Council’s adult safeguarding procedures have progressed, however these have not yet been concluded. What the service does well: What has improved since the last inspection? A visit to Worsley Lodge by us in May 2008 identified some improvements in both care practice and care planning and the requirements of the statutory requirement notice were assessed as being complied with. Since the last inspection we have been informed that quality audits have been carried out of care plans and medication practices however there are still shortfalls in the information recorded, which may lead to residents needs not being fully met. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 7 There has been an ongoing staff training and supervision programme since the last key inspection, however staff who are still in post need time to put the learning into practice and develop new skills in a supportive environment. Although the training statistics provided showed a commitment to the training and development of staff, the training matrix provided at the time of this visit did not clearly show that the training was given to staff who are currently employed at the home. Since the last inspection areas throughout the home have been redecorated and refurbished which has improved the environment for the residents living there. Some residents who expressed a view spoke positively about the environment in which they live. The company have appointed a manager who had commenced working in the home 2 days prior to the site visit. She stated she had started the process to register with the Commission. What they could do better: During this inspection similar concerns identified at previous inspections and in the statutory requirement notice were identified, particularly in relation to care plans not fully reflecting the care needs of residents or being regularly updated to show the residents’ changing needs, shortfalls in the recording of food and fluid monitoring and shortfalls in medication practices. Medication must be given to residents as prescribed. Records about medication handling must be accurate and show that residents are given their medicines properly and that all medicines can be fully accounted for. As raised at the last inspection the information gathered from the care assessments was not always clearly detailed in the care plan; this may lead to a risk to the resident’s health or personal care needs not being met. Care plans need to be more individual and person centred for each need identified to show all the care needs of each resident. Attention must be given to the evaluation and changing needs of the residents. The menu on display did not reflect the meal of the day and residents were kept waiting a lengthy time before the meal was served. Residents must be provided with food that is at a suitable temperature and staff should be aware of the meal being served. There was a lack of recreational activities provided. One of the residents responded in the survey saying, “There is no proper activities going on. The staff just sit us down and only move us for meals or the toilet sometimes.” The home has a system in place for the management of complaints however during this visit some relatives had a number of concerns, which included the care of their relatives, which relatives did not feel had been fully addressed. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 8 On the day of the visit two care workers were on induction training because they were new to the home; one care worker was in her second week of working in the home, there was one agency care worker and two experienced care staff on duty. Vacant care staff positions had now been filled and attention needs to be given to the development of the staff team. As the need for agency staff is reduced the staff will be able to work together to improve the care provided for the residents. The manager must make sure the new staff are appropriately supervised and are supported during their induction period to feel confident that they are given proper guidance and support. It is recommended that new workers receive their induction training and there is evidence the staff have received appropriate information during this process to protect themselves and the residents. Staff must be given the opportunity to acquire the skills and competencies needed to carry out their roles effectively. From the self assessment information provided by the home 25 of care staff at the home have successfully completed NVQ training in care, this needs to be extended to more staff. The management and staff must make sure the skill mix and competence of the staff on duty are appropriate to meet the needs of the residents and the health and safety of the residents living at the home are safeguarded and protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Worsley Lodge DS0000006733.V366574.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 Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ pre admission assessments are carried out to ensure that the care needs of prospective residents are known. EVIDENCE: A new Statement of Purpose and a Service User Guide was not on display on the day of this visit. The Operations manager said they were waiting for the new registration certificate and the documents would be readily available the following day. Since the last inspection there have been no new admissions to the home but the care plans looked at included an assessment of need. The judgement was based on the care plans looked at during this visit and information from the last inspection as no new evidence has been provided to the CSCI to suggest that residents do not receive an assessment of needs. The Annual Quality Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 11 Assurance Assessment (AQAA) stated that all prospective clients may have a trial period in which to make up their minds about the home. A recommendation made at the last inspection was for the pre admission needs assessment to include the individual’s concerns and wishes about coming into a care home to ensure these identified needs can be met. As there had been no new admissions since the last inspection the recommendation has been made again in this report. Worsley Lodge does not provide intermediate care facilities. Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans did not provide staff with sufficient detail to ensure that the health, safety and personal care needs of residents were being consistently met in full. EVIDENCE: There have been on going concerns regarding the quality of care records and care delivery at Worsley Lodge and on the 30 March 2008 we served the company Southern Cross with statutory requirement notices in relation to care planning and practices. A visit to Worsley Lodge by us in May 2008 identified some improvements in both care practice and care planning and the requirements of the statutory notice were assessed as being complied with. We received an improvement plan on the 22nd May 2008, which stated, that all care files had been audited and a list of corrective actions developed and ‘All corrective actions have been completed’. During this inspection similar concerns identified at previous inspections and in the statutory requirement notice were identified. Therefore we could not confirm the statement that ‘All corrective actions have been completed.’ Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 13 Five care plans were sampled during this visit and, where possible the resident to whom the care plan belonged to was spoken with. The care plans looked at did not give enough up to date information to enable the staff to properly monitor the progress of the health and personal care needs of the residents and their condition. The issues identified were: The care plans provided evidence that other health care professionals and services were provided to residents but the recommendations for care and treatment were not consistently incorporated into the individual plans. For example, one resident’s care file had at the back of the file written advice from a dietician to help improve the resident’s food and diet intake to prevent weight loss. This information, for example, offering puddings, snacks, offering full fat yogurt and custard with fruit mid morning, two chocolate biscuits and hot milky or hot chocolate made with full fat milk at bedtime and 2 or 3 glasses of milk throughout the day had not been included in the resident’s care plan and when the resident was asked about this she stated that no one had discussed the dietician’s advice with her. Not following specialist health advice does not promote the resident’s health and wellbeing. Further, not all care plans were kept up to date or showed all the care needs of each resident. Care plans for personal hygiene, catheter care, wound care, nutritional care, dementia/confusion and social care were either not available or completed fully. Two care plans for a resident indicated that she should drink at least 2 litres of fluid per day. The care plan for eating and drinking stated, “Ensure” resident “is offered adequate fluids (approximately 2 litres per day)” and the care plan for catheter care refers to encouraging to drink at least two litres of fluid each day. Fluid intake monitoring records were not available for this resident. A permanent care worker was asked if staff monitored this resident’s fluid intake and the care worker said that they did not. The care worker also said that she wasn’t aware that she was supposed to do this. The lack of fluid intake monitoring potentially places this resident at risk of dehydration as staff were unaware if this resident was drinking sufficient fluids and the resident was also potentially at risk from a blocked catheter. Insufficient fluid intake has also been shown to contribute to the development of urinary tract infections for people with urinary catheters. Pressure area care records for a resident showed that they needed a pressure relieving mattress to help maintain their skin integrity and that they had recently had pressure ulcers and the skin was fragile. The care plan stated, ‘Ensure supplied pressure relieving mattress is in place at all times’. Information detailing what type of mattress and what setting this was to be set at was not available. The mattress setting was not set correctly in line with this resident’s weight which places her at risk of developing pressure sores. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 14 Information in the care plan for a resident who had recently returned to the home from hospital following a planned hip operation was confusing. The falls risk assessment showed, “Falls reported last month and fractured hip. A care plan to support this resident psychologically and emotionally through the admission and discharge from hospital was not recorded. The information regarding the hospital admission was an entry in the daily statement and there was no care plan explaining how staff were to care for her and her hip post operatively, potentially putting the resident at risk from injury from inappropriate or unsafe moving and handling. The care plan for moving and handling had not been up dated since the 2 June 2008. This meant information and instructions to staff to move and support the resident safely was not available. Senior staff present were not clear whether the surgery had been planned or was undertaken following a fall. Further the community physiotherapist visited the resident on the 27 June 2008 to assist with mobility. Instruction or advice from the community physiotherapist was not recorded and included as part of the care plan for this resident. At the site visit in May 2008 there had been some progress made in relation to the concerns regarding the lack of completed food and fluid records raised previously. A recommendation was made for a formal system to be put in place for monitoring these. The improvement plan received on the 22nd May 2008, stated that all “Fluid/food monitoring charts need to be signed off by the senior carer responsible for the shift on a day to day basis to demonstrate that they have been completed as necessary and an adequate amount of fluid/foods have been taken. This process is in situ currently”. Staff spoken to during this visit said they did not always have time to complete the charts. A review of a sample of charts showed these were not always fully completed or showed no evidence of adding them up to form a view as to whether the resident had received an adequate nutritional or fluid input. Shortfalls in the lack of information for staff has the potential for staff to not be able to act appropriately if a resident’s intake or output was poor and has the potential to lead to shortfalls in the monitoring of the residents wellbeing. Another care plan required the fluid (drinks) intake of the resident to be monitored and weekly weights to be recorded neither of these instructions had been followed. The monthly evaluations over a two month period showed that reviews of the care plans had been undertaken until the middle of May 2008 but these reviews did not evaluate the effectiveness of care delivery. An evaluation of a care plan of a resident recorded on the 19/05/08 that had been discharged from the tissue viability nurse stated “to continue to monitor”. No further evaluation had been made to show this residents skin integrity. The Annual Quality Assurance Assessment (AQAA) returned to us stated that all residents had comprehensive care plans, which was reviewed and updated monthly and that resident’s choices and wishes were taken into account when Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 15 delivering personal care. Evidence to support these statements was not identified from the care records seen. On the morning of this visit one care worker said she was very frustrated because residents were still in bed and there were only two staff on duty, ‘who knew what they are doing’. Care staff confirmed that they had not had time to bath anyone nor had they had time to record nutritional and fluid intake charts. The administration of medication at Worsley Lodge has also been a concern and the company Southern Cross was served with a statutory requirement notice in December 2007 in relation to poor medication administration practices. A further visit by us to monitor compliance with the statutory requirement notice identified no improvement in medication practices and the company Southern Cross Care Homes No 2 Limited accepted a Simple Caution in relation to this. There had been some progress made in relation to the recording and administration of medication at the inspection in May 2008. On the morning of the inspection visit an agency care assistant was observed dispensing and administering medication from around 10 am. The medication round took a long time to complete. When spoken with the agency care assistant said she worked in the home about seven times this year and that she had medication training last year when she lived in London. She stated she had not dispensed and administered medication at Worsley Lodge before. The agency worker was observed struggling in completing the medication and in identifying who residents were. She was observed to ask for assistance from one new care worker, (who refused stating she didn’t know the medicines or residents) and she asked other care staff to point out residents. One of the completed surveys from a resident stated that, “The medicines take ages to give out in the morning often taking till lunch time which means those on three or four doses are missing vital medicines.” Residents were potentially at risk from receiving the medication not at the prescribed time because the agency worker took so long did not know the home’s medication systems or who the residents were; nor, from observation was she provided with appropriate support or supervision to make sure she administered medication safely. A sample of medication records was seen for eight residents. On the whole the medication administration records were filled out appropriately and these matched the medications dispensed. Records of receipt of medication into the home were available. One resident had recently been discharged from hospital and the medication administration time had been changed by the hospital from morning to evening, however the medication record for this medication had not been crossed out and re-written as we would expect so that staff responsible for Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 16 administering medication had a clear record so that potential errors in administration were minimised. Another resident was prescribed a sedative type medication with the prescriber’s instruction of one or two tablets if required. It was unclear from the signed medication administration sheets what dose of medication (either one or two tablets) was being administered. Clear guidelines explaining in what circumstances the resident should be administered two tablets were not available with the medication record. This meant that potentially the resident received a different dose at each medication round, dependent on the staff member administering the medication. A district nurse arrived to administer an injection for one resident and none of the staff in the home including managers knew where this medication was kept. The district nurse eventually found the medication in a large brown envelope on the desk in the office next to the medication storage room. This incident showed that storage of medication was not consistently appropriate and that the skill mix and knowledge of the staff on duty in relation to medication was not good enough and potentially put residents at risk. During the inspection we were told that all staff with responsibility for medication administration were due to attend intensive medication training the week after this visit. The improvement plan sent to the Commission on the 21st May 2008 showed that medication competency assessments and audits have been completed for all staff who administer medication and plans are in place to repeat these by the end of June 2008/beginning of July 2008. A list of staff specimen signatures regarding medication administration was available and this included staff that were new to working at the home. The returns book for medication showed that the returns were being recorded and made to the licensed waste contractor. Along with a requirement in the statutory enforcement notice issued on 27th March 2008, a requirement was made at the inspection in February 2008 to make sure the care home is conducted in a manner, which respects the privacy and dignity of the residents. During the site visit the residents were not always seen to look well cared for, a number of residents’ clothes had food stains on them and some residents did not appear to be wearing appropriate underwear with their clothes. One resident said, “I was got up in a hurry to get my breakfast that there was not enough time to spend in choosing my clothes.” Some residents were seen to be walking in slippers that did not appear to fit their feet appropriately. Two male residents had some facial growth and they had clearly not had a shave. A discussion with one of the residents highlighted that he liked an electric shave but his electric razor had gone missing. A manager in the home confirmed this and said that a replacement electric razor had been provided to the resident. As raised at the last visit the night staff had assisted this resident with his personal hygiene on Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 17 the morning of this visit and therefore she had not attended to his needs. A recommendation was made for the resident’s care plan to include the support required to assist residents to maintain their dignity with personal grooming and to be supported to dress appropriately. Before the site visit the CSCI sent surveys to residents and relatives asking about their views of the home. Of the three relatives who responded in May 2008 two of these said they were always kept up to date with important issues affecting their friend/relative. One of the residents said in response to “Do you receive the care and support you need?” “Due to calling for assistance it seems ages for the staff to come, then when they do they have not the time to listen. Though there are the odd one or two who do.” Managers spoken with at the inspection said that they had undertaken their own telephone survey of relatives to ask about the quality of service and that the feedback was good, however the records of these telephone surveys were not available. A copy of these responses were provided to the inspectors after the inspection. Results showed that fifteen relatives/residents were positive that improvements were being made and Worsley Lodge was progressing. Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A lack of person centred planning in relation to the social and dietary needs of the residents’ means that they are not purposefully engaged and their social, recreational, dietary and cultural expectations are not met. EVIDENCE: At the time of this visit the activities organiser was absent from the home and there had been minimal activities for “over a month” according to one of the relatives. Residents were seen to doze off to sleep and appear to lack stimulation and were seen to be sitting in the lounge with nothing to do and little interaction for long periods of time. The new manager showed us a chart she had introduced for the staff to go round to find out from the residents their likes and dislikes and what activities they would like. The staff had started this exercise and recordings were made to show what the residents had said. In the late afternoon one of the care workers was seen encouraging four residents to play a board game, which they appeared to enjoy. A discussion with the manager showed she was hopeful to introduce more activities, trips out and social events to meet the residents needs more fully. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 19 Staff were busy and interactions between staff and residents although appropriate was tasked focused. One resident spoken with said about activities, “there is not as much as I thought there would be”. A relative spoken with said, “I am disappointed by the lack of activities. I was told that some would be put into place and things did improve slightly but nothing is sustained. They promise to do a lot but nothing ever materialises. I think stimulation is very important.” One of the responses from a resident in the survey was, “There is no proper activities going on. The staff just sit us down and only move us for meals or toilet sometimes”. During the site visit the expert by experience spent time in the lounges, visited residents who chose to stay in their bedrooms and joined a group of residents for lunch. Comments made from her observations are included below. The large screen television was tuned into tennis, which no one, on asking was interested in. Others residents were watching the movement and behaviour of other people around them, although there was a lot of movement in this area of the lounge because this was the route to the other amenities on the ground floor, apart from one or two of the longer serving staff talking to the residents on passing, no one sat down in conversation with the residents. The record of recreational activities was looked at in some of the care plans and showed there was a shortfall in activities going on in the home. For one of the residents the activities record showed the days during the month she had spent in the lounge area. One plan for activities stated, ‘Requires encouragement to participate in social activities’. One would expect information about people’s personal wishes, preferences, likes and dislikes to be recorded. Some of the residents said they could remember going out on trips and also some of the things they had previously done and they did miss this. We observed the home environment and the wellbeing of the people living there and we noted that a high number of residents had some form of confusion and could not always speak with us. As raised at previous inspections, including February 2008, the plans to develop “Life Story Books”, and a “Memory lane” in the corridor had not been addressed. Residents who could express a view said they had a choice of where they spent their day. One resident however was still in her bedroom late morning and was waiting for staff to be free in order to assist her to join other residents in the lounge area. One resident said she did not have a choice of bedtime, because she needed the hoist. She said that she and another resident who required the hoist were always last to be assisted to bed. In relation to food and the lunchtime meal the expert by experience made the following observations; Some of the residents when asked about the staff and food were noncommittal others said, “staff change quite a bit but they do their best, no Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 20 complaints about the food.” Some of the residents said they had cereals for breakfast but could have a cooked breakfast if they wished. When I asked did they know what was for lunch no one could tell me, one resident said she had been told that morning but couldn’t remember. One staff member said the meal was beef casserole, however it was lamb stew. Staff should know what the meal is so they can explain to residents what they are being offered to eat. As I passed the dining hall at 12:05 two or three people were already seated at tables, the new senior female carer was taking them in, lunchtime was 12:30. At 12:25 I joined a male resident, then two other ladies joined us, the room was quite modern with a wooden floor and pictures on the wall, a large Welsh dresser contained the plastic menus that I had noticed on each table, when I had been shown the room earlier. Approximately seventeen people were seated at tables of four, other tables were unoccupied, and some residents ate in their rooms or the lounge. All the tables had been laid with white tablecloths a knife, fork, and spoon, a small vase of artificial flowers; but no napkins; nor water glasses; no condiment sets; no menus. When I asked why they were not any menus on display the care worker said, “they were the menu for the day before and staff had not had an opportunity to change them”. The heated lunch wagon came at 12:35 and after checking the food temperature with the probe the senior staff in charge then checked the residents lunch sheets (I was told the residents had been asked that morning for their lunch choice). There was also one other senior staff serving at this point. A bowl of tomato soup was placed in front of each resident and I didn’t see anyone given any other choice. Whilst the soup was being served a lady came round with a tea trolley and gave each person a cup of tea- no one was asked would they like coffee or water or fruit juice. One of the residents on my table kept getting up and leaving the room, saying she wanted to go home. One of the residents tried to encourage her into sitting down. She only had about three spoonfuls of soup then she left the table, she was brought back to the table. The main course was lamb stew, potatoes, and vegetables or fishcake and vegetables. A plate of stew was put in front of the resident who wanted to leave the table, she tried a couple of mouthfuls but then refused to eat any more, This resident was asked did she want a sandwich instead, the cook then came in with two separate plates of sandwiches. Staff spoken to was aware of her needs and they did follow her around with sandwiches to try and get her to eat. At 12:50 I had the lamb stew, which was good, and tasty, the portions on the plates were adequate, by this time it was not very hot. During this time I was offered some juice but this was not offered to the other residents on my table. The care worker picked up a few of the plastic glasses from the sidebar and Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 21 went randomly to some of the tables and asked only four of the residents did they want juice, they all had it but it was not offered to each table. At 1:10 the last meal on a tray came to be collected that had been left on the side counter. I asked was it not cold? The care worker reluctantly agreed that it was and took it away to be reheated. Lunch was a two course meal with no pudding or cakes. Residents seemed to be brought into the dining room far too early, as some of them had been seated at the tables almost three quarters of an hour before they got their main course. Most of the residents had forgotten what they had chosen. The improvement plan received in May 2008 stated that “daily menus are displayed on the dining tables”. Menus were seen to be placed together and a look at these showed these to have been the previous days menu and staff had not had an opportunity to change them. There was however a menu board displayed in the entrance hallway. One resident said, the soup was ‘gorgeous’, and another resident said, “Food is very good, there’s too much really. I would rather have too little than too much”. One resident replied in the survey, “There is very little choice and when we do opt for a menu it seems to get changed so we do not get what we ordered. Though the food is sometimes good.” The observations made from the mealtime showed that staff were aware of the importance of a well balanced diet and the residents well being. The staff need to be provided with training and support to enable them to provide a hot meal and to complete the serving of food in a timely manner. Residents were encouraged to maintain contact with family and friends and visitors were seen throughout the day. Three visitors who the inspectors spoke to said they once again felt uneasy at times because of the amount of staff changes. As raised at the last inspection the visitors said, “They felt they needed to visit regularly to feel reassured their relatives were cared for properly”. One relative commented that, “communication about what is going on is not always the best.” Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be confident that their complaints will be taken seriously. Staff would be confident to refer on potential abuse in order to protect residents. EVIDENCE: The complaints procedure was available and we were told there have been six complaints about different aspects of the service made directly to the home since April 2008. One of these complaints had been forwarded to the home by CSCI. All the complaints had evidence that the home had investigated and responded to the complainant’s concerns. At the time of writing this report the concerns/allegations being investigated under Salford Council’s adult safeguarding procedures have progressed, however these have not yet been concluded by the other agencies involved. Outcomes following the newly referred safeguarding concerns/allegations being investigated at the time of last inspection are not all concluded with other agencies being the lead investigators. Concerns raised in some of these referrals were addressed by the home as they were not considered to be safeguarding issues. The management have stated that in order to “cover themselves and be cautious”, they have referred concerns as safeguarding Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 23 referrals in order to protect the residents and the company however not all of these were accepted by safeguarding. From the three residents/relatives surveys returned in May 2008 all three surveys showed the care service “usually” responded appropriately if they or the person using the service had raised concerns about their care? Does the care home give the support or care to your relative /friend that you expect or agreed?” Three residents/relatives responded “sometimes”. One relative/resident commented that, “You complain and they make excuses or tell you something to pacify you. But apart from a couple of staff, they do not seem to care.” On the day of the visit two relatives were spoken to and they expressed some concerns. One stated, “I feel there had been improvements over recent months however I have some anxieties again currently with the care of my relative.” One of the relatives expressed concerns that the morale of the permanent staff was very low and this gave them cause for concern. We are aware one of the managers of the home spoke to this person during the visit regarding their concerns. During this visit staff spoken to were aware of different types of abuse and how to identify abuse and said they were aware of the whistle blowing policy. Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, well maintained home that was generally clean and odour free. EVIDENCE: A partial tour of the home showed that the residents’ bedrooms and the downstairs lounge and dining room were homely and pleasantly decorated. Bedrooms were personalised with photographs and ornaments. The AQAA showed that their plans for improvement in the next twelve months included the redecoration of lounges and communal areas. The lounge had doors that opened out onto a large patio area, which was furnished with garden furniture and umbrellas and some residents were seen to be enjoying sitting out with their visitors. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 25 Two residents who chose to stay in their bedrooms on the first floor told the expert by experience that their rooms were kept clean. One of the residents had personalized her bright well-appointed room, which she thought was “comfortable” and she “liked the food”, she had porridge for breakfast but sometimes had a cooked breakfast and she had no complaints. Another resident said she “ate her lunch sometimes, she had just come out of hospital where the food wasn’t as good as it is here”. She went on to say that changes in the staff was difficult for her and she commented, “switching staff causes upheaval.” This resident said she was quite comfortable and liked having her own telephone and personal things around her. Residents spoken with said they were happy with their rooms. The home employed domestic and laundry staff and these were observed to be busy throughout the home. Communal areas in the home were clean and tidy. One relative commented that laundry seemed to go missing regularly and that on occasion her loved one was wearing other residents’ clothing. The laundry room was organised and the laundress had systems in place to manage the clothes. A variety of equipment was available in the home to ensure the physical care needs of the residents could be met. All staff had received training in infection control practices since April 1st 2008. Worsley Lodge DS0000006733.V366574.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The skill mix and deployment of staff must be reviewed to make sure the care and health and safety needs of the residents are being met in full. Shortfalls in the continuity of care from competent staff may lead to residents needs not being met in full. EVIDENCE: On the day of the visit on the 1st July 2008 there were twenty-six residents accommodated in the home. The home no longer provides nursing care but continues to provide personal care. The majority of these residents were living on the ground floor, although seven residents had their bedrooms on the first floor. One manager in the home said five of these residents were brought downstairs to be with the other residents in the home and two residents chose to spend lengthy periods of time in their bedrooms on the first floor. A discussion with the three managers present highlighted concerns in relation to the space between the bedrooms the residents on the first floor are currently occupying and how the staff are deployed to meet the needs of these residents particularly during the night. One resident commented in the survey that, “Due to calling for assistance it seems ages for the staff to come, then when they do they have not the time to listen, though there are the odd one or two who do”. A look at the night duty rota for the week commencing the 30th June 2008 showed there to be three staff on duty between the hours of 20.00 to 08.00hours. The self-assessment completed by the project manager Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 27 showed that twenty residents have some form of dementia / confusion and five residents require two or more staff to help with their care. A review of a sample of night check records did show that staff were carrying out regular checks on the residents during the night. A requirement has been made for the manager to make sure the deployment of staff across the shifts was sufficient to meet the needs of the residents accommodated particularly in relation to the seven residents accommodated on the first floor. Shortfalls may lead to staff not supporting the residents accommodated in the appropriate way during the night. Staff on duty on the morning of this visit was one senior care worker from an agency and five carers, which included two supernumerary staff. Two care workers were permanent staff members who knew the residents and their needs well, one carer was following her induction programme, and the other carer was a new starter on day two of his induction and was on escort duties for part of the morning. Discussion with the staff team and from observations made during the visit identified that some resident’s care needs were not being met, for example morning baths had not been undertaken, one resident was reported by an ancillary worker to still waiting to be assisted to get out of bed at 11.30 am and fluid intake monitoring charts had not been completed. The care staff confirmed this resident liked to get up early but they said there were not enough experienced workers on duty who knew the residents and their needs A resident spoken with said she had not had her breakfast at 10.00am and she was waiting for assistance to join residents in the lounge area. A manager did check this out and reported that this resident had had her breakfast. Another resident who was anxiously waiting for assistance from the staff said, “I’m desperate for the toilet and I told you I needed help the last time I spoke to you.” One care worker was an agency worker who spent most of her time administering medication and the other care assistant was a new worker who had started in the home the week previous to the inspection. This worker was a foreign national and did appear to be struggling in understanding the routines in the home. Two other care staff were new to the home and were reported to be supernumerary, however both these workers were observed to undertake care tasks and duties without proper supervision and guidance. Both experienced care assistants expressed concerns about the skill mix of the staff on duty and the difficulty in supervising and assisting new staff when they had the needs of the residents to meet. One care assistant said that her colleague had to escort two leaving just her on duty with a care staff team who did not know the residents or their needs. The manager reviewed this and sent one of the new staff members on escort duty. One relative said, ‘There is not as much agency staff as there were and I feel better that there is continuity. Staff know the residents better.’ There was evidence that the Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 28 number of agency staff used by the home was decreasing, a look at the duty rotas for the week starting the 23rd June 2008 showed that fifteen shifts were covered by agency staff and these were by four agency staff who had worked at the home before. Residents were left waiting for their needs to be met whilst the care workers waited for the appropriate support from the other members of the staff team. Shortfalls in appropriately supervising and mentoring new staff on duty may lead them to not being able to carry out their roles and responsibilities in the best interests of the residents. Discussion with some the staff and visitors showed that morale amongst the staff was low and concerns were expressed that this may lead to more staff leaving the home. One staff member responded in the survey saying, “We need more permanent staff, not the agency people. If we have permanent staff we could be a team.” The conclusion from observations made during this visit is that the skill mix of the staff and the staffing complement were not sufficiently experienced to meet all the care needs of the residents in the home. The new manager was seen to support a resident to transfer from her wheelchair into a lounge chair although it was evident she did not know the specific needs of this resident and whether or not she was able to manager this transfer unaided. The home has had ongoing problems recruiting and retaining staff to work at Worsley Lodge, however a number of new starters were in post and a programme of induction and training had been started. A training matrix was available of the training provided to staff in the home and two new staff members said they were having medication training on the 3rd and 4th July 2008. The records showed that a high number of the staff had received training in fire safety and drills, moving and handling, medication, care planning and abuse awareness since the 1st April 2008. The matrix showed that no staff had received training yet in dementia awareness this year and there is a high number of residents accommodated with some level of confusion or dementia type illness. The self-assessment survey completed in May 2008 showed that out of sixteen permanent care staff currently working at the home, four were qualified to National Vocational Qualification level 2 and one staff member was working towards this qualification. In order to ensure staff are appropriately trained in the care of older people staff must be encouraged to complete training so their lack of knowledge does not leave residents’ vulnerable. Four staff files were looked at and were all found to contain completed application forms, written references, two had evidence of interview notes. All four files had proof that checks had been carried out by the Criminal Records Bureau and other forms of identification were seen. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 29 One file had a copy of an induction checklist however none of this had been signed off by the manager or deputy manager but the new employee had signed this as completed. The manager said this should have been gone through with the new staff member the day before but it had not happened for some reason. It is recommended that new workers receive their induction training and there is evidence the staff have received appropriate information during this process to protect themselves and the residents. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work is needed to ensure systems are in place to monitor care practices, staff competencies and recordkeeping so as to safeguard the interests and well being of the residents. EVIDENCE: The home has a long history of not being able to retain a manager in the home. At this visit a new manager had commenced and she was working her second day in the home, following an induction period and was still trying to get to know everyone. She had held a staff meeting the previous day to introduce herself and reassure the staff team about the way forward. The new manager was going to have a period of support and a handover from the current acting/project manager who has been in post over recent months. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 31 Staff and visitors expressed some concerns about “more new management arrangements,” following a discussion with the new manager she highlighted areas where she wanted to improve the service for the residents. Shortfalls in this report highlight the need for a continuous period of management stability and the establishment of a permanent staff team in order to promote and protect the health, welfare and safety of the residents. Equipment in the home is checked and maintained by professionals e.g. hoist, gas, electric and fire extinguishers. Records were maintained of professional visits and service reports were available which detailed the ongoing maintenance in the home and this included fire safety records. The maintenance man was observed working in the home. His duties included attending to the day to day repairs, general maintenance of the home and monitoring health and safety. A quality assurance questionnaire had not been sent out since previous to the last key inspection. It was reported that a telephone survey had been carried out to every relative to ask them how things were going for themselves and their relative at the home. Although we were told the results were verbally positive, a record of this in a written format was not available at the time of this visit. Staff were recording accidents in an appropriate accident logbook that met requirements of the Data Protection Act 1998. There were a number of accidents/incidents recorded that had not been reviewed or monitored by a senior staff member at the time of this visit. As part of the management process accidents and incidents must be audited in a timely manner to ensure any improvements to prevent recurrence or plans are in place to review current practice so residents are protected from harm. The Commission has continued to be informed of any notifiable incidents under Regulation 37 of the Care Homes Regulations 2007 in a timelier manner since the last inspection. The systems for the safekeeping of resident’s money’s were not assessed at this inspection as it was reported that the home’s administrator was absent. A discussion with the managers in the home was undertaken and the systems of maintaining resident’s money were described and these were subject to an auditing process. This will be reviewed at the next inspection. There was some evidence that since the last inspection audits had been carried out regarding care practices, for example, the care planning documentation and medication practices. As raised at the last inspection shortfalls were still identified during this visit, however this in part may be due to the need for the staff team to establish itself and have time to get to know the individual needs, likes and dislikes of each resident. The self assessment survey showed they planned to develop a more person centred approach to care planning and Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 32 service delivery which may address the shortfalls in the current record keeping system in place. Since April 2008 information has been supplied to us by acting ‘project’ managers who have been working in the home (the improvement plan and Annual Quality Assurance Assessment). The information from these documents would suggest that the concerns identified by us at previous inspections had all been addressed, however this inspection has identified that where improvements have been made these have not been sustained and many of the issues identified previously have been identified again at this inspection. A further meeting was held with the Commission and the service provider in May 2008 to stress the need to provide sustained improvement in care delivery and to explain that further enforcement action may be taken if the service fails to improve. Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 34 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 15/09/08 2. OP7 15(2)(b) 3. OP8 12(1) & (4) 4. OP9 13(2) You must ensure that each person living at the home has an up to date and detailed plan of his or her care needs. The plans must include comprehensive details of the needs of service users relating to their health and welfare and clear instruction to staff in how to meet those needs. You must ensure that each 25/08/08 person’s care plans are kept under review and changed as required so that changes in resident’s care needs are met. You must ensure that each 25/08/08 resident receives personal and health care treatment that is appropriate to meet their identified individual care needs and this includes pressure area care, catheter care and fluid intake monitoring. The registered person must 31/07/08 ensure that arrangements for the handling, safekeeping and safe administration of medication are implemented to ensure the health and welfare of residents DS0000006733.V366574.R01.S.doc Version 5.2 Worsley Lodge Page 35 5. OP9 18(1)(a) 6. OP10 12(4)(a) living in the home. The registered person must ensure that staff administering medication are competent to do so safely. The care home must be conducted in a manner, which respects the dignity of the residents by ensuring they are not left without the support to have their personal needs met. (The previous timescale of 6/06/08 had not been met). Ensure that at all times there are sufficient suitably qualified, competent and experienced staff on duty to ensure that service users’ needs are met and their health and safety maintained. 31/07/08 31/07/08 7. OP27 18(1)(a) 31/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The needs assessment should include the individual’s concerns and wishes about coming into a care home to ensure these identified needs can be met. The care plans should be developed in a more person centred way to show how residents can be supported to have their needs met. A record of the resident’s preferred social activities and those they have participated in should be recorded in the care plan to show how resident’s individual social needs are being met. The food served should be of a temperature that is satisfactory to meet the needs of the residents. DS0000006733.V366574.R01.S.doc Version 5.2 Page 36 2. OP7 3. OP12 4. OP15 Worsley Lodge 5. 6. OP15 OP15 The records of fluid and food should be recorded and monitored to ensure resident’s needs are met. A record of the resident’s preferred likes and dislikes should be recorded to show how their individual dietary needs could be met. The residents should be provided with details of the day’s menu, which should be displayed in a format that can be easily seen by residents or be verbally told to them, so that they know what the meal choices are for each day. Communication between the staff should be effective to make sure the staff are given sufficient information to enable them to support the residents to meet their needs in full. This should include the staff who are going through the induction programme. Training should be provided in areas associated with the conditions relevant to older people so the staff understand the needs of the residents they are caring for. Accident records should be audited in a timely manner to identify any strategies to minimise the risk to residents. 7. OP15 8. OP27 9. OP27 10. OP33 Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Worsley Lodge DS0000006733.V366574.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!