Inspection on 10/11/08 for Worsley Lodge

This inspection was carried out on 10th November 2008.

CSCI found this care home to be providing an Adequate 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 01/07/08

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Worsley Lodge 119 Worsley Road Worsley M28 2WG Lead Inspector Elizabeth Holt Unannounced Inspection 10th November 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.V373285.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.V373285.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 Ltd Manager post vacant Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Worsley Lodge DS0000006733.V373285.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 From the 17th June 2008 there shall be no further admissions of service users to Worsley Lodge without the prior written agreement of the Commission for Social Care Inspection. 1st July 2008 2. 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.V373285.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 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on Monday 10th November 2008 and also included the findings of the pharmacist inspector who visited the home on the same day. The manager of the home was not told beforehand of this inspection, which included a site visit. This key inspection included following up the requirements of the key inspection carried out on the 1st July 2008. An improvement plan, completed by the manager and Operations Director, was submitted to the Commission on 13th October 2008. This described the action being taken to make improvements and address the requirements made following the inspection in July 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 manager. Resident’s care files were looked at as part of the inspection and other documentation. A tour of some areas of the building including resident’s bedrooms also took place. As the last Annual Quality Assurance Assessment (AQAA) form was completed before the inspection in July 2008 a further one was not requested before this inspection. The AQAA tells us what they thought they did well and what they need to improve on. Service user surveys were returned to the Commission in November 2008 from residents, relatives, staff and health professionals. At the time of writing the report three relatives/residents and three staff members returned surveys. We considered the responses and other information gathered during the visit and have referred to this in the report. Since the last key inspection there have been further changes to the management arrangements for the home, the home had a new manager in place during the visit in July 2008 who is no longer is in post. The Project Manager who had worked at the home for a number of months has taken up the position as manager and is planning to submit her application to be registered with the Commission. 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 some further work is still required to make sure this is continued. 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. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide has been reviewed to make sure it has up to date information about the service provided. Since the last inspection there have been positive changes to the environment, which has created areas with items that encourage memories of the past for people living at the home. A programme of redecoration has continued to make the home look clean and fresh. There was evidence of some improvements in the review and development of care plans to show peoples current health care needs. There were some improvements for keeping track of medicines however there are still shortfalls in the recording. There has been an appointment of an activities organiser and improvements have been made to the level of activities provided for people living at the home. Each person had a Map of Life to give the reader a snapshot of his or her life and important people in it. Improvements had been made to the information provided to people about the food available and the meal was served in a more timely way. Since the last inspection the manager had increased the amount of training made available to staff and more staff have started the NVQ training in care. The last 4-5 weeks has shown no use of agency staff, which is contributing to establishing the staff team. Staff spoken to said, “We are working well together here, it is a pleasant atmosphere.” Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 7 Improvements have been made to the supervision and monitoring of staff and care delivery. What they could do better: 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.V373285.R01.S.doc Version 5.2 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 Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 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. 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. People are provided with satisfactory information about the home, so that they can make a choice about where they live. EVIDENCE: An updated Statement of Purpose and a Service User Guide was on display in the reception area on the day of this visit. Since the last inspection there have been no new admissions to the home and the care plans looked at included a pre admission assessment of people’s needs. A recommendation made at a previous 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 Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 10 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.V373285.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the monitoring of the care planning procedures to ensure people’s personal and health care needs are fully met. EVIDENCE: Five people’s care plans were looked at during this visit and where possible the person to whom the care plan belonged was spoken with and a visit to their bedroom was made with their permission. The improvement plan returned to the Commission in October 2008 showed that all the care files were in the process of being reviewed and re written to reflect the individual needs of the residents and care plans will reflect person centred care, which will relate to their current health care needs. There were improvements to show that care of people using the service had been reviewed and there was development of clearer records of how people should be supported in an individual way. One persons record showed that, “…. likes to take little breaks when mobilising long distances and she will stop and talk to people then carry on walking. Staff should allow her this time. She is confident with her Zimmer frame.” Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 12 It was of concern that one of the care plans did not show that the person’s health care needs were followed up by the senior staff. A staff member had recorded please refer to GP this morning for a full assessment. There was no record to show any action was taken. There was no further care plan or record to show that the health care needs of this person were being monitored. Following admission to hospital the record was not clearly reviewed after they were re-admitted to the care home. This shortfall meant that changes to the peoples’ conditions were not always recognised and addressed. Some of the daily statements recorded showed a lack of detail. Some statements used were brief, for example, “appears fine and well”, “settled night.” A discussion with the management highlighted the need to record more detail in relation to the care delivered during the twenty-four hour period. Some parts of the care plans were found to be confusing, one care plan showed the use of abbreviations which we were not clear as to what they meant and the management present at the visit were also unsure. A recommendation was made to avoid the use of abbreviations and use terms that the staff would be able to understand. Entries made in relation to the risk assessments for weight loss and nutrition and the frequency of a person being weighed were confusing. Although there was a nutritional risk assessment in place and the person was identified at risk, the persons weight recording chart stated to weigh monthly. The same person’s care plan for eating and drinking stated to weigh weekly. A recommendation was made for the weight charts to be date specific to ensure that accurate time scales for monitoring peoples weight are made. There was a record of a referral to the appropriate professional and they were on nutritional drinks. The manager updated this record during the visit. Appropriate risk assessments were in place and there were some examples of good practice. The pressure relieving mattress setting for one of the people who was assessed as needing this to maintain their skin integrity was set in line with the person’s weight. For another person, a visit to their bedroom showed they were being cared for on a pressure-relieving mattress in line with the risk assessment but this had not been updated in the care plan. There were body mapping records in place and one of the care plans looked at showed these had been updated to record bruising and any skin markings. For two of the people looked at risk assessments for falls were seen. These included detailed care plans in relation to falls and there was evidence of monthly evaluations of these in place. Improvements were seen in the care plans and risk assessments in relation to catheter care and pressure area care. A recommendation was made for pressure sore risk assessments to be updated when people’s needs/risks have changed. At the previous inspection there had been concerns that fluid and food charts were not well filled in and staff had not enough time to fill these in adequately. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 13 During this visit the staff spoken to said there were no people currently having their fluids recorded. The management confirmed this decision. Staff were seen to encourage people to drink throughout the day and fruit juice was readily available. One person said, “I do not like drinks being left in my bedroom overnight as I prefer to drink this fresh and the staff are quite good at giving me fresh drinks.” The care plans provided evidence that other health care professionals and services were provided to people at the care home and a visiting community nurse spoke positively about the way the staff supported the people at the home when she visited. Care plans included reports of reviews of people’s care needs that have been carried out with the person and their families either face to face or by telephone. One person commented that, “The staff here are very kind. The food is very good and sometimes there is too much.” Before the site visit the CSCI sent surveys to people living at the home asking about their views of the home. Of the three people who returned surveys, three people said the staff listened and acted on what they said. Two people said the staff are always available when they need them and one said usually. Two people said, they always received the care and support they need and one person usually received the care and support they needed. Comments from the people living at the home and from observations made during the inspection showed they were treated with respect and dignity. Where possible people were encouraged to carry out tasks to promote independence. One person said, “They keep me walking which I like because it stops me from getting lazy.” A discussion with the manager was held in relation to maintaining the privacy and dignity of the people at the home as notices were on the front of wardrobes in each persons bedroom about the support they needed in relation to their moving and handling needs. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. This was because at the previous inspection medicines had not been handled safely. Medication records belonging to seven residents were looked at together with their medicines. Medicines were stored in a locked room and the medicines currently in use were neatly stored in locked cabinets. However unwanted medicines, which were awaiting collection for disposal, were stored in open bags and were not stored securely. Some creams were stored in residents’ wardrobes but no one had recorded if this was a safe place to store medicines for residents. It is important that all medicines are stored safely at all times and the risk of chosen storage is assessed and recorded. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 14 We saw that some very good systems for keeping track of medicines had been put in place. When staff made accurate records it was possible to account for the medicines and to find out exactly how much medicine had been given to a resident. However we saw that staff sometimes made very poor or no records at all about medicines and this made it difficult to tell exactly what medication residents had been given. It also made it difficult to track medicines and account for them. If medicines cannot be accounted for there is a risk they may be mishandled. Residents were given most of their medicines as prescribed however some residents were not given their medicines properly. We found that four out of the seven residents had not been given their medicines as prescribed because one of their medicines had run out or had not been available in the home to administer. Not being given medicines as prescribed could put residents’ health at risk. We also saw that some medicines did not have proper directions for staff to follow when administering medicines. If staff do not know exactly how to give medicines properly residents’ health could be placed at risk. We saw that the manager had made regular checks about how well staff were handling medicines and had ensured that staff had had additional training in medicines handling. The checks on medicines had not always shown that there were problems in handling medicine and the manager said that the number of checks would be increased to increase residents’ safety. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some opportunities are in place for people to engage in social activities and an improvement in the care plans means that people’s social, dietary, cultural and recreational needs are being met more fully. EVIDENCE: Since the last inspection one of the care workers has been appointed as the activities organiser for twenty hours per week. Each person living at the home now had an individual log of activities. A programme of activities was displayed in the entrance hallway. Records for one person showed over a period of a week they had joined in soft ball exercises, had a one to one chat, watched a wild life programme and made some decorations for a Halloween party. Another person said they had enjoyed making cakes with a staff member and they “even tasted good.” Since the last inspection staff have worked hard to provide a snapshot of the person’s life in the care plans. A sample of the care plans looked at included a photograph of the person and each person has a “Map of Life” which details Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 16 where the person was born, school, employment, interests, marital status, children, grandchildren, pets, hobbies and holidays. One of the responses from a resident in the survey was, “Activities are not frequent enough, they are often promised to be more regular but the reality is that this rarely happens.” On the afternoon of the visit a small group of people sat and watched a film, “Tarzan the Movie” together and ate crisps during this. One person said, “It is good to watch a full film, I enjoyed it.” One of the staff members spoken said she felt the activities organiser was doing her best to make activities an important part of the day. One person showed us a picture she had coloured in which was on display in the hallway and a photograph of herself enjoying a party. She went on to say that, “You know we do have some fun here.” Since the last inspection improvements were made to the recording of information about people’s personal wishes, preferences, likes and dislikes. Two of the people living at the home said how much they had enjoyed going out to a Remembrance Sunday service the previous day. During the visit people living at the home who could express a view said they had a choice of where they spent their day. One person said she liked to be up and about in the day room and the staff had helped her to be there. People living at the home said they were able to receive visitors throughout the day and the home has an open visiting policy. One relative said, “The staff are always welcoming, I know there have been changes in the management but I speak to the staff who are directly involved with my mother. They update me when I have any worries.” In relation to food generally and the breakfast and lunchtime meal the following observations were made. At 9:20 some people were finishing off their breakfast, which they had chosen to have in the dining room. One person said, “I enjoy my breakfast because I am hungry but the only problem is there is so much jam put on my toast.” When we asked had she not raised this with the staff, the person said, “I don’t like to be a nuisance.” At twenty to eleven people were offered a fresh fruit platter and a drink. One of the people in receipt of this said, “This is lovely and tasty and I enjoy this very much.” Another person requested a marmalade sandwich before lunch and a cup of tea. The staff member was seen to approach this person in a kind way and they were grateful for the food provided. The observations made from the mealtime showed that staff were aware of the importance of a well balanced diet and the residents well being. It was reported at the last inspection that 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. During this visit the meal was served in a timely manner and there were choices made available in line with the likes and dislikes of individuals. The staff should be reminded of the need to consider the individual likes and Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 17 dislikes of individuals and whether they may prefer to apply their own jam onto the toast. The dining tables showed details of the day’s menu, which was displayed in a format that could be seen by the people living at the home, so that they know what the meal choices are for each day. Two people said they had been told what the meal was going to be but they had forgotten. Another person said, “That’s an easy question I fancy a jam sandwich”. Some of the residents when asked about the food and responses in the surveys stated, “The food is quite good but sometimes I don’t eat it all, there can be too much.” The meal served looked appetising and the new cook in post was enjoying his role and was finding the training and support offered useful. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 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. 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. The home encouraged and supported people to raise their concerns or complaints and had the policies, procedures and systems in place to protect people from abuse. EVIDENCE: The complaints procedure was available and we were told there have been no complaints made directly to the home since the last inspection in July 2008. The record of complaints showed the home had investigated and responded appropriately to 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. Two staff members were aware of the procedures to follow in the event of an allegation of abuse. The home has a copy of the guidance from the local council. Five staff had attended Protection of Vulnerable Adults (POVA) training since the last inspection. From the three residents/relatives surveys returned in November 2008 two surveys showed they were not sure how to make a complaint but one added they knew whom they would speak to if they had any concerns. In response to the question, “Does the care home give the support or care to your relative Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 19 /friend that you expect or agreed?” Three residents/relatives responded “always”. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 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 clean and comfortable. EVIDENCE: A partial tour of the home showed that the bedrooms of people living at the home and the downstairs lounge and dining room were homely and pleasantly decorated. The first floor lounge and dining areas had been redecorated and looked very homely. Bedrooms were personalised with photographs and ornaments. One person showed us her bedroom which she said was cosy and she was pleased with her room. Improvements had been made to the corridors of the home by the addition of pictures of film stars and interesting newspaper headlines/front page covers, which encourages people to use their memory. Two of the staff said this had been a positive addition. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 21 One person was seen looking out onto the patio area as it was too wet to go out and she said how she had enjoyed sitting out there in the summer months. The manager said that plans for the future involved the painting of the bedroom doors in different colours for each person and doorknocker to assist them in being orientated in their environment. 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. 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 2nd 2008. Of the three residents/relatives who returned comment cards two said they were happy with the cleanliness of the home. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The number, deployment and training of staff appeared sufficient to meet the needs of people accommodated. Procedures for staff recruitment were in place to protect people at the home. EVIDENCE: On the day of the visit there were 22 people living at the home. The manager, the deputy manager and three carers were on duty from 08.00 until 20.00 and then one senior care worker and two carers were on night duty. Domestic/housekeeping staff, a chef, kitchen assistant and the administrator supported these staff. A review of the staff duty rotas confirmed this. One of the care workers said, “I feel that things have got much better in the home in the last few months since the new manager has been in post and I feel we are encouraged to learn and develop.” As raised at the last inspection three people remained living on the first floor because this was their preferred choice of room and there have been no further concerns raised in relation to how the staff are deployed to meet the needs of these people particularly during the night. Discussion with the staff team and from observations made during the visit identified that people’s care needs were being met. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 23 People living at the home spoke favourably about the staff team and said they were kind and helpful. Staff were heard chatting pleasantly to people living at the home and they were seen to be kind and supportive. There was evidence that the number of agency staff used by the home had decreased, a look at the duty rotas for the week starting the 10th November 2008 showed that no shifts were covered by agency staff. A discussion with the senior management confirmed that agency staff had not been used for the last three weeks. One of the staff that worked at the home said they liked working as part of a team and it felt better like this. A review of a sample of staff files showed that the required documents were held on file. Staff files contained a photograph of the staff member and photocopies of documents, for example passports, utility bills and certificates of training qualifications. The staff-training matrix showed there was an ongoing programme of staff training. Recent training for some staff had included care planning, bed rail safety, moving and handling, fire safety and food hygiene. A recommendation has been made following the outcome of a strategy meeting where there was a shortfall identified in the staff’s knowledge and skills highlighted to support the needs of people with challenging behaviour and or dementia. Staff spoken to say that training was encouraged and they were supported to attend training. Three people completed staff surveys and all three stated that they were being given training that was relevant to their role and helps them to understand and meet the individual needs of service users. One staff member went on to say that they felt the service did the following well; “Good training, were approachable, a friendly and relaxed atmosphere, home was clean and they tried to resolve problems efficiently.” At the last inspection 21 of care staff had successfully completed NVQ training in care, a further two staff have started this course. Two staff files had copies of induction checklists, which had been signed off by the manager. A recommendation made at the last inspection was for new workers to receive their induction training and for there to be evidence that staff have received appropriate information during this process to protect themselves and the residents. Records of a staff member’s induction and a staff member spoken to confirmed this had been addressed. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 24 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. Some further work is needed to ensure systems are in place to monitor care practices, medication and record keeping to safeguard the interests and well being of the people living at the home. EVIDENCE: The management arrangements for the home have changed since the last inspection in July 2008. The former project manager who has been at the home for a number of months has now been appointed as the home manager. She stated that her application to register with the Commission for Social Care Inspection was in process and she will submit this soon. The service needs a period of management stability and continuity of staff in order for the service to respond to the needs of the people living there and protect and promote Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 25 their health, welfare and safety. It was of concern during this visit that issues identified in relation to medication had not been effectively managed and some shortfalls in the care planning process has the potential to put people at risk of not having their needs met. Staff said the manager was supportive, approachable and that she spent time working alongside the care staff in the home. The manager said she liked working with the staff as it gave her an opportunity to monitor the care practices and staff supervisions. Minutes were available of staff meetings, which included a recent meeting with the night staff. Discussions during the day with the new manager showed she had areas where she wanted to improve the service for the people living there. 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. An audit of the call bell system should be carried out, as there was an en suite bathroom where the person would not be able to access the buzzer from the toilet as this had been removed. This has the potential for the person to not be able to access support if they needed it. A quality assurance questionnaire had been sent out since the last inspection in July 2008 to find out the views of people living at the home, professionals and visitors. A copy of the results was held on file, which the manager said were generally positive. One of the visitors spoken to said she was not familiar with the new manager however the manager stated she had spent some time with her. In addition to the formal quality assurance programmes the views of the people living at the home are gained during the service provider’s Regulation 26 visits. Copies of these monthly visits have been forwarded to the Commission. The manager said she had held relatives drop in sessions however these were not well attended. She said she has an open door policy and encourages people to raise concerns or discuss any issues about the service being provided. Staff were recording accidents in an appropriate accident logbook that met requirements of the Data Protection Act 1998. There was evidence that accidents/incidents recorded were reviewed by a senior staff member at the time of this visit. The Commission has continued to be informed of any notifiable incidents under Regulation 37 of the Care Homes Regulations 2007. Procedures for the management of peoples’ monies were computerised. Money is not held on site but evidence of receipts for purchases made on a Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 26 person’s behalf were seen. The sample looked at was found to be satisfactory which ensured that peoples’ financial interests were protected. Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 27 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 28 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(2)(b) Requirement You must ensure that each person’s care plans are kept under review and changed as required so that changes in resident’s care needs are met. (The previous timescale of 25/08/08 had not been met in full). 1. All medicines must be stored securely and safely. To make sure the medicines are not mishandled. 2. All records about medicines must be clear and accurate to make sure that all medicines can be accounted for and show that residents are given their medicines as prescribed. 3. All medicines must be administered as prescribed to make sure that residents’ health is not placed at risk. 4. An adequate supply of all medicines must be maintained to ensure residents can be given DS0000006733.V373285.R01.S.doc Timescale for action 11/11/08 2. OP9 13(2) 11/11/08 Worsley Lodge Version 5.2 Page 29 3. OP38 13(4)(b) their medicines as prescribed (The previous timescale of the 31/07/08 had not been met). Call bells within the home must be checked and action taken to minimise any risks to people living at the home. 11/11/08 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. All risk assessments and care plans must be reviewed and monitored to ensure information is current; making sure it updates staff of the level of support required by each person. Risk assessments including prevention of pressure sores and nutritional assessments should be updated when people’s needs have changed. The manager should make sure that staff attend training around challenging behaviour and dementia care so they have the necessary skills to support the people living at the home appropriately. Information recorded in the care plans needs to be communicated to senior staff to make sure appropriate action is taken. 2. OP7 3. 4. OP7 OP30 5. OP8 Worsley Lodge DS0000006733.V373285.R01.S.doc Version 5.2 Page 30 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. 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