Inspection on 15/02/08 for Worsley Lodge

This inspection was carried out on 15th February 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 01/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Worsley Lodge 119 Worsley Road Worsley M28 2WG Lead Inspector Elizabeth Holt Unannounced Inspection 15th 19th and 27th February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Worsley Lodge DS0000006733.V360568.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.V360568.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 Mrs Alphoncina Hlapane Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Worsley Lodge DS0000006733.V360568.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 with nursing: Code N, 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. Date of last inspection 8th November 2007 Brief Description of the Service: Worsley Lodge is a care home that provides 24 hour nursing or 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 £497.00 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.V360568.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 visit was the third key inspection conducted this year and focused on assessing progress made to address concerns identified at the earlier key inspection, which took place in November 2007. This key unannounced inspection, which included three site visits and a specialist pharmacist inspection took place over two days on Friday 15th February 2008 and Wednesday 27th February 2008. The visit on the 19th February 2008 was to take photocopies of some of the medication administration records only. The person acting as the manager of the home was not told beforehand of the inspection visits. During the visits we looked at care plans and medicine records to ensure that the health and care needs of the residents were being met. The time we spent in the home included observing care practices and talking with residents, visitors and members of the staff team. As part of the inspection process survey forms were left for residents and their relatives/friends, staff and some for health professionals. At the time of writing this report only one service user survey was returned and none from staff members. A partial tour of the building was conducted and a sample of care and staff records was looked at, including employment and training records, staff duty rotas and resident’s care plans. The term preferred by the people consulted during the visit was “residents”. This term is, therefore, used throughout the report when referring to those living at the home. Since the last inspection there have been changes to the management arrangements for the home; the current registered manager is no longer employed by the company, the newly appointed manager made a decision not to return to Worsley Lodge after the New Year and the former project manager was appointed to manage the home. 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. Further concerns/allegations have been made under Salford Council’s adult safeguarding procedures and Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 6 these are currently being investigated. During the visit on the 27th Feb 2008 two members of the management team were called away to deal with concerns/allegations made which made the circumstances surrounding this visit quite difficult for the staff left on duty at the home. A Statutory Requirement Notice was issued regarding medication in December 2007 and compliance of the notice was looked at during a random inspection on the 15th January 2008. We are still working on the findings of this. What the service does well: What has improved since the last inspection? What they could do better: Care practices and continuity of care for the residents had deteriorated since the last inspection. Although since the last inspection audits had been carried out of each care plan shortfalls remain in the information provided which may lead to the residents not having their needs met in full. The plans of care were not clearly detailed, informative or clearly set out the action needed to be taken by staff to ensure that the health and personal care needs of the residents are met. These care plans were not always adequately Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 7 reviewed. Staff have not used the information recorded to assess the residents needs overall. The poor record keeping and lack of monitoring of residents’ overall condition and well being means that residents’ needs are not being met. There were shortfalls in the nutritional risk assessments and in the recording of the fluid intake/output records to ensure residents dietary and fluid needs are being met. Frail residents were seen to be kept waiting a lengthy period of time before they were supported with their lunch. Effective arrangements must be put into place to make sure that all records about medicines are completed accurately to show that medicines are administered properly to residents and to make sure all medicine can be accounted for. Also effective arrangements must be made to make sure that all medication is administered to residents as prescribed in order to make sure their health is not placed at potential risk. The company needs to find ways to keep staff once they have been through the training programme to make sure staff can get to know the resident’s individual needs well. The management need to look at the skill mix and competency of the staff on duty to make sure the staff are trained and competent to meet the residents’ needs. As raised at the last inspection the home needs to develop a staff team so that trusting relationships can be established between the residents and the staff so they can protect and meet the residents’ needs fully. The staff need to pay attention to the basic care needs of the residents. residents were not always appropriately dressed and attention to oral hygiene was needed. The staff must be supervised appropriately by staff who are trained and competent, to ensure that safe moving and handling practices are carried out to minimise the risk to residents. 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.V360568.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.V360568.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are carried out to ensure that the care needs of prospective residents are known. EVIDENCE: Since the last inspection there have been no new admissions to the home but the care plans looked at included an assessment of need. One filled in pre admission assessment form was seen for a prospective resident who had been assessed for respite care. 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. 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. Due to Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 10 the level of activity in the home on the 27th February 2008 this was not able to be looked at and the recommendation has been made again in this report. Worsley lodge does not provide intermediate care facilities. Worsley Lodge DS0000006733.V360568.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 poor. This judgement has been made using available evidence including a visit to this service. The care plans in place do not provide staff with adequate information to make sure the health and safety and personal care needs of the residents are met. Residents’ health is at risk of harm because of poor medication administration. EVIDENCE: Care plans were available for each resident and each one was organised in a standard layout. The care plans looked at did not give enough information to enable the staff to properly monitor the progress of the health and personal care needs of the residents and their condition. The following concerns were identified: Care plans were not adequately reviewed. This meant that changes to the resident’s health care needs were not always addressed. For example, care plans and risk assessments for a resident who had been seen by his General Practitioner in December in relation to an increase in falls were not updated to show the changes in the resident’s condition or the on going monitoring Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 12 required. The care plan for a resident with a marked deterioration in his mobility had not been updated to show the staff the support this resident now required. The evaluations for this resident’s care plan in both January and February 2008 stated, “care plan remain relevant”. Examples of risk assessments included mobility, moving and handling, prevention of pressure sores and nutrition. Risk assessments were not updated to show they were still relevant. For example, a resident who was being supported to transfer with three staff members (see staffing section) showed he was a high risk for falls but the information given did not include a detailed evaluation to include the number of falls he had experienced and the strategies to be put in place to support him appropriately. Information from the risk assessments was not always used. For example, a resident was seen at the dining table after lunch to appear generally unwell and she said she had eaten nothing. The care plan showed a MUST (Malnutrition Universal Screening Tool) assessment tool which indicated that she was High risk, and that the resident must have a care plan, reviewed monthly or more frequently if required. The care plans showed no link to the weight of the resident in line with her nutritional input or a comment in relation to her need to take a diabetic diet. The weight charts showed this resident’s weight had decreased by almost 5 kilograms since December 2007. There was no mention of any of her likes or dislikes or preferences or ways in which you could prompt or encourage the resident to eat. The care worker said, “we are going to put her on a fluid and food chart and she gets a dietary supplement sometimes”. This should be prescribed for individual residents and the medication administration record did not show this was currently prescribed for her. The staff appear to have followed the procedures required in relation to completing the necessary forms, but have not used the information to assess the residents needs overall. The poor record keeping and lack of monitoring of the residents’ overall condition and well being means that residents needs are not being met. A conversation with the staff highlighted a lack of communication between the staff about the residents’ changing needs. Staff spoken to had not been made aware of the reasons for a resident’s decline in mobility and none of the three spoken to knew about the resident’s condition. One staff member said the handovers were often brief and sometimes if they were needed “on the floor” they did not receive the daily report and then they did not get a detailed update on the residents’ conditions. A recommendation was made to make sure staff are given sufficient information to enable them to support the residents to meet their health, personal and social care needs. In some of the files reviewed there was a lack of recording of professional visits to enable up to date health care information of the individual resident to be available. Two care files noted the General Practitioners had visited but they failed to record the outcomes of these visits. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 13 As raised at the last inspection report, the handwriting in the care plans was not always legible. A recommendation has been remade that staff write clearly so that other people can read the entries made in the records. The records of some resident’s weight loss was discussed, the new scales which had been ordered at the last inspection had not arrived and a staff member did comment they felt there may be a problem with the existing weighing scales. This requirement has been repeated and must be addressed as a matter of urgency to ensure the accurate weights of individuals can be monitored and the appropriate action can be taken to address any significant weight loss. During the visit on the 15th January 2008 the food and fluid records and turn charts for the residents had not been completed however it was evident the residents who were in need of this had received attention from the staff and food and fluids had been offered. It was clearly that the staff had not yet got round to completing these which was confirmed by the agency care worker. Two of the new staff members stated they had not yet been shown how to complete these forms in full. At the end of this visit at approx 13.00 hours we returned to check the charts and all these had been completed and made up to date. These concerns were discussed with the Operations manager at the time of this visit. At the site visit on the 27th February 2008 none of the fluid intake and output charts or turn charts for the day on the first floor had even been started when we left the home at 17.00 hours. Incomplete food and fluid records show that the staff do not know if the residents are eating and drinking an adequate amount. One staff member said, “I don’t know why they have not been started even because it is up to the night staff to start these forms.” These shortfalls in the information recorded does not provide the staff with sufficient information to make a decision as to what they should do if a resident’s intake or output was poor. At previous inspections medicines were handled poorly, records had been inaccurate and residents’ health was at potential serious risk from harm. A Statutory Requirement Notice was issued regarding medication in December 2007 and compliance of the notice was looked at during a random inspection in January 2008. As part of this inspection the pharmacist inspector looked at how safely medicines were handled. Records about medicines were looked at together with some medication held for residents to make sure their health was not at risk. Some of the records kept about medicines administration had improved; staff had included much more detail on the medication administration records sheets (MARs). This information made it clearer to find out exactly what Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 14 medicines had been given to the residents and easier to keep a track of most of the medicines received. However some MARs had not been accurately completed and although medication had been signed for it had not been given to the residents. The records about unwanted medication were inaccurate. Not all of the medicines which were awaiting collection for destruction had been recorded accurately so the records could not show that medicines could be accounted for or that all the medicines which had been signed for had been given properly. A selection of fifteen residents’ MARs from the previous four weeks was examined. They showed that the stock of medication for each resident was being counted and checked on a regular basis, however some of the records of these checks were not always accurate and some were very confusing. Therefore it was difficult to place a lot of reliance on these records to evidence that medication had been given properly. During the previous four weeks, eight out of fifteen of the residents had not been given their medicines properly because some of their medicines had ‘run out’, which put residents’ heath at risk from harm. Some of the medicines, which had run out included painkillers and sleeping tablets. The records also showed that staff sometimes signed they had administered more medication than had been supplied for the residents, this included medicine for epilepsy. If residents are not given their medicines as prescribed their health could be at significant risk. The Statutory Requirement Notice issued in December 2007 required the home to make sure that all staff that have responsibility for the administration of medication were assessed as competent to do so safely. During the inspection the records to provide evidence that staff had been assessed as safe to give out medicines were not available. However there are still on going concerns regarding the competency of staff as shown by our findings. During the inspection we asked staff to confirm that all residents had a sufficient supply of medicines to ensure continuous treatment. Staff confirmed that all residents had enough medication in the home. We also noted that a new cycle of medication had just begun, three days before the inspection, indicating that an adequate stock of medicines should be in the home for each resident. Despite some improvements in some areas of medication recording there were serious concerns that medication was not administered to residents properly, that medication could not be fully accounted for and staff who were handling medicines do not do so competently. Residents’ health was at significant risk of harm due to poor medication handling and auditing systems. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 15 Observations during the inspection showed that the personal care needs of the residents were not being met. There was some lack of attention to personal grooming. For example, some resident’s faces did not look clean, some resident’s teeth were unclean and their lips were dry and crusted. Some of the female residents were seen without stockings or socks and one resident stated, “I don’t know why my legs are bare”. One gentleman’s jacket had dried crusted food down the front of it and the hem was down on the dress of a resident, which made her appear untidy and uncared for. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Some opportunities exist for residents to engage in social activities but some residents were left unoccupied and their dietary expectations were not met. EVIDENCE: As raised at the last inspection residents have some opportunities to be involved in the activities offered, however residents on the first floor in particular were seen to be sitting in the lounge with nothing to do and little interaction for periods of time. Some of the residents who stood up to have a walk around were told at times to, “come on sit down”, although in a pleasant manner; these residents were possibly bored. The highlight of the day on the first floor for the majority of residents appears to be going to the dining room. The plans mentioned at the last inspection to develop “Life Story Books”, and a “Memory lane” in the corridor had not been addressed. The activities organiser explained that she had been working as a care worker since December and had only just returned to her position as an activities organiser. She talked enthusiastically about her plans to develop more activities for the residents, however these had not yet been fully developed. Recent trips out had been Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 17 carried out in small groups to the local garden centre, a restaurant and Worsley Old Hall. A form to record any activities the resident has joined in with was available but these had not yet been completed to show the activities the resident had joined in. Some of the more frail residents did not appear to be moved from their chairs during the course of the visit. It was of concern that the meal for these residents who remained in the lounge throughout the day was brought to the floor at 12.20 and was still being served to them at 13.50 hrs. The meal on the day of the visit was mashed potato, broccoli mixed with cauliflower, cold sliced ham and gravy. An alternative for the main course was a beef burger and the dessert was Manchester tart. Not one resident appeared to have been asked before the meal, what their preferred choice was and the staff could not confirm that residents are asked their preferred choice of menu before the meal. One resident who has been in the home for over twelve months said, “The activities are hit and miss for me, lucky for me I can keep myself occupied sometimes. The food never comes on a warm plate and I just eat what I’m given and hope its okay.” A relative who visited the home on a daily basis said, “The soups are awful, they sometimes have a froth across the top and the paste sandwiches look awful. I bring in something for Mum regularly so that I am confident she gets something proper to eat.” There was no evidence of the menu of the day on the table, but the menu of the Friday before was in the display boards. Staff did not know what the meal was before it arrived and the staff should be aware of this so they can talk to the residents about the food they are to be offered. A resident in the lounge did not like the lunch she was given, and the care worker told the resident she would get her something else. We observed that the care worker had not returned to the resident within approximately twenty minutes. At 13.45 we said to the nurse in charge about the particular resident who had not been given an alternative and that some of the frail residents had still not been assisted with their lunch. The nurse in charge instructed the staff to feed these residents immediately before they had their own lunch breaks. The observations made during mealtime showed the staff were not aware of the need to closely monitor the residents food intake, the importance of a well balanced diet and the residents well being. The staff need to be provided with training to make sure they understand the importance of nutrition in elderly people and how to support them to receive an adequate nutritious diet. Residents were encouraged to maintain contact with family and friends. Visitors were seen throughout the day, sometimes meeting privately with residents. Two visitors who the inspector spoke to said they felt uneasy at times because of the amount of staff changes but the atmosphere was “all Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 18 right.” Both visitors said, “They felt they needed to visit regularly to feel reassured their relatives were cared for properly”. During the visit a staff member was seen attending to residents’ fingernails and the hairdresser was present on her weekly visit, which the residents said they enjoyed. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to ensure that people can be confident that their complaints will be listened to and acted upon. EVIDENCE: The complaints procedure was available and we were told there have been no complaints made directly to the home since the last inspection. The commission for social care inspection ( CSCI ) has been awaiting the response to one complaint made which was forwarded to the provider for their response on 5th December 2007 in relation to a former resident at the home. A response was finally received at the Commission on the 21/02/08. The complainant has since said he has not received a direct response which the provider was asked to do initially. It is of concern that a holding letter was not forwarded to the complainant or the CSCI explaining the reasons for the delay in this investigation. 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. A relative when asked in the survey, “Does the care home give the support or care to your relative /friend that you expect or agreed?” The relative responded “Last year there was a case of alleged abuse. The new manageress was very helpful and kept me informed. I do not know if this case is ongoing. I would like to be informed of the outcome. Since this event, things have Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 20 changed for the good. My grandmother has seemed happier and more relaxed.” A number of newly referred safeguarding concerns/allegations were being investigated at the time of this report with other agencies being the lead investigators. 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. Discussions with staff, visitors and managers showed that the home’s manager was approachable. Two relatives spoken to felt they could discuss concerns they had in relation to the care of their relative with the management but one relative was afraid to express concerns through fear of any ill effects on her relative. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 21 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 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was evidence of improvement in the décor of the environment but poorly maintained wheelchair equipment does not safeguard the residents or make their environment homely. EVIDENCE: A partial tour of the home showed that the residents’ bedrooms and the downstairs lounge were homely and pleasantly decorated, and since the last inspection the upstairs lounge had been redecorated which made it more comfortable and homely for the residents. Bedrooms were personalised with photographs and ornaments. One resident who has chosen to spend the majority of time in her bedroom now has been given a large room, which has been redecorated. The resident said, “It’s like my own flat, it’s lovely isn’t it and I have my telephone here too.” Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 22 Following the visit on the 15th February 2008, a review of the wheelchairs on the first floor showed that a number of the wheelchairs in resident’s bedrooms were unclean with food encrusted on them and were in need of repair or replacement. Wheelchairs in bedrooms 31and 32, had tape on them to protect the sharp bits from hurting someone and wheelchairs in rooms 22 and 23 had only one footplate on each wheelchair. These concerns were raised with the Operations manager following the visit on the 15th January 2008 and a requirement for a full audit of these to be carried out. The company should be carrying out their own equipment checks on a regular basis to make sure the equipment is safe and clean. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff must be reviewed to make sure the care, health and safety needs of the residents are being met in full. Shortfalls in the continuity of care from staff may lead to residents needs not being met in full. EVIDENCE: At the time of the visit there were 41 residents accommodated in the home. A lack of a permanent staff team who do not know the residents well may lead to the resident’s needs not being met in full. On the day of the visit on the 15th February 2008 there were two registered nurses and three care workers on the first floor. One of the nurses had been brought in from another home two weeks previously to support the staff at Worsley Lodge and the other registered nurse has been on the bank at Worsley lodge for a number of months. Two of the care workers were new starters and the third staff member was an agency care worker who had worked at the home for a number of months previously and said she knew the residents quite well. The Operations manager brought in a second registered nurse from another home to provide additional cover until 20.00 hours on the day of this visit. On the second day of this inspection,on the 27 February 2008, a number of the permanent staff were on medication training, which left a high number of Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 24 agency staff on both the floors supporting the residents whom they did not know well. Meeting the needs of residents who know their individual needs is compromised by an increase in the use of agency staff. This lack of continuity of care for the residents has the potential for their health, personal and social needs not being met in full. One of the new starters had been appointed as a senior care worker but the role expected of him had not been clearly explained prior to this visit. The Operations manager spoke to him and explained to him that as this was only his third day in the home and he did not yet know the residents well he was not expected to take on the role as a senior care worker on this shift. Staff that do not know the residents well should not be expected to take responsibility. When questioned about induction to the home one of the care workers stated that, “On my second day I was told about the residents by one of the care workers who had been in the home for five months herself, she told me about the residents and their needs. I haven’t had anything yet about fire or other policies and procedures. I have had hoist training and am on a list to have moving and handling training”. The care workers had not been shown how to complete the turn charts or the food and fluid records but did feel supported by the registered nurse on duty. The other care worker had not yet been on the two day induction course either and at times residents were left waiting for their needs to be met whilst the care workers waited for the appropriate support from other members of the staff team. Although there is an induction training plan in place, shortfalls in appropriately supervising and mentoring new staff at the start may lead to them not being able to carry out their roles in the best interests of the residents. On the ground floor there was the team leader with 2 care workers. The staff were seen to be attentive to the residents needs and all residents were up, dressed and looked appropriate. The drugs round on the ground floor was still being carried out at 09.50am and the team leader felt she had approximately a further twenty minutes before she completed this. On the first floor the drugs were still being done at 10.45am. The Registered Nurse giving out the tablets said he was quite new to the residents and due to the checking process in place, the staff felt it was taking them longer to get through the drugs rounds. A letter of immediate requirement was made following the visit on the 15th February 2008 for the management team to review the staffing arrangements to adequately meet the needs of the residents. A request was made for a copy of the duty rotas to be forwarded to the Commission to highlight the staffing levels on a weekly basis. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 25 It is of serious concern that inexperienced, new staff were left to support the residents, and the senior care worker from the ground floor had to come upstairs to support them. Comments made by residents were how kind, sensitive and lovely the new care staff were to them, however one resident said, “Oh my God, I need to get out of bed now”, when she was advised that she would have to wait for a staff member who would be able to assist one of the care workers. A review of the duty rotas and a discussion with the manager showed that three of the recently recruited care workers had stopped working at the home and there was regular use of agency staff. The care home was having problems keeping the staff once they had been through the induction training, which was leading to shortfalls in the continuity of care for residents. Staff spoken to and from observations made, indicated that communication between the staff was not always effective to make sure residents received continuity of care and had their needs met in full. As raised at the previous two inspections the residents would clearly benefit from a staff team who know their individual needs well and can support them appropriately. As raised at the last inspection a requirement was made for staff to be appropriately supervised and to carry out safe moving and handling practices to ensure the residents are safe. During the visit on the 27th February 2008 an observation of a poor moving and handling technique was observed by three care staff that were assisting to transfer a resident from a comfortable chair into a wheelchair. It was of serious concern that this transfer required the use of three staff. The resident was seen to be uncomfortable in the wheelchair he was placed in and the chair was clearly inappropriate for his height. The resident then had to go through this process again to transfer into a larger wheelchair. When questioned, the three staff present did not know about his diagnosis or his current treatment. The care plan for this resident did not show an updated moving and handling assessment and there was no record of any professional advice sought to make the transfer more appropriate for the resident’s needs. The resident may easily have sensed a lack of confidence/expertise in this transfer, particularly with the need for three staff supporting him with this transfer. Although training was planned for moving and handling the use of new starters and agency staff who do not know the residents well may lead to their needs not being met in full and put residents at risk. The staff files were not looked at during this site visit as these were inspected at the site visit in November2007 when appropriate recruitment procedures were being followed and the staff files contained the information required. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed effectively to ensure systems are in place to monitor care practices and recordkeeping to safeguard the interests and well being of the residents. EVIDENCE: Since the inspection in November 2007, the acting manager in charge at the time chose not to return to work at Worsley Lodge. The manager registered with the Commission was dismissed from her position with effect from 27th November 2007. The Project Manager, who is a Registered Nurse, has returned to manage the home full time until the successful recruitment of a new manager and deputy manager to oversee the home. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 27 Following observations made by the inspectors during these visits the conclusion gained is that the home is not being properly managed. The lack of a permanent full time manager to take on the leadership for this home is leading to shortfalls in overseeing the care and management of the residents accommodated and the supervision of the staff. There was evidence that the management team had been undertaking audits regarding medicine procedures and care plans in particular. Shortfalls remain in both these areas. Southern Cross has its own Quality Assurance section and internal audits are carried out on a regular basis. Checks are carried out in relation to health and safety and fire safety checks. Checks/audits are carried out of medicine procedures, care plans, the number of pressure sores, accidents/incidents. A review of the accident records for January was looked at and copies of these accidents /incidents were recorded in three of the care plans looked at. Procedures for the management of residents’ money were not checked at this visit and will be reviewed at the next inspection. The Commission had not been notified under regulation 37 of the Care Homes Regulations 2001 of some notifiable incidents/accidents that have taken place in the home and these are often not received within twenty four hours. More could be done to ensure that the home is run in the best interests of the residents by making sure there is an established staff team. After a number of incidents/occurrences in the home, the company has put in senior management. Although there are some areas of improvement, there are still shortfalls in the food provided and a lack of personal care. The residents, relatives and staff need to have confidence the company can meet the minimum standards. Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 1 28 1 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 X X X X X 2 Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 29 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 12 Requirement Care plans and risk assessments must reflect the changing needs of the residents and be reviewed and monitored to ensure information is current and informs staff of the level of support required by each resident. This includes the risk assessments and care plans for moving and handling, nutrition, and the provision of diet and fluids. Failure to address this puts residents at risk of not having their health, personal or social care needs met. Accurate weighing scales must be provided to make sure the recordings are accurate to monitor the resident’s weight. (the previous timescale of the 31/12/07) had not been met. Effective arrangements must be put in place to ensure that all medication administration records are completed to accurately record medication administered to service users. (This requirement was made in the Statutory Enforcement Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 30 Timescale for action 18/04/08 2. OP8 12 11/04/08 3. OP9 13(2) 28/02/08 3. OP9 13(2) Notice and was not met in the previous timescale 7/1/08) Effective arrangements must be put in place to ensure that all medication is administered in exact accordance with the prescribers’ directions, to ensure the health of residents is not put at risk. (This requirement was made in the Statutory Enforcement Notice and was not met in the previous timescale 7/1/08) Unwanted medication must be disposed of by returning it to a licensed waste contractor and maintaining a full record of the medication disposed in this way. (This requirement was made in the Statutory Enforcement Notice and was not met in the previous timescale 7/1/08) Effective arrangements must be put into place to ensure that all staff that have responsibility for the administration of medication are assessed as competent to do so safely. (This requirement was made in the Statutory Enforcement Notice and was not met in the previous timescale 7/1/08) The registered person must make sure the care home is conducted in a manner, which respects the privacy and dignity of the residents. Resident’s should be offered the chance to wear stockings or socks and attention to oral hygiene paid. Where residents are at risk of poor nutrition, due to poor health or dementia, the registered person must make sure that diet and fluids is DS0000006733.V360568.R01.S.doc 28/02/08 4. OP9 13(2) 28/02/08 5. OP9 13(2) 28/02/08 6. OP10 12(4)a 31/03/08 7. OP15 13(2)(i) 31/03/08 Worsley Lodge Version 5.2 Page 31 8. OP22 13(4)a 9. OP27 18 provided to residents in accordance with nutritional guidance and at reasonable intervals throughout the 24 hour day. Records must be kept up to date to monitor this. A full audit of the wheelchairs 14/03/08 provided for residents in accordance with appropriate assessments must be made to make sure these are safe and clean. The staffing levels, deployment 31/03/08 and competency of staff must be reviewed and monitored regularly to make sure the residents receive the appropriate care to meet their assessed health and personal care needs. (The previous timescale of 31/08/07 had not been met). 10. OP38 18(1)b The manager must ensure that staff working in the home are suitably trained to carry out safe moving and handling practices to ensure the residents are safe. (The previous timescale of 07/12/07 had not been met). 31/03/08 11. OP31 37 12. OP31 8 Procedures in relation to compliance with regulation 37 notifications must be reviewed to ensure we receive information within 24 hours, so that the Commission is aware of action needed to make sure residents are safe. The registered provider must appoint an individual to manage the care home. 31/03/08 05/05/08 Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 32 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 It is recommended the needs assessment includes the individual’s concerns and wishes about coming into a care home to ensure these identified needs can be met. It is recommended that the form for visits from health professionals is completed to ensure the appropriate health support is provided. Entries on records must be consistent and legible and not include the use of correction fluid. 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. A record of the resident’s preferred likes and dislikes should be recorded to show how their individual dietary needs could be met. The manager should ensure that staff are trained in feeding residents to ensure the residents receive an adequate, nutritious diet. 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. It is recommended that communication between the staff is effective to make sure the staff are given sufficient information to enable them to support the residents to meet their needs in full. It is recommended that training is provided in areas associated with the conditions relevant to older people so the staff understand the needs of the residents they are caring for. It is recommended the acting manager is supported and guided appropriately to manage the care home in the best interests of the residents. 2. OP7 3. 4. OP7 OP12 5. 6. 7. OP15 OP15 OP15 8. OP27 9. OP27 10. OP31 Worsley Lodge DS0000006733.V360568.R01.S.doc Version 5.2 Page 33 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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