CARE HOMES FOR OLDER PEOPLE
Worsley Lodge 119 Worsley Road Worsley M28 2WG Lead Inspector
Elizabeth Holt Unannounced Inspection 10:00 16 February 2006
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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.V278669.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 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 Southern Cross Home Properties Limited Karen Johnson Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A maximum of 48 service users aged 65 years and over may be accommodated. Minimum Nurse staffing levels will be maintained as specified in the Staffing Notice of 5th February 2003 issued in accordance with section 13 of the Care Standards Act 2000 with regards to the service users accommodated on the first floor. Dependency levels of service users requiring personal care only must be continually assessed and staffing levels adjusted in order that care staffing levels will be maintained in accordance with the minimum levels specified in the Residential Forum Guidance for staffing in Care Homes for Older People. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 19th August 2005 3. 4. Date of last inspection Brief Description of the Service: Worsley Lodge is a detached ,purpose built property set in its own grounds. The home is registered to accommodate up to 48 older people on two floors. A maximum of 20 residents requiring personal care only can be accommodated on the ground floor and up to 28 residents requiring nursing care can be accommodated on the first floor. Forty eight of the bedrooms are single, with 33 of them having an en suite facility 16 with shower en-suites and 17 toliet en suites. A passenger lift is available to both floors. A variety of aids and adaptations are around the building to allow residents to move about independently. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 16th February 2006. during the inspection time was spent talking to the manager, several of the residents, relatives and staff. In addition residents files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture how the home is meeting the needs of the people living there. What the service does well: What has improved since the last inspection?
Since the last inspection the home had worked to improve the care planning documentation. There was some evidence of improvement however some shortfalls were still identified and are detailed in the section below. During the previous inspection a requirement was made for the staff files to contain the required information. Evidence was seen that this requirement had been met. Staff training had been provided in a number of areas for example; wound care, medication, whistleblowing/adult protection and some mandatory training.
Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 6 The home was generally clean and orderly and it was evident that residents had some of their personal belongings with them. The home had sent out a quality audit questionnaire and the manager had taken step to make some improvements following this. 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. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 7 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.V278669.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection visit. EVIDENCE: The other core standard was assessed during the previous inspection. The home did not provide an intermediate care service. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Some areas of documentation required improvements to ensure that all residents’ health, personal and social care needs are fully met. These shortfalls have the potential to place residents at risk. Residents were not always treated with respect but had their privacy respected. Medication procedures require review. EVIDENCE: A sample of care files were inspected where a number of shortfalls were identified. Following a requirement made at the last inspection in relation to ensuring the recordings are clear to fully record the changing needs of residents it was of concern that little progress had been made. Plans gave little indication of the actual care given. They lacked continuity and follow through of information provided. One resident had significant weight
Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 10 loss since admission. The evidence to demonstrate the action taken by the home was not well recorded. Discussion with the nursing staff suggested that action had been taken however the associated care plan and risk assessments were not clear. A care plan for a resident who had been discharged from hospital following surgery for a fractured femur had not been updated since admission. Residents are at risk of not having their health care needs met if these tools are not used appropriately as described in the above situations. Recordings on fluid balance charts were not completed accurately. Evaluations of the care plans stated “ care as plan” and lacked any substance or reflection. It was pleasing to see that more detail had been provided in the residents’ social reviews/profiles. One resident’s calf was swollen and she was wearing an ankle sock that looked tight. The resident’s foot was on a low foot stool. This was discussed with the care staff member who went straight to the resident and without communicating their intended action lifted the resident’s leg to a higher position. The resident grimaced in discomfort. Staff must receive appropriate training in basic care and communication skills. A number of residents were seen wearing ankle socks with dresses. This must be the personal choice of the resident/relative. The practice of administering morning medication at lunchtime must be reviewed. This is of particular concern as the medication was analgesia which was obviously required. As raised at the last inspection there were some shortfalls seen in the recording of the medication administration records (MARS) on the personal care only floor. It is of serious concern as the staff member involved had received medication training since the last inspection. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Social activities were well managed for the residents on the personal care only floor but were limited for the more dependent residents in receipt of nursing care. EVIDENCE: Residents were consulted regarding the planning of activities, outings and entertainment. On the day of the inspection a “chocolate party” was being enjoyed by the residents. As raised at the last inspection there was minimal activity on the nursing floor apart from the television being on. Staff spoken to said they found the concentration span for the residents on the nursing floor to be short and therefore it made the entertainment difficult at times. Where possible the staff spoke to residents on a one to one basis. Staff should receive some training in the care of patients with dementia particularly in respect of activities. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents and relatives are confident their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The complaints procedure was available and appeared to have been followed. The complaint record held by the home showed two complaints since the previous inspection. The record showed these had been investigated and action taken. One allegation of poor practice has been investigated under Adult Protection procedures since the last inspection. This investigation highlighted some serious concerns in relation to poor record keeping, and staff training re wound care and its management. Requirements were made in a separate letter to the home in November 2005. These have been addressed in part however there are still concerns regarding the care planning documentation as raised earlier in this report. A further outcome of this investigation led the Commission requesting a copy of the monitoring of any wounds /pressure sores in the home. This continues to be monitored. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection visit. EVIDENCE: Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Staff have access to training and learning in order to carry out their job. However a review of training needs to take place to ensure all staff are fully competent. EVIDENCE: At the time of the inspection the home accommodated 17 residents in receipt of nursing care plus 2 in hospital and 25 residents in receipt of personal care only, plus 2 in hospital. Relatives and residents spoken to were positive about the staff and were complimentary about their attitude. There was some evidence that appropriate training had been undertaken however there was no clear system for showing when mandatory training was due to be redone. It is recommended that the home’s manager has access to a system which clearly highlights the staff training undertaken. Staff stated they had recently received training in wound care, whistleblowing/adult protection and in basic food hygiene. At the time of the inspection the staff team was complete and there was no use of agency staff. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 15 The requirement made at the previous inspection that staff files must contain the information listed in Schedule 2 of the Care Homes regulations 2001 had been met. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 Systems and procedures were in place to safeguard the financial interests of the residents, however an interest bearing account could benefit residents more fully. The home is managed and run in the interests of the residents. EVIDENCE: The manager had commenced a probationary period in January 2006. The CSCI has not yet received an application form for registration and a requirement has been made. From discussions with the manager it was clear she knew the residents well and she was adjusting to her role as the manager As raised at the last inspection there remain some concerns in relation to the overseeing of the care throughout the home. The responsible individual is requested again to review the management of the nursing and personal care only floors and the expertise of the staff leading the care delivered on these floors.
Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 17 Residents’ finances were managed and systems were in place to safeguard these. It was pleasing to see that the manager had acted upon the comments made following a residents’ opinion survey. It was pleasing to note that the enforcement notice from the fire service in relation to the electro magnetic door locks and the means of escape has been addressed. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X X Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 19 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 Requirement Residents care plans must be written with sufficient and accurate detail to provide clear guidance to staff of the actions to be taken to meet the residents health and welfare needs. Timescale for action 30/05/06 2 3 OP10 OP12 12 16 The plans of care and risk assessments must be accurately reviewed. The care home must be 15/05/06 conducted in a way which respects the dignity of residents. Appropriate recreational 30/05/06 activities must be provided for all residents. Medications must be signed for on the MAR chart immediately following administration. Medication must be administered at the prescribed time. Appropriate arrangements must be made for the recording, safe administration of medicines. 15/05/06 4 OP9 13 Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 20 5 6 OP31 OP30 9 18 An application must be made to the Commission for registration of the manager. All staff must undertake the necessary mandatory training including refresher training. 15/05/06 30/06/06 7 OP32 10 Training must also be provided to ensure staff have the knowledge to deal with the residents accommodated, for example dementia care training. The registered provider must 31/05/06 ensure the deployment of management staff of the home is satisfactory. 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 2 Refer to Standard OP30 OP35 Good Practice Recommendations It is recommended that the manager has access to a system that clearly highlights the staff training undertaken. It is recommended that residents’ monies are held in interest bearing accounts. Worsley Lodge DS0000006733.V278669.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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