Inspection on 06/08/07 for Worsley Lodge

This inspection was carried out on 6th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Worsley Lodge 10/11/08

Worsley Lodge 01/07/08

Worsley Lodge 15/02/08

Worsley Lodge 08/11/07

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 6 August 2007 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.V339137.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.V339137.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 Halpane Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Worsley Lodge DS0000006733.V339137.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 12th December 2006 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 toilet 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. The weekly fees range from £317.00 to £497.00. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken as part of a key inspection, the site visit started at 10.30am on the 6th August 2007 and it lasted for six and a half hours. The home did not know the inspector was going to visit. During the course of the visit time was spent talking to several residents, the staff and visitors to the home. Throughout the visit observations were made of care practices and records and a partial tour of the premises took place. The registered home manager was not available at work on the day of this visit. A self-assessment survey information form (Annual Quality Assurance Assessment) had been completed by the manager and was received before the inspection. Two service user survey forms were completed by residents and their families and returned to the Commission. Two separate concerns/allegations are currently being investigated under Salford Council’s adult safeguarding procedures. The outcomes of these investigations were not known at the time of this inspection. An investigation was carried out in February 2007 under safeguarding procedures following allegations made by a relative. Improvements were made for the care of the resident following this. The term preferred by the people consulted during the visit was “residents”. This term therefore, is used throughout the report when referring to the people living at the home. What the service does well: What has improved since the last inspection? Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 6 Improvements to the assessment information gathered in the pre-admission document had been made since the last inspection. Prospective residents needs and wishes were clearly recorded to provide the staff with information about the health, personal and social care needs before they moved into the home. What they could do better: The home’s Statement of Purpose should include further detailed information to ensure that prospective residents and their families have the information to be able to make an informed choice about the home. The manager must ensure that the residents living at Worsley Lodge are appropriately assessed for their care needs to be met by the staff. A full audit is needed of all the care plans to ensure these accurately reflect the care needs of the residents living at Worsley Lodge. The information gathered preadmission should be used to develop the care plan. Staff must receive training in the care of older people with a dementia type illness to assist in their communication and care of some of the people living in the home. Some shortfalls in the recording of appropriate information in the care plans may put people at risk of not having their needs fully met. Information gathered during the assessment phase should be used as part of the care planning process to ensure people’s health, personal and social care needs are met. Individual care plans should be made for each need identified. Risk assessments should be fully completed. Particularly in relation to the nutritional needs of the people accommodated. The systems in place for recording the care of residents requiring regular care and attention must be improved. Although changes had been made to the type of charts used, the shortfalls in filling these in may lead to peoples needs not being fully met. A number of residents living at the home were seen to have unclean and lengthy fingernails, untidy hair and unclean teeth. Staff must include these care routines on a regular basis and review this as part of the daily care provided to the people who need assistance. The manager had recently appointed a new activities organiser and plans to provide more appropriate and suitable activities in the home according to the wishes of the residents living there was being addressed. The home has a programme of redecoration in place, which is slow. Following a requirement to renew the damaged door frames, work remains in progress. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 7 Furniture must be replaced to make sure residents and staff are safe and the home is made homely. 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.V339137.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.V339137.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. Prospective residents’ are given information about the home and have their needs and wishes assessed before they are admitted to the home. EVIDENCE: A Statement of Purpose was available informing prospective residents about the home. A copy of the Statement of Purpose was available at the entrance of the home and two residents confirmed they were given a copy when they were recently admitted to the home. The information booklet should show how the service provides for the personal care and social needs of people with dementia, so that prospective residents and their families are fully informed. There is a pre admission booklet for recording the assessed needs and wishes of a person before they moved into Worsley Lodge. A review of three of these showed a thorough assessment of needs had been carried out prior to these residents recently moving into the home. The new, short-term project Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 10 manager (who is managing some aspects of the day to day running of the home in the registered managers absence) had gathered information about the residents’ activities of daily living and visits to the prospective residents had been made prior to them moving to Worsley Lodge to create this full needs assessment. These assessments ensure that any new admissions to the home can be assured that their individual needs can be met within the care environment. Residents who were referred through a social worker had a care management assessment and copies of these were made available to the home. One new resident said, “I am enjoying it here, I have a friend and we sit together having chats. I think I am settling in well.” Relatives and representatives are invited to visit the home and are encouraged to look around before making a decision to move into the home. Worsley Lodge does not provide intermediate care facilities. Worsley Lodge DS0000006733.V339137.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. Care plans and risk assessments lacked detail to show the current and changing needs of residents were being met and the procedures for the administration and recording of medication were inadequate. EVIDENCE: A sample of resident’s care plans were reviewed and these included information about a wide range of personal and health care needs. Serious shortfalls were noted, as the information gathered at the assessment phase was not followed on in detail in the care planning and implementation stage. One resident’s risk assessment stated to weigh the resident weekly and refer to the GP and dietician if his weight loss continued. There was no evidence to show the resident had been weighed for three and a half weeks until this visit. The resident was brought into the day room late morning and the staff member commented he had not received his breakfast. A review of the care plan showed the nutritional intake record had not been completed for a number of days in July and there was no record seen for August. The daily statements in the care plan regularly stated, “diet and fluids taken well”, with Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 12 no mention of any dietary difficulties. Following observation of this resident at lunchtime it was clear he had eaten only a mouthful of food and there was no evidence to suggest the staff would have noted this due to the demands upon them on this day. A different resident’s husband said he deliberately made his visits in the morning so that he was confident his wife received her food supplement. The resident’s care plan states “strict intake and output”, again there was no evidence to show that a record of the intake was being kept. Records of food and drinks must be maintained and recorded as assessed to allow anyone concerned to make a judgement that the person is receiving adequate nutrition. There was limited evidence that the plan of care had been drawn up with the involvement of the resident/relative. One resident’s next of kin was not aware of the care plan for his wife and what he could expect for her. As raised at the last inspection some of the daily information records were vague and did not accurately reflect the nursing care provided to the residents. A sample of medication records were looked at and these showed that some residents did not receive their medication as prescribed by the doctor. It was also seen that some medications had been handwritten onto the record sheet and these were not signed and witnessed by the staff members. The morning medicines were still being given late morning, which has the potential to prevent the resident getting the full benefit of their prescribed medicines. It was difficult to establish from the records whether residents did receive dietary supplements as prescribed. The nurse in charge administering the medicines was working her first shift in the home and some of the photographs did not accurately reflect the resident. Although there was one care staff member who knew the residents, he was busy attending to other resident’s needs. One resident was prescribed a medication for diabetes. There was no record on the medication administration record to show he had received this drug in line with the prescriber’s instructions until the request was made by the resident’s relative to check this. These shortfalls had the potential to put the residents at risk of not having their healthcare needs met. It was of serious concern that staff were not acting on the assessed information, which potentially has serious concerns for the well being of the residents. This serious concern was raised at the previous inspection and a requirement was made for the care plans to be reviewed to accurately reflect the planned and given care for them to be a useful tool and a legal document. This poor administration of medication gives serious concern despite a requirement had been made at the previous inspection for arrangements to be made for the safe management of medicines in the home. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 13 From observations made during the inspection and discussions with members of staff, it appeared the care staff and nurses were respectful to the residents in the way they spoke with them, however some observations led to the resident’s dignity being compromised. Some of the resident’s teeth were in urgent need of cleaning, a number of residents appeared in need of attention to their hair. The visiting podiatrist who treated the residents in the lounge area compromised the dignity of the resident’s. This was raised with the person managing the home and she was heard discussing this with the staff involved. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 14 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. Residents are given support and some opportunity to exercise some choice and control over their lives. Shortfalls in activities for the residents receiving nursing care and unappetising food placed the residents welfare at risk. EVIDENCE: An activities organiser had been newly appointed to the home. A discussion with the activities organiser showed her interest to plan and arrange activities and trips for the residents. Residents spoken to were aware some of the activities available and residents were observed having their fingernails painted. Some residents on the first floor were seen to have dirty fingernails that required attention. One resident said, “I enjoyed a game of monopoly last night”, while another resident said she had enjoyed watching a film. Another resident said, “I enjoy reading my catholic herald and the staff assist me to get to mass every Sunday, which I appreciate”. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 15 The activities organiser was in the process of “getting to know the residents and to explore their likes and needs”. It was pleasing to see she had a plan to start developing the life histories for the residents living at the home with the involvement of family members. Residents said they were able to receive visitors throughout the day and it was clear that visitors felt able to visit at any time. It was of concern that some of the visitors spoken to were clearly visiting their next of kin to be able to check for themselves that some of their basic needs were being met. Some relatives were very upset during this visit and expressed some serious concerns about the health and well being of their relatives. Senior staff spoke with the relatives to offer some reassurance that their relatives would be appropriately cared for. In the first floor lounge at 11.35 a number of residents were shouting out for a drink. It took a considerable time before this was effectively sorted out. Staff were clearly too busy attending to the needs of residents to be able to have the time to make a drink and give the assistance as required. The meal presented at lunchtime was poor. The meat looked very unappetising, the fish fingers could not even be offered to the residents and the sponge pudding was burnt. The timing was not well managed as the food was left in the hot trolley and the residents were left unsupervised in the dining room for a considerable time before the residents were given this food. Some residents found it difficult to sit for this period of time and were saying, “are you giving us our lunch?” “we have been here ages”. The residents had to wait for a second desert and some residents left the dining room before this arrived. One of the service user survey responses said, “The lunchtime meal seems okay but at tea time the food is substandard and always arrives in the form of sandwiches-inadequate!” One resident expressed her distress at sitting next to a resident whose table manners were not always appropriate. There were a high number of residents who required assistance at lunchtime to be fed. They were left for a considerable period of time due to the number of staff available to assist and their meals were just left going cold. Staff did sit and interact appropriately when they were assisting residents and were seen to be doing the best they could. The meal on the day of the inspection did not reflect the meal on the board in the entrance hallway. Although there were chalkboards available in the lounge areas, these were not completed to show the residents the meal of the day. In order to provide a varied and nutritious diet that the resident’s enjoy, there is a need to review the menus after meeting with the residents to establish their likes and dislikes. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 16 The crockery presented on the pleasantly laid small tables looked pleasant, however wine glasses were on the dining tables at lunchtime. One resident had previously thrown her plastic beaker across the lounge and there had been no apparent thought to assess the risk of providing unbreakable glasses. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 17 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. Residents and visitors are not currently confident that issues they raise will be dealt with appropriately and promptly. Procedures in place to protect residents from harm are not as robust as they should be. EVIDENCE: The home had a complaints procedure. The file to show a record of complaints made to the home could not be found at this inspection, the commission must be able to access these records at all times and they must be reinstated as soon as possible. The two representatives of relatives who responded to the service user surveys said that they knew how to make a complaint. One of the relatives responded by saying, “Yes but unless you have absolute concrete evidence of the complaint, nothing gets done. At the very best you might get an apology.” This is not appropriate as everyone needs to have confidence that all complaints will be properly looked at. A requirement was made following a recent visit to the home for the management to ensure serious concerns/allegations are appropriately referred to Salford Council’s Safeguarding Adults team for investigation. Shortfalls in the reporting of concerns/allegations potentially places the safety and welfare of the residents at risk. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 18 Concerns were raised in February 2007 to the provider and to the Commission. Issues raised included allegations regarding the residents buzzer being unplugged from the wall and a resident asked not to use it; the number of falls the resident had; use of a residents mobile phone by a staff member and theft of toiletries. These concerns of an adult protection nature were looked at under adult safeguarding procedures and more regular checks and equipment was put in place to assist the resident. Other aspects of the complaint were not upheld. All staff had received awareness training in adult safeguarding procedures and the home had a copy of Salford Councils safeguarding procedures. Some staff spoken to were clearly aware of the different types of abuse and understood what they would do in the event of suspicion of abuse. The project manager had recently held a staff meeting to discuss whistle blowing and the companies policy on this. This followed recent allegations made about care practices within the home. At the time of writing this report these concerns and allegations were under investigation by other agencies. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment, however, shortfalls in attention to furnishings and the temperature of the environment may lead to residents being uncomfortable and at risk of injury. EVIDENCE: There was evidence of a programme of redecoration as some of the bedrooms had been pleasantly re-decorated. One of the resident’s relatives said, “the facilities are quite pleasant and my husband has a lovely room.” Following a requirement at previous inspection there was evidence of some re plastering and new woodwork around the doorframes of some of the doorways in the corridors. These look unsightly due to the plasterwork and the work is not yet complete. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 20 One resident commented that he felt the recent arrival of new residents from another home has caused an environment that is too stimulating for his wife who has a diagnosis of dementia. A discussion highlighted that maybe he would go and sit in her bedroom for some quiet time together, however there is only one comfortable chair for his wife to sit on. This was raised with the project manager and she said this would be addressed. Resident’s bedrooms did contain photographs and personal effects. During this site visit the project manager showed some of the residents and relatives who wanted to sit and chat or watch a film the “quiet” lounge which was available for them. This is a pleasantly decorated and a homely room and may benefit the residents who would like the opportunity to sit in a less stimulating environment. Some of the upright and chair cushions were removed from the lounge during the visit as they were broken or soiled. There was a distinct lack of small chairs for anyone to be able to sit next to someone to sit and interact. To ensure the safety of the residents and visitors and a homely environment, a full audit of the current furniture must be done to ensure it is safe. The temperature of the room on the first floor was unbearable/uncomfortably hot. A request was made for thermometers to monitor this and for the temperature to be reduced. A fan was on and windows were open however residents, relatives and staff commented on how hot the room was. A partial tour of the premises showed some shortfalls in the management of odour in some of the bedrooms. There were no signs of any orientation aids to assist residents with dementia. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor.This judgement has been made using available evidence including a visit to this service. Staffing levels must be reviewed to make sure the care, health and safety needs of the residents and staff can be met. Improvements to staff recruitment are needed to make sure the residents are looked after by suitably recruited individuals. EVIDENCE: At the time of the visit the home was at full occupancy and only one of the staff members, a care worker knew the residents on the nursing floor. The staff did not know the resident’s names or their needs and this put resident’s at risk of their care and personal needs not being met. From observations made during the visit and the periods observed when the dining room and lounges were left unsupervised there was clearly not always sufficient staff on duty to meet the care needs of the residents. The numbers of staff require reviewing to ensure the needs of the residents are met in full. One relative commented that they are “short of helpers, I feel like doing it myself”. Another resident was not sure where to sit and another relative was seen to escort her to a chair. One resident had made attempts to dress herself and required some further assistance. She was visibly distressed about this, however it was a lengthy period of time before a staff member was able to assist her. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 22 A review of the staffing of the laundry was discussed as some of the resident’s wardrobes showed the clothes had just been “bundled” in and staff could not find sufficient bedding to remake some of the beds. A discussion highlighted that the project manager does have plans to increase laundry provision in the home. It was recognised that on the day of the inspection the deputy manager was new in post and the regular registered nurse had phoned in sick at short notice. The new deputy had only received a brief handover from the night nurse and she was caring for residents whom she did not know and had not read the care plans. It was of serious concern that a full handover of residents had not been given and the nurse was not aware of the care needs of one of the residents. The nurse had not received any induction however this was to be addressed by the end of her shift. The manager had brought in another agency nurse to assist in the afternoon to free up some time to enable the nurse to receive a basic induction. One resident was seen to request to spend a period of time on the toilet, however she was distressed as she was told, “we are too busy”. A number of residents requested a morning drink at 11.35 and were clearly becoming upset because they had been waiting a lengthy period of time for this. The permanent members of the staff team on duty at the home seemed tired and staff morale is low. The care staff are not getting two days off together in order to refresh themselves but are working long days and extra hours. This has the potential to put residents at risk. One resident said, “you are always saying in a few minutes, whenever I ask for something”. A sample of staff files were looked at and showed that POVA first checks had not been carried out on two care staff who had recently transferred from another home. One of these care workers had been employed as a domestic/laundry worker and was on night duty as a care worker at this home. The reference for one staff member was not the staff members last place of work and the application form had a gap in the recent employment section. The appropriate reference was addressed before the inspector left the premises and an extra staff member was put in post to supervise the care of the two care workers who did not have the appropriate recruitment checks. The acting managers must make sure that full details are obtained before new staff are employed to ensure the safety of the residents. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 23 Information provided by the home showed that a planned training programme was in place to cover the following areas between now and December 2007; first aid, moving and handling, medication, health and safety, customer care, challenging behaviour, abuse and whistle blowing, induction, fire safety and food handling and hygiene. The trainer was in the home on the day of the visit and was positive about starting this next week. Worsley Lodge DS0000006733.V339137.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 poor. This judgement has been made using available evidence including a visit to this service. Standards and practices in the home did not promote and safeguard the health, safety and welfare of the residents living there. EVIDENCE: Following the observations made by the inspector during this visit it was clearly evident the home has not been well managed. The manager was registered with the Commission in May 2007, she is currently absent from duty. The company have put in interim management arrangements and a meeting has been held with the provider and the Commission. An action plan was presented to the Commission with timescales, to show how the company intends to manage the home and ensure the health, safety and welfare of the residents. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 25 Two experienced managers have been brought in from other care homes owned by the company to start addressing the shortfalls. At the time of this visit both these managers were in the home, it was the first day for both of them. Clearly there was a lack of staff present in the home that knew the residents well and this was likely to hamper some progress. The Commission has been notified by the home of most notifiable incidents under Regulation 37 of the Care Homes Regulations 2001. The home has a policy and procedure for the management of resident’s finances. A sample of residents individual records were checked on the computerised system and the records appeared accurate. A full audit had recently been carried out by the company and at the time of this visit no discrepancies were reported. Staff were recording accidents in an appropriate logbook that complied with the requirements of the Data Protection Act 1998. An audit of accidents in the home was not available at the time of this visit. The pre inspection information showed that health and safety maintenance checks were carried out by the home A comprehensive file for the policies and procedures and health and safety risk assessments was available. Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 26 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 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 27 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 13 Requirement An audit of the care plans must be carried out to ensure these accurately detail the actions required by staff to ensure the health, social and personal care needs of the residents accommodated are met. Daily entries must be clear and linked to the care planned. Entries must be consistent and legible. The risk assessments must be accurate and appropriate for the individual and be carried out, reviewed and updated. (The previous timescale of the 31/01/07 had not been met). The Registered Person must make arrangements for the recording, handling and safe administration of medicines. Residents must be given medications which are prescribed for them in line with the prescribers’ instructions, with immediate effect. (The previous timescales of the 30/06/06 and the 13/07/07 had not been met). DS0000006733.V339137.R01.S.doc Timescale for action 12/10/07 2. OP9 13 30/08/07 Worsley Lodge Version 5.2 Page 28 3. OP8 15 4. OP10 12(3) 5. OP15 16(2)(i) 6. OP16 22 (3) (4) 7. OP16 22 (8) 8. OP16 17 (2) The nutritional risk assessments must be clearly recorded to ensure people receive the foods and diet, as needed. Food and fluid records and pressure relief charts must be clearly recorded to ensure people’s needs are met. All staff must be reminded of the need to ensure attention is paid to all residents personal care needs so that residents/representatives wishes are respected at all times and dignity of the resident is maintained. Food provided must be edible, adequate, nutritious and properly prepared to make it suitable for the residents. Drinks must be provided to residents at reasonable times. So that residents and staff can have confidence in the complaints process. All complaints made should be fully investigated within 28 days with the person making the complaint being informed of the outcome. (The timescale of 06/08/07 has not yet been responded to by the provider). In order that the Commission can satisfy itself that all complaints are properly addressed in line with regulations: A statement must be provided to the Commission of all complaints received within the home within the preceding 12 months and the action taken in response. A record of all complaints made must be kept on site and open to scrutiny. 07/09/07 03/09/07 13/08/07 30/08/07 13/08/07 31/08/07 Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 29 9. OP19 24 10. OP27 18 11. OP27 16 (1) (e) 12. OP30 19 13. OP30 18 The registered person must provide an action plan to show the programme of renewal and planned maintenance for the home, including resident’s bedrooms and communal areas so they are furnished and well equipped. This must include chairs, carpets, and sufficient bedding. The numbers and the skill mix of the staff on duty must be reviewed to make sure that the residents accommodated receive the appropriate care to meet their needs. The numbers of laundry staff must be reviewed to ensure resident clothes are properly laundered and an adequate supply of clean bedding is available. Appropriate recruitment procedures must be followed to show that appropriate action has been taken to minimise any risk to residents. The staff must receive appropriate training for their role to make sure the resident’s needs are met. A record must be kept of training undertaken. This includes basic and advanced training in dementia. 21/09/07 31/08/07 31/08/07 31/08/07 31/08/07 Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 30 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 OP1 Good Practice Recommendations The statement of purpose should include information about how the service provides for the needs of people with dementia, so prospective residents and their representatives are better informed. Handwritten entries on the medication records should be signed by the person making the entry and countersigned by a second person to ensure accuracy of the information, and to protect the health and welfare of the residents living in the home. Staff should ensure the fingernails of the people living at the home are kept clean and at a comfortable length. The tea time menu should be reviewed in consultation with residents, where possible and their representatives. Menus should be readily available to all residents each day. A review should be undertaken of those residents that require help to eat and drink; and arrangements put in place for staff to assist these residents in order to ensure they have proper nutrition. In order to assist residents with dementia, orientation aids should be provided. The temperature of the lounge on the first floor should be monitored and action taken to reduce the temperature if necessary. Improvements should be made with odour control in some resident’s bedroom. In the current circumstances at least one member of staff should be on duty on each floor who knows the residents well enough to identify them and give advice to new staff on their care needs. The handover system should be reviewed to ensure all staff have full information on each resident. 2. OP9 3. 4. 5. 6. OP8 OP16 OP16 OP16 7. 8. 9. 10. OP19 OP24 OP24 OP27 11. OP27 Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Worsley Lodge DS0000006733.V339137.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!