Inspection on 08/11/07 for Worsley Lodge

This inspection was carried out on 8th November 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 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 8th and 14th November 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.V354460.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.V354460.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.V354460.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 6th August 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 may also be made for hairdressing and other personal requirements. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was the second key inspection conducted this year and focused on assessing progress made to address concerns identified at the earlier key inspection, which took place in August 2007. A further visit was carried out in September 2007 specifically to follow up on the requirements made at the August inspection. This site visit started at 9.00am on the 8th November 2007 and it lasted for eight hours. Two inspectors were present for part of the inspection. On the 14th November 2007, the Pharmacist inspector undertook the inspection of medication systems and practices in the home as part of this inspection overall. During the course of the visit time was spent talking to several residents, the staff and visitors to the home. Feedback was given to the management team. Throughout the visit observations were made of care practices and records and a partial tour of the premises was made. Since the last inspection a new acting manager has been appointed and the current registered manager remains absent from duty. At the time of writing this report the concerns/allegations being investigated under Salford Council’s adult safeguarding procedures have progressed, however these have not yet been concluded. What the service does well: What has improved since the last inspection? Since the last inspection an audit has been carries out of each care plan however there are still some shortfalls in the information recorded which may lead to residents needs not being fully met. Care plan training was planned for the day after this visit and there were signs of improvement overall. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 6 There was evidence that staff were paying more attention to the basic care needs of the residents. Residents looked appropriately dressed and attention to their fingernails and hair had been made. Since the last inspection a number of staff have undertaken training in the prevention of abuse and, when talked to most were aware of what action to take if they suspected abuse within the home. There was evidence in the care plans that residents and some relatives had been consulted about their care plan. Improvements have been made 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. The atmosphere in the home felt happier and residents spoken to were happier with the care they received, one of the residents said that the care worker, “oh, she is kind and helpful to me”. What they could do better: Medication must be given to residents as prescribed. Records about medication handling must be accurate and show that residents are given their medicines properly and that all medicines can be fully accounted for. As raised at the last inspection the information gathered from the care assessed was not always clearly detailed in the care plan; this may lead to a risk to the resident’s health or personal care needs not being met. Individual care plans should be made for each need identified. In house training was planned in relation to care plans to assist the staff to complete the records appropriately. The sub kitchens were in need of a thorough cleaning to minimise the risk to residents. If the first floor lounge is redecorated and refurbished this would greatly improve the environment for the residents living there. Extra chairs should be provided to allow staff and visitors to sit by their relative/friend and provide support as required. The menu on display did not reflect the meal of the day and residents were kept waiting a lengthy time before the meal was served. The residents enjoyed the meal provided and residents confirmed they had a choice of what they wanted to eat at mealtimes. Attention needs to be made to the development of a staff team when all the vacant positions have been filled. When the need for agency staff is reduced Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 7 the staff will be able to work together to improve the care provided for the residents. The manager must make sure the staff are appropriately supervised to feel confident that safe moving and handling practices are carried out. 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.V354460.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.V354460.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. Each person considering moving to Worsley Lodge has an assessment of their needs carried out before admission is agreed. EVIDENCE: Prospective residents have an assessment of their care needs prior to them moving into Worsley Lodge. The home continues to use a pre admission booklet to record and assess the needs and wishes of a prospective resident and include the families as necessary. From this information the staff create a draft care plan to show the care needs required. During this visit, the pre admission booklets for three residents who had been admitted to the home most recently were seen. These showed that an assessment of needs had been carried out. One of these assessments was only partially filled in, however the assessor had written, “unable to assess at the time of this visit”. The draft care plan for this resident was not then fully completed, which may lead to resident’s needs not being identified and met. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 10 For a resident who was recently admitted as an emergency with very short notice, the acting manager had received a detailed risk assessment and social care assessment to enable the staff to create a draft care plan to provide them with the information required to care for the resident. Staff had been unable to visit the resident pre admission, however the in house assessment was completed upon admission to the home. A discussion with the acting manager highlighted that the pre admission assessment should include some comment about the individual’s wishes and concerns and how they feel about coming into the care home to make sure their needs can be met. New residents and their families are encouraged and invited to look around the home before making a decision to move into Worsley lodge. Worsley Lodge does not provide intermediate care facilities. Worsley Lodge DS0000006733.V354460.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 did not provide sufficient detail to ensure that the health and safety and personal care needs of residents were being met. Residents health is potentially at risk of harm because of poor medication administration. EVIDENCE: The files of five residents, including the three residents who were admitted to the home most recently, were seen. Since the previous inspection, a full audit of the care files had been carried out and immediate shortfalls had been sorted out. There was evidence of more involvement of some of the residents and or their families in the care plans. The care files did show signs of improvement since the previous inspection however some of the shortfalls still identified may lead to resident’s healthcare needs not being met in full. Care plans had been reviewed and updated to reflect changes in the healthcare needs. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 12 One of the care files contained information that was confusing. An entry by the nurse recorded “no fits noted”, however the care plan does not mention the resident had any risk of fits. Another care plan was not very clearly recorded when the resident’s catheter was inserted and when this was for renewal. The only record of this was on the pre-admission information. One of the resident’s pre admission assessment stated” will occasionally use walking stick or furniture walk”, a risk assessment for falls was in place however the care plan for “mobility” had not yet been filled in and there was no recording of the support this resident requires. Staff must ensure the information is followed on from the assessment phase into the implementation phase to make sure the care needs of the residents are appropriately met. Although an assessment for a resident had been carried out and one of the identified needs was in relation to the potential for the resident to make, “inappropriate sexual gestures”, there was no identified need in the care plan regarding the management of this resident’s behaviour. Failure of the staff to clearly document the care needs following the assessment phase may lead to the residents needs not being appropriately met or managed. In some of the files reviewed there was a lack of recording of professional visits in the homes files to enable up to date health care information of the individual resident to be available. The handwriting in the care plans was not always legible. It is recommended that staff write clearly so that other people can read the entries made in the records. There was some evidence of staff taking appropriate action and recording changes in the care plan. One example involved a resident who was reassessed as requiring a soft diet, which was fortified with vitamins. There was monitoring of the residents weight and an appropriate risk assessment in place. Improvements in the recording included more evaluations of the care given. The records of some resident’s weight loss was discussed, the Operations manager stated that new scales had been ordered as the home were convinced there was a problem with the existing weighing scales. This 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. Residents observed and conversations with some residents showed they were generally happy with the way most of the staff delivered the care. A resident who was being nursed in bed was seen to be comfortable and looked like his care needs were being met. The food and fluid records for this resident were detailed and showed the staff were recording clearly if the resident had been offered a drink and refused this. Staff must be reminded that correction fluid must not be used on medication charts or care plans, as these are legal documents. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 13 During the inspection we looked at records about medication together with the medicines held by the service to make sure that the requirements made at the previous inspection had been met and that residents were receiving their medication safely. At the last inspection the record keeping had improved on the nursing unit and it was shown that residents were being given their medicines properly and all medicines could be accounted for. This improvement was not maintained. At this inspection we found the standard of record keeping was poor. This was because staff had either altered records or not signed the medication administration record sheets (MARs) at all, so it was difficult to tell if people had been given their medicines. Staff failed to record enough information on the MARs to tell if all medicines were accounted for. Some residents were not given their medicines as prescribed by the doctor because they had ‘run out’. These medicines included vital medication for epilepsy, diabetes and pain relief. Other residents were not given their medicines properly because staff failed to follow the doctors’ instructions carefully. It was also seen that staff were making clinical judgments by not giving some medicines and not recording the reasons for this. They also failed to record if the doctor had been consulted. There had been an improvement in the storage of medicines awaiting collection for disposal, however waste medicine was still being kept in open topped disposal bins in the clinic rooms. It is essential that all medication be locked away safely at all times to prevent abuse or loss. Despite training and competency assessments nurses and care staff administering medicines continue to place residents’ health at risk of harm due to poor medication handling practices. As raised at the visit in August 2007, there remains a lack of chairs for staff and visitors to sit on. A staff member sat on a small table in the upstairs lounge so that she could assist a resident to eat. The care worker was seen to take the small table away from the residents’ side and the resident was clearly distressed by this action. The staff member continued with her actions and sat with her back to the resident. The inspector discussed these actions with the staff member who said she was not aware her actions had upset the resident. It appeared the agency worker was new to the home and did not know how to meet the resident’s needs. Staff must be reminded of the need to respect the resident’s dignity and privacy at all times. A staff member was seen to stand a resident up to rearrange her clothing, in carrying out this process the resident’s underwear was exposed to all present. Worsley Lodge DS0000006733.V354460.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 good. This judgement has been made using available evidence including a visit to this service. Residents are given support and some opportunity to exercise choice and control over their lives. Residents were provided with food, which they liked and have some opportunities to be involved in the activities offered EVIDENCE: 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. Mealtimes on this floor seemed to be the highlight of the day. One resident who was new to the home did say, “I am bored here” and wanted to walk around. Staff were then seen to assist him to walk and sit and chat to him following these concerns. There needs to be some further effort to find out resident’s previous hobbies and interests to provide appropriate and stimulating activities for the residents living there. Since the last inspection plans to develop “Life Story Books”, a “Memory lane” in the corridor and the development of more activities are planned for the residents, however these had not yet been fully developed and training had been planned. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 15 The service uses the ‘Nutmeg’ system, which assists the cook to prepare a well balanced diet and menus were clearly displayed in the entrance hallway of the home. It was disappointing to note that the main meal of the day had been changed so the menu did not show the planned meal. Residents were observed having their breakfast, which was a choice of cereals, porridge and toast. Residents spoken to said there was plenty to eat and they enjoyed what they had. One member of staff was observed supporting 15 residents with their breakfasts on the ground floor. All residents appeared to be able to manage with minimal assistance. Two residents said that you would have to put in a special request with the cook if you wanted a cooked breakfast for example bacon and eggs and they had never done this. Another resident said, “they never have the right bread for toast, it is only sandwich bread, never the thicker bread for toasting.” Residents confirmed that they had a choice of what they wanted to eat during mealtimes. The meal served at lunchtime was liver, sausages, mashed potato, sprouts and carrots followed by chocolate sponge and custard. The meal was observed being served, it looked appetising and ample portions were served. The staff were seen to support and encourage residents to eat their meal in a kind and friendly was in the dining room, while some residents were supported with their meal in the comfort of their chairs in the lounge area. Staff were seen testing the temperature of the food prior to it being served. 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 welcome at the home and felt the atmosphere was “quite pleasant.” Resident’s fingernails were seen to be clean and residents were appropriately dressed. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and visitors are confident that issues they raise will be dealt with appropriately. Policies and procedures are in place to protect residents from harm. EVIDENCE: Since the last inspection the home had reviewed the complaints procedure and a copy was available in the home. The acting manager said that she was currently holding a time each week when relatives are encouraged to meet with her to discuss any areas of concern. Relatives spoken to said they were conscious they could raise concerns and would not hesitate to do so if the need arose. Discussion with the manager highlighted that all complaints received at the home are now forwarded directly to the Operations manager who will meet with residents, or relatives to discuss concerns and take action as necessary. Since the last inspection there has been one new complaint received by the Commission for Social Care Inspection in relation to a lack of communication with a relative. These concerns were looked at by the service provider and were upheld. 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. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 17 Staff training since the last inspection included eighteen staff members who had undertaken training in abuse awareness and the Protection of Vulnerable Adults. Staff spoken to were aware of definitions of abuse and how to identify abuse. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some areas of the environment were in need of cleaning to make the home free from risks to residents. EVIDENCE: A partial tour of the home showed that the residents’ bedrooms and the downstairs lounge were homely and pleasantly decorated, however the upstairs lounge was dark in contrast to the ground floor and consideration should be given to redecorating and refurbishing this area to make this more comfortable and homely for the residents. Bedrooms were personalised with photographs and ornaments. One resident who was new to the home said, “I like my room, already it feels cosy and comfortable”. Since the last inspection a full review of the environment had been completed and a maintenance programme had been developed. Improvement work that had been carried out included new window restrictors, replacement flooring to Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 19 three toilet areas and three replacement fire doors. A partial tour of the home showed it was free from unpleasant odours. The two “sub” kitchens situated on the ground and first floor were found to be unclean and in need of a deep thorough cleaning. The acting manager was made aware of these concerns during the site visit and she said that she would ensure these were cleaned during the day of this visit. The refurbishment plans include refitting of the main kitchen within the next 4 months. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The number and deployment of staff levels must be reviewed to make sure the care; health and safety needs of the residents are being met in full. Shortfalls in the number of staff and continuous use of temporary staff may lead to residents needs not being met in full. EVIDENCE: At the time of the visit there were 43 residents accommodated in the home. The regular registered nurse for the first floor was off sick and an agency nurse who had worked a number of shifts at the home and knew some of the residents quite well was covering her shift. Of the three care workers on this floor during the morning shift, only one of the care workers knew the residents well. Sometimes there was a lack of communication with the residents. The agency care worker was seen to support a resident during breakfast and only spoke once to her throughout the time she was assisting her. A discussion with one of the residents highlighted that she felt the staff were often too busy to “sit with me and have a chat”. On the ground floor there were times observed when the lounge area was left unsupervised. As raised at the visit in September 2007, the duty rosters were reviewed again and showed the high use of agency staff, for example on the 6th November 2007, three care workers on the day shift on the nursing unit were agency Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 21 staff. A staff team who do not know the resident’s needs well may lead to the resident’s needs not being met in full. In the upstairs lounge there was some evidence of a staff member who had an excellent rapport with the residents and showed knowledge of the residents individual likes and dislikes. This staff member was unable to support and work with the staff that did not know the residents and two agency staff were seen to carry out an inappropriate moving and handling technique with a resident. The acting manager was informed and the manager discussed the concerns with the staff and said she would inform the agency of this poor practice. As raised at the previous inspection, the residents will clearly benefit from a staff team who know their individual needs well. A discussion with the acting manager highlighted that this use of agency staff was also due to the level of staff sickness current in the home, however each staff members sickness records was being monitored. Since the last inspection the home have had a recruitment drive and new recruits have undergone a thorough company induction programme. Some of the recently recruited staff were still on a probationary period and some more new starters were planned within the next few weeks. Since the last inspection a programme of staff training has been put in place and some of the staff spoken to said this was “informative and was good to be updated”. Three staff were currently following a ten-week dementia care training course, care plan training was being provided the day after this visit. Other training carried out had been in relation to fire safety, health and safety and medication. Staff files were not reviewed as part of this inspection as the requirement for the appropriate recruitment procedures to be followed were followed up in Septembers site visit and the files contained the information required. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work is needed to ensure the systems in place to monitor the care practices and record keeping is adequate to ensure the health and welfare needs of the residents are met. EVIDENCE: Since the last inspection the home had appointed a new experienced acting manager to take over the day-to-day running of the home and a new deputy manager. Staff said the manager was supportive and was carrying out regular “walkabouts” to observe care and show a physical presence around the home. Comments from the acting manager were positive in relation to her plans to develop the home and create links with the local community. Some of the shortfalls in this report highlight the need for continued support or guidance to manage this home for the well being of the residents. The Project Manager Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 23 had reduced the time she was present in the home and was supporting the new acting manager one full day each week. These management arrangements have been put in place while the manager registered with the Commission remains absent from duty. As part of the management process the acting manager must ensure that safe moving and handling practices are carried out by staff working at the home to ensure residents are protected from harm. There was some evidence during this inspection that residents were being given the opportunity to air their views so that improvements to the service could be made. Staff were recording accidents in an appropriate accident logbook that met requirements of the Data protection act 1998. The Commission has been notified of any notifiable incidents under Regulation 37 of the care Homes Regulations 2007 in a timelier manner since the last inspection. There was evidence that since the last inspection a number of audits had been carried out regarding care practices, for example, the care planning documentation and medication practices. Shortfalls were still identified during this visit, however this in part may be due to the need for the staff team to establish itself and have time to get to know the individual needs, likes and dislikes of each resident. It was pleasing to note that most of the statutory requirements made at the previous inspection had been addressed, however requirements in relation to medication had been repeated from earlier inspections. A further meeting was held with the Commission and the service provider in September 2007 to stress the importance of meeting the outstanding requirements and to explain that enforcement action may be taken if the service fails to improve. The service provider presented an updated action plan to detail the planned action to address the concerns raised. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 24 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 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 25 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 The care plans must contain a full assessment of resident’s needs, wishes and choices. The needs identified must be clearly recorded to assist the staff to meet the resident’s needs. Entries on records must be consistent and legible and not include the use of correction fluid. Accurate weighing scales must be provided to make sure the recordings are accurate to monitor the resident’s weight. The Registered Person must make arrangements for the recording, handling and safe administration of medicines. 1. All medication records must be accurate; including making sure medicines can be accounted for by means of a traceable audit trail to show that residents are being medication as directed. 2. All medication must be Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 26 Timescale for action 31/12/07 2. OP8 12 31/12/07 3. OP9 13 15/11/07 given in accordance with the prescribed directions to make sure residents’ health is not at risk. 3. All medication must be stored safely and securely at all times. (The previous timescales of the 25/09/07 30/06/06 13/07/07 and 30/08/07 had not been met). Medication must be administered by staff and nurses who are assessed as competent to do so safely to protect the health of residents 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 undergarments should not be exposed to other residents. The numbers and skill mix of the staff on duty must be reviewed to make sure the residents receive the appropriate care to meet their needs. (The previous timescale of 31/08/07 had not been met). The manager must ensure that staff working in the home are appropriately supervised and carry out safe moving and handling practices to ensure the residents are safe. 4 OP9 18 (1)a 07/12/07 5. OP10 12(4)a 07/12/07 6. OP27 18 07/12/07 7. OP38 18(1)b 07/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 27 No. 1. 2. 3. 4. Refer to Standard OP3 OP7 OP26 OP31 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. It is strongly recommended the upstairs lounge is re decorated and made more homely to make the environment more pleasant for the residents. It is recommended the acting manager is supported and guided appropriately to manage the care home in the best interests of the residents. Worsley Lodge DS0000006733.V354460.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ 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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