Care Home: Silversea Lodge Care Home

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What the care home does well Silversea Lodge was a very friendly home. Staff, residents, the staff trainer and the relative we spoke with were all helpful and open in their views and opinions. There was a comfortable and relaxing atmosphere within the home. We found that staff members enjoyed their work and spoke enthusiastically about their training opportunities. We noted that there was a good team spirit among the staff team. The relationship between the service manager and staff was good. Resident’s bedrooms were personalised and comfortable. The lounge area overlooked a very nice flowered patio area. Residents were positive about the Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 home but wanted more occupational and social activities. We could see that there was a good relationship between staff and residents. What has improved since the last inspection? Following the last inspection six months ago, the service manager quickly sent us an action plan providing us with detail of how the shortfalls noted would be addressed. At this inspection we saw that the rough carpet area in the main corridor had been sorted out, staff supervision had been established, residents’ records were now kept in a secure place and development work within the resident’s care planning system was evident. What the care home could do better: This report has acknowledged some of the improved and good practices within the home. We do have concerns about the lack of day to day monitoring tools in place to ensure that practice is monitored. We observed a number of shortfalls which would have been noted if an effective management monitoring system was in place. For example there were shortfalls in the resident’s nutritional intake record system, the storage of food in one of the freezers was not adequate, fire doors were wedged open, infection control measures were not robust particularly in the utility room and there was a potential fire hazard behind the tumble dryer. In addition, practices and procedures for the safe use of medicines and the records kept of medicines in use must be improved. Key inspection report CARE HOMES FOR OLDER PEOPLE Silversea Lodge Care Home 46 Silversea Drive Westcliff On Sea Essex SS0 9XE Lead Inspector Ann Davey Key Unannounced Inspection 3rd September 2009 08:45 DS0000068495.V377289.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Silversea Lodge Care Home Address 46 Silversea Drive Westcliff On Sea Essex SS0 9XE 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) 01702 480502 01702 710482 silversealodge@yahoo.co.uk Mr Pritesh Patel Manager post vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th March 2009 Brief Description of the Service: Silversea Lodge provides care and accommodation for fifteen elderly people. The premises and facilities are provided on ground and first floor levels and have been suitably upgraded and adapted for the accommodation of elderly people. There is one main lounge and a separate dining room. There is single bedroom accommodation throughout, some of which have en-suite facilities. A passenger lift is provided for residents to gain access to the first floor. There is a medium size garden to the rear of the premises and limited parking available to the front. Silversea Lodge is located in a residential area of Westcliff on Sea. It is in close proximity to local shops, bus routes and other local community amenities including Chalkwell Park. There is a Statement of Purpose and Service User’s Guide available. A copy of the last inspection report was also available. The weekly charges range from £388.00 - £450.00. The exact fee depends on the type of accommodation requested/available, assessed care needs and the source of funding i.e. private or local authority. There are additional charges for items of a personal nature. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this care home is 1* adequate provision. The last key inspection took place on 16th March 2009. Derek Brown, Pharmacist Inspector visited the home on 1st September 2009 and looked at the medicines storage, administration and recording systems. His findings have been incorporated within this report. This key inspection took place over eight hours. The visit started at 8.45am and finished approximately 4.15pm. The management of the home was overseen by the owner’s representative and consultant. This person is known as the service manager. The home also has an acting manager. The home’s service manager helped us throughout the inspection. Later in the day, the owner of the home was also present. The home’s Annual Quality Assurance Assessment (AQQA) which is required by law to be completed by the service had been returned to us within the agreed timescale. The document had been completed well and provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve months and its plans for the future. Since the inspection, we have sent questionnaires to the home asking that they be distributed to residents, staff and all other stakeholders, completed and returned to us. We will use the information for the next regulatory activity. The time spent in the home was pleasant and everybody was helpful. We spoke with residents, members of staff, a relative and a staff trainer. We looked around the home and viewed aspects of various records which were selected at random. All matters relating to the outcome of the inspection were discussed with the service manager and the owner so that where necessary, development work could begin. What the service does well: Silversea Lodge was a very friendly home. Staff, residents, the staff trainer and the relative we spoke with were all helpful and open in their views and opinions. There was a comfortable and relaxing atmosphere within the home. We found that staff members enjoyed their work and spoke enthusiastically about their training opportunities. We noted that there was a good team spirit among the staff team. The relationship between the service manager and staff was good. Resident’s bedrooms were personalised and comfortable. The lounge area overlooked a very nice flowered patio area. Residents were positive about the Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 6 home but wanted more occupational and social activities. We could see that there was a good relationship between staff and residents. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 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 Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (standard 6 was not assessed as intermediate care is not provided by the home) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ needs are assessed before admission to make sure that these can be met by the home. EVIDENCE: The home’s Service Users’ Guide and Statement of Purpose were displayed in the entrance hall way. We noted that there was a copy of the Service User’s Guide in each bedroom that we looked in. This means that prospective residents and their relatives can read about the home and understand what it can offer and provide. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 9 The preadmission assessment documentation of two residents admitted since the last inspection was viewed. There were clear and detailed records in place. The assessments had been undertaken by the service manager. We noted that the views and opinions of the residents had been recorded. Care plans had been put in place. We took the opportunity to speak with one of these residents and their respective relative. Both spoke in a positive way about their experience of the admission process. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive care based on an intuitive understanding of care needs but may be at some risk because the records about their required care and some medicine practices were not robust. EVIDENCE: Aspects of four care plans and associated documentation such as risk assessments and accident records were viewed. These records were selected at random. The service manager acknowledged that the various sections of the files were not well organised and there was some duplication of records. We were shown a ‘model’ file which was to be used as a template for all records. We were told that all existing records would be transferred to the new format by the end of October 2009 following a period of staff training. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 11 The records we saw ranged from good to not adequate in detail and content. For example, one record was very detailed about the assessed care needs and how they were to be met, whilst another care plan made no reference to the community nurse’s input about their regular visits to apply dressings. One care plan did not reflect the respective residents current care requirements but another was written in a very ‘client focused’ way. We noted a range of good and not adequate recording practices. All were discussed with the service manager who acknowledged the need for development. We noted that the care plan format provides the opportunity for residents to look at their care plans and to sign in acknowledgment. Of the four records we looked at only one had been completed. We could see that the respective residents had been included in the formulation of the care plan. We also discussed the format used during the monthly review of residents’ care needs. All the records we saw referred to ‘no change’. We asked the service manager to review the process to ensure that care needs were fully reviewed and all changes noted. For example, the acting manager told us about how they were now managing a named resident’s care, but this had not been recorded. The outcome of our findings was that not all known care needs had been adequately recorded. Staff on duty demonstrated that they had a good understanding of residents’ care needs. However, should that core group of staff not be on duty, new staff would not necessarily know the care needs of residents. Residents could therefore be at risk of not having their needs met because of inadequate recording. We noted that the quality of risk assessment also ranged from good to inadequate. For example, a known dietary need for one resident had clearly been noted, but there was no risk assessment in place for a resident who had stated a particular preference to the way in which they wanted to be manoeuvred. The resident’s wishes had clearly been recorded, but the outcome of staff meeting this preference meant there was potential risk of injury. We discussed all our findings with the service manager who agreed to review the assessment risk recording system. The outcome of our findings was that not all known residents’ personal care risks had been properly assessed and recorded. There was the potential for an untoward incident. Residents we spoke with told us that they had no complaints about the care they had received. They intimated that their care had been provided in a dignified and caring manner. Residents told us that staff ask about their respective choice and wishes. One resident said that they go to bed and get up when they wish. Another resident told us that ‘staff are very good when they bath me’. We noted that staff spoke with residents in a friendly and supportive manner. Staff were able to discuss with us individual resident’s care needs in some detail and told us that they always had access to care plans and risk assessments. The relative we spoke with expressed complete satisfaction with the care provided by the home. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 12 The service manager told us that the home had a good professional working relationship with all health and social care professionals. We were told that residents are provided with access to all community health and social care support. This was supported by the information we saw within residents care files and what residents told us. Medicines were stored securely for the protection of residents. The temperature of the room where medication was stored on the ground floor had not been monitored or recorded regularly since 19th July 2009. Prior to this the temperature had been recorded above the recommended maximum of 25C on several occasions. The temperature of the room used for the storage of surplus dressing and medicines on the first floor had also not been monitored or recorded regularly. We expected this to be managed by the home at the last inspection and this had not been done, so a requirement has been made. The failure to store medicines at the incorrect temperature may result in people receiving medicines that are ineffective. There was a large quantity of medication waiting to be disposed of but there was no record made of this. In some residents’ rooms, we found prescribed creams which were not recorded on their medication records and where the name of the person they were prescribed for (which was originally printed on the label) had been torn off. This means it was not possible to tell who the medicine was prescribed for and increases the risk that it may be used for more than one person. We looked at the medication records and medication in use for several people in the home and found a number of problems with these. In some cases it was difficult to account for all medicines in use as the records were inaccurate and some discrepancies were found that may indicate that people had not received their medication as prescribed. Medication prescribed for one person to be taken regularly was recorded as being administered only “when required” without any documented justification for this. We also found that some other medication was being given to people at variance to the instructions on the labels and for some people medicines had been omitted, one for a period of 4 days as it had “run out”. If people do not receive continued treatment with medication, this could seriously affect a person’s health and welfare and a requirement has been made about this. Medication is only given to residents by trained staff and although the level of training is acceptable not all people have a documented assessment that they are competent to undertake this task. The acting manager told us that these assessments had been done but we could not find this in the training files. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents would benefit from a more developed and varied occupation/social activity programme. Dietary provision is good but it is not supported by an adequate recording system. EVIDENCE: At the last inspection it was noted that the home did not provide a varied and interesting occupational and social activity programme to meet residents’ assessed care needs. This was acknowledged within the AQAA which recorded that the home’s plans for the future were ‘to have a better structured activity programme’. Within residents’ files we saw that residents had been consulted about their choice and preferences for corporate and personal activity. We acknowledged that there had been an entertainer recently but staff told us that in the main there was ‘nail painting, ball games and music’. Residents told us that they were ‘bored’ and ‘days seem long’. A relative told us that there was Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 14 little for residents to do unless they had motivation and ability to ‘read a book’, do puzzles or be lucky enough to be taken out by a relative’. The majority of residents were in the main lounge during the day. In the morning we noted that there was no music or radio on and this was the same in the afternoon. One resident said ‘many just sleep because there’s nothing to do’. We did not see any members of staff engage with residents on an occupational or social basis. Two residents told us about their personal interests and hobbies and we saw how the home had supported them in this. Residents had an ‘activity record’ in place. These records were not maintained very well and evidenced that the provision of this aspect of care needs to be developed. The service manager told us that two members of staff had been identified as having the potential to develop this aspect of care. The acting manager told us that nearly all the current residents have family or friends who come to see them on a regular basis. This was supported by the information and detail we saw in the visitor’s book. A relative told us that they were ‘always made to feel welcome and everybody was helpful’. We did not see a meal being prepared or served on this occasion, but residents told us that they enjoyed the food and there was a choice. Nobody had anything negative to say about the food. We found the records of what individual residents had eaten at each meal not adequate. There were regular gaps and the portion size of the meal eaten had not been completed. We were concerned about the way in which frozen food had been stored within one of the two freezers. We found unsecured packets of sausages, pastry cases, chipolatas, minted lamb steaklets, fish, peas, sweetcorn and brussel sprouts. The contents of these packets were exposed to the air within the freezer and had no date of opening. The outcome was that potentially there was a risk of contamination and residents could be affected. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that any concern would be managed appropriately and are protected by the home’s safeguarding adults from harm procedures. EVIDENCE: The home’s complaints procedure was clearly displayed in the hallway. The procedure was also within the Service User’s Guide which was in the bedrooms we saw. We asked residents about how they would feel if they needed to raise a concern about anything. The response was mixed but favourable. Some said that they would ask their respective relative to deal with the issue. Others said that they would speak directly with a member of staff. All intimated that they would be comfortable in raising an issue and were felt assured that the matter would be managed properly. Since the last inspection the home had recorded that they had received one complaint. We looked at the records and spoke with the service manager about it. The element of the complaint was about an aspect of poor communication between the home and a relative. The record told us how the service manager had competently managed the complaint investigation process and it was pleasing to note that it had been resolved to everyone’s satisfaction. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 16 We spoke with four members of staff about their understanding of the terms ‘safeguarding vulnerable adults’ and ‘whistle blowing’ in relation to their respective role and responsibility within the home. All had attended a training course. Three members of staff were competent and confident about their actions should they suspect an incident. The fourth member of staff did not express themselves in a competent way. The service manager assured us that the member of staff was aware of the correct procedures and the response was due to ‘nerves’. Because of the role and responsibility of this member of staff within the home, we asked the service manager to ensure that their respective competency levels were reassessed. We understood that further training on this subject had already been arranged. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in comfortable home but may be at some risk because fire doors were propped open and infection control procedures were not robust. EVIDENCE: Bedrooms viewed at random were clean and comfortable. There were items of personal belongings within them. The decoration, furniture and fitments within the bedrooms were of a good standard. The communal areas were bright, airy and comfortable. We noted that within the past year, a refurbishment and redecoration programme had been implemented. The outcome provided a much cleaner and fresher environment for residents. The storage facilities for wheelchairs and lifting hoists within the room remained inadequate. We saw Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 18 three wheelchairs stored in one of the main narrow corridors. Care must be taken that this arrangement does not pose an obstruction in the event of a fire. On the first floor bedroom doors, there were notices stating ‘fire door keep shut’. We saw five doors propped open with various items, one being a step stool. This practice placed residents at potential risk and should cease. Residents told us that their respective bedrooms were ‘nice’, ‘comfortable’ and ‘alright’. The lounge area was liked because ‘the glass doors let me see the garden and the birds’. Another resident told us ‘yes, the home always looks quite clean to me’ and ‘I’m comfortable here’. The rear garden area was very pleasant. The grass area had been well kept. There was also a patio area directly overlooking the lounge area. There were lots of brightly potted flowers and shrubs. This was a nice outlook for residents. One resident told us that they had enjoyed helping to make the areas so pleasant. At around 10am we noted that the kitchen was unkempt with dirty crockery in the sink, food left from the previous evening’s meal, two damp tea cloths were left by the sink and some unused food from the morning’s breakfast had been left on the side. The paper towel dispenser was empty. There were seven paper towels lying on the sink unit. The acting manager told us that the member of staff whose responsibility it was to clear and clean the kitchen was not on duty yet. In the outside utility room, we noted that a number of items such as flannels, tea towels and other material items had fallen down behind the tumble dryer. This posed a potential fire risk. There were various items of waste on the floor such as used paper towels. There was no waste disposal basket. The paper towel and the alcohol gel dispenser were both empty. There were eight paper towels on top of the water heater. We noted that two were wet. There was a bar of cracked ivory coloured soap on the windowsill. There were no plastic aprons or gloves in the immediate area. The laundry area is outside and staff have to transfer dirty laundry from the main building via communal areas to the utility area. We asked a senior member of staff about the policy which instructs staff on how to manage this task safely to minimise cross infection. There was a lack of competency in their response. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current residents are cared for by a team of staff who have been trained and recruited well. EVIDENCE: The home is registered to provide care for fifteen residents. On the day of the inspection, fourteen residents were accommodated. The outcome judgement for this section had been based on the staffing arrangements for fourteen residents. There was a clear staff rota in place. During the day, the rota recorded that there were three staff on duty during the day, except between the hours of 2pm – 4pm when numbers can go down to two staff on duty. During the night there was one ‘asleep’ member of staff and one ‘awake’ member of staff on duty. We noted that some staff work a 12 hour shift. One member of staff routinely works an 18 hour shift twice a week. We discussed this with the service manager. Staff on duty must be physically and mentally fit at all times to ensure that the provision of care is safe and their working arrangements do not pose any risk either to themselves or residents. We understood from the Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 20 service manager that this matter was being considered further. The home employed cooking and domestic staff. We have noted within this report that there was a lack of a structured occupational and social activity programme within the home. The service manager assured us that a programme was being developed and agreed that it would have staff resource implications. The acting manager stated that there were no staff vacancies. The service manager told us that since the last inspection, the core staff team had been relatively stable. However it was agreed that the more recent resignation of a senior member of staff had weakened the management structure within the home. We have developed this further in the management section of this report. We looked at the recruitment records of three members of staff who had started work in the home since the last inspection. The elements we looked at met regulatory requirements. We saw that staff induction, staff supervision and staff meeting records were in place. Staff confirmed these activities took place. The service manager showed us a detailed staff training matrix. Staff spoke to us about the various training courses they had attended. Staff were enthusiastic about their training and told us that the courses were very helpful. On the day of inspection, a trainer was in the home providing a day’s training programme on health and safety, risk assessment and moving and handling. It was encouraging to note that there was a ‘competency’ aspect to the training being provided. We spoke to residents about the staffing arrangements within the home. We received no negative comments apart from staff not having time to arrange or be involved with occupational or social activities. Residents told us ‘things are better now’…’they’re good to me’…’always have time’…’ I like x, she’s always smiling’. We received no negative comments from the relative we spoke with apart from staff not having sufficient time to ‘do activities’. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home where the day to day management is overseen by an external service manager. EVIDENCE: There had been no registered manager in post for approximately two years. The day to day management for approximately the past year had been overseen by an external consultant who now provided a service manager role to the home. The service manager told us that they visit the home two to three Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 22 times a week or when considered necessary by them and undertake the Regulation 26 report on behalf of the owner. We were told by the service manager that the deputy manager had unexpectedly left their employment in the home approximately four weeks before the inspection. The service manager explained that the deputy manager had been instrumental in monitoring practices and processes within the home. The service manager felt that the shortfalls noted at the inspection had been a direct result of this person leaving. The outcome was that the management structure of the home had been weakened. This they felt was evidenced in what we found during the inspection. There was a lack of daily management monitoring processes within the home. The current management monitoring tools required development and implementation for the wellbeing of residents. This was to ensure that practices and procures are monitored on a regular basis. Staff members in a senior position were not able to demonstrate competent management skills and ability, independent of the service manager’s direct input. For example there was inadequate management of some medicine practices, monitoring the food storage facilities, the upkeep of the kitchen area, the intake of food record, the infection control measures within the laundry area in particular were inadequate and fire doors were found to be propped open. Effective management would ensure that tools were in place to monitor practices. We discussed with the service manager how this could be developed better to ensure improved and safe practice within the home. We acknowledged the impact that the unexpected resignation of the deputy manger and the roles and responsibilities undertaken by that person had on the home at that current time. However, the owner has overall responsibility for the effective, efficient and competent management of the home at all times. This is for the wellbeing of residents. The owner told us that they visit the home on a regular basis. The service manager managed the Regulation 26 report on behalf of the owner. The regulation 26 visit and report is carried out by an owner or their representative on a monthly basis. The process requires the person to provide an overview of a registered provision and reports on the day to day management demonstrating compliance with statutory requirements. If non compliance is noted, it is the responsibility of the registered owner to address it. We saw the system in place whereby there was a contract between the service manager and the owner about the reports. It was clear that the owner saw each report and took responsibility for the outcomes. We saw that the quality assurance system had been developed since the last inspection. There were questionnaires in place on residents’ files. The service manager told us that questionnaires would be sent to all stakeholders in October 2009 and an Annual Development Plan would be in place shortly after. At the inspection six months ago we viewed a random selection of Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 23 maintenance and safety certificates. We also viewed the residents’ personal monies audit trail which is managed by the home. At that time we sampled the general environmental and safe working risk assessments together with the home’s updated polices and procedures. We were satisfied at that inspection that they were in place and did not view them again at this inspection. Since the last inspection the service manager had been in contact with us when the occasion had required this to happen. Silversea Lodge Care Home DS0000068495.V377289.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/A 18 3 2 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X X 2 Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No. Some requirements are the same but with different aspects identified as a shortfall. 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, Schedule 3 (2) Requirement Each resident must have a current plan of care in place which identifies every area of assessed care need, how the need is going to be met, who is going to meet the need and when. This plan of care must also contain adequate risk assessments. They must be kept under review at all times. This is to ensure that residents’ current care needs are known to staff and specifically relates to those care plans seen where care plans or risk assessments had not been adequately recorded or been updated. Timescale for action 03/10/09 2 OP9 13(2) Medicines must be stored under suitable environmental conditions and records kept to show this. This will ensure people receive medicines of suitable quality. 30/09/09 Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 26 3 OP9 13(2) People must only be given medication in line with the prescriber’s instructions. This will protect people from harm and ensure medication is given as intended. 30/09/09 4 OP9 13(2) There must be accurate records of the receipt, administration, and disposal of medicines. This will ensure all medicines are accounted for and demonstrate that people receive their medicines as prescribed. 30/09/09 5 OP9 12(1) 13(2) There must be sufficient supplies of medication for the continued treatment of people. This will protect people from harm. 30/09/09 6 OP9 13(2) Medication must only be used for the treatment of the person it is prescribed for. This will ensure appropriate use of medicines and protect people from harm. 30/09/09 7 OP12 16 (2)(m) Having consulted residents about their choice and preference for an occupational and social activity, staff resources and provision must be made for a programme to be put in place. This is to ensure that all residents are provided with a meaningful and appropriate occupational and social activity provision. 31/12/09 8 OP15 16(2)(i) The home must maintain a record 03/10/09 of what food residents have eaten DS0000068495.V377289.R01.S.doc Version 5.2 Page 27 Silversea Lodge Care Home and in what quantity. This is to ensure that there is a robust recording system in place to monitor residents’ wellbeing and to provide factual information should there be any query about food provision. 9 OP19 23(4) The home must consult with the Fire and Rescue Service about current practice as designated fire doors must not be propped open. In the event of a fire, residents would not be protected. 10 OP31 10(1) In the absence of a registered manager, arrangements must be made for the person(s) designated as being responsible for the day to day management of the home to be suitably qualified, competent and experienced. This is to ensure that the home is able to meet its stated Statement of Purpose and be managed in accordance with its policies and procedures. Residents must benefit from leadership who have sufficient skills and is able to support staff in meeting the service’s Statement of Purpose, protect residents’ wellbeing and understand how the service will achieve compliance with the Care Homes Regulations 2001. At the time of the inspection, the home was managed on a day-today basis by an external consultant. This requirement is in place to ensure that in the event Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 28 03/09/09 03/10/09 11 OP32 10(1) 03/10/09 of the consultant’s services being withdrawn, adequate arrangements are put in place by the provider for a suitably qualified and experienced person to be in charge of the day-to-day management of the home. 12 OP38 16(2)(j) Having consulted with the environmental health agency, arrangements must be made for adequate infection control measures to be put in place. This is to ensure that residents and staff are protected. 03/10/09 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 OP9 OP18 Good Practice Recommendations There should be a contemporaneous record kept of all medicines waiting to be disposed of. All staff should be able to demonstrate knowledge and competence upon request with regard to safeguarding vulnerable adults from harm procedures. Silversea Lodge Care Home DS0000068495.V377289.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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