Care Home: Warren Residential Lodge

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well The home provides a welcoming homely environment. The home provides a clean homely environment for the people who use the service. Feedback from residents, relatives, staff and visiting health professionals were in general very positive regarding the care provided by the home. Comments included the following: Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 • • • • • • • • • • •‘My mum seems very happy living here and is happy with the food’. ‘The staff keep me warm, fed and secure’. ‘The home provides good accommodation, good meals, friendly staff and a high standard of hygiene’. ‘The staff have good rapport with other health professionals’. ‘Good communication, very approachable caring staff. Always very helpful and assist we district nurses’ ‘Excellent rest home with fantastic atmosphere and excellent care’. ‘The staff are friendly and kind to the residents’. ‘I wish we had more activities to do or go out somewhere’. ‘I wish there were more activities for my friend who is mentally very alert’. ‘Staff are always friendly and jolly. They take time to have a laugh and listen and they ask about your family and keep the place a nice place to want to be’. ‘I am happy and contented at the Warren and do not want to move from here. I read about other homes who are treating the elderly badly and I am glad my daughter found this home for me. I feel safe and happy and have regular visitors’. comments were: ‘The service cares well for all residents’. ‘We create a home from home and a relaxed atmosphere’. ‘The manager needs to be more open to suggestions and others opinions and better communication’. ‘The home finds out about individuals likes and their previous problems’. ‘This is a friendly and relaxed home and excellent care is given to the residents. Training has improved and there is a better induction programme for new staff’. ‘Menus need revising’. ‘The home is friendly and homely and we communicate with families well. Training for staff is very good’. It is a pleasant and friendly environment to work in’. We respect clients’ wishes and listen to them and treat them with dignity and respect’. The care and support given to residents and their families is of a high standard. The atmosphere of the home is very good and homely and always welcoming to visitors and all needs are attended to’. ‘In most aspects the care in the home is exceptional and needs are listened to. I have worked at the home for many years and I thoroughly enjoy it’. ‘The home cares for the residents needs as individuals and the home provides good training’. ‘We always put the residents first. Good home to work in as they also care about staff and give lots of support to families’. ‘A very friendly happy home and we are one big family’.Staff • • • • • • • • • • • • • •All service users’ needs are assessed by the manager before they move into the home, to ensure their needs can be met. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 7Records show that the home liaises with health care professionals regarding residents medical and health needs. Residents and their relatives are provided with a copy of the complaints procedure and are aware of what to do if they have a complaint. The home’s routines were flexible and it promotes the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. Residents said they were pleased with the range of activities provided but the manager would like to provide a more extended activities programme in the future. Residents were positive about the food that the home provides. Staff were recruited properly ensuring that residents’ safety and welfare was given proper consideration. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents’ needs. What has improved since the last inspection? The care plans are now more structured and written in a more person centred way and describe how to meet the service users’ health care needs. The home’s medication system is now supplied by a new pharmacy who delivers the medication in the monitored dosage system and each pack has a photograph of the service user. The new system appears more efficient with the ordering and there was no evidence of over stocking of medications in the cupboards. The activities programme has been developed more and is advertised on the notice board but is not always adhered to. All new staff undertake an induction programme that is based on the Skills for Care Induction programme. All staff have a local induction initially at which time they undertake health and safety training and become familiar with the environment. The recruitment of new staff is more robust and the manager takes up CRB and POVA checks and requires two written references before the employee commences their employment. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 The manager is nearing completion of the Leadership and Management Award. The manager is endeavouring to undertake the quality assurance audits on systems and records. Questionnaires have been sent to service users and families but have not been analysed or any outcomes published. A staff supervision programme is in progress. Mandatory training in health and safety related matters is now undertaken by all staff and all new staff undertake this as part of their local induction. What the care home could do better: The home could extend the activities programme to ensure all service users’ preferences are taken into account. If staff have to transcribe medications onto a MAR sheet or alter a prescription, this should be done clearly and countersigned by a second person as evidence that the transcription is correct. The staff must cease from using erasing fluids on records and MAR sheets. The outside pathways leading to the front door are in need of repair and should be made even as they present a health and safety risk to service users who are mobile and visitors using this path. The shower room is in need of refurbishment. The shower chair is rusty and not clean and the shower unit is old and out of date. The manager should commence the registration process, as the home has been without a manager for some considerable time. Key inspection report CARE HOMES FOR OLDER PEOPLE Warren Residential Lodge Cherque Lane Lee-on-the-Solent Hampshire PO13 9PF Lead Inspector Jan Everitt Key Unannounced Inspection 25th August 2009 09:00 DS0000011771.V377237.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. Warren Residential Lodge DS0000011771.V377237.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 Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warren Residential Lodge Address Cherque Lane Lee-on-the-Solent Hampshire PO13 9PF 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) 023 9255 2810 Mr Allan Walsh Manager post vacant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 31. Date of last inspection 26th August 2008 Brief Description of the Service: The Warren Residential Lodge is a care home registered to accommodate thirty-one service users within the category of OP [Old Age] only. Warren Residential Lodge is a purpose built single-storey care home with all single room accommodation and is situated in a quiet area of Lee-on-Solent. It is surrounded by large well-established gardens, which are accessible to all of the residents, some who participate in the maintenance and growing of vegetables. The atmosphere in the home is friendly and homely. The home is a short drive from the coastline and the local amenities. The home is owned by a single provider and is run with family support. Fees and costs are available from the home. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The site inspection visit to Warren Lodge which was unannounced, took place over a one-day period on the 25th August 2009. The manager, deputy manager and senior carer were on duty and assisted us throughout the day. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) to the CQC. The content provided limited evidence of how well the service is performing and achieving outcomes for the people using your service. The focus of this visit to the home was to support the information stated in the AQAA and other information received by the CQC since the last fieldwork visit, which was a random visit on 23rd March 2009. This visit was to check on compliance with the improvement plan that CQC had requested following a site visit on 26th August 2008 when a number of requirements were made. The process for this visit included a tour of the premises, discussions with the manager, deputy manager and a senior carer. Staff on duty were spoken with and most of the residents were spoken to during the visit. CQC survey forms were distributed for comments prior to the visit. 10 of 20 service users, 1of 3 relative, 2 of 4 visiting health professionals and 14 of 20 staff returned surveys to the CQC. Generally the comments were very positive. Three visitors were also spoken to in private. Staff were observed interacting with the residents well. Twenty six people were in residence at the time of this visit. Polices and procedures were examined. Records, including residents care plans were also looked at as part of the inspection. What the service does well: The home provides a welcoming homely environment. The home provides a clean homely environment for the people who use the service. Feedback from residents, relatives, staff and visiting health professionals were in general very positive regarding the care provided by the home. Comments included the following: Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 6 • • • • • • • • • • • ‘My mum seems very happy living here and is happy with the food’. ‘The staff keep me warm, fed and secure’. ‘The home provides good accommodation, good meals, friendly staff and a high standard of hygiene’. ‘The staff have good rapport with other health professionals’. ‘Good communication, very approachable caring staff. Always very helpful and assist we district nurses’ ‘Excellent rest home with fantastic atmosphere and excellent care’. ‘The staff are friendly and kind to the residents’. ‘I wish we had more activities to do or go out somewhere’. ‘I wish there were more activities for my friend who is mentally very alert’. ‘Staff are always friendly and jolly. They take time to have a laugh and listen and they ask about your family and keep the place a nice place to want to be’. ‘I am happy and contented at the Warren and do not want to move from here. I read about other homes who are treating the elderly badly and I am glad my daughter found this home for me. I feel safe and happy and have regular visitors’. comments were: ‘The service cares well for all residents’. ‘We create a home from home and a relaxed atmosphere’. ‘The manager needs to be more open to suggestions and others opinions and better communication’. ‘The home finds out about individuals likes and their previous problems’. ‘This is a friendly and relaxed home and excellent care is given to the residents. Training has improved and there is a better induction programme for new staff’. ‘Menus need revising’. ‘The home is friendly and homely and we communicate with families well. Training for staff is very good’. It is a pleasant and friendly environment to work in’. We respect clients’ wishes and listen to them and treat them with dignity and respect’. The care and support given to residents and their families is of a high standard. The atmosphere of the home is very good and homely and always welcoming to visitors and all needs are attended to’. ‘In most aspects the care in the home is exceptional and needs are listened to. I have worked at the home for many years and I thoroughly enjoy it’. ‘The home cares for the residents needs as individuals and the home provides good training’. ‘We always put the residents first. Good home to work in as they also care about staff and give lots of support to families’. ‘A very friendly happy home and we are one big family’. Staff • • • • • • • • • • • • • • All service users’ needs are assessed by the manager before they move into the home, to ensure their needs can be met. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 7 Records show that the home liaises with health care professionals regarding residents medical and health needs. Residents and their relatives are provided with a copy of the complaints procedure and are aware of what to do if they have a complaint. The home’s routines were flexible and it promotes the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. Residents said they were pleased with the range of activities provided but the manager would like to provide a more extended activities programme in the future. Residents were positive about the food that the home provides. Staff were recruited properly ensuring that residents’ safety and welfare was given proper consideration. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents’ needs. What has improved since the last inspection? The care plans are now more structured and written in a more person centred way and describe how to meet the service users’ health care needs. The home’s medication system is now supplied by a new pharmacy who delivers the medication in the monitored dosage system and each pack has a photograph of the service user. The new system appears more efficient with the ordering and there was no evidence of over stocking of medications in the cupboards. The activities programme has been developed more and is advertised on the notice board but is not always adhered to. All new staff undertake an induction programme that is based on the Skills for Care Induction programme. All staff have a local induction initially at which time they undertake health and safety training and become familiar with the environment. The recruitment of new staff is more robust and the manager takes up CRB and POVA checks and requires two written references before the employee commences their employment. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 8 The manager is nearing completion of the Leadership and Management Award. The manager is endeavouring to undertake the quality assurance audits on systems and records. Questionnaires have been sent to service users and families but have not been analysed or any outcomes published. A staff supervision programme is in progress. Mandatory training in health and safety related matters is now undertaken by all staff and all new staff undertake this as part of their local induction. 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. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 9 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 Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 10 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): Standard 3 - Standard 6 is not applicable to this 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. Service users are assessed prior to them moving into the home to ensure the home can meet their needs. EVIDENCE: A sample of three service user’s pre-admission assessments was viewed, one of which had been admitted five days previous to this visit. Two of the assessments seen, covered all aspects of the person’s health care, their level of function with their daily activities of living, emotional needs, religious needs and some information about their previous social history. The service user, who had been admitted recently had not been visited in their previous care home as the distance prohibited this. The care manager had sent a Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 11 comprehensive care needs assessment to the home and discussed the case with the manager and an assessment undertaken when they moved into the home. The manager told us that she or the deputy manager assesses people who have been referred to the service before a decision is made if the home can meet their needs. When assessing in the clinical area the manager reports she is able to obtain thorough information from hospital records, who allow her to look at the medical history. This information could identify if the person were not appropriate and out of category for the admission criteria of the home. The manager said that in most cases families are involved with the assessment and contribute to the decision making about whether the home would be appropriate for their relative. One file evidenced a detailed needs assessment that had been received from the care manager when the service user was admitted to the home. One relative spoken to at the time of this visit said she had visited the home and obtained information about the home before a decision was made for her mother to move in. Ten service user comment surveys were received by CQC and all indicated that they had received sufficient information about the service before making a decision to move into the home. The criteria for admission to the home was discussed with the manager, as the home had recently applied to CQC to be able to admit people with a dementia. After consideration the manager withdraw this application and the home will continue to admit and care for people who need support and care through frailty of old age only. Intermediate care is not provided in this service, although the service does provide for short respite care. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9, & 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. Service users health, personal and social care needs are set out in individual plans. Service users are treated with respect and their privacy is upheld. EVIDENCE: A random inspection took place in March 2009 to monitor compliance with the improvement plan that the home had sent to CQC following the inspection of August 2008. A sample of care plans was viewed and evidenced that the home had made big improvements with the care planning system The returned AQAA stated that in the last 12 months the care planning is more person centred and it identified that the home could do better to produce more risk assessments for clients. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 13 A sample of three service users’ care plans was viewed. One person had only been admitted five days earlier so there was an initial assessment and general information about this lady but the home was still in the process of undertaking a full assessment and formulating care plans. The care plans viewed demonstrated that risk assessments are undertaken and care plans are written to manage any level of risk. The care plans contain a score matrix assessment and a dependency assessment completed for each person. There was evidence of moving and handling risk assessment in the care plans with a plan of how to manage any risk. Weights are monitored monthly for all service users and residents are referred to the GP if they are loosing weight. The manager is about to undertake a nutritional risk assessment on all service users as she has researched the various tools to use. There were risk assessments for falls, tissue viability, dependency, and mini mental score. These risk assessments were being reviewed three monthly. The daily records were documented but will little detail about how the service user had spent their day. It was observed that the manager had left a note for staff to remind them to put more detail into the daily notes. There was evidence in the care plans viewed, that service users had signed care plans and had participated in their content. There was a social history recorded that gave some information about the service users past life and social history. The daily routines section of the care plans show clearly that the home recognises and caters for each person’s specific daily preferences for routines and are divided into morning, afternoon and evening and clearly records how each routine preference such as getting up, breakfast, time of going to bed, is undertaken. The service users spoken with say that these preferences and wishes are respected and they may do as they wish throughout their daily lives. There was evidence of residents’ care plans being reviewed on a regular basis. Daily notes were also viewed. For most service users the daily notes did not record detailed information about how the resident had spent the day. This was discussed with the manager who told us she is working with staff to improve the standard of daily records. An audit trail was tracked through daily records, monitoring charts and care plans for a service user who had health care needs. The care plans now detail how this person’s medical needs were being monitored and managed. Care plans seen evidenced that records of health professionals visits, information Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 14 from the health professionals on how to monitor the medical condition and monitoring charts, were being maintained. The manager told us that service users can choose which GP they wish to see and all service users are registered with two local surgeries. The district nurse visits the home to attend to any nursing needs and she was attending the home to dress one service user’s legs and this was all recorded in the care plans. The community psychiatric nurse will call at the home if the GP requests they visit a resident. The community matron now visits the home to generally oversee the nursing needs of the home and will contact appropriate professionals for advice or for them to visit the home. Records are kept of all falls sustained by residents. If a service user has frequent falls these are recorded and a risk assessment is undertaken. The service user is then referred to the falls clinic nurse for advice. Records also show that the home liaises with health care professionals for dental care. Some of the service users go with relatives to private dentists in the community or others have the opportunity to go to the local health centre for consultation with the PCT community dentist, but they pay for this service if they are not exempt. Records demonstrate that health care needs are being met. The policies and procedures around management of medication were viewed. The method of obtaining medication was discussed. The home has recently changed suppliers again and the home sends their repeat prescriptions to the pharmacist who orders the required medication from the doctor and this is delivered to the home in a monitored dosage system (MDS) directly from the pharmacy. The deputy manager continues to co-ordinate the ordering, receiving, checking and returns of medication. She spoke to us and told us that this system is working well for this home and although she does not check the prescription before it is dispensed, they are not taking delivery of any medication that is not required. She told us that when the medication is received from the pharmacy she checks it all in against the medication administration records (MAR) sheets to ensure all medications are correct and it is what they have ordered. We observed that the medication round was undertaken by two carers to ensure safety and the person dispensing the drugs signed the MAR sheets. Only staff that have had medication training administer medication. The MAR sheets were viewed. These evidenced that they were being recorded each time medication was administered and reasons were documented on the Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 15 back if the medication was not taken. The deputy manager has introduced an auditing system for checking MAR sheets. On the front of the MAR sheets folder is a sheet of paper recording signatures of the two people who have undertaken each medication round and this is signed to say they have recorded and checked that all MAR sheets have been appropriately recorded. We did observed that on some MAR sheets the prescription had been altered by the senior staff in the home, as instructed by the doctor and for the most recently admitted person the MAR sheet had been hand written by the senior carer. These transcriptions had been signed by one person but had not been signed by a second person as evidence of them being checked and correct. This practice was identified in the report of last year. It was also observed that the senior carer was using correction fluid to make an alteration on a MAR sheet. This practice must cease and that any alterations to MAR sheets or care plans should be done by crossing through and re-writing correct information. The storage of medication was in order and cupboards and medication trolley were clean and well organised. There was no evidence of over stocking of the medication that is only taken on an ‘as required’ (PRN) basis. The home has a small drugs fridge and daily temperatures were being recorded. There were no residents choosing to self-medicate at the time of this visit. The AQAA says the home gives the service users choice, independence and promotes their dignity and privacy. Each resident has his or her own bedroom and their privacy is respected. Most like their bedroom doors left open during the day and this is respected. The proprietor has had automatic closures put on all doors that release if the fire alarm sounds. Observation throughout the day evidenced that staff had good relationships with service users and were very familiar with their needs and were giving them choices and respecting these. The home has a key worker system and each carer is responsible for a small number of residents, which is conducive to good working relationships and getting to know the residents well. Staff were observed to knock on doors before entering and referring to residents in a respectful manner. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 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. Service users’ preferred routines for their daily activities of living are recorded in their care plans. Recreational activities are available but do not take place on a regular basis to suit service users’ preferences and capacities. Visitors are made welcome and people receive a choice of fresh, home cooked meals. EVIDENCE: The random inspection report of March 2009 said that the home was providing wider activities programme for the service users and social histories and past recreational past times were being recorded for those residents willing share this information. An activities’ programme was seen to be displayed on the wall in the reception area. The AQAA told us that in the past year the home has recorded more information about the residents’ personal and social history. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 17 A sample of records was viewed. Service users’ social histories and past recreational preferences are recorded when the resident is initially assessed. This information is built on and may take some time to capture as relatives have to supply information if the memory of some residents is impaired, or they are reluctant to talk about their pasts. The home does endeavour to provide service users with activities that are appropriate to their past recreational hobbies and to suite their wishes. The manager told us this can be difficult. She had arranged an outing for ten residents who had expressed a wish to go out. On the day of the outing none of residents wanted to go and she had to cancel the transport. There is a programme of activities displayed in the reception area but these are not rigidly kept to. The home has no designated activities organiser and this role is undertaken willingly by the cares on duty each afternoon and service users are able to choose on the day what they wish to do. On the day of this visit there was no group work taking place and three residents were sitting in the lounge area chatting or sleeping. The home does have visiting entertainers and musicians regularly and a person who attends the home to do musical exercise with residents if they wish to join in. Another visitor attends to do cross words, quizzes and bingo which are a firm favourite. On the day of this visit a friend was visiting a resident and having a game of scrabble with her. She told us that she does the cross word every day and loves a game of scrabble with her friend. The senior carer told us that residents enjoy the pamper days that take place. Staff will manicure and paint residents’ nails, give skin care and hand massage, during which residents enjoy a glass of wine or sherry. The manager showed us a file with records of when and what activities have taken place and who has attended and the residents’ level of participation. These records demonstrated that activities are not structured and do not take place regularly, apart from the visiting entertainers who come on a regular basis. Residents spoken to at the time of this visit and information from surveys received by CQC told us that some residents wish there was more to do and one said ‘the days are sometimes so boring I wish they would put things on for us’. Another resident told us that they preferred to stay in their room and they were quite happy with that. The other surveys indicated that the home ‘always’ or ‘usually’ arrange activities that the residents can take part in. Other surveys made positive remarks like: ‘Staff are always friendly and jolly and take time to have a laugh and listen. They ask about my family and the photos I have and keep the place a lovely place to want to be’. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 18 Visitors are welcome to the home at any time and this was evidenced in the visitor’s book kept in reception. On the day of this visit there were several relatives and friends visiting residents, one bringing her dog, which delighted some of the other residents. They told us that they are made welcome at any time. Some residents are taken out by relatives for outings but in general the home has not been successful in providing outings into the community owing to the reluctance of some of the residents, once it is arranged. Service users told us they are able to do as they wish each day. The daily routines section of the care plans show that the home recognises and caters for each person’s specific daily preferences for routines such as getting up and breakfast and times of going to bed. The staff were over heard to be giving service users choices of what they wished to do or where they wished to be. Two service users smoke and there is a room designated for this. The only restriction is that they do not use it near meal times as the room is next to the dining area. One of the service users told us that she does not use the room much as she much prefers to sit in the garden to have a cigarette. It was observed that service users bedrooms have been personalised with their own pieces of furniture and an inventory is recorded in the care plans of what furniture and valuables the residents choose to bring into the home. The manager told us that one family had redecorated and furnished their mother’s bedroom to how she wanted it to be and the resident told us she enjoyed living in the home. The home’s menu plan is displayed in the dining room and shows a varied, nutritious and balanced diet. Residents are informed of the lunchtime meal in advance and are able to choose alternatives. When residents were asked what they were having for lunch, few had any idea what was on the menu. All residents’ food preferences are documented and records of this are kept in the kitchen. The lunchtime meal was a stew and vegetables and fruit flan and fresh cream for dessert. No one was choosing to take an alternative diet on this day. The meal was observed and was seen to be well presented and looked nutritious and wholesome and residents appeared to be enjoying the meal. Residents commented that they like the food provided by the home, one resident telling us that the food was ‘very good’. We observed that there was one resident taking a pureed diet. The meal had been pureed all together. This was discussed with the manager who reported that this resident preferred their meals like this and had requested it be mixed Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 19 all together when served and not in separate portions. This was recorded in the care plans. The resident was observed to eat all of her meal independently. On the day of this visit the regular cook was on annual leave and the cooking was being undertaken by one of the carers who had been rostered that day for cooking duties only and who told us she enjoys doing the cooking on occasions. The training matrix evidenced that most staff have undertaken the Food Handling and Hygiene course. Nutritional assessments are not undertaken routinely but weights are monitored monthly. The manager is in the process of introducing a nutritional assessment tool and is gradually risk assessing all residents for their nutritional status. Several residents have been assessed and have now been prescribed nutritional supplements by the GP. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 20 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 & 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 and their relatives are aware of the home’s complaints procedure. Residents are protected from possible abuse. EVIDENCE: The complaints policy is stated in the Statement of Purpose and a copy displayed on the wall. The manager told us that the home has not received any complaints in the past year. She said that if any complaints were received they would be recorded in the complaints log and any action or outcome from them would be recorded. The manager told us that the residents have the opportunity to discuss any issues at the residents’ meetings and she is confident that they would talk to her or staff if they had any issues. The service user surveys received by CQC and a survey from a relative confirmed that people would know how to make a complaint and the procedure to do so. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 21 The home has its own adult protection procedure for staff to follow should there be any suspected abuse of a resident in the home as well as a copy of the Department of Health booklet, ‘No Secrets.’ There have been no safeguarding investigations in the home in the past year. The AQAA stated that the home over the past year the staff induction programme has improved and includes on complaints and safeguarding vulnerable adults and that the home will continue to give regular training updates. The training matrix evidenced that all staff have received protection of vulnerable adults (POVA) training. This is done via a distance learning course involving a DVD and questionnaire. Staff spoken with and from the surveys received from staff, indicate that staff are aware of what to do if any person raised concerns about the home. The manager and deputy manager have recently attended training about the Deprivation of Liberty Safeguards (DOLS) and the Mental Capacity Act. (MCA) Booklets on these subjects have been distributed to staff to give them awareness and staff training has been booked for October 09. A sample of three staff personnel files was viewed. Criminal Bureau Records (CRB) checks along with Protection of Vulnerable Adults (POVA) checks had been received before employment had commenced. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 22 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 & 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. The home provides a clean homely environment for service users but some areas inside and out outside of the home are in need of updating and repair. EVIDENCE: The AQAA stated that the home is well maintained and is clean and hygienic. It lists the improvements made to the environment over the past twelve months and the improvements the home hopes to undertake over the coming year. We looked around the communal areas and a number of bedrooms were visited, whilst talking to residents. All rooms are single with six having en-suite Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 23 facilities. In general residents are very happy with their rooms and their environment. A number of service users have been able to bring with them their own furniture and chairs to personalise their rooms. The manager told us that there is no written or planned programme of repair and refurbishment for the home. Repairs and renewal are done on an ‘as needed’ basis. The manager told us that as a resident’s room is vacated it is decorated and a new carpet it purchased. The bedrooms were, in general, pleasantly decorated and clean. Two new boilers have been installed in recent months and solar heating panels which are proving to be able to supply sufficient hot water through the summer months. Areas of garden surround the home. The maintenance person cuts the grass areas but it was noted that the flowerbeds were not well kept, although more effort has been made with planting flowers and creating seating areas in the back garden. It was observed that the outside driveway and path to the front door was very uneven and could present a risk to service users who were using a mobility aid or who were independently mobile. The provider should make good uneven areas. Two of the bathrooms are rather dark and are in need of updating. The existing shower room is used frequently but the shower and shower chair are in a poor state of repair and need to be refurbished. This was discussed with the manager who agreed that she would request this from the provider as a priority. A comment from a service user said that the shower was in a poor state of repair and it did need replacing. A comments received on the survey returned to CQC said ‘Some areas would benefit from redecoration and refurbishment’ Comments from service users spoken to and observations identified that the home is kept clean and tidy. Comments on surveys returned to CQC said. ‘Rooms are cleaned every day and are very fresh’. ‘Always clean and homely’. We observed that the decoration in general was pleasant but the corridor at the end of the building was very dark and dingy. The manager told us that there are imminent plans to redecorate this area and the smaller lounge in this area in lighter colours. The home has an infection control policy in place. The training matrix on display identified that staff have or are in the process of undertaking infection control training via distance learning and work through three books which are verified by an assessor who visits the home. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 24 It was observed that soap dispensers and paper towels were available for use. Aprons and gloves were also available for staff to use. The laundry area was visited and observed to have appropriate washing machines with sluicing facilities and hand washing facilities within the room. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 25 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 & 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. Service users are cared for by a staff group who have received training and are in sufficient numbers to meet people’s needs. Service users are protected by the recruitment practices of the home EVIDENCE: The staff rotas were viewed. These evidenced that there were generally four care staff, the deputy manager and manager on duty in the mornings. On the day of this visit there were four care staff, the manager, deputy manager and senior carer in the home until the afternoon. The afternoons were documented as three staff with the manager and deputy in the home until the late afternoon. Two care staff are awake throughout the night. Separate cleaning staff and kitchen staff are employed and attend the home seven days a week. The manager told us that agency staff do not attend the home very often. From observation of the day and walking around the home there was evidence that sufficient staff were on duty to meet the service user’s needs that day. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 26 Comments received on surveys returned said that ‘Very approachable staff who are caring, always very helpful. Excellent home with good atmosphere and excellent care’. Another comment said ‘The staff have a good rapport with health care professionals’. The training matrix was displayed on the office wall and demonstrated that staff have attended the mandatory training and various training course that relate to the service users they care for. The AQAA states that the manager would like to increase the training programme. The manager and her deputy have gained the certificate in dementia care via distance learning and most staff have attended the day course dementia care. Staff told us in the surveys returned to CQC that they always get the support and training to meet the different needs of the service users. One commenting ‘the staff training is very good’. Another saying that ‘the home cares about the staff and provides good training’. This was confirmed by those staff spoken to at the time of this visit. The AQAA stated that the induction programme has improved over the last twelve months and that the home will endeavour to encourage staff to meet deadline dates for completion of the elements of the induction programme and for this to be monitored through regular supervision. The manager told us that the home has introduced a new induction programme supplied by Hants County Council PACT training which is based on the Skills for Care Induction standards. Evidence of the work books were not available to us as the staff either had them with them or the deputy manager, who coordinates the induction programmes, had the work books with her. The AQAA states that the home has good recruitment practices and provides adequate staffing levels to meet the needs of the service users. A sample of three staff personnel files was viewed. These evidenced that that all the appropriate checks from the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) had been sought and received before the person commenced employment and included two references, one being from their previous employer. Supervision records were also seen in personnel files. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 27 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 & 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. The manager of the home is not registered... The manager is developing a quality assurance system to ensure the home is run in the best interests of the service users. Staff are now being supervised at regular intervals by appropriately trained senior staff. The health and safety of service users and staff are now promoted and training is provided Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 28 EVIDENCE: The random inspection of 23/03/2009 said the provider had written to us to inform us that the manager would be applying for the registered manager’s post once she had completed her leadership course (RMA). It was anticipated this would be completed by the end of May 2009, at which time she would apply for registration with CQC. Although the manager has made improvements in the home over the last year with the introduction of the new care planning system and medication systems she has not yet completed the Leadership and Management Award and has not applied to CQC for registration. This was discussed with the manager who said she was in the process of obtaining the Criminal Record Bureau check before applying to CQC. The home has been without a registered manager since December 2006 and this will reflect in the overall rating for the home. The manager has distributed questionnaires to service users and their relatives. The returned questionnaires have not been analysed or reported on although she told us that any suggestions or comments made on the questionnaires have been discussed and action taken over any issues highlighted. The care plans are audited three monthly and the medication system is audited every 28 days. There was records of medication recording errors that had been identified during the auditing and also records of the care plan audit results to identify when care plans needed reviewing or if they had not been documented appropriately. The manager or senior member of staff check the general cleanliness and condition of the environment on a daily basis and told us that repairs are undertaken as and when identified. There are areas of the home that need to be refurbished and the outside pathways are uneven and present a hazard to service user and visitors. It is the responsibility of the manager to ensure risk assessments are undertaken and appropriate remedial steps are taken to make the environment safe. The accident book records all accidents in the home and the manager analyses these monthly to identify emerging themes. The manager holds a residents’ meeting every three months, at which time specific topics are discussed re the decorations of the home, activities and menus. The manager told us that she has tried to hold relatives meetings but they have not been well attended. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 29 The home does handle service user’s monies. A sample of three service user’s monies was checked. All records balanced with the monies present. Money and records are maintained in separate containers and receipts kept for monies spent and these were seen. At the random inspection of March 2009 the manager told us that she, her deputy and senior carer have now undertaken the performance management training and have found it very beneficial and informative. They have subsequently devised a programme between them to ensure all staff are appraised yearly, at which time training needs can be identified, and this together with six supervisions during the year, will fully support all staff members. We saw records of staff supervision and appraisal in the records that are maintained by the manager. Nine of the fourteen staff surveys returned to CQC told us that they ‘regularly’ meet with their manager to discuss how they are working with the remaining five surveys saying that they ‘sometimes’ meet with the manager. The home has health and safety policies and procedures in place. The fire risk assessment was seen and reported on by an outside fire consultant. The accident book was viewed and was being recorded in the correct format in line with the Data Protection Act and the manager was keeping copies of these for her own information and analysis. As part of the case tracking, records of falls or accidents were recorded in the resident’s daily notes. Information on guidance for storage and handling of the cleaning chemicals hazardous to health (COSHH materials) is kept in a folder and all cleaning materials were observed to be maintained safely in a locked environment. A sample of servicing certificates was viewed, all of which were found to be current. We discussed with the manager the lack of organisation of these certificates as the file had no index and contained old certificates that made it difficult to identify the current issues and gain evidence. The Environmental Health Officer (EHO) had visited the home in August 2009 and no recommendations were made. The random report of March 2009 said that the training matrix evidenced that all mandatory training has now taken place and the dates for the updates are also documented on the matrix. The manager told us that she is taking advantage of the training being offered by government training schemes. The matrix on the wall identified that staff have undertaken their mandatory health and safety training. All new starters come into the home for the local induction which includes fire training, moving and handling, meeting the Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 30 service users, policies and procedures and this is undertaken before they commence practice. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 31 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 3 8 3 9 2 10 3 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 2 X X X X X X 3 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 X 2 X 3 3 X 2 Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 Requirement The responsible person is required to ensure complete and accurate records of all prescribed medications are maintained and records are not altered with correction fluid. Timescale for action 10/10/09 2. OP19 13 Medication records that are transcribed onto MAR charts must be signed by two people to ensure correct information is recorded. The responsible person should 31/12/09 ensure that the surface of the outside paths leading to the front door be made even to ensure the safety of service users and visitors Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 33 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 OP19 Good Practice Recommendations The responsible person should make arrangements to repair and renew the shower unit, shower cubicle and replace the rusted chair in the shower room. Warren Residential Lodge DS0000011771.V377237.R01.S.doc Version 5.2 Page 34 Care Quality Commission South 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. 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