Care Home: Washington Lodge Nursing Home

What the care home does well The home continues to meet the remaining National Minimum Standards. What the care home could do better: If all of the care plans had sufficient detail and all parts of the plan were completed, staff would know that the information in them was up to date and correct. This would mean that they would be sure they were providing the people at the home with the support and care they need. Robust recruitment procedures and records would show that all of the staff have been properly vetted and this would demonstrate that the organisation have made sure that they only employ suitable people to work at the home and therefore safeguard the people who use the service. If some repairs and refurbishment were carried out this would make the home more pleasant and safe for the people who live there. Medication storage, if it was in line with good practice guidelines would show that the organisation take the welfare of the residents seriously. Readily available hand washing facilities in the laundry room would reduce the risk of cross infection therefore help to safeguard peoples health. Items stored on top of wardrobes has been known to fall off. If they were removed this would reduce the risk of injury to people in the home. Random inspection report Care homes for older people Name: Address: Washington Lodge Nursing Home The Avenue Washington NE38 7LE two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Hilary Stewart Date: 1 6 0 6 2 0 1 0 Information about the care home Name of care home: Address: Washington Lodge Nursing Home The Avenue Washington NE38 7LE 01914150304 01914150306 washingtonlodge@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Healthcare Services Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 65 Number of places (if applicable): Under 65 Over 65 0 dementia Conditions of registration: 65 The maximum number of service users who can be accommodated is: 65 The registered person may provide the following category of service only: Care Home with Nursing - Code N, To service users of the following gender: Either, Whose primary care needs on admission to the home are within the following category: Dementia Code DE, maximum number of places 65 Date of last inspection Brief description of the care home Washington Lodge is a purpose built care home that opened in September 1996. The home provides both nursing and personal care for people with dementia care needs. The home does not provide intermediate care services. Washington Lodge is a modern two-storey building. The home is divided into two units Care Homes for Older People Page 2 of 12 Brief description of the care home (one on each floor) and both have communal facilities, bathrooms and bedrooms. All bedrooms are single occupancy. The main kitchen, laundry area and staff room are at the rear of the ground floor. Access into the home is level and a passenger lift provides access to the first floor. At the centre of the home there is an enclosed garden, which has a seating area. Washington Lodge is set back on a tree-lined road in a pleasant residential area of Washington Village, near to local shops, church and pub. A bus route provides access to the Galleries shopping centre, Sunderland and Gateshead centres as well as surrounding areas. The fee for residential care is £417 per week. The fee for nursing care is £422 (which is topped up by £101 continuing care payments). There is an additional charge for people who are privately funded. Items not covered by the fees include chiropody, hairdressing, toiletries and clothing. Care Homes for Older People Page 3 of 12 What we found: The reason for this inspection was to check the following. 1. That there are sufficient staff employed at the home who are trained and supported to provide the people who live there with good care. Also that all staff are thoroughly vetted before they start to work there. 2. That the home has arrangements in place to safeguard the people who live there. 3. That the care plans are clear, accurate and contain enough detail to inform staff about how they must meet the needs of the residents and provide them with good care. 4.The home has adequate arrangements in place to protect the health and safety of the people who live there. 5. To check that any requirements made at the last inspection have been met. The outcome was as follows: At the time of the visit the home did not have a manager so the deputy manager was in charge. The manager who had been in post for a year left on the 29th May 2010, they had not been registered with the Commission. Another manager had been offered the post and was due to start on the 3rd July 2010. 1. The deputy manager said that all staff receive the training and support they need. Staff said and records showed that they all have mandatory training such as first aid, food hygiene and safeguarding adults training. The deputy manager said that there is always a qualified first aider on every shift. They were not sure if the nursing staff receive refresher first aid training. Sufficient staff were on duty at the time of the visit. Staff said and records showed that sufficient staff had been on duty in the home the previous week. The deputy manager said that there are enough staff to cover sickness and holidays. All staff go through a recruitment process and they cannot start to work at the home until this is completed. The deputy manager said that all staff have been (CRB) Criminal Records Bureau checked at an enhanced level to make sure they are suitable people to work at the home. They are interviewed and are only successful when they have two satisfactory references. Some of the staff records were looked at and they showed that most of the checks had been carried out. However some people had not completed their application forms in full so it was difficult to track whether their last employer had given them a reference, or if they had any gaps in their work history. Most did not have a recent photograph on their file for identification purposes. 2. Copies of the homes complaints procedure are in the information about the home. The deputy manager and staff said that the people who live there and their relatives know how to make a complaint. Records showed that there had been five complaints made to the home since January 2010. The deputy manager said that they have all been resolved. Care Homes for Older People Page 4 of 12 A record is kept of complaints and it looked up to date. The deputy manager said that all staff have had training in how to safeguard the people they care for. Staff have access to a copy of the Local Authority procedures and the home has copies of their own adult protection procedures. The deputy manager said that the safeguarding procedures are always followed if there are any issues. There are currently two safeguarding referrals which are being investigated by Sunderland Safeguarding Team and with full cooperation of the staff in the home. All staff have had training on the homes whistle blowing policy and procedure. 3. The deputy manager said and records showed that each person who lives at the home has an individual care plan. Three care plans were looked at during the inspection visit. Risk assessments were in place for pressure prevention, nutrition and hydration, falls, moving and assisting, dependency and dealing with challenging behaviours. Some peoples care plans contradicted information in their assessments of need care and they did not always identify how individual service users health and welfare needs were to be met. The care plans had not always been reviewed at least monthly or updated when peoples needs changed. For example one service user had been identified as immobile but can weight bare however there is a care plan for use of hoist and sling which does not identify which equipment staff are to use. The nutritional care plan stated to be offered soft moist diet and weekly weights but the risk assessment said to weigh the person every month. Recordings in the care plan said that the service user had a wound in April 2010 but there was no corresponding care plan in place to show how this was being cared for. Also the daily progress records show that the service user had a catheter removed on the 10 June 2010, however no care plan had been in place for the care of this persons catheter. Also a moving and handling care plan did specify which hoist staff were to use. Care plans for communication and dehydration were re written in March 2010 but had not been evaluated since April 2010 . A care plan for pressure ulcer care was also rewritten in March 2010 and identified a grade four healing ulcer. The evaluations for wound care were brief and although the ulcer was to be redressed every three days there was no evidence to show that this had always happened. Also there was no information to show what action the nurse had taken and whether the wound was healing or otherwise. The daily progress notes record dressing renewed and evidence of out of stock dressings. This plan identified the need for a high protein diet to aid the healing process but this is not mentioned in care plan for nutrition. Daily progress records reported the service user was seen by the GP and diagnosed with a chest infection and prescribed antibiotics but there was no short term care plan and no short term plan in place for a recent eye infection. Another service user required a pureed diet and was at risk of weight loss. The risk assessment tool identified that the service was at high risk and needed to be weighed every week, however no weight had been recorded from 19 April 2010 or from January 2010 until April 2010. The care plan for nutrition was being rewritten in April 2010 but had not been completed or signed by the author. 4. Safety checks have been carried out on the equipment in the home such as testing electrical equipment and servicing the central heating boiler. The deputy manager said that they have frequent fire drills and staff receive training so they know how to keep people safe if there is a fire. This training is repeated regularly. The deputy manager said that the medical equipment in the home is serviced regularly and they can buy new equipment through a supplier whenever it is needed. They also said that they did not Care Homes for Older People Page 5 of 12 know if there was risk assessments in place for the use of suction equipment, however they dont use it in the home. Facilities for the storage of medicines on both units were poor and were located within the nurses station which is not appropriate for the storage and preparation of medicines. The list of staff authorised to administer medicines was up to date which would make it easier to identify who was involved in administration of medicines if an error or discrepancy arose. A random check was made of the medicine administration records (MAR) which did not reveal any discrepancies. Should any service user refuse medication or if it was omitted the appropriate code was used and the reason was explained on the back sheet of the MAR. Handwritten directions for medication did not have two witness signatures to minimise the risk of errors. Staff carry out daily audits of medication and service users have their own blood monitoring machines so that blood sugar levels can be checked. Generally the home was warm and comfortable. The communal areas were pleasant and comfortable and the home was generally clean with no odours. There was a safe secure garden area which service users and their relatives were able to access throughout the day. The home has a pet rabbit and they have recently acquired doves. One room had been changed into a therapy room and another into a family room. The carpet in the therapy room has numerous old cigarette burns so looks unpleasant. None of the bedrooms have an en suite facility although there are toilets close by and near to all communal areas. People who live at the home and their families have been encouraged to bring small personal items into the home making the bedrooms comfortable and homely. Not all bedroom doors have automatic door closures and bedroom doors were being kept open by artificial means including an electric fan and bedside cabinet. Wardrobes are fixed to the walls but items are stored on the top of them so there is a possibility they may fall off causing injury to both service users, visitors and staff. The bathrooms and shower rooms are functional. A domestic bath and the bath where the overhead tracking is situated both have damaged panels. The laundry was separate from all service user areas. It was extremely busy and there were piles of wet washing waiting to be dried as one dryer was awaiting repair. The hand wash sink was full of dirty mop heads which made effective hand washing impossible, Some items were being stored behind machines which were removed immediately on request of inspectors. The manager said that they always notify the Commission of anything that adversely affects the well being of the service users at the home. They keep a copy of all notifications in the office. 5. The newly appointed manager takes up their post in July 2010, they were present at the home when we told the deputy manager what we had found. They said that they intend to update and improve all of the care plans and deal with all of the issues highlighted during this inspection visit. What the care home does well: Care Homes for Older People Page 6 of 12 The home continues to meet the remaining National Minimum Standards. 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 set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain 30/07/2010 sufficient detail to provide staff with up to date and accurate information about how they meet each persons needs and provide them with good care. This will make sure that staff have the information they need to meet the needs of the residents and provide them with good care. 2 8 12 Wound and pressure ulcer care must be recorded and any deterioration or improvement recorded and reviewed on a continual basis. Nutritional screening must be completed and a record of maintained of food and fliud intake kept. Weights must be recorded and any loss actioned with advice sought from specialists. Moving and handling equipment must be specified 30/07/2010 Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action including type of hoist,sling and action staff have to take to ensure sfae transfers. This will make sure that people at the home who are risk are protected and their health care needs are being met. 3 8 13 Ensure that individual service 30/07/2010 user risk assessments are reviewed and updated to reflect their changing health needs. This includes falls,moving and handling, nutrition and pressure ulcer care. This is to make sure that the people at the home are kept safe from risk of harm. 4 9 13 The registered manager 31/08/2010 must make sure that medicine storage facilities within the home are reviewed and updated in line with best practice guidance. Medicines must be stored safely and securely at the correct temperature recommended by the manufacturers. Make sure any hand written directions on the medicine administration records have two witness signatures. This will make sure that the residents are kept safe from harm. 5 19 13 Replace the carpet in the 30/09/2010 Page 10 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action therapy room. This will make the room more pleasant for the residents when they use it. 6 21 23 Repair or replace damaged bath panels in two identified bathrooms. This will make sure that the residents are kept safe from harm. 7 24 23 Make sure all items are removed from the tops of wardrobes and ensure bedroom doors are not held open by artifical means. This will make sure that the residents are kept safe from harm. 8 26 13 Ensure there are effective 30/07/2010 hand wash facilities available at all times in the laundry. This is to minimise the risk of cross infection. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/09/2010 30/07/2010 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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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