Care Home: Wells Lodge Nursing Home

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What the care home does well The AQAA completed by the Director demonstrates a good awareness of how the home is to meet the National Minimum Standards and Care Home Regulations. Residents are provided with good information about the services the home provides. Care plans contain good information about residents` wishes in respect of death and dying Residents praised the food. The home provides a pleasant environment for its residents. It is clean and well maintained. Residents said they feel comfortable to speak to staff about any issues that concern them. A resident said, "They are very kind." What has improved since the last inspection? The home is well managed since a manager has been appointed. A resident said, "She is a strong leader and gets things done."Self-funding residents now have a contract or statement of terms and conditions. It includes the details as to how the "free" nursing care component is to be deducted from the fee. A staff-training matrix is now in place. A staff supervision schedule has commenced but needs to be extended. A quality assurance programme has been introduced. CARE HOMES FOR OLDER PEOPLE Wells Lodge Nursing Home Wells Lodge Nursing Home 60 Earls Avenue Folkestone Kent CT20 2HA Lead Inspector Lisbeth Scoones Key Unannounced Inspection 17th October 2007 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wells Lodge Nursing Home Address Wells Lodge Nursing Home 60 Earls Avenue Folkestone Kent CT20 2HA 01303 850898 01303 220590 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) www.wellscare.com Wells Care Ltd Vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th February 2007 Brief Description of the Service: Wells Lodge Nursing Home provides nursing care for 22 older people. The registered provider is Wells Care Ltd, which also owns Wells House in Sandgate and 5 homes in Brighton. The premises comprise a two storey extended and adapted detached house with gardens in the centre of Folkestone. There are eight parking spaces available as well as on street parking. The home is located near the M20 motorway. Shops, bus stops and the railway station are nearby. The inspection report is available on request. Current weekly fees are in the range of £560 and £650 with additional charges for hairdressing, chiropody and newspapers. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit was carried out over two days and comprised discussions with the nurse in charge; two care staff and other staff. The manager was not on duty but telephone contact was made the following day and a return visit arranged for the purpose of examining records not available at the first visit. During a tour through the home, 6 residents were spoken with and their records examined. At the time of the visit, the home had 4 vacancies. At the return visit, feedback was given to the manager and Director. Prior to the inspection, the Director Mr P Burns completed an AQAA (Annual Quality and Audit). Comment cards were sent to residents, relatives and staff. Five of these were returned and comments made are incorporated in this report. What the service does well: What has improved since the last inspection? The home is well managed since a manager has been appointed. A resident said, “She is a strong leader and gets things done.” Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 6 Self-funding residents now have a contract or statement of terms and conditions. It includes the details as to how the “free” nursing care component is to be deducted from the fee. A staff-training matrix is now in place. A staff supervision schedule has commenced but needs to be extended. A quality assurance programme has been introduced. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wells Lodge Nursing Home DS0000062481.V348645.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 Wells Lodge Nursing Home DS0000062481.V348645.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective and current residents are provided with detailed information about the services the home offers. All residents are provided with a contract or statement of terms and conditions. Residents are only admitted to the home following an assessment of need. EVIDENCE: The home has a recently reviewed Statement of Purpose and Service User Guide. Minor amendments needed were discussed. The Service User Guide is given to all residents and their families. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 9 A sample of contracts was examined. Since the previous inspection, these are now kept on file and comply with the National Minimum Standards and Care Home Regulations. However, following a recent change in the RNCC contribution awarded, the contracts need further updating. From documentation seen it is evident that pre-admission assessments are carried out to ensure that the home can meet the resident’s needs. Wells Lodge Nursing Home DS0000062481.V348645.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide the necessary information for staff to care for the residents. Residents’ health care needs are met with evidence of GP visits and multidisciplinary health professionals input. Residents are protected by the home’s policies and procedures for dealing with medicines, but these could be improved. Personal care is offered in a way, which protects the residents’ privacy and dignity and promotes their dependence. Residents are assured that at the time of their death staff treat them with sensitivity and respect. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 11 EVIDENCE: A sample of care plans examined demonstrated that these are informed by risk assessments and regularly reviewed. Risks in respect of malnutrition and skin breakdown are undertaken and acted upon. However the home must ensure that all risk assessments are current and dated. There is some evidence that residents are involved in the care-planning process. This is good practice. The manager has recently undertaken training in respect of the Mental Capacity Act and its implications for residents’ care. The training is to be extended to all staff. Outside health professionals are involved with the care provision as e.g. dentist, optician, continence advisor, physiotherapist and community psychiatric nurse. Where residents’ care needs change, they are appropriately referred. The clinical room was tidy and clean. Records of medication disposal and medication charts are well maintained. Staff must ensure that every handwritten entry is signed and countersigned. For a self-medicating resident, no risk assessment was seen on file. The home has ensured that there is no overstock of oxygen and a foot-operated bin has been replaced. Residents said that staff are kind and courteous and treat them with patience and respect. Good records are maintained regarding residents’ wishes and care needs in relation to death and dying. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with some activities. Residents receive wholesome and varied meals and have a choice of what they would like to eat. EVIDENCE: An activities person provides activities during two afternoons a week. These are mainly one to one conversations, which the residents enjoy. Several residents said that they would like more activities. The Director and the manager are aware of this and said that the programme of activities is to be expanded. Visitors are welcome at any time. Residents’ religious needs are accommodated. A communion service is held regularly. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 13 The kitchen was visited and a conversation had with the chef. A new sixweekly menu has recently been introduced. This indicates that a choice of wholesome meals is provided. A resident said, “The food is good.” Lunch served looked appetising. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives feel confident that their complaints will be listened to. Residents are protected from abuse and staff have been trained in the protection of vulnerable people. EVIDENCE: Residents said that they feel comfortable in bringing any issues of concern to the attention of the staff. The home has received no complaints since the last inspection. Staff are provided with adult protection training by an in-house trainer. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained and homely environment. The home is clean and odour free. EVIDENCE: The home provides a comfortable and attractive environment for the residents. Residents’ room are personalised and there are a number of communal spaces, including two dining areas, available. A number of bedrooms have been decorated and carpets replaced. The programme of installing lockable facilities in all bedrooms is nearly completed. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 16 The home was clean and odour free. A housekeeper is employed for three days and a laundry person for five days a week Monday to Friday. Ways of making the most of the limited laundry space were discussed. Good clinical waste disposal systems were observed. In one en-suite bathroom a bin needs replacing; in another the ventilation needs attention. Staff are trained in Infection Control. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty meet residents’ needs. The home’s recruitment procedures support and protect the residents. A staff-training programme, which includes NVQ, ensures that residents are in safe hands. EVIDENCE: On the day of the visit, for the morning shift, the home was staffed as follows: nurse in charge and 4 permanent carers: chef, domestic and laundry staff and maintenance man. Whilst new care staff are given induction training based on the Skills for Care standards, such training should commence within 6 weeks of appointment. Standard 30.2 and 3 apply. The home is striving to achieve a minimum ratio of 50 NVQ trained staff. A formal training programme and training matrix has been introduced. This indicates that staff are provided with comprehensive training, both statutory Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 18 and specialist. The manager must ensure that each member of staff has an individual training and development assessment and profile. A discussion ensued about the need to link training needs to the supervision process. A return visit was made to examine a sample of staff files. This confirmed that appropriate recruitment procedures are in place. However, the manager must ensure that files for all employed staff are available at the home. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Since a manager has been appointed, the home is well managed. A quality assurance system has been introduced thus ensuring that the home is run in the best interests of the residents. Residents’ financial interests are safeguarded. Staff are supported but the supervision programme needs to be formalised. The health, safety and welfare of the residents and staff are promoted. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 20 EVIDENCE: The new manager has been in post for eight months and has clearly made a difference. Staff and residents said that the home is well managed. She is a registered nurse with many years of experience in caring for older people. She is supported by the Director, trained staff and the manager of Wells Care Ltd other local nursing home. There is no designated deputy manager to whom managerial responsibilities may be delegated. This issue was discussed at the inspection. Since her appointment and since the previous inspection, a formal training programme has been introduced. Quality assurance systems are now in place with regular audits and resident surveys. The Director carries out Regulation 26 visits although not always monthly. The need for an annual development plan was discussed. The home does not deal with residents’ monies and residents’ relatives are invoiced monthly. A staff supervision programme has been introduced. This however needs to be extended to all staff and take place six times a year. See also standard 30. Staff are provided with statutory training in respect of fire safety awareness and moving and handling. From information provided before the inspection, it is ascertained that all safety checks and maintenance contracts are carried out. Accidents are well recorded and monitored monthly. Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 21 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 2 x 3 Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP36 Regulation 18 (2) Requirement That staff are appropriately supervised Timescale for action 30/11/07 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 3 4 Refer to Standard OP9 OP28 OP30 OP33 Good Practice Recommendations That all handwritten entries on medication charts are signed and countersigned That at least 50 of staff are NVQ trained That every member of staff has a training and development assessment and profile That an annual development plan be developed Wells Lodge Nursing Home DS0000062481.V348645.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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