Care Home: White Lodge Residential Home

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What the care home does well People living at the home can be confident that their health needs are well monitored and staff work well with community health care professionals to ensure their health and wellbeing is promoted. People told us the home does the following well: `The majority of staff treat me with respect. Residents and staff are able to enjoy a joke and a chat at appropriate times. The staff create a comfortable and homely atmosphere` `Do well with all things` `The home does well` `Everything` `The home looks after me well` `It treats residents as individuals with differing requirements and likes and dislikes` `Care for individuals and meet their care needs` `I really enjoy working at White Lodge. The residents are great and staff are great to` `The home does well in the individual care of his residents. staff take the time to listen to the residents and encourage residents to take part in activities` `We all work as a team to make sure all service users are properly cared for in their home. All staff are updated on training courses regularly so that they are able to do their job to the best of their ability. The managers are supportive if any problems occur within the home. The home provides a good choice of menus for breakfast lunch and tea so that all service users get a good choice in what they wish to eat` `Person centred care. Mandatory training and updating it. Also other courses relevant to the care sector eg NVQ palliative care` `Looks after service users in a safe and clean environment` What has improved since the last inspection? A number of permanent staff have been employed since the last key inspection therefore the service has become less reliant on using agency staff, providing continuity of care for the residents. Care plans and risk assessments are now being updated at the required frequency to ensure staff have the up to date information available to meet people`s individual needs. Training opportunities for staff has improved ensuring people living at White Lodge are supported by a team of staff who have received training to keep them safe and meet their individual needs. For example most staff have received or are undertaking training in respect of dementia care and this is ongoing, providing them with the knowledge to care for people with dementia. The use of agency staff has declined with the recruitment of permanent staff this provides people living at the home with more continuity of care and support. A new management team have been appointed and they fully acknowledge the need to improve outcomes across all areas of service provision and appear committed to implement change in the best interests of people living at the home. Monthly quality assurance visits required by Law are now being undertaken at the required frequency to monitor and report on the quality of the service being provided to people living at White Lodge. What the care home could do better: People living at the home cannot be confident that all of the necessary checks have been undertaken prior to new staff commencing employment to ensure staff are suitable to work with vulnerable adults and that they are protected from the risk of harm or abuse. Care plans and risk assessments should be further developed and detail the action required by staff to meet people`s needs so care is individualised and people`s needs are met in a consistent and safe manner. The home is currently without an activity organiser therefore the provision of social and recreational activities currently available is limited. This needs to be addressed at the earliest opportunity taking into account the needs, preferences and capabilities of people who live at the home. These actions will help improve their quality of life by doing things they find enjoyable and stimulating. Quality monitoring of the service requires further development in order to gain the views of the residents and their representatives. For example residents and relatives meetings and staff supervision meetings need to be implemented to gain peoples views and needs and continue to improve the overall service. A complaints book needs to be made available to ensure any complaints are recorded and actioned so people feel confident their views are listened to and the necessary action taken. People told us the home could make the following improvements: `It would be better if I was kept informed of decisions made on my behalf by White Lodge, regarding my care e.g. if I am to be moved to a different room I would like to be given the opportunity to discuss why and if I want to move. Also aspects of the building and exterior of the white Lodge could do with renovation` `Nothing that I know of` `Provide more activities to stimulate residents` `Purchase new windows and carpets. Tend to the car park and the general inside and outside appearance of the home` `The car park need attention and the lighting outside the ramp is inadequate for any emergencies such as ambulance, doctors etc` `Work as a team` `Work hard to raise funds for the residents could go out on more trips throughout the year` Key inspection report Care homes for older people Name: Address: White Lodge Residential Home White Lodge Fenn Green Alveley Nr Bridgnorth Shropshire WV15 6JA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Becky Harrison     Date: 1 8 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: White Lodge Residential Home White Lodge Fenn Green Alveley Nr Bridgnorth Shropshire WV15 6JA 01299861120 01299862038 white-lodge@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Oldfield Residential Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Maximum number of Service Users is 36 (Thirty Six). Date of last inspection Brief description of the care home White Lodge is a care home for older people, registered to provide accommodation and personal care for up to 36 people. At the time of this inspection 30 people were accommodated. The home is a large three story adapted property located in a rural position on the A 442 between Bridgnorth and Kidderminster offering both single and double bedroom accommodation. Shared areas include two sitting areas and two dining areas in Care Homes for Older People Page 4 of 32 Over 65 15 21 0 0 0 1 0 2 2 0 1 0 Brief description of the care home addition to a conservatory. A passenger lift is provided to enable people with mobility difficulties to safely move between floors. The front door to this home is kept locked with a number of keypad entries to internal doors around the home. People have access to a secure garden and there is ample parking facilities provided to the front of the property for people visiting the home. The home is owned by Oldfield Care Ltd with White Lodge being one of six care homes within this company. People are able to gain information about the services provided at White Lodge from the Statement of Purpose and Service User Guide. Inspection reports are available direct from the provider and on our website at www.cqc.org.uk The current fees charged range from £380.00 to £500.00 per person per week based on dependency needs and the accommodation provided. The Reader is advised to contact the provider direct for more information about the fees as this information may be out of date. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the service was undertaken by one inspector over 6 hours. The people who live and work at the home did not know that we were coming. A range of evidence was used to make judgements about this service. We spoke with a number of residents and staff on duty, the deputy manager, the manager and registered provider who briefly visited the home. We looked at some parts of the home and sampled a number of records to include staff training, recruitment, quality assurance and health and safety records. We received five completed surveys from residents and seven surveys from staff informing us of their views of the home and some of the feedback gained has been included in our report. We looked at the outcomes for people living at White Lodge and information to produce this report was gathered from the findings on the day of our visit and also the information that we have received, or asked for, since our last key inspection Care Homes for Older People Page 6 of 32 undertaken on 3rd June 2008. An annual Service Review was undertaken on 9th June 2009. This did not involve a visit to the home but is a process where we collect information from various sources and if no changes are identified a report is produced based on the information received. A random unannounced inspection of the service was undertaken on 1st February 2010 following a referral made under safeguarding adult procedures and concerns raised about care documentation, risk management and the lack of supervision for residents in the main lounge. Shortfalls were fully acknowledged by the new manager and procedures were implemented to rectify the deficiencies identified in the best interests of people using the service. As a result we made a requirement and a recommendation regarding care planning and risk management. During this key inspection the care received by three people was looked at in detail. This included looking at personal records such as care plans, health records, daily records and discussing their care with them, where possible, and the staff who support them. We also had the opportunity to observe people being supported by the staff on duty in the shared areas of the home. This helps us gain information and understand the experiences of people who use the service and the quality of care they receive. The Operational Director completed an Annual Quality Assurance Assessment (AQAA) document for us, as requested. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. This provided us with some information and informed us about how they are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A number of permanent staff have been employed since the last key inspection therefore the service has become less reliant on using agency staff, providing continuity of care for the residents. Care plans and risk assessments are now being updated at the required frequency to ensure staff have the up to date information available to meet peoples individual needs. Training opportunities for staff has improved ensuring people living at White Lodge are Care Homes for Older People Page 8 of 32 supported by a team of staff who have received training to keep them safe and meet their individual needs. For example most staff have received or are undertaking training in respect of dementia care and this is ongoing, providing them with the knowledge to care for people with dementia. The use of agency staff has declined with the recruitment of permanent staff this provides people living at the home with more continuity of care and support. A new management team have been appointed and they fully acknowledge the need to improve outcomes across all areas of service provision and appear committed to implement change in the best interests of people living at the home. Monthly quality assurance visits required by Law are now being undertaken at the required frequency to monitor and report on the quality of the service being provided to people living at White Lodge. What they could do better: People living at the home cannot be confident that all of the necessary checks have been undertaken prior to new staff commencing employment to ensure staff are suitable to work with vulnerable adults and that they are protected from the risk of harm or abuse. Care plans and risk assessments should be further developed and detail the action required by staff to meet peoples needs so care is individualised and peoples needs are met in a consistent and safe manner. The home is currently without an activity organiser therefore the provision of social and recreational activities currently available is limited. This needs to be addressed at the earliest opportunity taking into account the needs, preferences and capabilities of people who live at the home. These actions will help improve their quality of life by doing things they find enjoyable and stimulating. Quality monitoring of the service requires further development in order to gain the views of the residents and their representatives. For example residents and relatives meetings and staff supervision meetings need to be implemented to gain peoples views and needs and continue to improve the overall service. A complaints book needs to be made available to ensure any complaints are recorded and actioned so people feel confident their views are listened to and the necessary action taken. People told us the home could make the following improvements: It would be better if I was kept informed of decisions made on my behalf by White Lodge, regarding my care e.g. if I am to be moved to a different room I would like to be given the opportunity to discuss why and if I want to move. Also aspects of the building and exterior of the white Lodge could do with renovation Nothing that I know of Provide more activities to stimulate residents Care Homes for Older People Page 9 of 32 Purchase new windows and carpets. Tend to the car park and the general inside and outside appearance of the home The car park need attention and the lighting outside the ramp is inadequate for any emergencies such as ambulance, doctors etc Work as a team Work hard to raise funds for the residents could go out on more trips throughout the year 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. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service is made available to help prospective residents make an informed choice about whether the home is suitable to meet their individual needs. An assessment is completed prior to admission, so staff can determine if peoples needs can be met upon moving into White Lodge. Evidence: Prospective residents and their representatives are provided with an information pack to include a Statement of Purpose and Service User Guide. This gives them information about the service and facilities available at the home and helps them decide if White Lodge will accommodate their needs. Information available is detailed but requires updating to reflect the change in managerial arrangements. The AQAA states We have developed a new pre-asessment form recently which has a lot more important information on it, the resident and family are encouraged to be Care Homes for Older People Page 12 of 32 Evidence: involved in the assessment...We also assess the resident to make sure the home has appropriately trained staff to enable us to deliver care to a high standard. We encourage visits to the home and lunch/tea, for prospective residents to get a feel of the environment. We looked at the file of the person most recently admitted to the home and saw the home had undertaken a pre-admission assessment prior to admission and staff spoken with were confident that they are able to meet the persons identified needs. The deputy manager reported that the format for assessment has improved, is more detailed and easier to complete. The home does not provide intermediate care. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 systems in place for planning peoples care and meeting health care needs require further development to ensure peoples needs are being met. Medication systems appear satisfactory ensuring people receive the medication that is prescribed for them ensuring their health and wellbeing. The actions of staff and their approach to care ensures that residents are treated with respect and their right to privacy is upheld. Evidence: All of the residents spoken with told us that they are happy with the care provided and this was reflected in the completed surveys we received. The AQAA states Each resident has an individual care plan regarding areas of care delivered to them, some need 100 involvement others are capable of assisted care with encouragement. We looked at the care records for three people with diverse needs and found each person had a plan of care in place, which had been reviewed and updated at the required frequency or sooner if their needs had changed. We also saw evidence that the person Care Homes for Older People Page 14 of 32 Evidence: or their relative had been involved in planning their care this helps to ensure people receive their care in the way that they prefer. During the inspection one persons care was formally reviewed with the persons representatives and a member of staff was seen discussing the care documentation with a representative. Each of the care plans sampled included information about peoples personal and health care needs in addition to basic risk assessments such as falls, tissue viability, manual handling and nutrition and identify any areas of risk and enable staff to put appropriate measures in place to reduce the risks, so that peoples well being is promoted. Although staff spoken with demonstrated a good understanding of the needs of the people whose care we looked at in detail we advised that care plans be further developed to ensure they cover all aspects of care and support required for example the care plan seen for a person with diabetes lacked information on what staff should do to effectively monitor the condition to ensure the persons positive health and wellbeing. For example the care plan did not indicate the range of acceptable blood sugars although there was a clear record of blood glucose monitoring taking place. Moving and handling assessments seen had been reviewed however require more detail regarding the type of hoist, size of sling and technique used for people who need hoisting to ensure consistent practice and the safety of the people concerned. Feedback gained from staff surveys indicate the majority of them feel that they are always given up to date information about the needs of residents they support. Residents now have designated keyworkers who are responsible for maintaining their records. Staff spoken with considered that care plans and risk assessments were much improved and that they had received input from managers on how to complete these adopting a more person centred approach. However managers fully acknowledged that further work is required on care documentation overall so that people using the service can be confident that detailed information is readily available to address their individual needs. People can have confidence that their health needs are kept under review and that staff seek the appropriate professional input from community health care services although we advised managers to obtain professional advice regarding an individual who had a substance addiction prior to moving into the home so that staff can support the individual appropriately. Records sampled detailed health needs, action taken and outcomes from visits undertaken by visiting GPs, district nurses, community mental health nurse, chiropodists and opticians. People we spoke with felt their health is well monitored and that staff take the appropriate action if they are not feeling well. Residents prescribed medication is currently supplied to the home using a box system with printed Medication Administration Record (MAR) sheets being supplied by the Care Homes for Older People Page 15 of 32 Evidence: dispensing pharmacist. The deputy manager advised that they are hoping to change the system to blister packs for easier dispensing. We found medication securely stored and systems satisfactory. Only staff who have received training in the safe handling of medicines are authorised to administer medication and we were advised assessments to monitor staff competency have now been implemented. Feedback from residents indicate that their privacy and dignity is promoted. We saw a member of staff knocking on bedroom doors prior to entry. Bedroom doors are lockable and people can be provided with a key to their room if they wish to enhance their privacy. Staff were seen to interact with the people in their care in a positive manner. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 should ensure that people are involved with developing a programme of activities, based on the needs, preferences and capabilities of people, including people with dementia. The effectiveness of these activities should be evaluated on an ongoing basis to ensure they are appropriate and meet with peoples expectations and needs. Evidence: The home is currently without a designated Activity Organiser to arrange and provide people with a range of social and recreational activities therefore care staff are aiming to provide people with some activities in addition to fulfilling their care duties. It was reported that the position has been advertised in the local papers but to date the home has received no interest. During the inspection we saw people entertain themselves by reading, watching television or listening to background music. During the afternoon a small group of people joined in a game of bingo and appeared to enjoy the activity. Staff spoken with told us that is a challenge at times to engage people in activities as they just want to do their own thing. It was reported that the home recently held an event and that future plans include holding a fathers day event and a summer fete to raise funds towards the purchase of a minibus so people can access the community. Areas for improvement stated in the AQAA include fundraising for a mini bus, introducing residents/family meetings and developing memory boxes Care Homes for Older People Page 17 of 32 Evidence: for residents with personal items, rummage boxes and pictures of old times. Records for the people whose care we looked at in detail evidence that daily routines are flexible and people can rise and retire to bed at times that suited them. Feedback gained in surveys and discussions held indicate more activities could be provided. The AQAA states Residents are given choice on day to day living and all are treated as individuals, staggered getting up and breakfast and choice of full English to cereals/toast. One resident told us It would be better if I was kept informed of decisions made on my behalf by White Lodge, regarding my care e.g. if I am to be moved to a different room I would like to be given the opportunity to discuss why and if I want to move. Therefore it is essential that staff document any decisions made with and on behalf of residents and clearly state the reasons for this. People spoken with said that their visitors are made welcome and contact with family was recorded on the files sampled. A visitor to the home told us that they are always made welcome. Visiting is flexible so people living in the home are able to maintain important relationships. People told us that they like the food provided. One person said I like my cooked breakfast. Drinks and snacks were made available between meals. The care files sampled contained individual preferences although this could be further developed for example the records of the person with diabetes failed to provide information on what the person can and cannot eat. We looked at the menus and spoke with the cook and he demonstrated a good understanding of special dietary needs and peoples preferences. Lunch was observed and staff were seen providing discreet assistance to individuals who required support. The atmosphere was relaxed and people appeared to enjoy the meal provided. Alternatives were available. Dining tables are due to be replaced in addition to the floor covering which will enhance the environment where people dine. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have access to a complaints procedure, which is accessible and ensures the views of people are listened to. The majority of staff have received training in adult protection so they have an understanding of abuse, ensuring residents wellbeing. Evidence: Feedback gained from people who use the service indicate that most people know how to complain about the service and staff who completed surveys stated they know what to do if someone has concerns. We saw the complaints procedure displayed in the reception area of the home and this is also documented in the Statement of Purpose and Service User Guide. People we spoke with during our visit had no concerns about the home and felt if they had then the appropriate action would be taken to put things right. The home has a comments book in place but no formal documentation to log complaints and the action taken. The deputy agreed to action this. The local multi-agency policy and procedure in relation to adult protection was accessible in the office and a leaflet produced by the local authority was seen available on the notice board about safeguarding vulnerable adults. The deputy manager told us that 18 of the 19 carers have now received training in the protection of vulnerable adults, as confirmed by staff we spoke with. The deputy manager reported that she hopes to attend a protection of vulnerable adults course for provider managers, due to take place shortly. Training ensures staff have an understanding of abuse and the Care Homes for Older People Page 19 of 32 Evidence: procedures to follow ensuring residents wellbeing. There have been a number of referrals made under safeguarding adult procedures since the last key inspection mainly around the lack of care documentation, risk management and staffing levels. This triggered an unannounced random inspection being undertaken earlier this year and meetings held with other agencies. Shortfalls were fully acknowledged by managers and improvements have taken place to better protect people using the service. However how the home recruits staff needs to be urgently reviewed as recent practices may place people at risk of harm. This is fully acknowledged in the AQAA as an area requiring improvement. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some areas of the home are in need of improvement to ensure people live in a homely and comfortable place to live. Procedures in respect of infection control are robust to reduce the risk of cross infection. Evidence: White Lodge is a large three story adapted property offering both single and double bedroom accommodation. Shared areas include two sitting areas and two dining areas in addition to a conservatory. A passenger lift is provided to enable people with mobility difficulties to safely move between floors. People have access to a secure garden which was being maintained at the time of the inspection. We looked at the shared areas of the home and the bedrooms of the people whose care we looked at in detail. There is a lack of visual design features such as pictures and visual signage to help people with dementia move around their environment or to aid their remaining capacity. For example there is no identification on bedroom doors to help people identify their own bedroom. Feedback from residents evidence they are satisfied with their personal accommodation and observations made indicate they are encouraged to bring in their own possessions in order to have familiar items around them to make their bedrooms more homely. Comments received include the need to improve the environment both internally and externally to provide people with a nicer place to live. The provider fully acknowledged this during the inspection and it was reported that quotations for replacement windows and carpets are being obtained in addition to Care Homes for Older People Page 21 of 32 Evidence: dining room furniture and new armchairs for lounges. The AQAA identifies what could be done better and states Updating bedrooms and decorating bedrooms with residents involvement. We advised the deputy manager to produce a programme of renewal and refurbishment. People living at the home can be confident that they live in a clean home and that robust procedures are in place to prevent the risk of infection. Completed surveys received from residents stated that home is always clean. An infection control audit was undertaken in October 2009 by Shropshires Prevention and Control Training and Development Nurse and the home received a score of 86 and matters arising have been addressed for example the laundry floor has been resealed, new cleaning schedules implemented and a number of staff have received training in infection control procedures. Substances such as cleaning products that could cause harm to people are safely stored and the necessary data sheets on their safe use readily available. Laundry facilities are adequate and well organised. Staff were seen using personal protective equipment such as hand gels, aprons and gloves throughout our visit. Visitors to the home are requested to use hand gel prior to entry reducing the risk of infection for residents. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff appear committed to their work and receive good training opportunities to equip them with the skills and knowledge to meet the individual needs of the people they care for. Shortfalls in recruitment practices do not fully ensure that the home only appoints people who are suitable to work with vulnerable people living at White Lodge potentially placing them at risk of harm. Evidence: Feedback gained from residents indicate they feel well cared for and comments from staff were also positive. People told us: The staff are very good They look after me well The staff morale is good now, improvements have been made for the residents and the team work really well. I enjoy coming to work The whole place has completely improved in the last 6 months, shift patterns have changed, the residents are happy and its a much better environment to work Care Homes for Older People Page 23 of 32 Evidence: I get good care and we have nice food Of the 19 permanent care staff employed, it was reported 12 have obtained a nationally recognised care qualification known as NVQ at level 2 and above in care and 6 are nearing completion this will ensure people living at the home are cared for by a qualified workforce. We spoke with staff about the needs of the three people whose care we looked at in detail and they demonstrated a good understanding of their diverse needs and considered the home is able to effectively meet their individual needs. Staff spoken to reported opportunities for training is much improved which helps equip them with the skills and knowledge to support the people in their care. Training includes Causes and Management of Challenging Behaviour in Dementia, Palliative Care, Dementia Care, Deprivation of Liberty Safeguards, Adult Protection, Medication and Care Planning in addition to training in safe working practices moving and handling, health and safety, food hygiene, first aid and fire training which supports people living and working at the home to remain safe. Some staff require refresher training in first aid and manual handling and the deputy manager was seen to action this during our visit. It was reported that shift patterns have changed in the best interests of the residents and that the home is now fully staffed although awaiting checks for one applicant. The deputy also advised that the home is far less reliant on agency staff providing continuity of care for residents. Staff considered that staffing levels meet the current needs of residents and this was reflected in discussions with residents we spoke with. We looked at how new staff are recruited and randomly sampled the records of four staff recruited in the last six months. The AQAA acknowledged there have been some issues with how staff have been recruited and that this is an area requiring improvement. We found that the home had not obtained a full employment history and a number of references were not dated and/or addressed To whom it may concern. The deputy manager could not provide evidence that a Pova First check had been obtained whilst waiting for a Criminal Record Bureau (CRB) check. We were told changes have been made to the recruitment process and that new staff will not be allowed to commence direct work until a CRB has been obtained. CRB checks help providers make informed decisions when recruiting people to work with vulnerable adults and are a requirement by Law. We were told that new staff receive induction training to the required specification and are subject to a 13 week probationary period. The AQAA states plans for improvement include Regular supervisions and staff appraisals, the training matrix to be kept up to date and further training identified by Care Homes for Older People Page 24 of 32 Evidence: managers to be carried out to protect and assist the residents. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a committed management team however action needs to be taken to improve some processes and outcomes in the best interests of people living at White Lodge. Evidence: Over the last six months there has been a change in the management team of the home with a new manager and deputy manager being appointed. The new manager is currently on long term leave and reasons for this have been shared with us however she intends to return to work as soon as she is able. We had the opportunity to meet with the new manager during the random inspection undertaken in February 2010 and she also telephoned the home to speak with us during this inspection. The manager has maintained contact with the staff and residents and is nearing completion of the qualifications required of her role and agreed to submit her application for registration as soon as she is able. In the interim the deputy manager is overseeing all management aspects of the home supported by the Operational Director. The deputy manager fully assisted us with the inspection process and appeared committed to her Care Homes for Older People Page 26 of 32 Evidence: work. Managers acknowledged that there remains work still to be done to improve outcomes for people living at the home and appear committed to make the necessary changes in peoples best interests. The manager reported that staff have upped their standards and put in a lot of work People we spoke with were positive about the new management team. Comments include: The manager is definitely approachable She very nice, I think she will do a great job It was reported that the majority of staff have undertaken training in respect of the Mental Capacity Act Deprivation of Liberty safeguards to ensure they are aware of their responsibilities in respect of supporting people who lack capacity to make decisions especially as there are currently 15 people who suffer with dementia living in the home. Staff are currently completing documentation for each individual and this needs completing at the earliest opportunity and if it is identified that the home is restricting an individuals liberty that an application for authorisation be made to the local authority on behalf of any current resident. Residents have the choice to manage their own finances, however some people deposit small amounts of money in the home for safekeeping to purchase papers, pay for hairdressing, chiropody etc. The home maintains individual records for people and receipts given for all transactions ensuring that peoples monies are held safely. However information regarding financial management should also be recorded in peoples care plans. There was little evidence of formal staff supervision on the files sampled however it reported that staff have started to receive this and that staff handovers take place at the end and start of each shift. We advised the deputy manager to arrange a staff meeting as soon as possible as staff meetings have not been held for a number of months. This will provide staff with the opportunity to discuss the service, any concerns, their training needs etc. The AQAA states Quality assurance is now carried out and questionnaires have been sent to staff and residents. Managers should develop a plan of action to address any areas that require development based on the outcome of he surveys so that improvements can be achieved for people living in the home. The implementation of regular resident and staff meetings should also provide opportunity to gain peoples views on the service. Care Homes for Older People Page 27 of 32 Evidence: The home employs a full-time handy man to attend to any maintenance issues and he was attending to the garden during the inspection. The AQAA reports that Service users are in a safe environment and all services are maintained according to relevant legislation. Feedback gained in discussions held with people and safety records seen reflect this. As reported earlier staff receive training to keep them and the people they care for safe although some staff require refresher training in first aid and manual handling, which has been actioned. Care Homes for Older People Page 28 of 32 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 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, Care Homes 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 29 19 All of the necessary checks 17/06/2010 required by Law must be obtained for all new staff prior to their commencement of employment. This is to ensure safety and protection of people who use the service. 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 1 7 Care plans should be further developed and detail the action required by staff to meet peoples needs so care is individualised and peoples needs are met in a consistent and person centred manner. Systems should be in place to ensure staff are fully aware of the risk assessment process and how it links into careplanning to ensure they plan care effectively for people living in the home. The provision of social and recreational activities should be addressed at the earliest opportunity taking into account the needs, preferences and capabilities of people who live Page 30 of 32 2 8 3 12 Care Homes for Older People 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 at the home. These actions will help improve their quality of life by doing things they find enjoyable and stimulating. 4 18 Review the systems for recording complaints to demonstrate a proactive approach to them and continued improvement. Produce a programme of renewal and refurbishment and undertake the work identified to enhance the envionment for people to live. Environmental improvements should be made for people with dementia to enable their independence and aid their remaining capacity. 5 26 6 26 Care Homes for Older People Page 31 of 32 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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