Care Home: Whitestone Lodge Residential Care Home

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What the care home does well The appearance of Whitestone Lodge is clean and welcoming. It is well maintained and decorated in a "homely" manner. People living in the home are offered the opportunity to make their bedrooms their own by bringing personal items. This makes the bedrooms look warm and welcoming. There are well maintained gardens to the rear of the building that are easily accessed by the people living in the service. We were told by staff and people living in the service that the gardens were well used in warmer weather. The service has a variety of seating and a dining area that supports people to decide how to spend their time. The majority of people living in the service believe that any concerns they have will be addressed. Staff were confident that they understood the ways to protect people from potential abuse and were able to clearly explain who had responsibility for dealing with serious concerns. Where the service needs support from external professionals such as doctors this accessed appropriately and good records kept regarding what actions staff need to take to meet health care needs. What has improved since the last inspection? The manager and staff have undertaken to improve the management of medications. Which with the exception of two minor areas has significantly improved and peoples medications are now ordered, administrated, stored and returned in a safe manner. The service now makes sure that the majority of instructions from professionals are recorded and followed up this helps maintain their health care needs. What the care home could do better: The most recent admission to the service was not undertaken in a manner that maintained the safety of the person or those already living in the service. The manager was reminded to make sure that the service can meet individual needs before the person moves into the service. A significant number of records including care plans, risk assessments and staff training were out of date and as such no longer accurate. The lack of clear instructions to staff places people living in the service at risk of receiving incorrect support. People living in the service were mixed about the daily routine. some told us that they were not offered choices that meet their personal choices, preferences and needs. We noticed that the information in the service that wold help people maintain their independence and make their own choices was not in formats to meet the needs of all the people living in the service. health and safety was not always well managed. Fire risk assessments were out of date and we observed that fire doors were inappropriately wedged open and in some cases did not close correctly. Staff recruitment and training was in need of development not all staff were recruited in a manner to maintain the safety of people living in the service. Staff training was unclear and records showed that some staff had up to date training. Key inspection report Care homes for older people Name: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP     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: Julie Garrity     Date: 0 9 0 3 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 34 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 34 Information about the care home Name of care home: Address: Whitestone Lodge Residential Care Home 56 - 58 Church Road Roby Knowsley Merseyside L36 9TP 0151-480-4237 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: whitestonelodge@btconnect.com Mr Caulton,Mrs V Caulton care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability, over 65 years of age Code PD(E) The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Whitestone Lodge is located in the Roby area of Liverpool, close to Huyton Village. Mr & Mrs Caulton own the home and the registered manager is Ms Paula Allen. The home is situated in a residential area within access to public transport to surrounding areas, Prescot and Liverpool. The home can have up to twenty residents who are of old age or with a physical disability. The home is pleasantly decorated and is situated over two floors. Single accommodation is provided and there are two double bedrooms for couples or for those who wish to share. There are three bathrooms, which are Care Homes for Older People Page 4 of 34 Over 65 20 20 0 0 1 4 0 7 2 0 0 9 Brief description of the care home equipped with aids to assist less independent residents. There is a large enclosed garden to the rear of the home with a ramp and handrail and car parking space to the front. The fee rate for accommodation is £418.00 a week. Care Homes for Older People Page 5 of 34 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 home started at 09.30 and finishing at 18.00. We spoke with a total of seven people who live in the home, five members of staff and the manager. The home completed a document known as an Annual Quality Assurance Assessment (AQAA). This documented is completed and sent to us by the home before we visit. The AQAA tells us what the home does well and what their plans are to increase the quality of the home. We sent surveys to people living in the home and staff their responses are included in this report. When we visited the home we looked at many of the records these included care records, staff records, medications, policies and procedures, menus, duty rota, staff training and activities records. We also looked around the building and observed staffs interactions with the people living in the service. After out last visit an enforcement notice was issued regarding medications as a result a specialist pharmacy inspector was included in this visit. Feedback was given to the manager during and in detail at the end of the visit. Care Homes for Older People Page 6 of 34 The day after the visit we sent a letter to the provider and the manager with concerns regarding admissions and staff recruitment. This was followed up with three calls to remind the manager that a response was needed. At the time of writing this report three weeks after the visit no response had be received and the report cold not be delayed any further awaiting a response. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The most recent admission to the service was not undertaken in a manner that maintained the safety of the person or those already living in the service. The manager was reminded to make sure that the service can meet individual needs before the person moves into the service. A significant number of records including care plans, risk assessments and staff training were out of date and as such no longer accurate. The lack of clear instructions to staff places people living in the service at risk of receiving incorrect support. People living in the service were mixed about the daily routine. some told us that they were not offered choices that meet their personal choices, preferences and needs. We noticed that the information in the service that wold help people maintain their independence and make their own choices was not in formats to meet the needs of all the people living in the service. health and safety was not always well managed. Fire risk assessments were out of date and we observed that fire doors were inappropriately wedged open and in some cases did not close correctly. Care Homes for Older People Page 8 of 34 Staff recruitment and training was in need of development not all staff were recruited in a manner to maintain the safety of people living in the service. Staff training was unclear and records showed that some staff had up to date training. 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 9 of 34 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 10 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service does not always make sure that an assessment of peoples needs is available before they move in. Without a full assessment the staff will not be aware of what peoples needs are or how to meet them. Evidence: We looked at how the service assessed (a review of peoples needs), before they moved into the home. To do this we spoke to the manager who told us that she usually assess people before they move in to see if the service can meet the persons individual needs. The AQAA submitted by the manager stated, Visitors are told of the need for a thorough assessment of a potential resident, by someone appropriately qualified from the home to ensure that the home can meet the needs of the prospective resident. We have a very comprehensive assessment form and check list for this purpose. We looked at four peoples records and noticed that all had an assessment after they Care Homes for Older People Page 11 of 34 Evidence: moved in. As three people had lived in the service for some time their initial preadmission assessments were no longer available. One person who had recently come to stay in the service had not received a pre-admission assessment that would inform the manager if they could meet their needs. The individual had no contact with social services and as such there was no information available about the persons needs before they moved into the service. We noticed during the visit and in care records that person was unsettled and needed significant reassurance. When we looked closely at the assessment we noticed that it had been done on the day that the person moved in and did not fully identify their needs. We wrote to the service following our visit detailing our concerns at the lack of assessment for this person before they moved in. We also noted that the service had not taken the opportunity to make sure that the individuals medications were correct and up to date. Without a pre-admission assessment the manager will not have enough information for them to decide if the service can meet the persons individual needs. We spoke to people living in the home about the information they received before they moved into the home. We received surveys from people living in the service all who told us that they had received sufficient information before they moved in. We looked around the service and noticed that each person had a copy of this information available in their bedrooms. When we reviewed this information we noticed it had not been updated and several sections were unclear. The information needed an explanation for the circumstances that a person can be admitted to the service and the arrangements for emergency admissions. The AQAA told us that, We have access to document translation facilities for our brochure into other languages. The copies of information viewed were available in one format only and no copies in large print or audio for people who are visually impaired as an example were available. Several people living in the service are assessed as having some visual impairment. Information available to people needs to be in formats to meet their needs in order for them to make an informed choice. The manager and the AQAA told us that, We always give prospective residents or their families a full tour of the home. We do not require appointments to be made and when giving a tour staff have a check list of topics to discuss to ensure that they give full and frank information. We leave our inspection report, including the drafts when they arrive, on display in the visitors lounge. People living in the service told us that they were offered an opportunity to look around and meet the staff before they move in. Care Homes for Older People Page 12 of 34 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. Instruction to staff in written records that detail how to meet peoples individual needs are not always accurate or up to date. Staff need clear and up to date instructions in order that they can provide support in a consistent manner that meets peoples individual needs, choices and preferences. Evidence: We received surveys from people living in the service. They told us that they receive the correct medical support. We looked at the professional visits records. These show when a professional has visited the home and what actions they wish to be taken to support individuals medical needs. These included detailed information about the reasons that a visit had been requested and what actions staff needed to take. It was not possible to determine that these actions had always been carried out as the information from professionals was not used to update individual care plans. We were able to locate some information about following professionals instructions in the diary, but this was not always the case. Surveys sent to staff asked them if communication in the service was effective these Care Homes for Older People Page 13 of 34 Evidence: had a mixed response with two staff saying always and five staff said usually. When asked if there was enough information to help them meet peoples needs three said always and four said usually. The results from the staff surveys showed that the communication and meeting of peoples needs had room for improvement. We observed part of the morning medicines round. This was done in a manner that helped to reduce the risk of mistakes. The home had a policy for the use of Home Remedies so people can have prompt treatment for minor ailments without a prescription. We found records of medicines receipt, administration and disposal to be generally accurate helped to support the safe administration of medicines. We looked at a sample of medicines stocks and records showed with the exception of rare discrepancy medicines could be (tracked) accounted for. For example, it was not possible to tell how many prescribed supplementary drinks someone was taking because the medicines administration record (MAR) and a separate diet chart did not match. As such staff were not aware if they managing the persons diet correctly. We looked at how information within peoples care plans supported the use of their medicines. In most cases we found that the information was not up to date, and there was no clear guidance for staff about the use of medicines prescribed when required and the application of creams. When we looked closely at four care plans and a brief look at a fifth we noted that most plans had not been updated since January 2010 some two months previously. There was useful information about peoples needs but information on how staff were to meet these needs was very brief and in some cases sufficiently out of date to no longer be accurate. A warning letter was issued following the last visit highlighting the concerns regarding care planning. The manager had undertaken work to improve care plans but they remained lacking in accurate instructions that would help staff decide what actions they need to take to support individuals. We looked at how people were supported to manage their medications themselves. We found that there was not enough information about how this was supported or monitored. The risk assessment in place had not been updated to reflect changing needs or to determine if the actions needed were still correct. When we looked at other risk assessments such as falls, developing pressure ulcers we found that these were not always updated or in place. Were needs were identified such as someone being at risk of developing pressure ulcers the actions that staff needed to take to reduce this identified risk was not available. Regular medicines audits (checks) were carried out by the manager. Although these identified some areas of practice and had assisted in significantly improving the Care Homes for Older People Page 14 of 34 Evidence: management of medications, they were brief and would not always assist in maintaining safe practice. During the day we observed staff talking to people in a respectful manner and actions were taken to maintain their dignity with the exception of one incident. A staff member was observed to enter a persons bedroom without knocking and did not explain what they were doing until asked by the person in the room what did they want. These actions did not demonstrate any respect of the individuals personal space. This was discussed with the manager who stated that she would deal with it. When we looked at staff meetings we noticed that the manager responded rapidly to any issues that might impact on peoples dignity reminding staff of their roles and how to maintain respect for people living in the home. Care Homes for Older People Page 15 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service do not have a lifestyle that supports their personal choices preferences and needs. Evidence: We looked at how people living in the service were supported to have a life style of their choosing. The AQAA for the service stated Our meals are varied, of the residents choices and we use only top quality fresh ingredients. We have local volunteers visiting and entertaining. Surveys returned from people living in the service were mixed two people said they usually liked the meals and one said sometimes. None were returned stating always. We spoke to people living in the service who told us, Not overly fond of the food, theres enough of it is filling, thats the best I can say, its all aside like a bit more variety, the pork pie would be nice, its all packet soup. We spoke to the kitchen staff and viewed the kitchen staff confirmed that they do not make fresh soup and it is made from packets. Other people told us, I dont like cornflakes but its a question of having those or nothing, I do like much of what they have but its a need to eat something, like Chinese food but its not on the menu. The staff confirmed that in this case they had often used their own money to buy this person Chinese takeaways as he liked them. Care Homes for Older People Page 16 of 34 Evidence: We looked at how people living in the service were offered a choice of meals. We noticed that the menus available did not show a choice available and this menu was not available to people living in the service. People living in the service told us, food not too bad not much of it. Some of meals are just sandwiches, a lot of the sandwiches of salmon and I dont like salmon, I have no idea whats for lunch today and they do come around and say. We watched lunchtime and noticed that all meals were presented in an identical manner. One person was presented with their meal and told staff I dont like gravy. They had lived in the service for several years. No one was observed to be asked what they would like to eat or what they would wish to have on their plate that meal time. Peoples personal choices and needs to be supported by offering a choice of meals that meets their personal preferences. We looked at how the service manager meals for people with a special diet or in need of additional support. We noticed that people were weighed regularly and were they had lost weight this was recognised and dealt with. When we looked at how supplements were given to people we noticed that it was not possible to determine that they had received these correctly. The menus available did not show any provision to special diets such as diabetic diet. We discussed with the kitchen and the manager how the meals were decided on. The manager stated that she had written the menu and the kitchen staff ordered the food. Records as to what people liked to eat were not always completed. We found only one person had completed a food choice record. All menus should be in place that is taken from peoples personal choices and preferences. During the day we looked at how staff supported people to spend their time. We did not observe any activities taking place during the day and could not locate a programme of activities that were on offer. Staff surveys returned to us included comments such as, arranging, trips or outings for residents who do not have any family and would love a trip to the shops or a park. Surveys from people living in the home had varied opinions. One person stated that there were no activities that suited them, one stated always and one stated sometimes. We spoke to people during the day who told us, more outdoor activities, and more activities we dont go out When the weather gets better will go out, just sit around and get very bored and would like to get a pub. We looked at care records available in the service there was a brief history about the person but very little information was available as to how people would like to spend their time. We asked people living in the service how they were supported to decide how to spend their days. One person told us, they come into your room and pull the covers down Care Homes for Older People Page 17 of 34 Evidence: and say its time to get up. The manager was informed of this she detailed that she had been aware of some staff encouraging people to fit in with a staff routine as apposed to their own choices. She had recently discussed this at a staff meeting. We looked at the minutes of the last meeting these showed that the manager had discussed the need to maintain peoples choices with staff. Care Homes for Older People Page 18 of 34 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. People living in the service are not all aware of how to raise concerns. Evidence: The home has a complaints policy and procedure. This is on display in the hallway with a copy available in the information given to people when they move into the service. Surveys returned from people living in the service told us that two people knew how to make a complaint and one person was not aware. When we looked at the policy we noticed that it was out of date and did not include clear information about how the service would address any concerns received. A log of complaints is maintained. This showed that there have been no complaints made since the last visit. There have also have been no complaints raised directly with the commission about this service from people living in the service. When we looked at staff minutes and observed the practice in the service there were incidents that could have been logged as a complaint but staff were dealing with this directly and not recording these as a potential concern. It is good practice to log and investigate any concerns as it supports the manager to monitor the quality of the service and address any concerns rapidly. An adult protection policy and procedure is in place. We spoke to staff about their understanding of concerns of this nature. Staff had a clear understanding of whose role and responsibility it was to deal with concerns of this nature. A policy is also available from Social Service for the service to refer to. When we looked at the AQAA for this section that is meant to detail what the service feels they cold do better with complaints we noted that this section had not be completed. As such the service Care Homes for Older People Page 19 of 34 Evidence: had not told us what actions it thinks can be improved on to deal with complaints. We noticed that the homes own policy was out of date and did not show how concerns of this nature would be managed within the service. We looked at how staff were recruited in order to safeguard the people living in the service. We noticed that staff were not recruited in a manner that maintained the safety of people living in the service. Staff spoken with detailed training in dealing with serious concerns and records showed that staff had last received training in this area in January 2009. The manager informed us that she plans that all staff will receive a renew of this training in the near future. Care Homes for Older People Page 20 of 34 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. Whitestone is a well presented home that is clean and tidy. There are maintenance areas within the service that need to be addressed in order to maintain the safety of people living in the service. Evidence: Whitestone Lodge is a two storey house situated in well presented grounds. The home is located approximately 1/2 mile from Huyton Town Centre and is well served by public transport. There is car parking available at the front of the building. Within the service is a television lounge and a large lounge/dining area. We looked around the service and noticed that is was decorated in a style in keeping with peoples own homes. Surveys returned to us stated that, Whitestone lodge is a bright clean and very cheerful care home. Staff comments were, clean home. The service has a cleaning staff available and on viewing the service we noticed that it was generally clean and tidy. The service is a no smoking building this information is not reflected in the services service users guide which is used by people to help them decide if they wish to live in Whitestone Lodge. We looked at how the fire safety was maintained and noticed that a significant number of bedroom fire doors were wedged open and a number of the fire doors failed to correctly close. Ineffective fire doors increase any risk to people living in the service in Care Homes for Older People Page 21 of 34 Evidence: the event of a fire. We noticed that creams which are a prescribed medication were not safely maintained within a lockable space and in one case the cream for one person was in the bedroom of a different person. This places both individuals at risk. One person told us how the mobile hoist was stored in her room. Staff were observed to enter the persons bedroom to retrieve the hoist. We could find no explanation in discuss with staff as to why the hoist was stored in the persons bedroom. Effective storage for people medications and equipment used by all is not in use. A recently incident had meant that overnight an individual had been able to leave the building into the garden without staff being aware of this. The manager told us that all but the door the person used were alarmed. She believed that this door needed to be alarmed not only to prevent people getting out without staff knowing but also to prevent other people gaining access. We looked at how the prevention of the spread of infection was managed. Of the four staffing records viewed for staff we could find one person had received training preventing the spread of infection in the last three years. Observations showed that gloves and plastic aprons were available in the service for staff to use. Staff were observed to use these appropriately during mealtimes. One of the bathrooms was marked out of order. People living in the service and staff told us that this had been out of order for some months. We discussed this with the manager and there was no plans in place to repair this bathroom. There is a single bath and shower available in the service. There is presently thirteen people living in the service. When the service has more people living there the bathrooms available may not be sufficient to meet peoples needs. The AQAA informed us that further redecoration was planned for bedrooms currently not occupied. There was no formal action plan available for refurbishment of areas of the service. When we looked at bedrooms we noticed that the majority were well maintained and personalised with peoples own items making them much more homely in appearance. People spoken with told us that they were supported to bring in their own items to Whitestone Lodge. Care Homes for Older People Page 22 of 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment and training is not sufficient to meet the assessed needs of people living in the service. Evidence: We spoke to people living in the service and staff all agreed that there was enough staff working in the service. Care staff also undertake some additional duties such as kitchen duties in the evening and laundry duties during the day. The service has cleaning staff additional to the care staff available. As staff give out food in the evenings and undertake some minor cooking duties we looked to see if they had received up to date food hygiene training. The AQAA for the service told us that all care staff had received food hygiene training. When we looked at staff records of the four records we looked at we could find a record that one person had received training in food hygiene. We looked at the training that staff had undertaken in the last 12 months and found that records were not clear as to what training staff had received this included fire safety, food hygiene, infection control and safeguarding training. Staff spoken with thought that they had undertaken this training. We received surveys from staff and people living in the service. Staff surveys told us that they thought that they received suitable training and support one person commented some of the carers could be more tolerant. We spoke to people living in the service on the day we visited who told Care Homes for Older People Page 23 of 34 Evidence: us, staff are really nice the odd one or two would be difficult on the whole the jolly good, I prefer the mature ones the new kids think they know all. The majority staff are okay one or two are awkward they are too young and they dont know what they are doing and They dont seem to be trained properly. All staff need training that supports them to develop the skills that they need to undertake their job role. As part of their training staff need to have an induction we looked at the inductions for staff working in the service. We noticed that these were a checklist and did not always include the full training needed to be in place before the person started working in the service. One person was working in the home without an induction. Staff need to have an induction that trains them in meeting the needs of people living in the service. The AQAA for the service told us that, All recruitment is now the sole responsibility of the Homes Manager and the properly written procedure rigidly adhered to. We looked at staff files that showed how staff were recruited. Of the files we looked at none had full checks in place such as two valid working references, police check and any gaps in working history explored. One member of staff had references that indicated an issue of concern and had started work prior to the police check being in place. There was no determination of any risk or any plans to reduce any possible risks. Another member of staff was due to work in the service without references and a full working history. A further member of staff had an overseas passport, the service had not made any checks to determine if they were able to work in the United Kingdom. The lack of proper checks on staff places people living in the service at risk. Staff meetings take place on a three monthly basis and these are recorded. We were shown copies of the staff minutes. Staff surveys told s that they thought that they were well supported and were proud to work in Whitestone Lodge. They told us that they thought that they were a good team who works well together. Care Homes for Older People Page 24 of 34 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. The manager and staff have undertaken to improve issues highlighted from previous visits. Other areas in need of improvement have not been identified and addressed. Evidence: The manager has achieved a Level 4 National Vocational Qualification (N.V.Q) and the Registered Managers Award. She has been the manager for several years and regularly works approximately 55 hours a week. The manager told us that she does the majority of tasks in the service such as writing care plan and updating the care plans. All the care plans viewed had been signed by the manager all had not been reviewed since January 2010 and were not accurate and up to date. Surveys from staff were mixed told us that manager give support. Three staff said regularly, two said often and two said sometimes. Staff comments were generally positive and included comments such as excellent manager who gives 100 percent. We looked at how the service monitored and improved the quality of the service. The AQAA for the service stated Because we involve families in our search for feedback Care Homes for Older People Page 25 of 34 Evidence: and quality monitoring we receive constructive criticism that we can act upon and they appreciate that we are doing our ever improving best for their relative. We were given copies of surveys sent to relatives and people living in the service these were dated 2007 and there was no evidence that this quality assurance survey has been recently repeated. Audits in the service were not available such as recruitment, care planning, environment and accidents. We looked at the accident records for the last 6 months and noticed that there have been thirty five accidents. One person had fallen seven times in that period and there was no falls risk assessment in their file that showed that this had been recognised or what actions the service had taken to reduce any risks. Auditing areas in the service such as accidents will help identify areas of that can be improved and helps provide the opportunity for staff to take preventative action. The owners of the home attend the service daily and also have a responsibility for checking on the quality we could find no written reports from them that detailed what they had done to monitor the quality of the service and the performance of the manager to maintain quality. The AQAA for the service told us that in the last 12 months there has been, three admissions to hospital and sadly four people have died. When we looked at our records we noticed that we have been informed of one persons death and none of the admissions to hospital. The service needs to inform the commission of all incidents detrimental to the health and welfare of people living in the home. This includes injury to people living in the service, death and admission to hospital. We also noticed that an accident record detailed an incident when one person living in the service struck another we had not been notified of this incident nor had social services. Incidents when one person living in the home hits another are considered to be potential adult protection and should be report to social services to determine if further support is needed. A random sample of staff files were looked at in order to assess the frequency of supervision meetings. The records showed that some staff have been provided with supervision whilst others have had not received any in the last 12 months. Staff need to have regular supervision in order to identify the strengths and weaknesses and support them to develop and maintain their skills to undertake their job role. The manager told us that people who live in the home have the opportunity to manage their own money when appropriate and in line with their wishes. As with previous visits this records could not be produced as the manager has no input. As such it is not possible for the manager to act as an advocate on behalf of the people living in the service or for the commission to review the arrangements for managing peoples Care Homes for Older People Page 26 of 34 Evidence: personal allowances. Risk assessments for the environment such as fire safety had not been updated for three years and practice observed within the home during the visit showed that peoples safety regarding fire was being placed at risk. The service had an enforcement notice in place following previous visits. This was in relation to medications. This visit showed that the manager and the staff team had taken action to meet this breach in regulations and had made sure that medications were now safely managed. Care Homes for Older People Page 27 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 (1) (2) (b) The health and personal care 05/07/2008 of the resident must be recorded in a plan of care. This will ensure staff are aware of their current needs and will provide the necessary care and support. 15 Care plans must include an appropriate level of information on the persons support with their individual needs. So as to ensure care staff are aware of the persons needs and how to meet these. 20/07/2009 2 7 Care Homes for Older People Page 28 of 34 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 3 14 Accommodation in the 31/03/2010 service can only be provided following an assessment that identifies peoples needs. In order to make sure that the service can meet peoples needs before they move in. 2 7 15 Care records for a people need to have sufficient information to support staff to meet peoples individula needs. Care plans need to be up to date and accurate. The failure to provide accurate and up to date instructions to staff may have a detrimental impact on the health and welfare of the people living at Whitestone Lodge. 23/04/2010 3 12 16 The services needs to consult service users about their social interests, the 25/06/2010 Care Homes for Older People Page 29 of 34 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 programme of activities arranged by or on behalf of the care home. Provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation and fitness. Provide suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by service users. In order to meet peoples personal choices preferences and needs. 4 19 19 The manager needs to contact the local authority for advice on the safe methods to keep fire doors open. All fire doors need to be checked to make sure that they are working correctly. In order to maintain the safety of people living in the service. 5 27 18 The service needs to make sure that the staff employed by the registered person to work at the care home receive training appropriate 23/04/2010 29/04/2010 Care Homes for Older People Page 30 of 34 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 to the work they are to perform. In order to make sure that staff have the skills to support the people that live in the home. 6 29 19 The service needs to make 31/03/2010 sure that they do not employ a person to work at the care home unless the person is fit to work at the care home. That all checks including relevant and validated references, past history, police checks are in place before the start working. Were staff are from overseas the service needs to check that they are legally entitled to work in the united kingdom including any relevant work permits In order to make sure that people living in the service have their safety maintained. 7 38 36 All incidents detrimental to the health and welfare of people living in the service need to be reported to the commission. In order to monitor the quality of the service provided. 22/04/2010 Care Homes for Older People Page 31 of 34 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 1 Review the format that information is provided. These needs to be in a manner to meet the assessed needs of people wishing to move into the service. Make sure that peoples up to date medical needs such as medications are checked before they move into Whitestone Lodge. Where medicines are prescribed when required and external preparations such as creams there should be information for staff on how to give these to meet the persons need. Where people choose to manage their own medications these needs to be a clear plan and instructions as to how to reduce any potential risks. The times that medicines are administered should be monitored to help make sure they are given at the right and best times for people living in the home. Where staff are required to support people with their medication, their medication needs to be confirmed as soon as possible on admission to the home. 2 3 3 9 4 12 Information to people living in the service such as menus and what support is available to provide a stimulating lifestyle needs to be made available in formats that meets the needs of people living in the service. Policies and procedure that inform people living in the service and staff on how to deal with any concerns would benefit from being updated to reflect changes is recent law. Review the security arrangements of the building. Repair to out of order bathroom. Keep training records up to date and develop a plan that highlights training that meets the assessed needs of people living in the service. Quality assurance systems that audit aspects of the service need to be increased. The provider needs to have a written record of their visits to help inform the manager of areas of improvement. Policies and procedures that are three years out of date need to up dated in order to provide staff with Page 32 of 34 5 16 6 7 8 19 21 29 9 33 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 clear guidance. 10 35 The financial records of peoples personal allowances need to be available for review. By the manager and by the commission. Risk assessments that are inaccurate or out of date need to be updated to maintain the safety of people living in the service. 11 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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