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Inspection on 11/11/09 for Colton Lodges Nursing Home

Also see our care home review for Colton Lodges Nursing Home for more information

This is the latest available inspection report for this service, carried out on 11th November 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living in the home are provided with care plans and risk assessments that are robust and person centred in their approach. They are informative and contain the necessary detail needed to ensure staff are informed as to how they should meet people`s care needs. People were dressed in a dignified way. They looked clean and tidy, their hair was neat and all had some form of footwear. We observed staff being caring and respectful to people when carrying out their basic care needs. The medication administration and recording systems help ensure people are properly protected. All care staff are now employed following a robust recruitment process. Robust policies and procedure for the smooth running of the home are in place and reviewed regularly. Good Quality Assurance tools are in place to assist the manager with maintaining and improving the care provided within the home.

What has improved since the last inspection?

The care plans and risk assessments are now reviewed regularly and action is now quickly taken to respond to highlighted risks such as pressure area damage. Staff now take quick action to provide the necessary equipment and care needed when a person is identified as being at risk of pressure area damage. Care plans and risk assessments are reviewed regularly to reflect changes in people`s care needs. This helps to ensure staff are aware of individual care needs for people living in the home. New activities have been introduced that are relevant to people who have dementia. These have produced some positive outcomes for people who live in the home. The recruitment process is now robust to ensure people are properly protected. Complaints are now being investigated following the internal procedures and this is providing people with renewed confidence in the management team. Safeguarding incidents are now being correctly identified and referred following internal and external guidelines. This helps protect people living in the home. Regulation 26 visits are now completed and are more robust. A Regulation 26 visit is a quality monitoring tool that a Responsible Individual must complete on a monthly basis. Auditing of pressure area care is now in place and monitored regularly.

What the care home could do better:

More evidence is needed in the care planning and risk assessments to show people or their representatives are involved with consenting to their care. People living in the care home must receive a package of care that does not compromise their privacy or dignity at any time. Staff must be more aware of people`s personal needs during meal times. This will help ensure people receive a well balanced diet and that there dignity is not compromised. Alternative methods to promote should be used in the dementia unit when meals are being offered. A more structured programme of activity should be implemented throughout all the units of the home. This will improve the wellbeing of people who live there. Improvement is needed in relation to the cleanliness of the home. We found a number of concerns such as dirty mattresses, walls and floors that compromised dignity and highlighted potential infection control risks. People who use the service are still concerned about staffing levels not being appropriate in the home. This was in particular relation to enough staff being available to help with personal toileting needs. These must be reviewed to ensure there are enough staff on duty to meet people`s care needs.

Key inspection report Care homes for older people Name: Address: Colton Lodges Nursing Home 2 Northwood Gardens Leeds Yorkshire LS15 9HH     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: Sean Cassidy     Date: 1 2 1 1 2 0 0 9 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 33 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Colton Lodges Nursing Home 2 Northwood Gardens Leeds Yorkshire LS15 9HH 01132645288 01132326676 brownch@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 138 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Colton Lodges is in a residential area of Colton, close to local amenities and public transport routes. There is a car park to the front of the home and gardens are accessible to people who use the service. The home is registered as a care home with nursing for 138 older people. Three places are registered for people with a physical disability who are under pensionable age. Colton Lodges is purpose built comprising of four bungalows- Newsam, Garforth, Whitkirk and Elmet, each accommodating 30 people. Newsam provides nursing care for older people with dementia. Each bungalow provides single rooms, a communal lounge and dining area and three communal bathrooms. There is level access throughout the bungalows. Kitchen and laundry facilities are located centrally, although each unit has its own kitchenette for making drinks and light snacks. The fees charged by the care home at the time of the inspection were GBP463.89- GBP825.00. Care Homes for Older People Page 4 of 33 Over 65 0 110 38 0 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 quality rating for this service is One Star Adequate Service. This means the people who use this service experience adequate quality outcomes. The accumulated evidence in this report has included: A review of the information held on the homes file since the last inspection. Information obtained from people who use the service, relatives, staff and other health care professionals. Two Inspectors and an Expert by Experience conducted an unannounced visit to the home and it lasted two days. An Expert by Experience is a person, who because of their shared experience of using services or ways of communicating, visits with an inspector to help them get a picture of what it is like to live in a service. Care Homes for Older People Page 5 of 33 Garforth Unit has been closed until further notice. We did visit this unit to ensure no care was being provided. We inspected all remaining units, Elmet, Newsam and Whitkirk. The majority of time was spent speaking to people who live in the home, management, staff and relatives. A number of documents were looked at and some areas of the home used by the people living there. The information required from the service in the form of the Annual Quality Assurance Assessment (AQAA) was obtained before this report was written. Feedback was provided at the end of the inspection to various members of the homes management team. This home is currently undergoing a safeguarding investigation that started at the beginning of April. This was brought about after concerns were raised about the standard of care in certain areas provided at the home. The investigation involves all the health and social care professionals involved with the service. The West Yorkshire Police and the Coroners Office are also involved. The Care Quality Commission asked Bupa not to admit any more people. The commissioning department of Leeds Social Services have informed Bupa that they will not be placing any people in the home until further notice. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? The care plans and risk assessments are now reviewed regularly and action is now quickly taken to respond to highlighted risks such as pressure area damage. Staff now take quick action to provide the necessary equipment and care needed when a person is identified as being at risk of pressure area damage. Care plans and risk assessments are reviewed regularly to reflect changes in peoples care needs. This helps to ensure staff are aware of individual care needs for people living in the home. New activities have been introduced that are relevant to people who have dementia. These have produced some positive outcomes for people who live in the home. The recruitment process is now robust to ensure people are properly protected. Complaints are now being investigated following the internal procedures and this is providing people with renewed confidence in the management team. Safeguarding incidents are now being correctly identified and referred following internal and external guidelines. This helps protect people living in the home. Regulation 26 visits are now completed and are more robust. A Regulation 26 visit is a quality monitoring tool that a Responsible Individual must complete on a monthly basis. Auditing of pressure area care is now in place and monitored regularly. Care Homes for Older People Page 7 of 33 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 33 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 9 of 33 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. People are provided with up to date information about the service before they move in. The pre assessment documentation used by the home allows the assessor to ensure they can meet the needs of each individual prior to moving in. Evidence: The Statement of Purpose (SOP) and Service User Guide (SUG) have been reviewed to reflect the changes to the the management structure within the home. The SOP is available at the main entrance of the home and a copy is also provided on request. The SUG is available in peoples bedrooms and this was evidenced during the inspection. At the previous key inspection we identified a number of areas where peoples needs were not being met by the home. There were also a high number of safeguarding Care Homes for Older People Page 10 of 33 Evidence: concerns being investigated by the local authority safeguarding team. We requested that the home stop admitting new admissions to the service until we assessed that improvement had been made in the areas identified. They have complied with this request and there have been no new admissions. There is an admission policy in place that includes action that must be taken following an emergency admission to the home. The preadmission documentation is thorough and previous completed admission documentation showed staff completed these documents thoroughly. This helps ensure staff are assured that they are able to meet individuals needs in the home. Several people spoken with said they or their family were able to visit and look around the home before making a choice to move in. My son and his wife talked to the manager, looked around and told me I would like it,and I do. Care Homes for Older People Page 11 of 33 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. People are provided with care plans and risk assessments that assist staff with ensuring the daily care needs are met. More involvement of the individual or their representative is needed to show the consent has been gained. More work is needed to ensure staff actively promote the privacy and dignity of all people living in the home. Evidence: The documentation used to risk assess and plan peoples care is called Quest. This document is very thorough, substantive and informative. We inspected the care documentation for twelve people living in the home. All the records we looked at were up to date and gave clear information about how to look after people properly. In individual bedrooms there we saw single page documents Resident information at a glance. These gave a quick prompt for staff about essential areas of care, such as the correct mattress setting for the specialist mattress and the equipment and number of staff needed to safely move someone. These documents were written in a person centred way and staff said they found them useful. Care Homes for Older People Page 12 of 33 Evidence: We identified that a range of risk assessments are completed for people, for example, the risk of skin damage and nutritional risk. We saw that risk assessments were reviewed and updated regularly. When risk is identified care plans provided detail of how the risk should be managed. One person had skin damage and due to their condition was at great risk of developing further damage. The home had sought the advice of the tissue viability nurse to manage this care need. Records showed detail of the type of dressing being used and the progress of the wounds as well as how other risk areas were being managed. There was a turn chart in this persons room which showed that position changes were being done as planned every 3hours. Health professionals who visit Colton Lodges were contacted about their views in relation to care practice n the home. They told us: Initial Quest assessment and care plans are comprehensive.. There appears to be a higher awareness of the need for reviewing pressure relief equipment. Updating of care plans to ensure changes in care need are clearly recognised and addressed. Responses to to changes in care needs that require the referral to other health care professionals could be more timely in some cases. Care plans need to be regularly updated to reflect the recommendations of outside professionals. We assessed that the people living on Elmet were highly dependant with several people being nursed in bed and a great number of people being completely dependant on staff. People needed a great deal of support with their nutritional needs but only a small number of people were having food diaries recorded. Following discussion with senior staff we were reassured that there are sound monitoring systems in place and staff are vigilant in reporting if people do not eat. In the records were looked at we saw that people were weighed regularly and that weights were steady and being maintained. However, it was agreed that the detail in daily records would be reviewed to make sure that there was enough detail recorded about what people ate on a daily basis. The care documentation in Newsam unit showed evidence that improvement in care planning and risk assessment has taken place.The care plans seen were informative and written in a person centred approach. Staff spoken to said they are now more Care Homes for Older People Page 13 of 33 Evidence: involved with recording information in the care planning. There was little evidence seen that showed people or their representatives are involved with the development of the care plans and risk assessments which indicates that there is a lack of obtaining consent to the care package provided. People were dressed in a dignified way. They looked clean and tidy, their hair was neat and all had some form of footwear. We observed staff being caring and respectful to people when carrying out their basic care needs. Positive comments were received from relatives regarding the helpful and caring nature of the staff, but the relatives also said that there was never enough staff to give everyone equal attention. Staff were observed using good practice handling techniques. Although on one occasion a person who had been asleep for sometime was moved from his chair by hoist by two carers and transferred to wheelchair. This task was carried out quietly and respectfully to that person, but with no dialogue. We observed poor practice in relation to ensuring peoples personal care needs were being met. On several occasions people were calling on staff to assist them with the toilet but there were not enough staff on duty to manage these requests which caused some unnecessary stress to those people.Three relatives spoken to said that there were times of the day, mainly afternoons, where the staffing levels were not enough to assist people with their personal toileting needs. We received more comments in relation to this problem in the surveys returned by people. They said: When needing the toilet, ask staff to take me instead of leaving me for long periods of time. If the staff are busy on my side the low-side staff wont come and help to toilet. When i need the toilet sometimes Im asked to wait and sometimes it could be up to forty five minutes. The following are some relatives comments about the care provision in the home: People look cleaner now They always manage to dress mum in her own clothes, for which Im grateful Care Homes for Older People Page 14 of 33 Evidence: There are not enough staff to care for the difficult cases The staff are always helpful Some of the staff go out of their way to help you Things seem to have settled down, there are some good staff People are not changed often enough (referring to toileting) People dont get enough help at mealtimes, and then their food goes cold There have been a number of medication errors reported to us during the past six months. We looked at the reporting of these errors and the investigations taken by the provider. The evidence showed the investigations were managed appropriately and action taken to reduce further risk was taken. The medication charts looked at showed medication is recorded and administered safely. Regular medication audits are carried out weekly. This is good practice. Care Homes for Older People Page 15 of 33 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. People are supported to maintain links with family and friends at all times. The visiting times are flexible and help support these contacts. Peoples interests are assessed when they are admitted into the service and their involvement with various activities are generally well recorded in the care documents. Not all people living in the service are well supported to maintain their dignity when meals are provided. Evidence: The provider told us in the Annual Quality Assurance Assessment (AQAA) document that they: a) They ensure that all Personal Plans are individual and based on the choices and preferences of the residents. b) We encourage the personalisation of a residents personal space, giving somewhere they can really feel at home. c) The have developed our menus to allow for resident choice and preferences. Care Homes for Older People Page 16 of 33 Evidence: d) They employ an open visiting policy, taking into account residents wishes. e)The menu master helps ensure every menu within the home is customer led and nutritionally balanced. f) We have a structured activities programme, with dedicated activities organisers and they encourage a weekend activities programme. The Newsam unit had an activities programme displayed for people to look at. The environment of this dementia unit has been visually adapted to include pictures and photographs of Leeds as it was in the 40s and 50s. There are also framed pictures of film stars from that era. Memory boxes are placed outside peoples doors as well as pictures of themselves to try and assist those people identify their own rooms. This is good practice. We spoke to the new activity person for this specialist dementia unit. He works thirty hours a week. He has introduced one to one therapy sessions and group sessions that include reminiscence therapy and introduction of doll therapy. Some people were observed interacting with such things as cuddly toys, a large toy dog, baby dolls and a full size pram, they looked comfortable and happy. This appeared to satisfy their need for something to hold or touch. We found evidence in the care plans that showed peoples social activity needs are assessed at admission and that there are records in place that showed these are assessed regularly and records are kept to show what activities people have been involved with during the day.He was pleased to report that he is now employed solely for the activities in this unit. This is good practice. This will enable familiarity and continuity for the people in Newsam. The activity co ordinator was very enthusiastic about his role in providing the right activities for people with dementia. For the people there he is collating items that had some significance in their lives. For example, boxing gloves, ballet shoes, golf clubs the golf club will be used reminiscence therapy for specific people in the home. This is good practice. On our arrival on Elmet people were watching the the Remembrance Day Service on the television. During the afternoon the activities organiser arrived and we saw her encouraging people on an individual basis with occupations such as knitting or reading. We spoke with the activities person who told us that people living on Elmet enjoyed music and films and that it was generally quite a quiet house. The activities programme was displayed and we saw a fairly limited range of options for people such Care Homes for Older People Page 17 of 33 Evidence: as a quiz, dominoes, skittles, discussion, Sunday papers. Generally staff had a good rapport with the people they were looking after and the atmosphere was quiet and relaxed. One person said, The activities organiser is good she tries to get us involved in things Although peoples social interests are assessed at the beginning of their stay at the home, their was not a lot of evidence to show what activities people have been involved in. Some staff interaction with people was very positive. During the inspection in Newsam we observed an afternoon group therapy that took place in the lounge. This involved around eleven people who live in the home. It started out quite calmly but later started to get quite rowdy and later two people became quite aggressive with one and other. Staff were not available to assist the activity co ordinator due to the fact that they were involved in other tasks around the home. It is important that all activities are appropriately monitored and supported with the correct numbers of staff to ensure safety at all times People who use the service sent us comments in the surveys we sent them. Some examples of those are: Activities could have a lot more games and other items to do as well as entertainment and more trips out. More activities needed to keep residents active. The activity co ordinator only works Monday to Friday. Nothing happens over the weekend. The people who us the service said they can have visitors at any time. The home provides meals that cooked on site. These are sent over to each unit in hot trolleys and are plated up and served in the units. The menus were displayed on tables in Garforth and they reflected the food that was being offered for that meal. A larger menu board is displayed on the wall that can be read by people if they wish. One family member told us , They asked me what food mum likes and we told them. We are encouraged to take in food to help build mum up. She always gets the food she likes incorporated into her diet and thats great. Care Homes for Older People Page 18 of 33 Evidence: In Whitkirk, some people complained about the changes made to meal times. They said they were not consulted about the change. The management team confirmed that consultation did take place to implement this change. They added that they would revisit this with people and their families. Two people said I fell asleep, no one came to my room to ask if I needed a meal. When I did wake all the meals had gone. I missed a few meals since Ive been here. The only thing left was a sandwich which i dont like. The staff at the service must ensure that there is a robust system in place for ensuring meals are provided to everyone at meal times. At meal times in two units we observed a significant number of people who have communication difficulties and staff did not always respond to this appropriately. Examples of this were, one person who could not easily communicate was sleeping before lunch and a member of staff put a protective plastic apron over his head without waking him first or talking to him when he woke startled. Another carer walked up to a person with the hoist to move them to the table and did not explain what she was going to do. The staff members who were serving were polite and friendly. However, although people were being polite during assisting people with meals there was little communication observed throughout the care task. Two other carers were giving out the morning refreshments and biscuits very late in the morning this seemed rather late and close to lunchtime at 12:PM. This late snack could possibly have an effect on how much an individual eats for their lunch and it is recommended that the snacks be provided much earlier in the morning.The staff were displaying good communication skills and were observed talking to people at eye level and explaining what they were doing. An identified concern was that once the people had been given their drinks they were not supervised, as the carers had to move on to the next person. Three people were observed struggling to drink the hot drink from the cups and one person spilt one down herself, another lady couldnt reach the biscuits. We were able to observe the lunchtime meal in Newsam. Some people stayed in their lounge chairs who were unable or did not want to eat in the dining area. Two relatives were present helping their relative to eat their food. One person at a table was being fed by a carer who was caring and respectful to the persons needs. We observed that some people were not given any choice of their meal. Some people were asked their choice but were not given adequate time to decide and food was then placed in front Care Homes for Older People Page 19 of 33 Evidence: of them. More appropriate ways of identifying and explaining the dish of the day should be introduced so that choice is seen as being promoted. Examples of this could be showing people plated meals or pictures of food. We observed one person being given a small sandwich to eat. She became distracted and walked out of the dining room. When she returned, a member of staff who was unaware that she had previously been sat at a table took her to another table and gave her some ice cream. This person did not like it saying it was too cold and left the table again to go out of the room. Staff should be more observant during meal times to ensure they are aware of what people have eaten. One person was having difficulty in eating pasta with his knife. Another person was given her food with no choice and left to get on with it. Once or twice a member of staff would prompt her to eat it, but this person lost concentration with what she was eating. We also spoke with a relative who said her mother was eating a liquidised meal not because she had a swallowing problem but because it was easier for staff to get her to eat. This compromises her dignity and is poor practice. Jugs were on each table containing blackcurrant and bitter lemon juices. Care Homes for Older People Page 20 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes safeguarding of vulnerable people seriously. Systems are in place to ensure safeguarding incidents are correctly reported and investigated. The management team work closely with the local authority safeguarding team to ensure safeguarding incidents are correctly managed. Evidence: The home has a complaint procedure which is included in the SOP and SUG as well as being displayed around each unit. People told us that the staff were approachable and that they were quick to respond to their concerns. People said they knew how to complain and who to go to to complain formally. Three relatives spoken to said that they have seen positive changes since the new management team have taken over. They all said that they are not yet confident in the complaint procedure of the home. These concerns were relayed to the management team and the relatives were encouraged to use the complaint process. The manager holds regular surgeries for people to approach her to speak about any issues that are concerning them. This is good practice. The manager provided evidence that showed there is a safeguarding policy and procedure that assists staff with ensuring that people who live in the home are protected. This also includes a whistle blowing policy. Care Homes for Older People Page 21 of 33 Evidence: There have been several safeguarding referrals made since the last key inspection at the home and many of these are still being investigated by the safeguarding team. The manager works closely with the safeguarding team and has improved the internal reporting and management of safeguarding incidents when they are identified. The staff training records showed staff receive training in safeguarding vulnerable people. We spoke to six members of staff about their understanding of the safeguarding process and their role within it. They provided us with a good understanding of their role. Care Homes for Older People Page 22 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that meets their needs and promotes well being. More attention must be given to ensuring the standard of cleanliness in the home is improved and maintained. Evidence: The layout of the home was designed so that all bedrooms are on the ground floor. Each of the four units have ample dining and lounge facilities for people and their relatives to use when they wish. There is an ongoing refurbishment programme for the home which ensures the environment is improved continually. Newsam House has ample space for people with dementia to wander if they wish to. The corridors have pictures in place that can assist people with reminiscence therapy. These included old pictures of Leeds and old Films and stars. Memory boxes are also in place outside peoples bedrooms that include pictures of themselves and family members and events. This is good practice. People told us that there are domestics working regularly throughout the day and that they work hard to keep the home clean. Five people we spoke to said they thought there had been a general improvement in the overall standard of cleanliness. Care Homes for Older People Page 23 of 33 Evidence: The second lounge also has dining tables and chairs. This is used for special occasions and for group activities. These lounges were clean and bright. The main lounge had access to the gardens. The areas were secure for people to walk outside. This was beneficial for people living there; they could experience fresh air and the outdoors safely. There was some improvement to the garden areas, but these were still in need of attention to achieve a pleasant outlook for people. The specially adapted bathrooms were clean and to take away some of their clinical appearance, bright and cheerful picture scenes had recently been introduced and these had been prominently placed on the walls for the service user to notice when bathing. One of the domestics with an industrial machine was walking round the unit spraying air freshener onto the carpets. We spoke with three relatives and these were their comments: The place smells a lot better these days They keep spraying the carpets, so that helps a lot The smell seems to be worse at the weekends When I do visit, it seems a better atmosphere During our random tour of the premises we identified a number of concerns that raised issue with infection control, hygiene and the dignity of people who live in the home. We found: - A Mattress was placed at the side of a persons bed with what looked liked stains that appeared to be bodily fluids. - A Duvet was stuck in the bottom of a persons wardrobe and had bodily fluid stains on it. - Two rooms had dirty walls. These appeared to be old stains and should have been identified and cleaned. - Duvet covers missing from duvets. Pillow case covers were missing from pillows. -Two bedroom floors were dirty and both bedrooms had a number of picture hooks around the room walls, but were devoid of any pictures. Care Homes for Older People Page 24 of 33 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 good 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 home are protected by a the implementation of a robust recruitment procedure. Staff are provided with a training programme that helps support them with meeting the needs of the people who live in the home. There is a need for the staffing levels to be reviewed to ensure peoples care needs are appropriately met. Evidence: We observed the staff working in the home over the course of the inspection. We found evidence that showed staff worked hard to ensure the care needs of the people living in the home were met. The manager provided evidence that showed they have made changes to the patterns which staff work. Staff had time to sit and chat with people and provide comfort to individuals when they appeared distressed. Communication between staff and people who live in the home was mostly positive. Relatives of people living in the specialist dementia unit, Newsam, told us that they felt more staff are on duty. However, they felt that they were not being utilised properly. Comments made included: There seems to be more staff on duty but there are many times when you cant get anyone to help. Care Homes for Older People Page 25 of 33 Evidence: There are times when people need help but there is no one available. This happens when you know people are on duty. However, we received a lot of feedback from relatives and people who live in the home that said the home does not have enough staff on duty at all times of the day to ensure peoples needs are met. The concerns were mostly relating to staff not having enough time to ensure people were taken to the toilet when they needed it or when it was part of a continence promotion regime. They told us: There is still not enough staff on duty to meet the continence needs of people over the course of the day. Mum always tells me that she is being asked to wait for long periods when she requires the toilet. There simply arent enough staff on duty to manage the personal toilet needs of peoples at certain points of the day. This is an area that the home should review to ensure staffing levels are correctly set to ensure care needs of people are met. The recruitment procedures were closely looked at during the inspection. We looked at the recruitment files of some of the newest carers recruited to the home. The files contained all the required information that showed people are properly protected by the process. We spoke to staff who told us the training offered by the home was good. they said: We are offered regular up to date training in many areas relevant to our jobs. My manager informs us of the training programme and we discuss what training i want to attend at supervision. The training offered by the home has improved over recent months. It seems to have been given more importance. The manager is committed to ensuring all staff are trained to National Vocational Qualification level 2 and above. Staff told us they are encouraged to start this training at the earliest point. Care Homes for Older People Page 26 of 33 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 home has structured and robust management systems in place that helps to assure the standard of care provided. Evidence: The manager has been in post for over eight months and has had an opportunity to assess the standard of care and make positive changes. She has all the qualifications needed to support her with managing a care home. People who live in the care home and their relatives know who the manager is and they said that she is approachable to discuss any concerns. We did receive information from people who said that they are still somewhat distrustful of the management team and that they need more time to regain confidence in them. However, they did acknowledge the positive improvements that have been made since the last inspection. The home looks after some personal monies for a significant number of people living Care Homes for Older People Page 27 of 33 Evidence: there. Receipts are kept for all transactions that are made and they receive interest on the money the home keeps for them. The AQAA clearly indicated that the home has robust systems in place for regularly monitoring and maintaining the health and safety of people and the environment. The quality assurance systems implemented by the organisation are robust and are implemented in lines with the organisations guidelines. The home is required to perform monthly Regulation 26 visits that monitor the quality standards of the home. At the last key inspection we asked the service to send these to us which they have done. They showed evidence that the Responsible Individual for the organisation was regularly checking the quality of the care provided and making recommendations for improvement. However, these quality assessments are not picking up on the concerns that we have identified in this report and it is recommended that the organisation reviews how they perform these vists so that poor practice can be identified and acted upon quickly. The systems in place to monitor the health and safety systems within the home are robust. Care Homes for Older People Page 28 of 33 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) The care plans and risk 31/07/2010 assessments must provide evidence to show, where possible, people living in the home or their representatives have been involved with developing the care plans and risk assessments. This will ensure agreement to provide the care package has been gained. 2 10 12(4)(a) People living in the care 31/07/2010 home must receive a package of care that does not compromise their privacy or dignity at any time. Care Homes for Older People Page 29 of 33 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 7 12 Evidence must be in place to 28/02/2010 show that people or their representatives are involved with developing their care plans and risk assessments. This will provide evidence that people are involved with consenting to their care. 2 10 12 People living in the care home must receive a package of care that does not compromise their privacy or dignity at any time. This will promote wellbeing. 28/02/2010 3 15 12 People who use the service should receive the appropriate support with eating meals and snacks. This will hel ensure their privacy and dignity is promoted. 28/02/2010 Care Homes for Older People Page 30 of 33 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 4 26 23 All areas of the home must be well maintained and kept clean. This will ensure people live in an environment that meets their needs. 28/02/2010 5 27 18 The numbers of staff allocated to work in each unit must be appropriate in relation to the care needs of the people who live there. This will ensure peoples care needs will be met. 28/02/2010 6 31 24 The management systems for assessing and improving the quality of care provision in the home must be improved to ensure peoples privacy and dignity needs are met. This will improve wellbeing of people who live there. 31/03/2010 7 33 26 The Regulation 26 visits must be reviewed to ensure they are robust and identify poor practices within the service. This will help protect people who live in the home and improve the standard of care. 31/03/2010 Care Homes for Older People Page 31 of 33 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 Care Homes for Older People Page 32 of 33 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). 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