Inspection on 23/06/09 for Gordon Lodge Nursing Home

This is the latest available inspection report for this service, carried out on 23rd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gordon Lodge Nursing Home 31/10/06

Gordon Lodge Nursing Home 18/01/06

Gordon Lodge Nursing Home 22/09/05

Gordon Lodge Nursing Home 28/02/05

Gordon Lodge Nursing Home 08/09/04

Gordon Lodge Nursing Home 09/03/04

Gordon Lodge Nursing Home 24/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gordon Lodge Nursing Home 102 Gordon Road Ealing London W13 8PS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 0 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: Gordon Lodge Nursing Home 102 Gordon Road Ealing London W13 8PS 02089978967 02089973548 gordonlodge-home@hotmail.com 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) : Mrs Maudlyn Cecilia Andall care home 17 Number of places (if applicable): Under 65 Over 65 0 0 17 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 17 17 0 17 Service Users to indicate up to 7 MD(E)`s and up to 17 Service Users in total Date of last inspection Brief description of the care home Gordon Lodge Nursing Home is registered to provide care for seventeen service users. It is a stand alone home in an attractive, detached house in West Ealing close to the local amenities in West Ealing and Ealing Broadway. The home provides a warm and comfortable environment consisting of five single and six double bedrooms. There are bath and new shower and wet room facilities. The home has a passenger lift. Hand washing facilities are available in each service users bedroom. The home has a medium sized lounge and dining area with an attached Victorian conservatory. There is an attractive garden to the rear of the building that can be accessed via the conservatory. The fees range from £550 to £650 per week. Care Homes for Older People Page 4 of 26 1 9 0 7 2 0 0 7 Care Homes for Older People Page 5 of 26 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: two star good 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: This was an unannounced inspection carried out as part of the regulatory process. A total of 8 hours was spent on the inspection process. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents and staff were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and staff have also been used to inform this report. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 7 of 26 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 26 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 26 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. Prospective residents are assessed prior to admission to ensure that the home is able to meet their needs. Evidence: The home has a pre-admission assessment document and this is completed for all prospective residents to identify if the home is able to meet their needs. A copy of the Social Services assessment is also obtained if available, plus any additional documentation available from healthcare professionals. Prospective residents and their relatives are encouraged to visit the home prior to admission and can stay for a meal and chat to staff and residents, in order to help them make an informed decision. Care Homes for Older People Page 10 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service user plans are in place for each resident, providing staff with a picture of their needs. Healthcare needs are being met, thus helping residents to maintain optimum well-being. Medications are being managed, however some shortfalls were identified which could pose a risk to residents. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity, and recognising individuality. Work is being commenced in respect of the management of end of life care, and this needs to be progressed so that the wishes of the residents and their families are ascertained, recorded and met. Evidence: We viewed 2 service user plans. These had been well completed and were up to date, providing a good picture of each resident and their needs. There was evidence of reviews being carried out monthly and whenever there had been a significant change in a residents condition. Risk assessments for falls were in place and there had been no recent falls in the home. There was some evidence of input from residents and their representatives, and the need to ensure that all residents and, where they are not able Care Homes for Older People Page 11 of 26 Evidence: to participate, their representatives are involved in the formulation and review of the service user plan documentation was discussed. Wound care documentation was viewed. This provided a clear picture of each wound and the dressing regime to be followed. In 2 instances the wounds had healed and the documentation was amended to reflect this. Assessments for pressure sore risk, nutrition and moving and handling were in place. The home has copies the Primary Care Trust continence assessments for each resident and we recommended that they also formulate their own continence assessment for inclusion in the service user plan documentation. There is evidence of input from the GP, Community Psychiatric Nurse, Chiropodist, Optician and other healthcare professionals. We viewed the medication management for the home. There is a list of specimen staff signatures and initials, to identify who signs for each medication administration. The home uses a monitored dosage system (MDS) and the majority of medications are supplied on a 28 day cycle in blister packs. We viewed some of the medication administration records (MAR) and these had been completed for each resident, to include receipts and administration recording. Where there is a variable dose of a medication, for example, paracetamol one or two tablets, the actual number given is now being recorded. For one medication with a very specific administration instruction, the instructions were only available on one of the four boxes viewed. The Registered Manager was clear about the regime to be followed and arranged to have the instructions recorded for each resident on this medication. Some liquid medications had not been dated when opened, however in all but one instance the medication labels had a dispensing date to tally with the most recent 28 day medication cycle. The Registered Manager said she would remind all staff of the importance of dating liquid medications when opened. For one medication that often requires a combination of different tablet strengths, this had not been identified on the MAR and was addressed at the time of inspection. Also, on the first day of the inspection it was not possible to audit some boxed medications as the stock balances had not always been carried forward from the previous month. This was addressed by the second day of inspection. The controlled drugs register was viewed and 2 staff sign for each administration and the stock balances were up to date and accurate. Medications are being securely stored in the home, however the room temperature is sometimes rising above 25 degrees centigrade, which is the maximum safe temperature for medication storage. A fan was placed in the room, and the need to install an air conditioning unit was discussed. The medication fridge minimum, maximum and actual temperatures were being recorded, however it became clear that staff were unsure how to re-set the thermometer each day. The deputy manager has since shown the nursing staff how to carry out this procedure, and the fridge temperature recordings seen on the second day of inspection were within safe range. The home had 2 types of lancing devices for Care Homes for Older People Page 12 of 26 Evidence: use for blood glucose monitoring. Some in use were not those recognised for use in Care Homes and these were disposed of at the time of inspection. A box of approved lancing devices was available and the Registered Manager assured CQC that these were now being used. It was clear that effective auditing of the medication management in the home is required, which would identify any shortfalls promptly so they can be addressed. Staff were seen caring for residents in a gentle and professional manner, respecting their privacy and dignity. Residents looked well cared for and were dressed to reflect individuality. We viewed some bedrooms and these were personalised. It was clear from the comments received that the residents feel safe and well cared for at the home and that staff take a pride in their work and strive to provide the best care for the residents. There was no information regarding the wishes of the residents and their representatives in respect of health deterioration and end of life care. The importance of affording residents and their representatives the opportunity to discuss this, in order that if they have any specific wishes these can be identified, recorded and respected, was discussed. The Registered Manager explained that currently if a residents health deteriorates significantly then they are likely to be sent to hospital for management. The Deputy Manager said that he has enrolled for a bereavement course and has also been in contact with Ealing Primary Care Trust and obtained information about the Gold Standards Framework, which is specifically for palliative care management. In addition 2 of the bank registered nurses have already undertaken palliative care training and this area is to be progressed so that residents can end their days at the home if they so wish. Care Homes for Older People Page 13 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provision at the home is varied and provides something for all those who wish to participate, thus meeting the needs of each resident. The home has an open visiting policy, thus encouraging residents to maintain contact with friends and family. Information is available for advocacy services, thus ensuring each residents right to independent representation is respected. The food provision at the home is of a good standard, offering variety and choice with menus to meet the residents preferences. Evidence: The home has recruited an activities co-ordinator who has a wealth of experience in nursing and occupational therapy, to include caring for people with cognitive impairment. At the time of inspection the residents were enjoying discussing current affairs and were very animated and engaged. Other activities seen taking place included gardening and the activities co-ordinator has a wide range of activities taking place throughout the week. Residents are taken out shopping locally as they so wish. Care plans for social and leisure interests were available in most of the residents service user plans, and for people more recently admitted this is being progressed. The home has an open visiting policy and visiting is encouraged. Visitors can choose to Care Homes for Older People Page 14 of 26 Evidence: receive visitors in the communal area or in their own room, as they so wish. If visitors are going to attend the home later in the evening they are asked to ring first for security purposes. Visitors can stay overnight, especially if a loved one is unwell. The home has information about advocacy services, to include information booklets for from The Department of Health about the Deprivation of Liberty Safeguards and also Independent Mental Capacity Advocate Services. The Deputy Manager said that they are awaiting a visit from Ealing Social Services to discuss the Deprivation of Liberty Safeguards assessments. We viewed the kitchen and it was clean and tidy. Kitchen records were up to date, to include fridge and freezer temperatures and cleaning schedules. The menus are varied and offer choices at each meal. We observed the lunchtime meal and each resident had the meal of their choice, to include specific preferences, and a record of the meals is kept. Residents confirmed that they are offered a choice of meals, and it was clear that care is taken to provide each resident with meals to meet their individual preferences. Care Homes for Older People Page 15 of 26 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. There are clear procedures in place for the management of complaints and safeguarding and these are followed, thus protecting residents. Evidence: The home has a clear complaints procedure and there have been no complaints in the last 12 months. The Deputy Manager said that if a concern is raised then this is addressed promptly. Where appropriate, regular meetings are set up with residents and representatives in order to discuss any issues and resolve them. The home has policies in place for safeguarding adults, and also follows the Ealing Safeguarding Adults procedures. There have been no safeguarding issues in the last 12 months. Staff spoken to were clear to report any concerns and understood Whistle Blowing procedures. Care Homes for Older People Page 16 of 26 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. The home is being well maintained and provides a homely, clean and fresh environment for residents to live in. Infection control procedures are in place and adhered to, thus minimising the risk of infection. Evidence: We carried out a tour of the home. There was evidence of redecoration and refurbishment, to include newly installed shower and wet room facilities and new armchairs and bedside tables. Bedrooms had been personalised and residents are encouraged to bring in personal belongings in line with fire safety. The garden is being well maintained and there are plans for a sensory garden area. There were no health and safety issues identified at the time of inspection. The home has a rolling programme of bed replacement and 2 are replaced each year with fully adjustable beds. The AQAA records that there are plans in place to upgrade the whole environment in the near future. There is a laundry area in the home and this was clean and tidy. There are clear instructions for wash programmes and the home has infection control procedures in place, which are followed, thus minimising any risks. Protective clothing to include gloves and aprons was available, plus disinfection gel is available in the reception area of the home, and all visitors are encouraged to use this to assist with control of Care Homes for Older People Page 17 of 26 Evidence: infection. The home was clean, bright and fresh throughout. Care Homes for Older People Page 18 of 26 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. The home is appropriately staffed to meet the needs of the residents at all times. Staff receive the training they need to provide them with the skills and knowledge to care for residents effectively. There are robust employment procedures in place, however shortfalls identified could place residents at risk. Evidence: At the time of inspection the home was being staffed to meet the needs of the residents. The home has a steady core staff team, many of who have been at the home for several years. The registered nurses have the skills and experience to care effectively for the residents needs. The home was clean and fresh and employs kitchen, domestic and maintenance in such numbers as to meet the overall needs of the home. The home also has work experience placements for students studying health care, to enhance their learning and development. Information provided on the AQAA states that 90 of staff are qualified to or are currently undertaking NVQ in care level 2 or 3, and it was clear from observing staff interaction with the residents that the staff have the skills and knowledge to care for the residents effectively. We viewed 3 sets of staff employment records. In one instance the reference from the Care Homes for Older People Page 19 of 26 Evidence: previous employer was not available, and has since been obtained. One application form did not have the health check information signed and this was addressed at the time of inspection. The importance of obtaining all the information required under Schedule 2 of the Care Homes Regulations 2001 was discussed with the Registered Manager and Deputy Manager, who fully understood the importance of this. The home has an induction programme that incorporates the Skills for Care common induction standards.Staff spoken with confirmed that they had completed induction training and did receive training in topics relevant to the diagnoses and needs of the residents. Some of the training had not been listed on the training records, and we recommended that this be kept up to date for all staff. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being effectively managed to promote good outcomes for the residents and staff. Quality assurance systems are in place and being developed to ensure an ongoing process of audit and review. There are robust procedures in place for the management of residents monies, and these are followed, thus protecting residents interests. Heath and safety is being well managed, providing a safe environment for residents, staff and visitors. Evidence: The Registered Manager is also the Registered Provider for the home. She is a first level nurse with general and mental health nursing qualifications and has a diploma in Management. The Deputy Manager is nearing completion of the Registered Managers Award and together they ensure the effective running of the home. Staff and residents spoken with said that the Managers are approachable and supportive and it was clear the well-being of the residents in their care is their top priority and this ethos is cascaded down to all the staff. Care Homes for Older People Page 21 of 26 Evidence: The home uses the Registered Nursing Homes Association quality assurance system. On the first day of inspection this had been completed annually, however no audits had taken place of specific areas, for example, medications and the kitchen. This had been discussed at the last inspection and was again dicussed on the first day of inspection. By the second day of inspection audits had been commenced for medications, care planning, fire safety, the kitchen and the environment. The Managers said that they would ensure regular audits are now undertaken and any shortfalls identified addressed. The home does have a registered nurse who specifically monitors the ongoing care of the residents, and the home provides a high standard of care to the residents. At the time of inspection the home only held personal monies for one resident and clear records of income and expenditure were being maintained. We sampled the servicing and maintenance records and those viewed were up to date. The fire risk assessment had last been reviewed in November 2008. Day fire drills had been taking place each month, and a night fire drill had taken place in May 2009, and the Deputy Manager said he would ensure that further night fire drills are carried out at intervals in line with current legislation and guidance. Staff have received training in health and safety topics and confirmed that they do receive updates at the required intervals. There were no health and safety issues identified at the time of inspection. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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 9 13 There must be evidence of 18/07/2009 regular audits of medication, to include liquids, warfarin, other complex medicines and medicines not in the monitored dosage system. This is to provide evidence that medications are being given as prescribed and are being well managed. 2 9 13 Air conditioning must be installed in the medications room. In order to ensure medications are being stored at the appropriate temperature. 01/08/2009 3 11 12 Where possible, the wishes 01/09/2009 of the residents and their representatives in respect of their wishes with regard to health deterioration and end of life care must be discussed and recorded. Care Homes for Older People Page 24 of 26 In order that their wishes are identified, recorded and can be met. 4 29 16 Staff records must include all the information required under Schedule 2 of the Care Homes Regulations 2001. To protect residents. 01/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The home should engage more with residents and their representatives in the formulation and review of the service user plans. Where it is not possible for this to happen, then this should be recorded. That the home develop a continence assessment document to monitor the continence status and needs of each resident. It is recommended that the training record for all staff be kept up to date to provide a clear picture of all the training each individual has undertaken. 2 8 3 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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