Inspection on 28/07/09 for Norton Lodge Care Home

This is the latest available inspection report for this service, carried out on 28th July 2009.

CQC found this care home to be providing an Good 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Norton Lodge Care Home Norton Village Runcorn Cheshire WA7 6QA     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: David Jones     Date: 2 8 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 31 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 31 Information about the care home Name of care home: Address: Norton Lodge Care Home Norton Village Runcorn Cheshire WA7 6QA 01928714792 01928795107 jwilliams@nortonlodge-cheshire.co.uk 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) : Janet Bailey,Dawn Gittins care home 32 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 32 The registered person may provide the following category 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: Dementia - Code DE. The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Norton Lodge is a privately run care in the Norton Village area of Runcorn. The home provides personal care to up to a maximum of 32 people. The building is an eighteenth century Georgian House set in an acre of well-maintained gardens. A bus route and train station are nearby. Halton Lea shopping centre and Runcorn old town are within easy travelling distance. There are 30 bedrooms, two of which can be used as twin rooms, and 10 of which have en-suite facilities. There are two communal lounges and two separate dining rooms. There is a passenger lift for access between the first and ground floors. Information about Norton Lodge including copies of the most recent inspection report can be obtained by contacting the home. Care Homes for Older People Page 4 of 31 Brief description of the care home Fees for accommodation, board and care are 485.00 pounds per week. There are no additional charges. People who live at the home buy their own items such as newspapers and toiletries. Care Homes for Older People Page 5 of 31 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: The quality rating for this service is two stars. This means that people who use this agency experience good quality outcomes. This visit was unannounced. It took place over one day, taking 7 hours in total, and was done by one inspector. This report will say we when referring to our activities and findings, as it is written on behalf of the Care Quality Commission. Our visit was just one part of the inspection. Before the visit took place we asked the manager to complete a questionnaire that we call an annual quality assurance assessment or AQAA for short. It gives us information about how the service is meeting the needs of the people who use it and includes plans for future development. Care Homes for Older People Page 6 of 31 We made survey questionnaires available for the people who live at the home, some of their relatives and staff. Replies we received have been taken into account in the report. We also looked at the information that we already had about the home and this, with the information from the AQAA, helped us to form our inspection plan. We checked the records of three people who lived at the home to see what care they receive. We spoke with them, some of their relatives and the staff who support and care for them and their views were taken into account. We looked at the communal areas of the home, including lounges, bathrooms and toilets to see how the home was decorated, maintained and furnished. We also looked at some policies and procedures to check that these were up to date and provided suitable guidance for staff. What the care home does well: What has improved since the last inspection? At our last inspection we found that some staff needed and more training on the care of people with dementia. We could see that this was being addressed. The manager and some senior staff had completed courses in dementia care mapping and most care staff had done the positive dementia course. The staff carried at their work with confidence and skill so the people who lived at the home were confident that there needs would be met by trained and competent staff. The staff training programmed had been improved. The Skills for Care common Care Homes for Older People Page 8 of 31 induction standards had been incorporated into the homes staff training programme so all new staff were given the training and guidance they needed to do their jobs effectively and safely. Most of the new staff had completed this and were preparing to develop their skills further by doing an NVQ in care at level two. This showed us that the people who lived at the home were in safe and competent hands. Improvements had also been made to the general layout of the home including changes to the location of the office and significant improvements to toilet and bathroom accommodation. These changes have made the home more homely and comfortable. The information provided by the home to had also been improved. The manager had produced a version of the information in large print and with illustrations so people with dementia were helped to understand the information. What they could do better: We found that the home had good procedures for introducing new people to the home but we recommend that arrangements for admitting people in an emergency are improved so all people benefit from a thorough needs assessment. This will help to make sure that people always get the care they need in a way they want to receive it. We could see that people were helped to make decisions but there was no record of assessments being made to make sure that people received the right kind and amount of support to help them with their decision making. We recommend that if there is any doubt about a persons capacity to make important decisions about their lifestyle and the care they receive that an assessment of their capacity to make the decision is made. This will help to make sure that people always get the support and assistance they need to make important decisions about their lives and lifestyle. Care plans had been reviewed on a monthly basis but we found that they had not always been updated when the persons social needs had changed. We recommend that all aspects of each persons care plan is reviewed on a regular basis or as and when their needs change so people continue to get the support they need to do the things they want to do in their lives. At our last inspection we found that improvements needed to be made in the way the home gave and recorded medication. We found similar errors on this inspection. We have required the manager to take action to make sure that records of medicines given to people who live in the home are always accurate and up to date. This needs to be done so people who live at the home are safe and receive their medicines as their doctor prescribed them. Improvements had been made to the layout of the home since our last inspection so people were more comfortable and their privacy and dignity was promoted. To make these changes the ramp to the ground floor extension had been altered making it steeper than the recommended gradient of one in twelve. We could see form our observations and discussion with people that this may present difficulties to those who use wheelchairs or other walking equipment. We have required the manager to reassess the ramp and to take action, if necessary, to make sure the home is safe and Care Homes for Older People Page 9 of 31 accessible to people with a physical disability. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 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 who are thinking of moving to Norton Lodge are given clear information and are invited to visit so they can make a choice about the homes suitability for them. They have their needs assessed so they can be confident that their needs will be met when they move in. Arrangements for admitting people in an emergency need to be improved so all people benefit from a thorough assessment of their needs. Evidence: People who lived at the home and their relatives told us that the information they were given was very good. They were encouraged to visit the home with their relatives before they moved in so they were helped to make an informed decision about the homes suitability for them. The information about what the home provides and who it is for (the statement of purpose and service users guide) were written in plain and clear language so people were helped to understand what the home had to offer. In addition there was an illustrated version of the statement of purpose and service users Care Homes for Older People Page 12 of 31 Evidence: guide available in large print so people with dementia were helped to understand the information. This showed us that managers and staff understood the importance of providing people who were thinking of moving to Norton Lodge with the information they need to help them decide whether the home is suitable for them. We checked the records of three people who lived at the home. We could see that two of these people had their needs assessed before they moved in so they could be confident that their needs would be met. We could see that their assessments were done with them and their representatives so they would receive care and support in the way they would prefer. The third person had moved in to the home in an emergency when it was found that they were at risk living alone in their own home. They had their needs assessed by the manager on the day they arrived at the home and a basic care plan was written so we could see how their main needs were being met. A risk assessment was also completed so we could see they were safe. However, there was no written assessment in their records. The manager told us that the findings of this persons assessment were recorded directly in their care plan so there was no separate assessment covering all their needs. They had lived at the home for over two months but there was no written evidence that some of their social care needs had been assessed. This showed us that the homes arrangements for admitting people in an emergency needed to be improved to make sure that all people benefited from having their needs assessed thoroughly. The manager told us that arrangements will be made to make sure that people admitted in an emergency with have all their needs assessed within 48 hours of moving in. This will help to make sure that all people receive care and support in the way they want and prefer. Care Homes for Older People Page 13 of 31 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. The care plans were well written so that the health and personal care that people received was based on their individual needs. The principles of respect, dignity and privacy were put into practice and promoted so the people who live at the home feel respected and valued. Evidence: We looked at the personal care records of three people who lived at the home and we spoke with them and some of their relatives about the care and support they received. We observed staff operate as an effective and caring team. We could see that the staff were familiar with each persons individual care needs and personal preferences so people received care and support in the way they wanted and preferred. We observed staff treating people as individuals providing care with warmth and showing genuine affection and concern. They were always quick to respond to people who needed help and support and spent time with them listening and engaging them in conversation. We could see that people had good relationships with staff and the principles of dignity and respect were promoted in all interactions. Relatives and visiting health care Care Homes for Older People Page 14 of 31 Evidence: professionals praised the staff team for the high standards of care they provided. For example one relative told us The home is very good we have confidence that our relative is well cared for. The staff are very good, very caring. They always treat people with respect and always make us feel welcome. Each person had a care plan. We could see that improvements continue to be made in the way care plans were written. They were more person centred so people would receive care and support in the way they wanted and preferred. For example one of the younger people who lived at the home wanted to capitalise on opportunities for their personal growth and development. We could see that their care plan addressed aspects of their life which were very important to them including motivation, personal development, education, occupation, leisure, relationships, community links and social inclusion. This showed us that managers and staff understand the importance of helping younger adults to achieve their goals, follow their interest and become integrated into community life in a way that the person wants. All the care plans we looked at had been reviewed monthly and most had been kept up to date. However, there was still room for improvement. For example one persons care plan did not record the arrangements made to meet their social care needs and another persons care plan had been reviewed but important parts of it had not been updated when circumstances had changed. Managers and staff need to make sure that all aspects of each persons care plan are reviewed and revised when circumstances change so their health and social care needs continue to be met in the way the person wants them to be. All staff we spoke with had a good knowledge of each persons health care needs. Care records and discussion with a visiting health care professional showed that each persons health care needs were monitored and where necessary, care staff had made contact with their health care professionals so the persons health care needs were met. We checked the medication records and could see that people usually received their medicines as their Doctor prescribed them. We noted that there were some recording errors and it was recorded that one person had been given their medication but it was still in the pack. The manager told us that these errors would be addressed with the staff responsible and where appropriate further training and supervision will be provided. We could also see that stock records for loose medication needed to be improved so managers and staff could make effective stock checks of all medicines kept in the home. Care Homes for Older People Page 15 of 31 Care Homes for Older People Page 16 of 31 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. People who live at the home are supported to make choices about their lifestyle and are offered a range of activities in the home and in the local community that meets their needs and expectations. Evidence: The home had a relaxed, friendly and welcoming atmosphere. We observed people living at the home socialising with each other, their visitors and staff and we could see that they all enjoyed good relationships. The home has a cat and dog and we could see that these animals provided a constant source of amusement and pleasure. There was a range of activities on offer and we could see evidence of peoples art work and crafts around the home. It was clear that people were supported with their hobbies and interest. One of the relatives we spoke with told us that they were thrilled that the home had helped their relative to find something they were interested in. The staff had found, through person centred planning, that the person had always been interested in insects and the subject of entomology. The activities coordinator had encouraged the person to develop this interest and was helping them to cultivate butterflies from caterpillars. Activities in the Care Homes for Older People Page 17 of 31 Evidence: local community were also supported. A group of people attended a local interests group each week, some people went out for walks on their own and others were supported by staff to enjoy what the local community had to offer. This showed us that the home continued to provide a range of suitable activities so each persons needs and expectations were met. We could see that people were able to please themselves and their choices were respected. Staff were seen to be caring and sensitive to peoples needs, immediately responding to them to make sure they had the support they needed to do the things they wanted to do. We could see that staff respected peoples wishes regarding getting up and going to bed and they tried to promote choice in all aspects of daily living. Records showed that managers and staff had made decisions on behalf of some of the people who lived at the home in the interests of the persons safety and well being. However, there were no records to show that an appropriate assessment of the persons capacity to make the decision had been made. Where there is doubt that a person may not have capacity to make decisions about the care they receive managers and staff need to make an assessment of the persons capacity to make the decision. The purpose of the assessment is to decide the level of support the person needs to make the decision and who should be asked to speak on their behalf where required. The assessments need to be recorded in the persons personal care records along with details of the decision making process. This will help to make sure that the people who live at the home always receive the support they need to help them make decisions. Records of meals served showed that the home provided a varied and nutritious diet. The days menu was written on a white board in the hall in large print so people could read it. Consideration should be given as to how the presentation of the menu could be improved so people with a dementia could be helped to make an informed choice. Other homes have found success using illustrations and photographs to help people make an informed choice. Meal times were enjoyable occasions. All the people we spoke with praised the standard of catering in the home. Each persons likes, dislikes and personal preferences were recorded and as far as could be seen respected and catered for. One person told us that food was a very important part of their life. They told us that the food was excellent, always a choice and good home cooking. Care Homes for Older People Page 18 of 31 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. Norton Lodge has a complaints procedure and thorough adult safeguarding procedures so the people who live at the home are able to express their concerns, are listened to and safeguarded from abuse. Evidence: Norton Lodge has a detailed complaints procedure which is available in an illustrated version with large print so it is easier for people with a dementia to understand. The complaints procedure sets out how to make a complaint and provides details on contacting other agencies including the social services department and the Care Quality Commission. People who live at the home are encouraged to speak with managers and staff to discuss any concerns they may have about the home or standard of care provided so action can taken to improve the service if necessary. The people who lived at the home and their representatives where aware of the complaints procedure but none of the people we spoke with had ever had cause to make a complaint. The complaints records showed that the home had received one complaint in the 12 months before out visit. This had been investigated by the manager and responded to in writing. The home had policies and procedures for responding to suspicion or evidence of abuse or neglect including a whistle blowing policy so staff know that they can report Care Homes for Older People Page 19 of 31 Evidence: poor practice. There had been four safeguarding referrals to the local authority since our last inspection. Information provided by the social services department showed us that managers and staff had worked in partnership with them to address these issues and ensure that vulnerable people were safeguarded. Care Homes for Older People Page 20 of 31 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 maintained so it provides clean and comfortable accommodation that meets peoples needs and expectations. Evidence: The people who live at Norton Lodge told us that they were happy with the accommodation and comfortable in their surroundings. We could see from our observations that they live in a clean, fresh and well maintained home which meets their needs and expectations. People told us that they were encouraged to personalise their bedrooms. For example one person told us that he was a keen supporter of Liverpool United Football club. He had named his room Anfiled and was pleased that he had been able to decorate it in the the clubs colours and regalia. The home had a programme to improve fixtures, fittings and internal decoration. Improvements had also been made to the general layout of the home including changes to the location of the office, and significant improvements to toilet and bathroom accommodation which have made the home more homely and comfortable However, changes made to a ramp on the ground floor have presented increased difficulties for people who need to use wheelchairs or other walking aids for their mobility. We had a look at the ramp and we could see that the gradient is steeper than the recommended maximum gradient of one in twelve. The manager needs to make Care Homes for Older People Page 21 of 31 Evidence: an assessment of the ramp and subsequently take whatever action may be necessary to ensure that the home is safe and accessible for people with a physical disability. The standard of cleanliness throughout the home was good. There were no noticeable odours and policies and procedures on infection control were in place and followed by staff. Care Homes for Older People Page 22 of 31 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. Staff were qualified and competent. They benefited from a comprehensive staff training programme so they were knowledgeable about the needs of people with a dementia and skilled in their approach. The homes recruitment procedures were thorough so managers could be confident that new staff were suitable to work with the people who lived at the home. Evidence: We could see from our observations that the staff working at the home were experienced and well trained in caring for people with dementia. They carried out their work in good humour, skill and sensitivity for each persons needs so people received the care and support they needed when they needed it and in the way they wanted to receive it. The people who lived at the home and their representatives including relatives and visiting health care professionals spoke highly of the staff team and the standard of care provided. Two relatives told us that the staff were excellent and a visiting health care professional told us that the care staff always gave people time and treated them with respect. They told us the staff were very caring, had the right skills and knowledge and they knew when to seek advice. Care Homes for Older People Page 23 of 31 Evidence: Some of the staff who responded to our survey questionnaire told us that there were not always enough staff to meet peoples needs. However, we found no evidence to support this during our visit. Relatives and a visiting health care professionals told us that there always seemed to be enough staff to respond to people and meet their health and social care needs appropriately. Staff rotas and our observations during the inspection supported this. We could see that staffing rotas took account of the changing needs of people and more staff were employed at times of higher demand. The manager told us that she was aware that some staff held the view that there were too few staff to meet peoples social care needs and she had given this a lot of consideration. Although she was confident that staffing levels were right she told us that she would keep them under review and would raise them if circumstances changed. This showed us that the home was being managed in the best interests of people who lived there and staff were employed in sufficient numbers to meet peoples needs and ensure their well being. Staff training records showed that most new staff complete the Skills for Care induction training programme shortly after staring work at the home. This includes the common induction training standards agreed by the national training organisation so new staff have the skills they need to carry out their work safely and effectively. The training records for one of the more recently recruited staff showed that they had a comprehensive induction to the home but the Skills for Care induction training programme had not been done. The manager told us that this was an oversight that would be rectified in the near future. Staff training records showed that 21 of the homes 29 care staff had either achieved or were working toward a national vocational qualification (NVQ) in care at level 2 or above. NVQs are nationally recognised qualifications for staff in the care profession. This showed that the home was on track to exceed the target for a minimum of 50 percent of staff to achieve a nationally recognised qualification in care. Staff training records showed that most of the staff had received training on equality and diversity, the manager had completed a course in care of people with dementia at Bradford University and most other staff had done the positive dementia course. Most of the staff had done protection of vulnerable adults training, basic food hygiene, moving and handling, challenging behaviour and all those involved in handling medicines had received training in administration, recording and safekeeping of medicines. This showed us that the home had a comprehensive staff training and development programme. We looked at the recruitment records for the most recently recruited staff member. We could see that the home had good procedures for recruiting staff so managers could be Care Homes for Older People Page 24 of 31 Evidence: confident that new staff were suitable to work with the people who lived at the home. Care Homes for Older People Page 25 of 31 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. Norton Lodge has a strong and competent management team and good quality assurance systems in place so it is run in the best interests of the people who live there. Evidence: The manager of Norton Lodge is suitably qualified and experienced in the care of older people with dementia. She has 29 years of experience working in a social care setting including eleven years working as a district nurse. She has completed NVQ level 4 in care and the registered managers award. In addition she has maintained and developed her skills by further training covering a wide range of topics including attending a course at Bradford University on dementia care mapping. The management structure is suitable for the stated purpose of the home. It includes an area manager who visits the home on a regular basis, the registered manager, three senior staff with the title officer in charge. They led a strong and consistent team Care Homes for Older People Page 26 of 31 Evidence: of staff who were well trained and well supervised so they were able to meet the needs of the people who lived at the home. The home had quality assurance processes including regular visits from the area manager to assess the quality of staffing, staff support and development, care planning and review. In addition a quality assurance survey of the views of the people who live at the home and their relatives was completed every six months. Where quality issues were identified action was taken to address them so people know their views are taken seriously and acted upon. Our observations and discussions with staff, the people who live at the home their relatives and a visiting health care professional showed us that the manager is person centred and has a clear understanding of what needs to be done to make sure the home is run in the best interests of the people who live there. Records showed that the home had good systems for assisting people with their money so their financial interests were safeguarded. We could see that the the health and safety of the people who live at the home, their visitors and staff was promoted. Information provided in the AQAA showed us that installations and equipment were serviced regularly so people were safe. The manager and other senior staff completed risk assessments so hazards were identified and where appropriate risk assessments and risk management plans were put in place so people were safe. One of the risk assessments seen needed revising because it did not provide clear guidance on how safety would be ensured, but the manager took immediate action to address this so people were safe. Improvements had been made to the home since our last inspection and better bathroom facilities had been provided so people were more comfortable and their privacy and dignity was promoted. To accommodate these changes the ramp to the ground floor extension had been altered making it steeper than the recommended gradient of one in twelve. We could see form our observations and discussion with people that this may present difficulties to people who use wheelchairs or other walking equipment. The ramp needs to be reassessed and if necessary action must be taken to ensure that the home is safe and accessible to people with a physical disability. Care Homes for Older People Page 27 of 31 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 9 13 (2) Action must be taken to 31/07/2007 make sure that records of medicines given to people who live in the home are accurate and up to date to show that they have received their medicines as prescribed. Care Homes for Older People Page 28 of 31 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 Action must be taken to make sure that records of medicines given to people who live in the home are accurate and up to date. So the people who live at the home always receive their medicines as their doctor prescribed them and their health and wellbeing is assured. 30/08/2009 2 22 23 Reassess the ramp leading 03/11/2009 to the ground floor extension to make sure it is not to steep for people who use a wheelchair (or walking aid) to use unaided. So the physical design and layout of the home is suitable for the people who live there. 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 Care Homes for Older People Page 29 of 31 improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Arrangements for admitting people in an emergency situation need to be improved so a full assessment of the persons needs is completed as soon as possible after they move in. This will help to make sure that all people benefit from a thorough assessment of their needs. Review and where necessary revise each persons care plan when circumstances change so their health and social care needs continue to be met in the way the person wants them to be and they get the support they need to realise their life goals. Keep detailed records of the stocks of loose medicines so managers and staff can make effective stock checks and ensure that medicines are stored safely in the home. Where there is any doubt about a persons capacity to make important decisions about their lifestyle and the care they receive, managers and staff need to do an assessment of the persons capacity to make the decision. This will help to make sure that people always get the support and assistance they need to make important decisions about their lives and lifestyle. 2 7 3 9 4 14 Care Homes for Older People Page 30 of 31 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). 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. 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