Inspection on 05/10/05 for Aden Lodge Nursing Home

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Aden Lodge Nursing Home 23/01/08

Aden Lodge Nursing Home 21/02/07

Aden Lodge Nursing Home 01/08/06

Aden Lodge Nursing Home 08/12/04

Aden Lodge Nursing Home 06/05/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Aden Lodge Nursing Home Long Lane Clayton West Huddersfield West Yorkshire HD8 9PR Lead Inspector Sally McSharry and Stephen French Unannounced Inspection 5th October 2005 10:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Aden Lodge Nursing Home Address Long Lane Clayton West Huddersfield West Yorkshire HD8 9PR 01484 866602 01484 863749 kazsmith@gmaiol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Aden House Ltd Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Aden Lodge provides nursing care and accommodation for up to forty elderly people. It is a purpose built brick home adjacent to its larger sister home Aden House. The home provides single room accommodation with en-suite facilities. It is situated on the corner of the main Wakefield Road in Clayton West. Aden Lodge is owned by Aden House Limited, a local company. The home is centrally located for Barnsley, Huddersfield and Wakefield with the villages of Clayton West and Scissett providing all local amenities within a few minutes walk. There is a bus stop outside the home. There is a garden area for service user’s use. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on 5 October 2005 by two inspectors. The inspection commenced at 10.30am. During the visit the inspectors spoke to some service users and staff, carried out a brief tour of the premises, audited a sample of four care plans, medications and service users finances. Staff recruitment and training records were inspected. Staffing levels were checked against rotas and the health and safety records relating to the home were seen. A selection of the core national minimum standards was assessed during this visit. What the service does well: What has improved since the last inspection? What they could do better: Information about the home should be updated regularly. Care planning needs to be improved, detailed and specific advice should be given to staff about each service user’s needs and how these are to be met in the home. Care plans should be maintained using current professional guidance. The management of medications within the home should be reviewed. All staff must receive training to enable them to identify potential abuse and take appropriate action. Staffing levels particularly during the night should be reviewed and sufficient staff must be provided at all times. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 6 Work should continue to ensure staff recruitment files contain all the necessary references and checks. Fire tests and checks must be carried out weekly and there should be an up to date fire risk assessment for the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Some information about the home is available however this is out of date. Service users are admitted to the home on the basis of good assessments that ensure that the service users’ social and health needs can be met. EVIDENCE: Information about the home is available in the statement of purpose which is available in the entrance of Aden Lodge, however once again this information is out of date and does not reflect the current management or staff skills. Therefore it remains a requirement of this report that accurate information about the home must be available. There is clear evidence in service users’ records that prior to admission a member of staff from the home assesses the prospective service user. This ensures the home and the staff are able to meet the service users’ needs. No intermediate care is offered at the home, however if the home has a vacancy some respite care is offered. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 9. Care plans are available but need to include more specific information and advice. There is clear evidence that staff at the home help service users access health care professionals and services to ensure their health needs are addressed. Medications are not being managed correctly. EVIDENCE: Care plans provide basic information about the service user’s health and welfare needs. However some care plans lack detail and fail to advise staff clearly how those needs are to be met in the home. Not all service users have their nutritional needs assessed. Some assessments such as the activities of daily living assessment are not dated or signed and some written records are not contemporaneous. Ms Ellis, the acting manager has audited care records and identified some issues. Action now needs to be taken to address the shortfalls. The home continues to share a pair of sit on scales with the sister home Aden House, it remains a recommendation of this report that sit on scales be purchased specifically for Aden Lodge. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 10 In some service users’ records there is a statement about whether they wish to be resuscitated. In some cases a relative of the service user has signed this. The company’s legal advisors should check the legality of such a statement. Care records show clear evidence that service users are able to access the services of other health care professionals and NHS services when required. Systems for the management of medications are not clear. When medications were audited during the inspection some staff signatures were missing on administration sheets and not all medication could be reconciled against records. Some hand written advice on medication administration sheets was not clear. Ms Ellis advised she has commenced an audit of the system. Issues identified must be addressed. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users have good access to a range of activities that satisfies their needs and have unlimited contact with family and friends. Service users have access to choices within their lives at the home. EVIDENCE: There are a variety of activities offered in the home. Service users were taking part in a quiz at the time of the inspection and some service users told the inspector of recent trips out to the races and to a local community farm. Service users described choices available to them in the home, whether they involved themselves in activities, where they ate their meals, when they went to bed and when they arose. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Some systems are in place to protect service users from abuse, however these must be improved through staff training. EVIDENCE: It was required in the last inspection report that all staff be trained to recognise abuse and be familiar with the protection of vulnerable adult procedures and how to make a referral or raise concerns. Not all staff have been trained in this area and therefore it remains a requirement of this report. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26. Aden Lodge provides a safe and well-maintained environment, with access to indoor and outdoor areas. The home is clean and tidy but the practice of staff smoking in the hairdresser’s room should be reviewed. EVIDENCE: Aden Lodge is well presented and maintained with access to communal areas for all service users. During the visit this visit the home was found to be clean and tidy. It was noted that the hairdresser’s room smelt strongly of smoke, this is because the staff use this area as the staff smoking room, it is strongly recommended this practice be reviewed. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The basic staffing levels are provided to meet the needs of the current number of service users. Current recruitment practice needs to be more stringent to ensure service users are supported and protected. EVIDENCE: Since the last inspection there has been one complaint about staffing levels in the home. This complaint was investigated by the registered provider and was not substantiated. During this visit staff rotas were examined. Some staff shortages were noted and care must be taken to ensure sufficient staff are on duty at all times. A recent incident which occurred during the night resulted in a service user being moved from a first floor room to a ground floor room to facilitate better supervision, however all service users in the home must be supervised regardless of the location of their room. It is recommended that staffing levels at night be reviewed to ensure there are sufficient staff on duty to supervise and care for service users. In the last inspection report a requirement was made to ensure recruitment practices and records were of an acceptable standard. Ms Ellis advised that some efforts have been made to ensure missing references and checks are obtained, however some documentation is still missing, therefore the requirement remains in this report. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 and 38. Service user’s financial interests are safeguarded. The health, safety and welfare of service users and staff is not being protected fully. EVIDENCE: The financial records of four service users for which the home hold money, were examined and found to be in order. Health and safety records and checks have been carried out, however weekly fire test records were not up to date and there was not a fire risk assessment available. This must be addressed to ensure the safety of service users and staff. Ms Ellis advised that the maintenance person provides cover for Aden Lodge and Aden House; sometimes Aden Lodge has to wait for repairs to be carried out due to the work load and some routine health and safety checks have been missed, therefore it is recommended that further maintenance hours be provided for Aden Lodge. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 3 X X X X 2 3 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 1 Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement Timescale for action 30/11/05 2 OP7 15 3 OP9 13 4 OP18 13 Staff experience and training should be updated in the statement of purpose. Information about emergency procedures must be added. Time scale of 30/08/05 made in the previous report has not been met. Care plans must give clear and 31/12/05 specific information to staff about service users’ needs and how they are to be met in the home. All medications entering the 31/12/05 home must be accouinted for. There must be safe systems for the recording, administration, storage and disposal of medication in the home. Work must continue until all staff 30/11/05 have completed this training in relation to abuse and the protection of vulnerable adults. Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 18 5 OP29 7,9,19 and schedule 2. 6 7 OP38 OP38 23 23 Two satisfactory written references must be held on file for each member of staff. CRB checks are not transportable from one employer to another. A new check must be carried out before a new employee commences work at the home regardless of how recently their last employer carried out the check. Time scale of 30/08/05 made in the previous report has not been met. Weekly fire tests and checks must be carried out and a record maintained. Fire risk assessments must be available in relation to the home. 31/12/05 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP7 OP7 OP7 OP7 OP7 OP26 OP27 OP38 Good Practice Recommendations All service users should have a nutritional assessment carried out. All care plans and risk assessments should be signed, dated and reviewed monthly. All written records should be contemporaneous. The company’s legal advisers should check the legal status of the resuscitation statement, particularly when a relative has signed this document on behalf of a service user. It remains a recommendation of this report that sit on scales be purchased specifically for Aden Lodge. It is strongly recommended that the practice of staff smoking in the hairdresser’s room be reviewed. It is recommended that staffing levels provided at night be reviewed. It is recommended that further maintenance hours be provided for Aden Lodge. DS0000001106.V256615.R01.S.doc Version 5.0 Page 19 Aden Lodge Nursing Home Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Aden Lodge Nursing Home DS0000001106.V256615.R01.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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