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Inspection on 14/06/05 for Alistre Lodge Nursing Home

Also see our care home review for Alistre Lodge Nursing Home for more information

This inspection was carried out on 14th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

What the care home does well

Residents who use the service said that all the staff were good, one resident told the inspector she "likes living here staff are very kind". There have been some significant changes to the staff group since the last inspection but it was evident that the staff and residents have built up good relationships. Staff were seen responding to the residents needs appropriately and all tasks of a personal nature were carried out in a sensitive and caring way.

What has improved since the last inspection?

The care documentation has much improved with the paperwork templates working well with the new manager of the home. Care plans were well written and had been reviewed on a regular basis. Assessments prior to admission, during their stay at Hill Lodge and any issues that has arisen were detailed and comprehensive. Activities in the home have improved. An entertainer visits the home every three weeks. The acts are varied and are enjoyed by the residents who wish to participate in them. The manager spoke of doing hand massages and doing nails. A clothes party was recently held in the home, which had proved a success.

What the care home could do better:

With the turnover of staff recently the home has no carers with the National Vocational Qualification (NVQ) in Care. While many of the staff haveexperience it is important to have under pining knowledge to ensure quality practice. One to one clinical supervision has yet to commence in the home with care staff. The manager or senior care staff have not attended a clinical supervision course to enable them to deliver the supervision effectively. Staff recruitment needs to be improved. Staffing files found that required checks had not been performed on staff to ensure that members of staff at Hill Lodge being recruited were safe sake to work with vulnerable people.

CARE HOMES FOR OLDER PEOPLE Hill Lodge Nursing Home 67 St Annes Road East St Annes On Sea Lancashire FY8 1UR Lead Inspector Elaine Clare Unannounced 14 June 2005 12:30 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 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. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hill Lodge Nursing Home Address 67 St Annes Road East, St Annes, Lancashire. FY8 1UR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01253 726786 J Parker (Care) Limited MIss Charlotte Clements Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 25 service users to include: 24 service users in the category of OP (Old Age) and 1 named service user under 65 years of age in the category PD (Physical Disability). 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 11 January 2005 Brief Description of the Service: Hill lodge Care Home with Nursing offers care and nursing to 25 residentswithin the catogory of Old Age: within the registered number of 25, the home may also accommodate one named person under the age of 65 years of age. There are 15 single bedrooms, one of which is ensuite and 5 double rooms, three of which are ensuite.There are adequate toilet and bathing facilities as well as three lounge spaces. The home is situated within ten minutes walk of St.Annes and is within reach of local shops, post office and churches. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours and was carried out to ensure that compliance had been achieved to the requirements made at the last inspection. A tour of the premises took place and staff and care records were inspected. Two of the staff on duty, six of the twenty-one residents, and two visitors was spoken to. What the service does well: What has improved since the last inspection? What they could do better: With the turnover of staff recently the home has no carers with the National Vocational Qualification (NVQ) in Care. While many of the staff have Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 6 experience it is important to have under pining knowledge to ensure quality practice. One to one clinical supervision has yet to commence in the home with care staff. The manager or senior care staff have not attended a clinical supervision course to enable them to deliver the supervision effectively. Staff recruitment needs to be improved. Staffing files found that required checks had not been performed on staff to ensure that members of staff at Hill Lodge being recruited were safe sake to work with vulnerable people. 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. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 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 standard(s) 3,4 Residents move into the home having had their needs assessed and have been assured that these will be met. EVIDENCE: One resident’s care documentation, which had recently moved into the home, was looked through as part of the inspection. The resident had only been admitted on the basis of a full assessment undertaken by the Registered Manager of the home. The assessment format is a pre-printed template supplied to Hill Lodge from a suitable organisation. The assessment covers for example personal care and physical well-being, diet and weight, including dietary preferences; sight, hearing and communication. Each resident has a plan of care for daily living, and longer term outcomes, based on the assessment and Care Plan. All services offered by Hill lodge are demonstrably based on current good practice, and reflect relevant specialist and clinical guidance. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 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 standard(s) 7,8,10 The health and personal care, which a resident receives, is based on the individual’s needs. EVIDENCE: The resident’s plan of care was seen to have been generated from a comprehensive assessment. The three care plans that were examined found that the plan set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. The Care Plan had recently been reviewed just prior to the unannounced inspection. Space on the Care Plan, which allows the resident to sign his plan of care, had been left blank on all the care plans looked at. The registered manager confirmed that involving the residents and/or relative in the development of the plan of care had yet to commence in the home. The manager confirmed that this would be started shortly. One resident required additional services from the Incontinence advisor and this had been arranged by the home. There appeared to be a good relationship Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 10 between the continence advisor and the home and the manager spoke of how she regular receives advice from the specialist. Nutritional screening is undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken was seen to be recorded in the three files looked at. Residents spoken with had no concern about having their privacy and dignity respected. The manager was observed knocking on resident’s doors and speaking with the residents in a respectful manner. A member of staff was observed assisting a gentleman with his meals. This was being performed in a sensitive and dignified way. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15 The capacity for social activity varies for each resident but residents are given special support and assistance to engage in the activities of daily life. EVIDENCE: The routine of daily living and activities are flexible and varied to suit resident’s expectations and preferences. Residents can exercise their choice in relation to leisure and social activities, food, meals and mealtimes and religious observance. Within the homes plan of care resident’s interests are recorded. The residents are given opportunities for stimulation through leisure and recreational activities. One resident spoke how care staff had recently taken him out for a walk. Around the home were posters of forthcoming entertainment acts. One resident spoke ‘ I really enjoy the different people coming to entertain us’. The home has always welcomed visitors into the home and during the inspection it was observed that a number of visitors were present. Visitors are welcomed to join their relative at meal times and enjoy a meal alongside their family or friend. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 12 The main meal of the day was observed being taken and was much enjoyed by the residents at the home. It was a balanced, nutritious, appealing, varied and wholesome meal. The meal was taken in a congenial setting. Should a resident be out meals are kept to one side to be served at a more convenient time for the resident. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 17 Residents and staff have a robust and effective complaints procedure, which they feel able to use. EVIDENCE: The registered person has ensured that there is a simple, clear and accessible complaints procedure, which includes the stages and timescale for the process, and that complaints are dealt with promptly and effectively. There have been no complaints made to the Commission for Social Care Inspection since the last inspection. Residents spoken with had no complaints to make about the home, they were thoroughly happy with the care they were receiving at Hill Lodge. Residents are free to exercise their legal rights and participate in the political process should they wish. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,22,23,24,25,26 The home sets out to offer a family–like philosophy of care that is interwoven between the style of home; it’s size, design and layout. EVIDENCE: The location and layout of the home is suitable for its stated purpose. It was undergoing a refurbishment programme, which was causing minimal disruption to the residents. The plan was to overhaul the whole home including individual bedrooms. The grounds, which include an ornamental garden pond is kept safe, attractive and accessible to the residents. Residents spoke how they had enjoyed the good weather recently and sat out around the pond. The home has three lounge spaces for residents to enjoy one of which is a large conservatory, which is used for dining purposes. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 15 There are accessible toilets for residents, which are clearly marked, and close to the lounge and dining area. Some bedrooms have ensuite facilities. The home has a number of aids, hoists and assisted toilets and baths. Individual bedrooms were looked at and found to be furnished and equipped to assure comfort and privacy. Bedrooms were tastefully decorated and personal items had been brought in from the resident’s own home. Where residents had chosen to share screening is provided to ensure privacy for personal care. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Staffing levels and skills mix are adequate to meet the assessed needs of the residents. The required checks on staff are not being performed to the required standard whichcreates some potential risks for residents. EVIDENCE: A staff rota showed which staff are on duty at any time during the day and night. The ratios of care staff to residents must be determined according to the assessed needs of residents. Domestic staff are employed and were observed during the visit. The home has employed a number of new staff members none of which have their National Vocational Qualification level 2 in care. It is written in the Care Homes For Older People Standards that a minimum ratio of 50 trained members of care staff excluding those members of the care staff who are registered nurses should be employed by January 2005. Four staff files were looked at during the inspection. Two of the four files had no references for the member of staff currently in employment from Hill Lodge. All four staff had no current Criminal Record Bureau (CRB) certificate, which had been sought by the registered manager. Two staff members had brought an old copy from another employer but this is not satisfactory. References in relation to two staff were not present. The manager had also not obtained a photocopy of the registered nurses pin card. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 36, 37,38 The manager has a good understanding of the areas in which the home needs to improve. Planning should be in place to set out how this improvement is going to be resourced and managed. EVIDENCE: The registered manager has been in post for six months and meets the required standard with regard to qualifications and experience. Currently the registered provider is not in day-to-day control of the home and therefore needs to meet the regulation to visit the care home and prepare a written report on the conduct of the care home. The registered manager communicates a clear sense of direction and leadership, which staff and residents understand. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 18 Care staff have not received formal supervision at least six times a year. This is an outstanding recommendation. Supervision needs to cover • • • All aspects of practise Philosophy of care in the home Career development needs It is further recommended that supervisors of the care staff attend a relevant training course to enhance their skills in this important area. The home had regularly checks on equipment and all major services. Certificates were seen that demonstrated that appliances were safe and in good working order. Fire checks were carried out regularly. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 2 3 x x x 2 3 3 Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 20 na Are there any outstanding requirements from the last inspection? 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. 2. Standard 28 29 Regulation 19 19 Requirement Care staff must have qualifications suitable to the work that they are to perform. All staff must have two written references and valid CRB clearance on file. The registered manager must be able to demonstrate that care staff are of good character and integrity. Visits must be conducted by the registered provider and a short report of the visit must be sent to the CSCI. Timescale for action 31 December 2005 30 June 2005 3. 31 26 30 June 2005 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. Refer to Standard 36 Good Practice Recommendations Clinical supervision should commence within the home for all care staff. Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ 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 Hill Lodge Nursing Home F57 F09 S63623 Hill Lodge V219237 140605 Stage 4.doc Version 1.30 Page 22 - 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. 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