Inspection on 04/01/07 for Atherton Lodge Nursing Home

This inspection was carried out on 4th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Atherton Lodge Nursing Home 22/04/09

Atherton Lodge Nursing Home 28/05/08

Atherton Lodge Nursing Home 22/05/07

Atherton Lodge Nursing Home 18/08/06

Atherton Lodge Nursing Home 30/12/05

Atherton Lodge Nursing Home 05/08/05

Atherton Lodge Nursing Home 16/03/05

Atherton Lodge Nursing Home 15/06/04

Atherton Lodge Nursing Home 05/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Atherton Lodge Nursing Home Atherton Lodge 202 Pooltown Road Ellesmere Port South Wirral CH65 7ED Lead Inspector Wendy Smith Unannounced Inspection 9:20 4 January 2007 th 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 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 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. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Atherton Lodge Nursing Home Address Atherton Lodge 202 Pooltown Road Ellesmere Port South Wirral CH65 7ED 0151 3554089 0151 3560141 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) Par Nursing Homes Limited Mrs Sue Maudsley Care Home 49 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (40) of places Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 49 service users to include: * Up to 40 service users in the category of OP (old age not falling within any other category * Up to 9 service users in the category of DE(E) (Dementia over the age of 65 years) Date of last inspection 18th August 2006 Brief Description of the Service: Atherton Lodge is a two-storey detached property that has been converted and extended into a care home with nursing for 49 older people. It is situated within a mile of Ellesmere Port town centre and is close to local shops and amenities. Bedrooms are on both floors and are accessed by stairs, a passenger lift, a wheelchair lift and several ramps. On the ground floor there are three lounges and a dining room. Assisted baths and toilets are provided on both floors. The dementia care unit, which was added in 2006, has its own lounge/dining room and assisted bathroom. There are attractive gardens with access for residents from the lounge, and ample parking space. The home’s fees are from £343.34 to £417 per week. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 4th January 2006 and lasted five hours. The visit was carried out by two inspectors. An expert by experience was also present. The Commission for Social Care Inspection are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘expert by experience’ used in this report describes a person who has been appointed by Help the Aged, under the direction of the Commission for Social Care Inspection, to take part in the inspection of services for older people. This visit was just one part of the inspection. Before the visit the home manager was asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were made available for residents and their families to find out their views and two were returned. Other information received since the last key inspection was reviewed. During the visit, various records and the premises were looked at. Most of the residents, members of staff and a visiting relative were spoken with and they gave their views about the home. What the service does well: Senior staff go out to assess all prospective residents before admission is arranged. The staff working on the dementia care unit had a positive attitude towards the residents and made sure that their dignity was protected. The home employs a number of very experienced care staff who have worked at Atherton Lodge for a long time and have achieved a national vocational qualification. The manager and deputy have both been in post for more than ten years and the home owner visits regularly and is involved in the day to day running of the home. Records showed that all plant and equipment in the home is serviced and maintained in good condition. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Make sure that assessment documents and care plans are fully completed and kept under review. Make sure that wound care plans are completed at each change of dressing and show whether wounds are healing. Make sure that all bedrails have protective covers and are fitted correctly. Investigate missing signatures on medicines records and make satisfactory arrangements for the residents on the dementia care to receive their prescribed medicines. Ensure that prescribed creams and ointments are stored securely. Provide more social stimulation for the residents who spend their time in the lounges. Review meals arrangements to ensure that all residents have a choice. Keep a record of any complaints about the home in the complaints folder. Eliminate offensive odours. Fit window restrictors in all bedrooms that do not already have them. Fit paper towel dispensers for all basins where staff wash their hands. Eliminate the risk of burns to residents from hot radiators. Ensure that staff do not provide care to residents until a satisfactory POVA check has been received to confirm that they are suitable to work with vulnerable people. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 7 Provide further training for staff working with residents who have dementia to give them more in-depth knowledge about dealing with challenging behaviour . Develop a monitoring system by which the manager can identify and address any shortfalls in the way that procedures are carried out and recorded. Carry out monthly fire drills to make sure that all staff know how to act appropriately in the case of a fire. 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. The summary of this inspection report can be made available in other formats on request. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 8 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 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New residents are assessed before admission to ensure that their needs can be met. EVIDENCE: Evidence from looking at care plans and speaking with the manager showed that residents are assessed before admission is agreed to ensure that their needs can be met, however the assessment documents in the care plans were not always completed in full and some were not signed or dated. The home does not employ any psychiatric nurses and currently does not provide care for people who require nursing care due to dementia. Information about the home is provided in a brochure in each bedroom. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The personal and health needs of residents are met but recording is not always good and there remain some unsafe bedrails. Medicines procedures need to be tightened up for the protection of residents. EVIDENCE: Care plans were looked at on the Charles Roberts dementia care unit and in the main part of the home. On the dementia care unit the plans had generally been completed to a good standard although not all of the assessment documents had been completed in full. The care plans contained good daily records of how residents’ needs are met. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 11 In the main part of the home the care plans looked at had not all been kept up to date to reflect the changing needs of residents. Important assessment documents relating to pressure sore risk and nutritional risk were not kept under regular review and the reviews that were recorded rarely contained any meaningful comments to demonstrate that the nurse carrying out the review had considered any changes that may have occurred. For example, one resident had care plan for the risk of falls. The care plan had been in place since 2003 but there was no evidence that resident had ever had any falls so it was not clear why the plan was still there. The care plan files contained some forms that didn’t seem to be used at all, for example daily hygiene record, bowel record, and it would be better to remove these if they are not required. One of the inspectors spent much of the time observing the care provided on the dementia care unit and found that the personal care needs of residents were met in a sensitive manner that respected the privacy and dignity of residents. Staff were attentive and reassuring and showed a knowledge of the residents. In the main part of the home a number of frail residents were being cared for in bed. All of these residents had charts in their rooms to record repositioning, fluid intake and output and nutrition. The charts showed that they were regularly repositioned and that food and fluids were offered regularly. Two of the most poorly residents had taken very little over the last 48 hours. This information needs to be carried forward to their care plans. A number of residents had bedrails fitted. Since the last inspection some padded protective covers have been purchased to minimise the risk of any injury to residents from the bedrails, however there were still a small number of residents with rails that were not adequately protected with covers. Most of the rails had been fitted correctly but one resident had a single rail on the bed, and they should always be used in pairs, and another set of rails had been fitted too far from the head of the bed presenting a risk of the resident’s head getting trapped. This was discussed with the manager who said that she would ensure that the maintenance person checked the fitting of all bedrails. The risk assessments both for the bedrails and for cocoons are very brief and do not properly explain why restraint is needed, or that this has been discussed with the resident and/or their relative and the risks explained to them. Not all had been kept under review. There is a daily diary for the recording of wound care, however when wounds are redressed there is not usually a progress report to record whether the wound is healing or deteriorating. The recording of the size and condition of wounds is spasmodic and there are no photographs. One resident has serious pressure sores and this was very well documented, but for several other residents, who had developed red areas or small areas of broken skin, the records were not as good. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 12 One resident had three changes to the type of dressing within a few days. The manager was able to explain why this had been done, but nothing was written down. Two residents spoken with in their bedrooms expressed satisfaction with the staff and with the care they received and said that they didn’t wait long for attention when they ring the call bell. Two comments cards were received from relatives and both expressed their satisfaction: ‘My family are very pleased with the way my mother is cared for’ and ‘My Mum’s nursing care is excellent’. Name labels have been put onto residents’ glasses to stop them from getting lost, but the way in which it has been done is very obtrusive and detracts from the dignity of residents. The medicine storage room is tidy with minimal amounts of stock in the cupboards. The room is rather small and the intention is to move to a bigger room in the near future. The new room is much more spacious however it is very warm and the room temperature will need to be monitored to ensure that medicines can be stored safely or whether additional ventilation is needed. A review of medicine administration record sheets showed some unexplained gaps in signatures. Some handwritten medicine administration records were not signed or dated by the nurse who had written them. One resident had missed quite a lot of medicines and the reason for this was not clearly explained on the records. Some residents require controlled drugs. Storage is good but there was one unsigned entry on the controlled drugs sheet and another with only one signature when there should be two. Arrangements for the administration of medicines in the dementia care unit were unsatisfactory. It appeared that nursing staff bring the medicines to the unit and sign the medicine administration record sheets, but the care staff actually administer the medicines. This is unsafe practice and was discussed with the manager and the registered person. Prescribed ointments and creams had been left out in residents’ bedrooms. This home previously had a very good record of satisfactory medicines procedures and the management team needs to carry out regular medicines audits and find out why these mistakes are happening. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 13 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home could do more to ensure that individual needs and preferences are identified and catered for. EVIDENCE: On the dementia care unit at least one member of staff spends most of their time in the lounge with the residents and residents are engaged in social activities and interactions throughout the day. The expert by experience spent time with residents in the main part of the home and made the following observations: On the ground floor are situated three light, spacious lounges all with comfortable easy chairs, plenty cushions, a few tables, also some footstools. No drinks or water were in evidence until after lunch at about 1:45 pm. All three lounges had TV’s which were switched on. The middle lounge also had a book case and a rack of CD’s. An alert lady in this lounge had crossword and word search books. In this area there was also a budgie in a cage. There was very little conversation between the staff and the residents, none of the staff, except one of the cleaners, took any special interest in speaking to the residents, they appeared to be too busy elsewhere. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 14 Whenever I observed them dealing with the residents they were courteous and helpful, I did observe two of the staff carefully take a lady from her wheelchair and settle her into a large easy reclining chair, she did look, and said she was, comfortable. I couldn’t converse with many of the people, but of the ones I could only one of the residents mentioned that they used to have Bingo and remembered going to Blackpool illuminations. I tried to talk to a resident, and make her understand what I was saying. She said the staff are all kind except one who is very abrupt, then looking round the room she said ‘they need stimulation’. Most weren’t watching the TV, she then said she was deaf. I asked whether she had a hearing aid - it was in her room, the one she had previously was better, she didn’t like this one, and then she mentioned that she didn’t have any batteries. She also said she would like her hair washing, the hairdresser comes on Wednesday but hadn’t been for a while. Mainly the residents were just sitting and dozing or staring into space. The expert by experience spoke to a resident who had been at the home for six months, and her visitor. Both said they were satisfied with the home and if there were any problems they could be sorted out. She spoke to a member of staff who she assured her that they had some activity every afternoon and pointed to a large ball that they threw to each other. She kept a book to record what they did. Later the expert by experience noticed a daily activities chart on the notice-board that was partially obscured by cards and letters, many of which went back to 2003, and this mentioned bingo and nail trimming. The manager said that she had taken some residents to a pub for a meal over Christmas. The local school had an Arts section that will come four times a year to interact with the residents. Entertainment has been provided for residents over Christmas but it is quite expensive to get singers and artists to come and perform. Other than this, the expert by experience couldn’t get any feedback from the residents regarding what they actually did. There was no evidence of any activities for the afternoon when she left after 2 o’clock. One of the inspectors observed the serving of lunch on the dementia care unit and the expert by experience had lunch with residents in the main dining room. There is no cutlery or any facilities to make hot drinks in the dementia care unit, however there is now a fridge and biscuits are available. Meals arrived already plated from the kitchen and were barely warm. Staff were unsure how to react when three residents refused the meal. As the meals were already plated there was no flexibility for staff to be able to offer a smaller portion etc and the meal did not look particularly appetising. One resident said that he very much appreciated having a cooked breakfast. He didn’t know what was for lunch but said that if it was something he didn’t like the cook would make him something else. Another lady told the expert by experience that the staff were very good and that the food was good and sometimes too much. She can have what she wants for breakfast and very often has egg on toast. She also has tea and toast for supper. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 15 Lunch is taken in two sittings in the dining room, the first sitting is for the less able people who need help. The expert by experience took lunch with residents at the second sitting. She observed that: the dining room is attractively decorated in pale blues, each of the dining tables had a royal blue damask tablecloths with a knife and fork at each of four places - nothing else was on the tables, no condiments, no glasses, no juice, no teacups and no flowers. Residents did not have any water or fruit juice on the table during the meal. Having lunch in the dining room was very much like being in a canteen, it was not a particularly a pleasant experience. One elderly gentleman only had two or three spoonfuls. One of the carers asked was he not eating it, he said no, but they didn’t try to persuade him or help him to eat. I ate it and enjoyed it (although I would have preferred more corned beef in my hash or even proper meat) most of the residents also seemed to enjoy it. The residents asked what was for pudding and were told semolina and jam. the staff then started serving it around the tables. One resident said that she didn’t want this and a member of staff said ‘Oh you’ll like it, it’s good for you’. The staff came to me and asked did I want semolina and jam, I asked was there anything else, she said ‘yes cheesecake’. I said I would have that. When she brought it to me I asked why was everyone else having semolina and jam, she then asked the rest of the residents, who had still to be served, did they want semolina and jam or cheesecake, and quite a few had the cheesecake- which again was very good. I spoke to the cook after lunch and asked him about the choices - he knew they all liked the Hash that day and said that one of the men didn’t like gravy so he didn’t get it. I asked what was the later meal he replied soup and sandwiches with a hot pasty as an alternative. He couldn’t ask them too far in advance because they would forget. In the small corridor leading into the dining room there was a sheet of paper pinned high up. Written on it were the choices for the lunch menu. The notice wasn’t large enough to accommodate the evening meal but the residents would not have been able to see it from their wheelchairs anyway. The food I had was tasty and all the residents say it is good, but I don’t know where their individual choice comes from, other than the cook saying he knows what they like. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints about the home have been addressed by the provider but a written record has not been maintained. EVIDENCE: Since the last inspection two complaints have been made to the Commission for Social Care Inspection and have been investigated and responded to by the registered person for the home. The lead inspector was also aware of two other complaints that had been made. The home has a complaints folder but no details of these complaints had been recorded in it. Records should be kept of any complaints received at the home from whatever source and of the action taken to address the complaint. Procedures are in place to deal with any allegations of abuse and staff have received training about this. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment has improved considerably over recent months but some areas had an unpleasant odour and some health and safety issues were identified. EVIDENCE: There has been considerable investment in the environment over recent months and the overall standard of accommodation has been improved for all residents. The floor in the ground floor corridor had been prepared for new carpet to be laid. Gardens and outdoor areas were tidy and well-maintained. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 18 Areas requiring attention were noticed as follows: some of the hand-washing basins did not have a paper towel dispenser or liquid soap; some windows need to have restrictors fitted so that they don’t open too far; uncovered radiators in three bedrooms, and one in a corridor, were very hot presenting a possible risk of burns to residents; the preparation table in the middle of the kitchen needs re-painting. All areas looked clean and there were two cleaners on duty however there was a noticeable odour of urine in the environment. The home has a new maintenance person following the retirement of the previous post-holder. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers have been increased to better meet the needs of residents. Staff are enabled to achieve a national vocational qualification but more indepth training about dementia is needed. EVIDENCE: At the last inspection concern was expressed that there were not always enough staff on duty to meet the needs of the residents and ensure their health and safety. Since then six new care staff have been recruited but some have left. The home has nine registered nurses, 33 care staff and 12 ancillary staff. Agency staff are used to make up any shortfalls in the number on duty. On 4th January 2006 there were two nurses, eight care staff, and the home manager on duty in the morning and in the afternoon/evening two nurses and four care staff. There were five vacant rooms at the time and this appeared to be sufficient staff however it needs to be kept under review as occupancy increases. Fourteen care staff have a national vocational qualification in care and a number of these have almost completed level 3. The manager said that other staff will then have the opportunity to start NVQ. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 20 Records for the four most recently recruited staff were looked at. In general they provided evidence that good procedures had been followed however for one person there was no Criminal Records Bureau disclosure. There was evidence that the disclosure had been sent for but a POVA check should be obtained before any staff provide care for residents. Records of a structured induction for new staff were seen. In recent months staff have received training in moving and handling and fire safety. Before the Charles Roberts unit opened all staff attended a one day dementia care training course, however the staff who are working on the unit regularly would benefit from some further, more in-depth training to help them deal with difficult situations for example when residents refuse meals. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a stable management team but more auditing needs to be carried out regularly to ensure that any shortfalls are identified and there is continuous improvement of the services provided. EVIDENCE: The manager has been in post for 11 years and the deputy for 15 years. Management responsibilities are shared between these two staff members. The home owner also visits regularly and is involved in the day to day running of the home; she keeps a book where she makes observations on her visits. Accident records are audited each month to identify any issues but there is very little other formal monitoring taking place. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 22 Following the increase in size of the home there is a greater need to carry out auditing of medicines, care plans, food, environment etc. Whilst there have been significant improvements since the last visit in August 2006, a number of issues identified at that visit, which relate to the health and safety of residents, have not been addressed in full. There have been no recent staff meetings but the manager said that there is a full handover for every shift when any issues can be discussed and information passed to staff. There have been no relatives meetings, however any visitors entering the home pass by the manager’s office and it is clear that relatives feel able to come into the office and speak with the manager. A satisfaction survey was done a few months ago but very few forms were returned. Two comments cards were returned to the Commission for Social Care Inspection from relatives and both expressed their satisfaction with the home. Information provided by the manager showed that equipment is regularly tested and maintained as required. The new maintenance person has considerable experience in a health and safety role and will be able to provide training for staff in fire safety and other health and safety subjects. He said that he was enjoying his new job and residents very much appreciated small jobs like putting up pictures in their bedrooms. Fire drills were held monthly up to July 2006 but none have been held since. The fire drills need to be reinstated, and particularly for new staff, to ensure they will act appropriately in case of a fire or suspected fire. Other matters relating to the health and safety of residents have been detailed in the ‘Environment’ section of this report. Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 23 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X X X 2 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 13(4)(c) Requirement Residents must always be adequately protected from the risk of injury from bedrails. Timescale of 30/12/05 and 30/09/06 not met in full. Ensure that administration of medicines is always recorded in full and any non-administration is clearly explained. Ensure that full and accurate records of controlled drug administration are kept. Make arrangements for residents of the dementia care unit to receive their prescribed medicines in a safe manner. Provide a programme of social activities for residents. Timetable of 30/09/06 not met in full. The registered person must keep a record of any complaints received at the home. Fit window restrictors in all bedrooms that do not already have them. Eliminate the risk of burns to residents from hot radiators. Timescale for action 31/01/07 2 OP9 13(2) 11/01/07 3 4 OP9 OP9 13(2) 13(2) 11/01/07 31/01/07 5 6 7 8 OP12 OP16 OP38 OP38 16(2)(n) 22 13(4)(c) 13(4)(c) 31/01/07 11/01/07 28/02/07 28/02/07 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 25 9 OP29 19 10 OP38 23 11 OP33 24 Ensure that staff do not provide 11/01/07 care to residents until a satisfactory POVA check has been received to confirm that they are suitable to work with vulnerable people. Carry out monthly fire drills to 31/01/07 make sure that all staff know how to act appropriately in the case of a fire. Develop auditing and monitoring 28/02/07 systems to show that performance is monitored and that the home consults with all interested parties, including staff, and identifies where improvements can be made. 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 OP7 Good Practice Recommendations Make sure that assessment documents and care plans are fully completed and kept under review. Make sure that wound care plans are completed at each change of dressing and show whether wounds are healing. Ensure that residents are able to have a choice of what they eat. Keep the home free from offensive odours. Fit paper towel dispensers for all basins where staff wash their hands. Provide further training for staff working with residents who have dementia to give them more in-depth knowledge about dealing with challenging behaviour. 2. 3. 4. 5 OP15 OP26 OP26 OP30 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Atherton Lodge Nursing Home DS0000018711.V317666.R01.S.doc Version 5.2 Page 27 - 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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