Inspection on 18/03/09 for Beeston Lodge

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beeston Lodge 15-17 Meadow Road Beeston Rylands Nottingham NG9 1JP     The quality rating for this care home is:   zero star poor 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: Steve Keeling     Date: 1 8 0 3 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 28 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 28 Information about the care home Name of care home: Address: Beeston Lodge 15-17 Meadow Road Beeston Rylands Nottingham NG9 1JP 01159259014 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Rodenvine Nottingham Limited Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability - Code PD - maximum number of places 3 Date of last inspection 0 3 Over 65 28 0 Care Homes for Older People Page 4 of 28 Brief description of the care home Beeston Lodge is situated in the Beeston Rylands area in close proximity to Beeston Town and Chilwell. The area is well served by public transport. The home provides care for up to 28 people aged 65 and over that require nursing and residential care. The home is registered to accept up to three people with physical disability. The Accommodation is over two floors and a passenger lift and staircase access is provided. Peoples bedrooms are sited on both ground and first floor levels, none of the rooms have en-suite facilities. Ramped access is provided to the front garden and there is also an enclosed courtyard garden to the rear of the home. At the time of the inspection the registered manager stated that the fees charged at the home range from 349 pounds for residential care and 483 pounds for nursing care. Care Homes for Older People Page 5 of 28 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: zero star poor 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 focus of the inspection undertaken by the Commission is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager and members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion about the quality of care provided. Care Homes for Older People Page 6 of 28 A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since it was reregistered with the Commission by the new owners in June 2008. We also utilised the Annual Quality Assurance Assessment, which was completed by the manager in October 2008. In addition we utilised Have your Say surveys, which were distributed to people who use the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 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. Needs assessments are performed to identify peoples needs. The home does not provide an intermediate care service. Evidence: We looked at the records of two recently admitted people, each had an assessment of their needs. The assessment process incorporates a recognised assessment tool and provides the opportunity to identify peoples needs, in relation to promoting their health and wellbeing. The assessment process also uses information provided by other agencies, such as Adult Social Care and Health, when available. Care Homes for Older People Page 10 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of people who use the service are recorded but not fully met and medication is not managed appropriately. People who use the service are afforded appropriate levels of privacy. Evidence: The Have your Say service users survey asked Do you receive the care and support you need. Five respondents stated Always and two respondents stated Usually. The manager stated within the Annual Quality Assurance Assessment All residents have a personal care plan which is updated monthly. We examined the care plans of two people who use the service. The care plans contained risk assessments in relation to peoples susceptibility of pressure sore formation, one case tracked person had been identified as very high risk of pressure sore formation but a care plan was not in place to address the concern. In addition a risk assessment in relation to Moving and Handling required a person to Care Homes for Older People Page 11 of 28 Evidence: have a specific care plan to be in place to address the concern, a care plan had not been formulated. The care planning documentation had been reviewed on a monthly basis but the reviews were very basic as they only stated, care as plan and did not provide sufficient evidence to show how care workers had arrived at that conclusion. The care plans contained a daily records section but on examination it was shown that daily records had only been filled in on a sporadic basis, one case tracked persons daily records had not been filled in for the past 46 days. When asked about the lack of daily record the manager stated We do not have time to fill in the daily records on a daily basis. It is a requirement that care plans are signed by people who use the service or representatives of theirs if people lack capacity, to shown that consent to the content of the care plans is obtained. Both care plans did not show that the required consent had been obtained, indeed on case tracked person said I have never seen the plans, what are they. The Have your Say service users survey asked Do you receive the medical support you need Six respondents stated Always and one respondent stated Usually. Records showed and people confirmed that they have access to general practitioners, Podiatrists, Dentists. One person spoken with said you only have to ask to see your GP and the staff will arrange it, they are very good in that area. The Have your Say service users survey asked Do staff listen and act on what you say, all seven respondents stated Always. One person commented, the staff are smashing, they cannot do enough for you, they always listen and respect my opinion but they are rushed off their feet, I dont know how they do it. We observed interactions between staff and people who use the service throughout the day and at meal times, people were being assisted to have their meals in a kind, considerate and un-rushed manner, offering suitable assistance when required. We briefly observed the morning medication round. The manager, who is also a qualified nurse, confirmed that qualified nurses only administer medication. Medication Administration Records were filled out correctly and appropriate medication storage facilities are available. The morning medication round took a very long time to complete and some people did not receive their morning mediation until 1145hrs. Care Homes for Older People Page 12 of 28 Evidence: The nurse manager stated that it is very difficult to administer the prescribed medication on time, as she was the only person on duty who could administer medication and due to the conflicting demands of her managerial and nursing roles the medication administration can be delayed. Care Homes for Older People Page 13 of 28 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. Recreational activities are provided within the home and opportunities are available for people to interact within the broader community. People expressed satisfaction with the quality and variety of meals provided. Evidence: Information received in the Annual Quality Assurance Assessment stated,We have a good social programme, 16 hours per fortnight are allocated to activities when two members of staff work together for 8 hours. The Have your Say pre inspection questionnaire asked people Are activities arranged in the home that you can take part in, two respondents stated Always four respondents stated Usually and one respondents stated Sometimes. People spoken with stated, and records showed, that in addition to the activities day additional social activities are provided such as baking, board games and bingo. Guest entertainers also attend the home and significant events such as birthdays, Christmas, Easter and Bonfire Night are celebrated. People also stated that staff at the home respect their choice if they do not wish to attend the social activities. Care Homes for Older People Page 14 of 28 Evidence: People told us that the manager promotes an open door policy in relation to relatives and friends visiting the home. People who use the service confirmed that visitors are made very welcome by all the staff at the home and they are offered drinks and meals if they wish. The Have your Say pre inspection questionnaire asked people Do you like the meals at the home, four respondents stated Always one respondents stated Usually and one respondents stated Sometimes. All people spoken with on the day of the inspection stated that the meals are very good and a choice is always available. Care Homes for Older People Page 15 of 28 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. People feel safe at the home and are able to express their views and concerns. Not all staff have received refresher training in relation to safeguarding Vulnerable adults which could compromise peoples safety. Evidence: A complaints procedure is displayed in the foyer of the home and the procedure is also supplied in the Service User Guide. The Commission has not received any complaints about the service since it was re registered in June 2008. The manager stated and records showed that three complaints have been made, all the complaints were documented which included the actions and outcomes following the complaints. The Have your Say pre inspection questionnaire asked people Do you know how to make a complaint all respondents stated Yes. Information received in the Annual Quality Assurance Assessment stated, Staff work well as a close knit team and receive twice yearly Safeguarding of Vulnerable Adults and Whistle Blowing training. We examined staff training records that showed that refresher training in Safeguarding Vulnerable Adults had not been provided as specified within the Annual Quality Assurance Assessment as not all staff had attended the planned event, which was last performed on the 14th April 2008. Care Homes for Older People Page 16 of 28 Evidence: We spoke to a member staff to determine her level of understanding in regard to Safeguarding of Vulnerable Adults. The member of staff demonstrated a good level knowledge in this area, in addition the member of staff said that the revised Nottinghamshire Safeguarding Adults policy is available at the home if further guidance if required. Care Homes for Older People Page 17 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an environment, which is comfortable, clean and odour free but some bathrooms facilities would benefit from redecoration and upgrades. Evidence: Information provided in the Annual Quality Assurance Assessment stated, We provide a warm clean safe homely environment. The Have your Say pre inspection questionnaire asked people Is the home fresh and clean. Six respondents stated, Always and one respondent stated Usually. We asked people, on the day of the inspection if they are satisfied with the standard cleanliness in the home, they all said the home was clean and odour free but stated that the some areas within the home would benefit from an upgrade. We did a partial tour of the building, which included peoples bedrooms, communal areas and the kitchen facility. All areas were safe, fresh and warm which included peoples bedrooms. Some bathroom areas would indeed benefit from upgrade and redecoration. Staff said that gloves and aprons are worn at all times when providing personal care to promote infection control; we observed that gloves and aprons were available in Care Homes for Older People Page 18 of 28 Evidence: bathrooms and staff were using them appropriately. Care Homes for Older People Page 19 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current staffing levels require review to ensure they are suitable to meet the needs of people. A staff training programme is in place but not all staff have attended the training programme. Recruitment practices are robust and protect people from those that may be unsuitable to work with vulnerable adults. Evidence: The Have your Say pre inspection questionnaire asked people Are staff available when you need them. Three respondents stated, Always and four respondents stated Usually. On the day of the visit, twenty-eight people were in residency at the home, nineteen of which required nursing care and the remaining nine people requiring residential care. In the morning period people were being supported by the manager, who is also counted as the qualified nurse on duty, five care staff, a cook, and a cleaner. Throughout the afternoon the care staffing numbers drop to four, and throughout the night people are supported by a qualified nurse and two care staff. We asked as person who users the service if staff are available when needed, the response was Yes, they [care staff] are available but they are rushed off their feet, I Care Homes for Older People Page 20 of 28 Evidence: think we more carers. A member of staff also expressed concerns in relation to staffing levels and said that more staff are required to meet the needs of people. On the day of the inspection it was observed that some residents were left in wheelchairs and not helped to transfer to the seating area within the lounge. We asked a member of staff why the residents were not transferred, her response was we did not have time. The manager expressed concerns that she cannot fulfill her managerial duties to the full as it is an expectation that only thirteen hour per week is allocated to managerial duties, with the rest of her time being allocated to direct nursing duties. It was also evident [See Standard 9] that her managerial duties are also affecting her ability to perform her nursing duties to the full as medication was not administered at the prescribed time. We examined the staff files of two recently employed care staff, which showed that recruitment processes are effective in promoting safety. Staff files contained, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form and two written references. Records showed and staff confirmed that an induction process is provided when they commence employment to promote the health and well being of people at the home. The manager confirmed that the induction process has been recently amended and now incorporates the Skills for Care common induction standards. Records showed, and staff confirmed that a staff training programme is in place. We examined the staff traing rota which showed that not all care staff had attended the planned refresher training. Care Homes for Older People Page 21 of 28 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management structure is not currently effective in supporting staff to promote the health and wellbeing of people at the home due to the conflicting demands on the managers time. Evidence: The registered manager has been in employment at the home for several years and is in the process of obtaining the degree level registered managers award. People who use the service and staff employed at the home praised the manager and felt confident in her managerial abilities. The manager expressed concerns that she cannot address her managerial duties to the full, due to the limited time allocated to managerial duties (currently thirteen hours per week) and confirmed that annual staff appraisals have not taken place since 2005. In addition the content of staff supervision was lacking detail, in some cases the supervision records consisted of just one sentence. Care Homes for Older People Page 22 of 28 Evidence: The manager stated and people who use the service confirmed that at present residents meetings are not performed and people who use the service are not provided with a forum to discuss the quality of service provision. As discussed earlier in the report, due to conflicting managerial and nursing duties the quality of service provision is compromised especially in relation to the quality of peoples care plans, the evaluation of care plans, the recording of daily records and the administration of medicines. In addition the Annual Quality Assurance Assessment provided by the manager on the 29.10.2008 lacked specific detail to inform the inspection process. When discussed with the manager, the lack of allocated managerial time was cited as an influencing factor. Secure facilities are available for people to store their spending money at the home. Records showed that the process of recording financial transactions has been recently reviewed to protect people from financial abuse. We checked the financial records of two people who reside at the home and it was shown that procedures that are in place would protect people from financial abuse. Information provided by the registered manager within the Annual Quality Assurance Assessment showed that routine maintenance such as electrical circuit tests, gas appliance tests, fire detection alarms and fire fighting equipment has been performed as required. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 28 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 7 15 The registered person must ensure that care plans and risk assessments are reviewed effectively. To ensure that the review process is effective in identifying peoples changing health care needs 05/06/2009 2 7 15 The registered person must ensure that consent to the content of care plans is sought whenever practically possible To ensure that people who use the service or people acting on their behalf agree to the care provided. 05/06/2009 3 7 15 The registered person must 05/06/2009 ensure that care plans are formulated to address all the identified needs of people accommodated at the home. Care Homes for Older People Page 25 of 28 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 To ensure that health and wellbeing of people at the home is promoted. 4 9 13 The registered person must ensure that medication is administered at the prescribed time. To ensure that peoples medication management promotes peoples health and wellbeing. 5 18 13 The registered person must ensure that all staff receive the planned refresher training in relation to Safeguarding Adults. To ensure that all staff are aware of any updates in relation to Safeguarding Adults to promote people safety. 6 27 18 The registered person must 05/06/2009 provide evidence in relation to how staffing levels are calculated to meet the needs of people. To ensure that peoples needs are met by the staffing levels at the home. 7 30 18 The registered person must 30/06/2009 ensure that all staff received the planned refresher training. 30/06/2009 05/06/2009 Care Homes for Older People Page 26 of 28 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 To ensure that staff are confident and competent in performing their duties. 8 31 18 The registered person must provide evidence that the current manager has sufficient time to perform her managerial duties to the full. To ensure the service is managed effectively. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 05/06/2009 1 2 26 33 The registered person should ensure that bathroom facilities are well decorated and fit for purpose. A process should be initiated to ensure that people who use the service are provided with a forum to express their opinion of the quality of service provision. Care Homes for Older People Page 27 of 28 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. Care Homes for Older People Page 28 of 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!