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Inspection on 15/05/06 for Belton Lodge Nursing Home

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

This inspection was carried out on 15th May 2006.

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

People living in this home are happy and content. Staff know how to care for the residents. They are lead by a manager who knows the needs of the residents and the staff. There is a relaxing atmosphere in the home. Residents enjoy the food, which is provided.

What has improved since the last inspection?

Clinical procedures have been provided to enable nurses to deliver safe and up to date clinical practice. Care plans have improved. Training in care to NVQ level 2 standard is taking place. A new call system is being installed.

What the care home could do better:

The owner must ensure that repairs are made to the conservatory in order to allow residents to use this throughout the year. In addition, there must be a redecoration and refurbishment programme. The owner must ensure that a report is made of the monthly visits made to the home and a copy sent to CSCI.The manager should introduce internal audits in order to monitor the care records, medication and care practice in the home.

CARE HOMES FOR OLDER PEOPLE Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW Lead Inspector Mr Toby Payne Unannounced Inspection 15th May 2006 08:00 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 Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 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. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Belton Lodge Nursing Home Address 213 Belton Lane Grantham Lincs NG31 9PW 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) 01476 579798 01476 579798 R S Medicare Limited Mrs Indra Nathan Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of Registration The maximum number of service users in the home with nursing does not exceed 10 and the maximum number of service users with personal care only does not exceed 3. 6th February 2006 Date of last inspection Brief Description of the Service: Belton Lodge is registered as a care home with nursing for 13 older persons. On the day of the inspection there were 10 people requiring nursing and 2 people requiring personal care. The home is a modern bungalow situated in Belton, a village located on the outskirts of Grantham. A garden area is located at the rear of the home and there is car parking space to the front of the property. All accommodation is situated on the ground floor. There are 7 single bedrooms one with en-suite and 3 shared bedrooms each with en-suite The home has one lounge/dining room and an adjacent conservatory. The fees at the inspection on the 15/5/2006 ranged from £400 to £500 per week. Extras are for hairdressing, chiropody, toiletries and personal newspapers and magazines Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection with a site visit was unannounced and started at 8.00 am. It was undertaken using a review of all the information available to the inspector regarding our service history about Belton Lodge. It took place over 4 hours. The inspector spoke to 6 residents, 4 visitors, 4 staff and the nurse in charge of the home as the manager was on holiday. The main method of the inspection was called “case tracking”. This involved selecting one resident and tracking the care they received through the checking of records, discussion with them and the care staff. The inspector also observed how care was delivered and how staff responded to other residents living in the home. Prior to the inspection the manager had completed a pre-inspection questionnaire and the inspector in preparing the inspection used this. Three comment cards were received from 3 residents. What the service does well: What has improved since the last inspection? What they could do better: The owner must ensure that repairs are made to the conservatory in order to allow residents to use this throughout the year. In addition, there must be a redecoration and refurbishment programme. The owner must ensure that a report is made of the monthly visits made to the home and a copy sent to CSCI. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 6 The manager should introduce internal audits in order to monitor the care records, medication and care practice in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Belton Lodge meets the needs of residents coming into the home. The home provides information to enable them to make a choice whether or not to come into the home. There is inconsistency as although all people receive an assessment before entering the home, not every one receives written confirmation that the home can meet their needs. EVIDENCE: The home has a detailed statement of purpose, which includes a service user’s guide and this gives information about the services provided, the aims and objectives, the philosophy of care and also rights of each person. A copy of this is in each bedroom within the home. Each person has a copy of their terms and conditions. Records showed a resident admitted to the home in February 2006 had been assessed by the manager and written confirmation sent to them that based on this assessment the home could meet their health and welfare needs. However a resident admitted on the 10/5/2006 did not have this information. A comment card received stated, I was admitted as an emergency and was made to feel very welcome. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 9 The home does not provide intermediate care. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Although efforts had been made to improve the care plans there was still inconsistency, as one person did not have a care plan. The way care is recorded still needs to be further developed to enable staff to have sufficient information to ensure that the health and welfare needs of people living in the home are fully met. Medication is safely administered. EVIDENCE: Not all residents had care records and care plans. Of the care records examined one had a very detailed care plan and one did not have a care plan. Care plans had improved since the last inspection. A resident admitted to the home on the 10/5/2006 who did not have a care plan or treatment regime even though the person had diabetes and a pressure sore. The care record identified the care being provided but did not show how staff were to meet the person’s needs. Where required risk assessments have been included. Records showed evidence of review every month. However there was still no evidence to show that the care plans had been produced with the resident or relatives involvement. There were however signatures of the resident or their relative where there was any risk involved in caring for the resident. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 11 Care plans showed evidence of promoting the resident’s independence, respect, dignity and choice and detailed the care carried out every day. The inspector spoke with 6 residents and 2 visitors. Each person was satisfied that their care needs were appropriately met. Comments included: “my father is unwell and the nurse and staff are doing all they can to address his needs”, “I am very satisfied with the care and have been kept fully informed” and “we are well looked after”. The home had a medication policy and medication is administered by Registered Nurses who have received training on this subject. Records examined were seen to be well maintained. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. A programme of social activities is available which provides stimulation and interest for people living in this home. However, what is provided may not be what residents want to see. Visitors are made to feel welcome and supported. Residents have nutritious and varied meals EVIDENCE: There are no restrictions concerning how residents spend their time. Residents were sat in the lounge watching television, sleeping or in their bedrooms. There are activities provided but several residents commented that they felt bored. There are meetings with residents twice a year. There is however, not a great deal of information in the care records about how people wish to spend their time and what interests they have. All residents said they liked the food. There is a 4 week menu displayed on the notice board at the entrance to the home. The home received an inspection by the Environmental Health Officer on the 10/2/2006. There were concerns that risks were not being identified. As a result of this, the manager is to go on a “safer food better business workshop” provided by South Kesteven District Council in the very near future. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 13 A comment card stated, “I find the food very good and always enough. They offer fresh fruit throughout the day”. Comments from residents were, “I enjoyed my breakfast”, “we get good food”, “food is very enjoyable”, “I would like to go out” and “I feel bored”. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Any complaints received by the home are handled properly and residents know that any complaints they have will be listened to and taken seriously. Staff are recruited to ensure that residents are protected from abuse. Staff receive training on this subject during their induction EVIDENCE: Each resident receives a copy of the complaints procedure when admitted to the home. The complaints procedure is also displayed on the notice board at the entrance to the home. No complaints have been received by the home and the CSCI since the last inspection. None of the residents had any concerns about the home. Comments were, “I have no worries and if I do I can talk to the staff or the manager”. Staff receive a detailed induction programme, which includes information about abuse. Staff knew what constituted abuse and what to do if abuse was suspected. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to this service. Residents live in clean accommodation. Any risks to the resident’s safety have been identified and acted upon. The conservatory leading from the lounge cannot be used due to a leaking roof. This prevents residents using this facility. However this is to be addressed in the future. EVIDENCE: Residents who spoke to the inspector said how they liked their rooms and how clean the home was. The home has one lounge leading to a conservatory and a dining room. Residents have access to all these areas of the home, which are on the ground floor level and systems are in place to minimise risks to people who are confused. This includes door alarms. The conservatory however cannot be used as a result of it leaking. During the inspection the inspector spoke to the owner of the home about this issue. He was told that the a new roof and windows are to installed depending on the weather in June 2006 and with this there will also be a new door to access the rear garden which will have a patio Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 16 provided to enable residents to use the garden. He also said that the worn external wood and paintwork would also be attended to. The home has one operational bathroom with a bath hoist. The second bathroom is no longer suitable to meet the needs of the people living in the home. All areas of the home appeared clean. Health and safety policies and procedures were available and the last fire safety officer’s inspection was on the 13/12/2005. There were no concerns. During the inspection the inspector tested using a calibrated thermometer the hot water temperatures from hot taps in 4 bedrooms. The temperatures tested ranged from 44 to 46° Centigrade. As the safe temperature recommended by the Health and Safety Executive is 43° Centigrade this was safe. Water was tested for Legionella on the 12/1/2006. A comment card stated, “the home is very good but it could do with being redecorated”. Comments from residents and visitors were “the home is clean but does need redecorating”. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. There is a competent staff team. The numbers of staff were sufficient to meet the needs of the residents. Staff were correctly recruited and supported in their work. Staff have started to receive training in care (National Vocational Qualification). EVIDENCE: None of the residents or staff expressed any worries about the level or availability of staff. During the inspection, staff were seen to attend to residents promptly. One of the residents was unwell during the inspection and staff attended to this person in a caring, sensitive manner. Offering support to both the resident and their family. Staff commented. “I have time to care for the people” and “I like working here”. The home has Link Nurses for palliative care, tissue viability and incontinence. These link up with specialists from the NHS Primary Care Trust to promote good and latest practice in these important care practices. Since the last inspection 3 staff have started to study a care qualification (NVQ). Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home is well lead by a competent, experienced and committed manager. People living in the home have confidence in the staff and management of the home. Staff receive formal supervision and feel supported. EVIDENCE: The manager is a Registered Nurse and has extensive care and management experience. She is studying for a management qualification to NVQ level 4. Residents monies were looked after securely and records kept of the amount kept by the home for each person. Staff receive formal staff supervision. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 19 Systems were in place to monitor the quality of the service offered. Residents meetings are held approximately twice each year. Also, quality satisfaction questionnaires are sent to each person each year. The last questionnaires were sent out on the 1/10/2005 and 5 returned. There were no negative comments. The questionnaire concerned the quality of care, friendliness of staff, response to phone calls, decoration and ambience, response to complaints, meals and their overall impression of the home. Residents were satisfied that they were supported to express their views regarding life within the home and that suggestions or comments would be acted upon. Although the registered provider visits the home every month no written report of this visit was in the home or sent to CSCI. This has been outstanding from several inspections. Health and safety policies and procedures were in place. The home has an internal sluice and gloves and aprons were available for staff. Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 20 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 3 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 2 2 x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 21 No 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. Standard OP7 Regulation 15 Requirement The manager must ensure that each person admitted to the home has a care plan outlining the assessed needs. This needs to be done as soon as possible to give an accurate account of treatment, care planning and delivery. It must also clearly identify how the staff are to provide the care and support for people living in the home. Care plans must also wherever possible involve the resident in identifying their health and welfare needs. Nurses must be reminded that record keeping must be in accordance with guidance laid down by the Nursing and Midwifery Council. Timescale for action 15/07/06 Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 22 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 OP12 Good Practice Recommendations It is recommended that the manager carry out a survey of residents to find out from them what type of leisure activities they would wish the home to provide as the current activities provided may not suit all the residents. It is recommended that the owner introduce internal audits for care records, medication and care practice. 2. OP33 Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Belton Lodge Nursing Home DS0000002587.V293898.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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