Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 04/01/07 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 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.

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 the home are happy and content and satisfied with the approach of the staff. The staff know how to care for the needs of the residents and are supported in their work. There is a friendly and relaxing atmosphere in the home.

What has improved since the last inspection?

Since the last random inspection residents were asked their views about what activities they wished to see in the home. As a result, a new activities programme had been produced.

What the care home could do better:

It is most concerning that the owner has continued to breach the regulations requiring him to address the state of the conservatory and decoration and condition of paint and woodwork. Despite assurances being given to the commission very little improvement has taken place. The manager must ensure people are admitted to the home within the category of registration. The owner must ensure that the statement of purpose accurately describes the registration category on the registration certificate. The owner must introduce quality monitoring procedures, which include making a report of his monthly visits to the home.

CARE HOMES FOR OLDER PEOPLE Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW Lead Inspector Toby Payne Key Unannounced Inspection 4th January 2007 08:20 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.V325153.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. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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.V325153.R01.S.doc Version 5.2 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. 15th May 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 12 people living in the home. The home is a 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 4/1/2007 ranged from £400 to £500 per week. Extras are for hairdressing, chiropody, toiletries and personal newspapers and magazines Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second key inspection visit was unannounced. It took any previous information held by the commission into account. The first key inspection took place on the 15/5/2006 and as a result of concerns about the records and environment a random unannounced inspection took place on the 19/10/2006. As a result of continual concerns about activities, the environment and non-action with regard to previous inspection requirements this second key inspection took place. The site visit took place over approximately 4 hours with the assistance of a registered nurse. The main method of inspection used was called case tracking which involved following the experience of 2 residents and assessing the service they received. Feedback was also gained from staff and 2 visiting general practitioners and conversations with 7 residents. What the service does well: What has improved since the last inspection? What they could do better: It is most concerning that the owner has continued to breach the regulations requiring him to address the state of the conservatory and decoration and condition of paint and woodwork. Despite assurances being given to the commission very little improvement has taken place. The manager must ensure people are admitted to the home within the category of registration. The owner must ensure that the statement of purpose accurately describes the registration category on the registration certificate. The owner must introduce quality monitoring procedures, which include making a report of his monthly visits to the home. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 6 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. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Belton Lodge meets the needs of people coming into the home. Information is provided to enable people living in the home to make a choice as to whether or not they wished to come to the home. However the information does not accurately describe the type of person able to admitted to the home. EVIDENCE: The home had a detailed statement of purpose, which also included a service user’s guide, which gave information about the services provided in the home. This included the aims and objectives, philosophy of care and also rights of each person. A copy of this document was in each bedroom in the home. However the statement of person stated that the home was registered to admit people who had a dementia. This is not stated on the registration certificate and by admitting people out of category the home was breaking the law. This needs to be amended. The most recent admission records were examined for one person who was admitted in November 2006. There was evidence to show that the person had Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 9 been assessed by a competent person (registered nurse) and there was also detailed information from the hospital and referring agency. There was also a letter to confirm that the home could meet this person’s assessed needs. The person also had costed terms and conditions. The person told the inspector they liked the home and had settled in. . The home did not provide intermediate care. Belton Lodge Nursing Home DS0000002587.V325153.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): Standards 7, 8, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information in the care records has improved. Resident’s health needs were being met. EVIDENCE: Care records had improved since the last key inspection. All residents had care plans. The care plans detailed the daily living activities needed to support the person. Care records were examined for 2 people. Care plans were clearly written and showed evidence of review every month. Staff knew about their care. Care records also showed written confirmation that the home could meet the resident’s needs. Where required they now had a body map. There were also nutritional assessment, pain, sleep, mental state and social interests included. There was an evaluation with dates but no evidence to show the resident had been involved in their care plans. Two visiting GPs were satisfied with the care and approach and the professional way staff went about their work. The medication records were examined. There was a medication policy and medication administration records recorded medication coming into the home. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 11 The records were clearly written and there was also a return book when medication was returned to the pharmacy. A medication round was observed. There was no concern about the medication practice. Staff attended to residents promptly and in a courteous and friendly manner. Residents were got up and taken to the lounge at different times during the inspection during the morning. Five were in the lounge/dining room at 08.20 hours when the inspection started and others came into the room during the morning. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Since the last random inspection the activities programme has been improved and provides stimulation and interest for people living in the home. Visitors were made to feel welcome. Residents had nutritious and varied meals EVIDENCE: There were no restrictions about how residents spent their time. Since the last random inspection action had taken place to address the issue of activities in the home. The registered nurse in charge of the home during the inspection told the inspector that the manager had asked the residents what type of activities they wished to see in the home. As a result of this there was a new activities programme. This was displayed outside the office. It showed programmes in the morning and afternoon each day of the week. They included pass the ball, hand massage, gentle movement with music and foot spa. Staff carried out activities, though on the day of the inspection no morning activities were taking place. Residents were sat in the lounge a number were dosing and others were watching the television. Staff were, when they had time, sitting talking to them. None of the residents had any concerns and all said they were happy in the home and did not feel bored. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 13 The kitchen was clean and tidy and records of food temperatures and cleaning records were kept. However the cook confirmed that records of food provided were not being kept so it was difficult to confirm what food residents had received. The first aid box in the kitchen had a sling and plastic glove. It was not correctly stocked. All residents said they liked the food. There was a 4 week menu displayed on the notice board at the entrance to the home. Staff were seen to assist residents who could not feed themselves in a calm and sensitive manner. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Any complaints received by the home were handled properly and residents knew that any complaints they have were listened to and taken seriously. Staff were recruited to ensure that residents were safe. However, not all staff received training on adult protection and a recent adult protection investigation showed that the procedures had not been followed and could place residents at risk. EVIDENCE: The complaints procedure was in the statement of purpose and service user’s guide a copy of which was in each bedroom. The complaints procedure was also displayed on the notice board at the entrance to the home. The commission had been made aware of an allegation of abuse, which was initially investigated by the home before the commission and Lincoln Social Services were informed. This was not the correct procedure. The investigation has not been completed. The resident concerned is no longer living in the home. The nurse in charge during the inspection was aware of the continuing adult protection investigation but was not aware of the Lincolnshire Adult Protection policy which was in the office and up to date. She was not aware that the home should not have investigated the incident before informing social services and the commission. She clearly knew what abuse was but acknowledged she had not received any training on the subject. It was therefore apparent that not all staff had received adult protection training. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents lived in clean accommodation. Since the last key inspection very little action had taken place to address the environment in the home. Although assurances had been received from the owner very little had been done to improve the decoration in the home. The conservatory still could not be used by residents and the condition of some of the external woodwork and windows were no longer acceptable. EVIDENCE: Residents said they liked their rooms. The home had one lounge leading to a conservatory and dining room. Residents could have access to all areas of the home, which were on ground floor level and systems were in place to minimise the risk to people who were frail or confused. This included door alarms. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 16 The nurse acknowledged that no action had taken place since the last key and random inspection to address the state of the conservatory. Assurances had been made by the owner that a new roof and windows were to be installed depending on the weather in June 2006 and with this would also include a new door to access the rear garden which would have a patio provided to enable residents to enjoy the garden. External wood and paintwork would also be attended to. This issue was followed up by a random inspection in October 2006. Very little improvement had been seen at that inspection. There was paint damage and carpets were worn but not to such an extent to put residents at risk. There was still one operational bathroom. All areas of the home were clean, warm and odour free throughout. Health and safety policies were available and the last fire safety officer’s inspection was on the 13/12/2006. There were no concerns. During the inspection, the inspector tested the hot water temperatures from hot taps in 3 bedrooms using a calibrated thermometer. The temperatures ranged from 39º to 42.6º Centigrade. The safe temperature recommended by the Health and Safety Executive was 43º Centigrade. The temperatures were within safe limits. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a competent and educated team of staff. Staff were correctly recruited and supported in their work. EVIDENCE: None of the residents or staff expressed any concerns about the level or availability of staff. Staff were seen to attend to residents promptly. A new member of staff was on her 5th day of working in the home and explained that she had seen an advertisement, completed an application form, been interviewed, references obtained and check by the Criminal Records Bureau. She felt supported and was being supported by a registered nurse. None the residents expressed any worries about the level or availability of staff. One care assistant was studying for a qualification in care (National Vocational qualification) and a further 2 were waiting to start NVQ. Staff were seen throughout the inspection to speak to residents politely in a calm and friendly manner. Residents said that staff were always kind and they were happy in the home. Staff said they enjoyed working in the home and had time to care for the residents. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is lead by a competent, experienced manager. People living in the home have confidence in the staff. Staff received regular supervision and feel supported. The service however is affected by the deteriorating quality of the accommodation, non-action by the owner over requirements and continued breach of regulations. The quality of the service needs to be addressed. EVIDENCE: The manager is a registered nurse and had extensive care and management experience. She continued to study for a management qualification to NVQ level 4. Residents monies were looked after securely and records were kept of the amount kept by the home for each person. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 19 Staff received formal supervision. The inspector was unable to find out when the last residents survey took place and also when the last residents’ meeting was. However it was confirmed that the manager spoke to residents about what they wanted in the activities programme following the last random inspection in October 2006. Although the provider made regular visits to the home there was no record of his visit or whether he spoke to staff, residents or examined records. This has been outstanding from many inspections. There was a mention of equal opportunities in the statement of purpose regarding recognising equality. There was no specific policy on equality and diversity. It was evident that the quality of the service needs to be addressed. Although Health and safety policies and procedures were in place, the first aid box in the kitchen needed to be replenished, as it was very nearly empty. The home has an internal sluice and gloves and aprons were available for staff. During the inspection it was noticed that several beds had bed rails attached in order to prevent residents injuring themselves by falling out of bed. However, not all of these rails had protected covers to prevent limbs being trapped. This has been recommended by the Department of Health and needs to be addressed. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 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 2 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 2 2 x x x 2 3 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 3 x 2 x 3 3 x 2 Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 21 Yes 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 OP1 Regulation 4 and 5 Requirement Timescale for action 04/03/07 2 OP18 13(6) 3. OP15 17(2)(13 of schedule 4 The registered person must ensure the statement of purpose and service user’s guide and information about the home accurately describes the registration category of people able to be admitted to the home. References to the home being registered for dementia must be removed. 04/03/07 The registered person must ensure that all staff have received adult protection training and that the manager and nurses in charge of the home are aware of the Lincolnshire County Council’s Adult Protection procedures. Also that any adult protection issue must be reported to Lincolnshire County Council Social Services dept. immediately as well as notifying the commission. The home must not investigate any issue before the Social Services dept. have been notified. The registered person must 04/03/07 ensure that the home maintains a record of food provided of meals every day. This to enable DS0000002587.V325153.R01.S.doc Version 5.2 Belton Lodge Nursing Home Page 22 4. OP19 23(2)(b)( d)(j) any person inspecting the record to determine whether the food provided is nutritionally satisfactory and has variety. This includes a record of any special diets. The registered person must 04/03/07 attend to the outstanding issues relating to the state of the conservatory, external windows, external woodwork and provide a suitable second bathroom and patio area to the rear garden. The registered person is required to send written proposals with dates when this work will be commenced and completed to the commission. Further the registered person must carry out an audit of the environment and introduce a programme of planned refurbishment/replacement of carpets and furniture etc. The timescales of the 15/5/2006 and 19/10/2006 have not been met. The registered person must 04/03/07 establish and maintain a system of evaluating the quality of the services provided at the care home. The registered person must visit 04/03/07 the home unannounced at least once a month in accordance with this regulation. Reports of this visit must either be available for inspection at the home or sent to the commission. The timescales of the 15/5/2006 and 19/10/2006 have not been met. The registered person must ensure that where as a result of a risk assessment, protective bed rails have been provided, DS0000002587.V325153.R01.S.doc 5 OP33 24 6. OP33 26 7 OP38 13(4) 04/03/07 Belton Lodge Nursing Home Version 5.2 Page 23 that suitable protective covers are also provided to prevent entrapment of limbs etc. Further that the first aid box in the kitchen is replenished and that arrangements have been made to train staff in first aid. 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 OP33 Good Practice Recommendations It is again recommended that the manager introduce internal audits for care records, medication and care practice. Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Belton Lodge Nursing Home DS0000002587.V325153.R01.S.doc Version 5.2 Page 25 - 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!