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Inspection on 07/10/08 for Belton Lodge Nursing Home

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

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 continue to live in a clean and comfortable environment. People who live in the home have again told us that they are happy and content and satisfied with the care and approach of the staff. There is a friendly and relaxing atmosphere in the home.

What has improved since the last inspection?

Improvements have continued to the environment in the home by making the conservatory more comfortable and an alternative to the lounge. New curtains and more suitable chairs have been provided. The existing lounge has been made more comfortable and less cluttered. A review has taken place of the way the people spend their time with the emphasis being on choice and staff spending more individual time with the people living in the home. Staff have spoken to the people lving in the home about their interests and what they want to do with their time during the day. Care plans continue to improve and are more individual. More choice has been provided at tea. Staff training has continued to improve since the last inspection to ensure that staff have more skills and are more competent to care and support the people in the home. Quality assurance has improved through regular visits by the homeowner, reports of his findings as well as regular quality assurance surveys to learn about, and begin to take action on, the people and visitors` views about the home.

What the care home could do better:

There were no again no requirements from this inspection visit. However, registered nurses who work at the home and the management need to continue to develop care plans to outline clearly how staff can meet the varying needs of the people who live at the home. Staff need to continue to develop spending more individual time with the people living in the home who either cannot or do not want to join in group activities. The owner needs to consider as a result of findings from our inspection an addtional stand aid hoist to encourage independence as the existing hoist is not approrpriate in all cases. In addtion the access to the bathroom should be made easier for these lifting aids. The owner should continue to develop the home to provide a quality service focussing on developing staff skills to provide a person focussed approach to care.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW     The quality rating for this care home is:   one star adequate 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: Tobias Payne     Date: 0 7 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Belton Lodge Nursing Home 213 Belton Lane Grantham Lincs NG31 9PW 01476579798 01476579798FP dimplemotors@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Indra Nathan Type of registration: Number of places registered: R S Medicare Limited care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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. Date of last inspection Brief description of the care home Belton Lodge is a care home providing personal and nursing care for 13 older persons. The home is a converted bungalow situated in Belton, a village located on the outskirts of Grantham. There is a lawned garden 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 visit on the 7/10/2008 ranged from 400 to 495 pounds a week. Extras are for hairdressing which ranged from 9 pounds and 75 pence to 23 pounds , chiropody 10 pounds , toiletries and personal newspapers and Care Homes for Older People Page 4 of 27 Over 65 13 0 Brief description of the care home magazines. Information about the home including a copy of the last inspection report, the statement of purpose and service users guide can be obtained from the manager. Care Homes for Older People Page 5 of 27 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: one star adequate 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection visit was unannounced and started at 8 am. It was done using a review of all the information available to us about Belton Lodge Nursing Home. It took place over 4 hours. This inspection was carried out by 2 inspectors from the Commission. We spoke with 5 people living in the home together with 3 staff and the registered nurse who was in charge of the home during our visit. The main method of inspection used during our visit was called case tracking. This involved spending time to find out how the care was provided for one person through Care Homes for Older People Page 6 of 27 the checking of records, discussion with them, the care staff and looking at how the care was actually given and the outcomes for the person. Before making our visit we asked the people who live there to send us comments about the support they receive. We received comment cards from 4 of the people living in the home. All comments were in the main positive. We also received comments from one member of staff. We also looked at records, spoke with staff and other people who live at the home and walked around the home. 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. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 10 of 27 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. People who choose to come into the home receive an assessment and know their needs can be met. They are also involved wherever possible in this process. There is clear information to enable them to make a decision about whether or not to move into the home. Evidence: There was a detailed statement of purpose and service users guide a copy of which was in each of persons bedroom. Since the last inspection this information also had our Cambridge office address and phone number included. We looked at information for 2 people who had been admitted to the home. This showed they had detailed information from the hospital or referring authority and from this a care plan had been produced. Information had wherever possible come from the person, their family/advocates and other relevant people. We spoke to one person who Care Homes for Older People Page 11 of 27 Evidence: told us I like my room and I chose what I wanted to bring with me. They got to know me quickly and also about my ways. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans, created from assessments of need help to ensure that peoples current health and welfare needs are met. Improvements have taken place to ensure that care plans are up to date and reflect the needs of each person. However the people living in the home are not yet fully involved in identifying their needs or when reviews take place. Medication is safely given by staff who know what they are doing. Evidence: Each person had a care plan. Records included an admission assessment of their needs, nutritional assessment, a detailed care plan, dependency assessment, risk assessment with the signature of the member of staff, specific care plan outlining the care and support, daily record and evidence of monthly review. We looked in detail at the care plans for 2 people. Effort had been taken to address the the way their needs were recorded. Care plans were more individual and had been expanded to give details about how staff can support and meet the needs of the people. The staff completed daily records so that the changing needs could be recorded and responded to in the Care Homes for Older People Page 13 of 27 Evidence: right way by the care team. We saw that the care plans also considered the capacity of people to make decisions about their lives. Staff also told us that they knew how important it was to respect each persons capacity to make decisions about their lives. Although there had been an improvement we could see no evidence that the people themselves had been involved in identifying their needs or at reviews. There were plastic aprons, gloves and antibacterial hand wash in each bedroom. Staff were seen to attend to people promptly and with little fuss. We saw staff encouraging people to remain independent and in control of their lives by being asked about what they wanted to do. Staff we spoke with told us that we do not like to take his independence away and we leave it up to him about what he chooses to do The home had an electric hoist with a variety of slings and pressure relieving mattresses. Staff told us that they had a range of equipment to support the people but that they could benefit the people further by having an alternative stand aid. Registered nurses who work at the home administered the medication. Each nurse was assessed by the manager and considered competent to administer medication. All the people who live at the home needed some form of support to take their medicines when they needed them. We observed this being done in a sensitive way. The nurse explained clearly and slowly how she was to provide suport to the person receiving the medication before she gave it. Medicines were given from a trolley, checked against the chart, given to the person and signed for after this. The home received a pharmacy inspection visit in August 2008. There were concerns that not all entries had a medication quantity and drug box was not locked in the clincal fridge. All these issues had since beeen addressed. Care Homes for Older People Page 14 of 27 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. People are able to choose to take part in a range of social activities offered. This helped to ensure that their social and cultural needs are being met. People choose and enjoy a well balanced diet. Evidence: Efforts have continued to provide more stimulation in order prevent boredom for the people living in the home. More information has been included in the care plans about the peoples interests and what they like to do. We could see there was an activities programme and an outside music entertainer had been arranged for the 5/11/2008. Other activities provided by the staff have included pass the ball, hand massage, gentle movements to music and hairdressing every week. Apart from the organised activities the nurse in charge at our inspection showed us how efforts have been made to make routines more person centred. During our inspection we saw people being assisted to be active or choosing to be in their rooms. We discussed with the nurse in charge developing this further by encouraging staff to spend more individual time with the people talking to them, listening to them and doing what they chose to do. Where this was taking place we saw the people actively involved in conversation, aughing and smiling. Some were encouraged to sit with the staff and have a cup of tea during their Care Homes for Older People Page 15 of 27 Evidence: breaks. We were told that meal times had been made more important by inviting the people to eat at the dining table rather than sat at a table in front of the television. Dining room tables had clean table cloths and table decorations. The way food was served had been made more attractive. The menu was displayed on the wall. As a result of these changes and switching off the televison during meal times we were told that the people living in the home had not been so agitated and were enjoying their meals in a more relaxed atmosphere. More conversation was also taking place. People we spoke with told us I like the food and I have had a nice lunch. We also noticed a care worker supporting one person to put salt on his food in a sensitive way which left him fully in control of his actions and choices. Staff also told us we do not want to take the peoples independence away The kitchen was seen to be clean, tidy, well organised and well stocked with meat, fresh fruit and vegetables. The cook was appropriately dressed. An Environmental Health Officer’s inspection by South Kesteven District Council took place on the 9/4/2008. As a result the home was awarded 3 stars (good) award. Care Homes for Older People Page 16 of 27 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 know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. Evidence: There was an up to date complaints procedure with our Cambridge address and phone number displayed at the entrance to the home and each person received a copy of the complaints procedure in the service users guide. The home and the commission had received no complaints since the last inspection. No one had any complaints about the home during the inspection. We had been aware of a safe guarding adults issue in May 2008 which was investigated by Lincolnshire County Council with the full cooperation of the owner and the manager. As a result of the invetigation the owner was required to take action to make sure the people were supported safely. A further meeting is to take place in November 2008 to review outcomes and what progress has been made. Through discussions with staff during our visit we saw they knew about abuse and their role and that refresher training had been provided for all staff on abuse prevention on the 17/7/2008. The home also had a copy of Lincolnshires Adult Protection Policy for the care team to refer to. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in comfortable, clean accommodation. Evidence: Since the last key inspection the environment in the home has continued to improve. Efforts have been made to make the conservatory a more attractive alternative to the lounge. This now had new curtains, comfortable chairs and was a more pleasant and less cluttered environment. There was a second bathroom with a shower, toilet and washbasin but it had not been finished yet and needed pipes to be boxed in. The home had an electric hoist with a variety of slings and pressure relieving mattresses. We were told that it was felt that the meet all the needs of the people in the home an alternative stand aid hoist should be provided. We found the home was clean, tidy, well organised and odour free throughout our inspection visit. There were antibacterial hand washes in each bedroom and there was an infection policy which staff used to reduce the risk of cross infection. There were also gloves and aprons and alcohol rubs which we saw being used by staff. There were 2 commercial washing machines and one commercial tumble dryer being used to make sure peoples personal clothing was cleaned regularly. The laundry room was clean and tidy. Facilities were available to ensure clinical waste was well managed. Care Homes for Older People Page 19 of 27 Evidence: Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available in the right numbers to support people with care needs in the right way. Training has been provided to ensure that staff were competent and skilled to care and support people safely. People are protected by clear recruitment practices. Evidence: We spoke with one new member of staff who confirmed they had been recruited correctly and safely with a check by the Criminal Records Bureau check, interview notes, contract and supported induction. Staff rotas were available and none of the residents or staff had any concerns about the levels or availability of staff. Throughout our visit we saw staff promptly attend to the needs of the people living in the home. A comment we received was we have enough staff at each shift. We were told that since the last inspection all care staff were studying for a care qualification to National Vocational Qualification standards. Training since our last inspection had also included, safe guarding adults, infection control, food awareness and dementia awareness (we noted that 2 staff had been on a 2.5 day training course). During our inspection we saw staff applying their training outcomes to their daily work. For example when supporting people who were confused and taking time Care Homes for Older People Page 21 of 27 Evidence: with them to talk to them in a calm and sensitve manner. We also discussed the previous observations in our reports that there were some staff employed who did not have very good command of the English language and how this could affect their communication and confidence when speaking with the residents. We were told that the staff were now attending English classes and were being observed and supported. During our inspection visit staff spoke, kindly and politely to people. We did not see any issues of concern. Care Homes for Older People Page 22 of 27 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living and working in the home benefit from the positive leadership of the management team. Management record systems show that peoples health, safety and welfare are in the main promoted. The management team ensures that the people have the opportunity to voice their views and opinions. The management team uses feedback from questionnaires to make improvements. The lack of a consistent day to day management is affecting the way the home is managed and staff supported. Evidence: Before we made our inspection visit we were told by the owner that the manager is currently unavailable . However, an acting manager has been appointed and is providing support in her absence. The acting manager was not present for this inspection but the home was being managed competently by a registered nurse who assisted us during our visit. Before our visit we also had a meeting with the owner of the home with Lincolnshire Care Homes for Older People Page 23 of 27 Evidence: County Council. He told us that he was in the process of reviewing the way the home was managed and agreed to keep us informed about his future proposals. As part of this review the owner and acting manager had ensured that there was a full range of policies and procedures available, clinical procedures and Lincolnshire Teaching Primary Care NHS Trust guidance. The manager had as a result of a previous recommendation obtained a copy of the Mental Capacity Act 2005 code of practice. Staff received regular formal supervision and notes were being kept. Staff told us that they felt the management were more supportive. Staff told us my manager discusses issues with me regularly and always encourages me to improve my quality of work and If I have a problem I can discuss it with my manager. Regular monthly visits have continued to take place by the owner. Records of his visits were available. In addition, service users questionnaires were sent out to 2 people living in the home in September 2008 with them rating aspects of the home from good to excellent. A comment we received was I am very happy here. Everything is fine. Staff meetings took place every month with clear minutes. There was a detailed equal opportunities policy, which referred to discrimination, disability and victimisation. Action had been taken since our last inspection visit to assist staff who had poor command of the English language by encouraging and supporting staff to attend English classes. There was a comprehensive and detailed health and safety policy together with risk assessments covering all aspects of daily living activities. Records also showed there were regular tests of the fire system as well as regular fire drills. However as a result of the recent health and safety inspection the owner has been asked to make sure that the servicing of equipment used to support the people is monitored regularly. He has also been asked to ensure that any servicing needs are arranged as they become due. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 1 7 The manager and owner should wherever possible involve each person in identifying their needs in the care plan and also at the review of their care plan. Where identified suitable training should be provided for staff. This will ensure that a person centred service is provided. The manager and owner should encourage staff to develop and spend more individual time with those people who choose not to be involved in group activities. By doing this people living in the home will feel more valued and stimulated. The owner should consider providing an alternative hoist (Stand aid) to assist those people who cannot or do not need assistance from the existing hoist. In addition consideration needs to made to making the access to the ground floor bathroom easier (by widening the doorway) for the hoists, for the staff and the people living in the home. By doing this it will make it easier and safer for all people using the bathroom. 2 12 3 22 Care Homes for Older People Page 26 of 27 Helpline: 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 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 © (2008) 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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!