Inspection on 14/09/06 for Chester Lodge General Nursing Home

This inspection was carried out on 14th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chester Lodge General Nursing... 18/09/08

Chester Lodge General Nursing... 05/09/07

Chester Lodge General Nursing... 20/09/05

Chester Lodge General Nursing... 19/05/05

Chester Lodge General Nursing... 21/10/04

Chester Lodge General Nursing... 13/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Chester Lodge General Nursing Home Brook Street Chester Cheshire CH1 3BX Lead Inspector Wendy Smith Unannounced Inspection 14th September 2006 10 am 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 Chester Lodge General Nursing Home DS0000018715.V306257.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. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chester Lodge General Nursing Home Address Brook Street Chester Cheshire CH1 3BX 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) 01244 342259 01244 403249 Heathbrook Limited Sheila Percival Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (1) of places Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 40 service users to include: * Up to 40 service users in the category of OP (old age not falling within any other category) * 1 named service user in the category PD (physical disability under the age of 65) Date of last inspection 20th September 2005 Brief Description of the Service: Chester Lodge nursing home is a modern three-storey building situated close to Chester city centre and convenient for all local amenities and public transport. There are bedrooms and bathrooms on all three floors. A passenger lift and two staircases provide access to all levels. Communal space consists of a lounge, dining room and conservatory on the ground floor, with smaller lounges on the first and second floors. Outside there is a small garden with sitting space, and a small car park at the rear of the property. The home provides personal care and nursing care for older people who are physically frail. The home’s fees are from £343.43 to £529 per week. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for Chester Lodge included a site visit to the home on 14th September 2006 which was unannounced and took five hours, with a follow up visit to spend time speaking with the manager on 17th September 2006. Time was spent talking with the proprietor, manager, staff and residents, and observing the day to day routines of the home and care staff as they provided support. The building was looked at to assess its suitability to provide a comfortable, homely and safe environment. A sample of care plans and other records was looked at and the arrangements for medicines were reviewed. Before the visit, comments cards were sent to residents and relatives and some mostly positive comments were made. Comments cards have also been sent to GPs and other professionals who visit the home but none were returned. The home manager provided written information prior to the visit. The home promotes equality by treating people as individuals and ensuring that diversity needs such as impaired mobility and gender are appropriately met. People who use the service confirmed that care staff are kind, caring and responsive to meeting individual’s needs. The home had 37 residents, some of whom require nursing care and some personal care. What the service does well: Chester Lodge provides care for older people with a wide range of needs and abilities. All prospective residents are assessed by the home manager to ensure that their needs can be met at Chester Lodge. Some residents require a high level of nursing care; others are independent with some support from staff. Residents said that they are very happy living at Chester Lodge and receive the care and attention that they require. A number of residents enjoy going out to the local shops and going out with their relatives. Residents are encouraged to remain mobile and have freedom of movement within the home. The more frail residents are provided with the equipment they need to keep them comfortable and safe. Chester Lodge has a homely atmosphere and residents were seen to be treated very much as individuals. The home has a strong and stable management team. The registered person is part of the staff team and has been so since the home opened. She works Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 6 closely with the home manager and has responsibility for day to day administration. The home has a stable team of registered nurses and care assistants and there is little use of agency staff. All parts of the building are clean and in good repair. Maintenance contracts are in place to ensure that the environment is kept safe for residents and staff. What has improved since the last inspection? What they could do better: 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. Chester Lodge General Nursing Home DS0000018715.V306257.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 Chester Lodge General Nursing Home DS0000018715.V306257.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed before admission and their needs can be met at Chester Lodge. EVIDENCE: Chester Lodge is a city centre home and the majority of residents are older people who are accustomed to living in an urban area and enjoy living near to a variety of shops and other amenities, and being able to see traffic and pedestrians passing by. Some of the home’s residents have a degree of memory loss and/or cognitive impairment however they also have needs due to physical illness or frailty and their needs can be met at Chester Lodge. One resident sometimes has challenging behaviour and has been reassessed by medical professionals. A more suitable placement is being looked for to meet this person’s needs. One resident is under 65 years of age. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 9 The manager said that she receives good assessments from social workers when new residents are referred, however she always goes out to meet, and to assess the needs of, all prospective residents before they are admitted. Chester Lodge General Nursing Home DS0000018715.V306257.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 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 available evidence including a visit to this service. The health and personal needs of residents are met to a good standard but the recording in care plans and on medication records needs to be improved to meet the required standard. EVIDENCE: Each resident has a care plan that is kept in the manager’s office. The care plans are written by registered nurses and detail the needs of residents. Care plans are reviewed monthly but frequently the review consists only of a signature and date, and this does not adequately demonstrate that any changes have been identified and catered for. Some care plans have been in place for two years or more without any meaningful review being written to show that staff have an awareness of the changing needs of residents. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 11 The home has residents with a widely differing range of needs. Some are relatively independent whilst others have a high level of need. One very frail resident has lived at the home for many years and is cared for in bed for most of the time however a new chair has been provided for her and she is now able to spend some of the time out of bed. She has an adjustable bed, bedrail protectors and an alternating pressure mattress; the nurses said that her skin remains intact. A re-positioning chart was used to record pressure area care. One resident had recently returned from a stay in hospital with serious pressure sores on both heels. The home manager, who was previously a district nurse, was taking lead responsibility for dressings changes and closely monitoring the progress of the sores. One resident said that he was concerned that he was losing weight. This was discussed with the manager and one of the nurses who were both very aware of his condition. No weight had been recorded in his care plan since April 2006 although there was no reason why he could not be weighed. The care plans do not contain a nutritional risk assessment, but a nurse spoken with considered that she and her colleagues did identify residents who were underweight and care plans were written to address their needs, an example of this was seen. The home’s weighing scales are only suitable for residents who are able to stand unaided. The registered person said that she does intend to buy sit-on weighing scales when the budget allows. All of the seven residents spoken with were very satisfied with the care that they were receiving and said that they were happy living at Chester Lodge. The medicine room is not kept locked as it is also used for other storage. Trolleys and cupboards were all locked but the two drugs fridges were not fitted with locks. This was a requirement made at the last inspection of the home. At the time of this visit the fridges contained only eye drops and creams so this was not a very serious matter, however it needs to be addressed to ensure that other refrigerated items that may be prescribed can be stored securely. Medicines records need to be improved to show that residents always receive their prescribed medication. Drugs received at the home were often not checked in on the medicine administration record sheets and hand-written medicine administration record sheets were not signed or dated and the quantity received was not recorded. This means that it is not possible to check whether all have been given as prescribed. This was a requirement made at the last inspection of the home. A more systematic system of auditing is needed to identify when and why staff are not recording properly. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 12 The controlled drugs cupboard was being used to store money in and this is not good practice. A small quantity of controlled drugs left from 2005 needs to be disposed of. The manager said that she and one of the other nurses are booked to attend a medicines management training course in October. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choices and remain part of the local community EVIDENCE: There is an atmosphere of openness and good humour in the home. One resident spoken with has lived at the home since it opened fifteen years ago and three members of staff have worked at the home since then. The resident is pleased to be still able to go out to the local shops. The activities organiser has left recently and a replacement is being recruited. The manager has arranged for residents to go out to a local tea dance and they had a trip to Chester Zoo in the summer. Musical entertainment is provided on a regular basis. The lounge was busy with residents talking to one another. The TV was on for those who wanted to watch it but was not intrusive for others. Some residents were reading and most appeared occupied. There is no indoor smoking area for residents but there is a sheltered outdoor area where residents go for a smoke. A good proportion of residents are mobile and a variety of walking aids were in use in the lounge. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 14 The clothes that residents were wearing looked well cared for and a resident said that she was happy with the laundry service. Three residents spoken with said that they have a bath once a week and that was often enough for them. The menu for the day was written on a blackboard in the dining room but one resident said that she found it difficult to see. Residents were generally happy with their meals but one felt that the quality depended on which cook was on duty that day. Two residents spoken with in their bedrooms have a small kettle and small fridge in their room. Both expressed how happy they were at Chester Lodge and were going downstairs together for lunch. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. No complaints have been received since the last inspection. Staff have received adult protection training but did not respond appropriately for the protection of residents. EVIDENCE: The home has policies and procedures for dealing with complaints and the manager keeps a record of any complaints received and the outcome. No complaints have been received since the last inspection. The manager said that all staff, except for the four most recently recruited, have attended adult protection training and training for the new staff has been booked for October 2006. In May 2006 there was an allegation of abuse by a member of staff and the member of staff has been suspended. The manager said that she was ‘very disappointed’ that the senior staff did not follow the No Secrets local protocol and the incident was not reported to social services until the manager returned from holiday. The manager said that she hoped the home’s nurses would now be aware of the correct procedure however they had not received any additional training to make sure of this. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable, clean, safe and homely environment. EVIDENCE: A tour of the home included all communal areas and some bedrooms. Everywhere was clean and looked in a good state of repair and decoration. Communal space is limited in size and the two smaller lounges on the first and second floors were not being used by any residents. The laundry floor covering is in need of repair to ensure that it can be thoroughly cleaned and disinfected. There are two bathrooms on the first floor, one is spacious and the other is small. Unfortunately the bath in the large bathroom cannot be accessed using a hoist and the manager said that the room is used for storage purposes only. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 17 Residents are bathed in the small room, and during the visit a resident had to be brought out into the main corridor to complete dressing. Portable screening was used to ensure privacy, however the arrangements were not satisfactory, with other residents waiting to pass in the corridor. This was discussed with the registered person who considered that staff did not always make good use of the facilities and equipment provided and that the resident should have been taken to the second floor where there is a larger bathroom which could have been used. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by skilled staff, but the recruitment procedures need to be more robust. EVIDENCE: The home employs 8 registered nurses, 19 care staff and 9 ancillary staff. Staff rotas showed that there are sufficient nurses and care staff on duty over the 24 hour period to ensure that the residents’ needs can be met. At the time of this visit the overall dependency level of residents was not high. Nurses confirmed that they are authorised to phone an agency to cover any gaps caused by staff reporting in sick. They have found a good agency that tries to send the same agency worker who is familiar with the residents. The staff spoken with were friendly and open. Two new members of staff were spoken with and both said that they were enjoying working at Chester Lodge. A new carer said that other staff have been very friendly and helpful and she has been impressed with their positive attitude towards residents. Ten staff have achieved a national vocational qualification in care and some would like to carry on to a higher qualification. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 19 Training is accessed through the Cheshire Training Consortium and the manager confirmed that statutory training has been kept up to date for all members of staff. The registered person keeps records to show the recruitment process for new staff. All had completed an application form and there was evidence that written references had been requested however it was not clear whether references had all been received. The registered person said that all staff except the newest one have a Criminal Records Bureau disclosure. She was under the impression that a recent Criminal Records Bureau disclosure from another employment could be accepted as a temporary measure until a new disclosure is received, but this is incorrect. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 20 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, 37 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 has a competent and experienced management team and residents are kept safe, but the home would benefit from more robust auditing systems to measure performance and identify areas for improvement. EVIDENCE: The home manager is an experienced nurse and is registered with the Commission for Social Care Inspection. She has recently completed a management qualification. From speaking with staff and residents it was evident that the manager is trusted and respected by all at the home. She is on duty in the home at 7:15 am each weekday and is always available for staff, residents and visitors to speak with. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 21 The manager considered that she had little time available for auditing and did not have any formal auditing tools to use. This means that areas in need of improvement are not always identified. Staff are able to put forward their views at regular staff meetings. The role of senior care staff is not very clear at present and it is under discussion that they could be given additional responsibilities for the care of residents receiving personal care which would take some pressure off the nurses and allow care staff to develop more skills. The arrangements for handling residents’ personal money remain the same and are satisfactory. Information provided prior to the visit showed that all plant and equipment is serviced and maintained on a regular basis to ensure safety. All staff have attended recent fire safety training and regular fire alarm testing and fire drills are carried out. Between 8th May 2006 and 22nd August 2006, 32 accident forms had been completed and the great majority of these related to falls. Two of the falls had resulted in fractures and these had not been notified to the Commission for Social Care Inspection. The monitoring of accident records should form part of an auditing system. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 3 X x X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X 2 3 Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The drugs fridge must be kept locked. Requirement outstanding from 30/09/05 Hand-written medicine administration sheets must be signed, and the quantity of medicines brought into the home must be recorded. Requirement outstanding from 30/09/05 The care plans must show how the needs of residents and the care provided is kept under review. Ensure that all staff are aware of their responsibility to report any allegation of abuse to statutory authorities. Develop a quality monitoring system. Ensure that the Commission for Social Care Inspection is notified of all serious accidents and pressure sores. Timescale for action 31/10/06 2. OP9 13(2) 20/09/06 3 OP7 15(2)(b) 31/10/06 4 OP18 13(6) 31/10/06 5 6 OP33 OP38 24(1) 37 31/12/06 20/09/06 Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 24 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 OP8 Good Practice Recommendations Provide equipment to monitor the weight of all residents. Chester Lodge General Nursing Home DS0000018715.V306257.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. 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