Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Chester Lodge General Nursing Home Brook Street Chester Cheshire CH1 3BX 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: Wendy Smith
Date: 1 8 0 9 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: Chester Lodge General Nursing Home Brook Street Chester Cheshire CH1 3BX 01244342259 01244403249 chesterlodge@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sheila Percival Type of registration: Number of places registered: Heathbrook Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 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 cateogry PD (physical disability under the age of 65) Date of last inspection Brief description of the care home Chester Lodge is a privately owned nursing home. It is a modern three-storey building situated close to Chester city centre. The home is convenient for local shops and other amenities and is accessible by public transport. The home provides personal care and nursing care for older people who are physically frail. 0 1 Over 65 40 0 Care Homes for Older People Page 4 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: We made an unannounced visit to Chester Lodge on 18 September 2008. There were two inspectors and we were accompanied by an expert by experience (a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service). The expert by experience spent time talking with residents and had lunch with them. There were 27 people living at the home. During the visit we spoke with the home manager, one of the directors, staff, residents and a visitor. Before the visit the manager was asked to complete a questionnaire to provide us with up to date information about the home. Some of the comments we received and the information Care Homes for Older People
Page 5 of 27 we were given are included in the report. We walked around the building, looking all communal areas and some bedrooms and bathrooms. We looked at a sample of care records to see what care people living in the home were receiving and checked how medicines were stored and recorded. We also looked at management records. What the care home does well: What has improved since the last inspection? What they could do better: Pressure wound care records need to be improved to provide a detailed and accurate record of what dressings are currently in use and chart the progress of healing. This will enable accurate evaluation of wounds to make sure that residents with pressure wounds are given the right treatment. Care Homes for Older People Page 7 of 27 Bed rails must not be fitted to residents beds unless a full risk assessment has been carried to show that this is the best way to keep the individual safe. Where bed rails are considered to be necessary they must be fitted properly and have padded protected covers. The fitting must be checked regularly and a record kept to show that this has been done. The risk assessment must be reviewed regularly to show that this is still the best way to keep the person safe. Improvements are needed to the medication records to make sure that entries are accurate, sufficient information is recorded to evaluate the effectiveness of variable dose medicines and accurate stock balances are kept. This is to make sure that residents receive their medicines safely, in accordance with good practice. The drugs fridge should be repaired or replaced to ensure that medicines can be stored at the right temperature so they do not deteriorate and become ineffective. The fridge should be locked when medicines are being kept in it, to make sure those medicines are secure. All staff who work at the home must receive training about safeguarding people from abuse. They must be familiar with how to recognise abuse and what their own responsibilities are for reporting any observed or suspected abuse to make sure that the residents are protected from abuse. The lighting in some corridors and bathrooms needs to be improved to ensure that there is adequate light for people to be able to see clearly when moving around the home. The home must develop ways of checking the quality of the service they provide and this needs to include consultation with residents, relatives, staff and any other stakeholders to make sure the home is being run in the best interests of the people who live there. Action needs to be taken without delay to resolve the situation of a resident who is smoking in their bedroom, in order to make sure that all residents are protected from the risk of fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 8 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 9 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 have a full assessment of their needs before they go to live at Chester Lodge so they know their needs can be met there. Evidence: On the day of our visit there were 27 people living at Chester Lodge, including one who was on holiday. All but seven of the residents needed nursing care. Two people had come to live at the home since our last visit. We looked at the records of these two people and they showed that information about their needs had been provided by a social worker and by NHS staff before they came to live at the home. This had indicated that theire needs could be met at Chester Lodge. The manager told us that she had been to visit both of these people while they were in hospital but she had not kept any written record of these visits. However there were records in other care plans that showed the manager had visited people before they came to Chester Lodge to find out about their needs and to make sure these could be met at the home.
Care Homes for Older People Page 10 of 27 Care Homes for Older People Page 11 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. The health and personal care needs of people living at the home are met, however the accuracy of record keeping still falls below the required standard to make sure that peoples needs are met effectively. Evidence: Each resident has a care plan that details their needs and gives information to staff about how their needs should be met. Since our last inspection, a new format had been introduced for the care plans. In general, they were greatly improved and the staff seem to be working well with the new format. One person who moved into Chester Lodge earlier this year had a serious pressure sore at that time. The manager told us this was now healing well and there were photographs to show this. However the recording of wound care was not good and it was unclear what dressings were currently in use. There was no evidence that the wound had been measured since 8 May 2008 but staff used phrases like wound looks smaller. The photographs were not dated and the care plan did not have any
Care Homes for Older People Page 12 of 27 Evidence: reference to when they were taken. This means that nurses looking after this person do not have all the information they need to provide the right care to make sure the residents wound was healing well. A significant number of people had bed rails fitted to their beds. There were not always risk assessments for the use of these. As bed rails are a form of restraint, they should only be used when essential to keep the person safe. Bed rails are also a hazard because there is a risk of entrapment if they are not fitted properly or not adequately protected with padded covers. This should be checked regularly and fully recorded in the care plans to make sure that it is appropriate to be using bed rails for that person, to show the risk is regularly evaluated and the bedrails are being used safely. The people we met during the visit looked well cared for and told us that they were happy living at Chester Lodge. There were no people who were very ill at this time, but a person who has lived at the home for many years is very frail and is cared for in bed. She looked very comfortable and well cared for. The care staff we spoke with were very friendly and helpful. A room on the ground floor is used to store medicines. The room is not kept locked as it is also used for other storage. Two medicine fridges were not locked and the thermostats were recording temperatures above safe limits. Fridge temperatures had not been recorded since 12/7/08. This means that the items kept in the fridge may not be safe to use. Other medicine storage was satisfactory. There is a medicine trolley for each floor of the home and controlled drugs were stored and recorded as required. Monthly repeat medicines were signed in, but handwritten entries on the medicine administration record (MAR) sheets were not always signed, dated, or the quantity received recorded. They were never signed by two people, which is recommended good practice as a check to make sure the information being recorded is accurate. Where pain relief medication was prescribed one or two tablets as required, the amount given was often not recorded. This means that there is no record of how much pain relief the person needs. Also, there were no stock balances of medicines carried over from one month to the next so it is not possible to check whether there right amount is left. Some nurses record a pulse reading daily for people taking digoxin, but others do not. One of the nurses had omitted giving digoxin to a resident whose pulse was low. Someone else had written on the MAR sheet, Inform GP if pulse is 45 or below for 2
Care Homes for Older People Page 13 of 27 Evidence: days. This was not signed so we did not know who has written it. However on four days the pulse was not recorded so they would not know if the pulse was low for two days. For another person there was a chart in the MAR sheets to record daily pulse rate in the left and right arm, but it was not always done daily. The care plan did not tell us why this was being done and the manager said that she didnt think it was really needed. The manager needs to take control of such matters rather than leave it to individual nurses to do what they think is right. 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 living at Chester Lodge are able to exercise choices in their daily lives and activities are provided for people who wish to join in, to keep them busy and socially active. Evidence: The expert by experience spent time with residents and found that they were satisfied with daily life at Chester Lodge. People can choose what time they get up and go to bed, and where they spend their time so they have some control over what they do each day. People can bring personal belongings with them so that their room feels more homely. They have choice of what they would like to eat although there were no menus on display. The owner said that they spend a lot of money on twice weekly deliveries of fresh fruit and vegetables. Attention was paid to setting the tables properly for lunch so the room looked attractive for the residents. However, some people sat for a long time at the table before their meal arrived and a member of staff who assisted a resident with his meal did not do so in a sensitive way. Care Homes for Older People Page 15 of 27 Evidence: Activities are arranged in the home by a member of the catering staff and this seemed very popular with residents. There have also been several trips out and visiting entertainment so people who live at the home have choices about activities they can take part in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure for the home is thorough to make sure peoples concerns are listened to but staff have not received training about safeguarding people from abuse so may not know what to do to protect people who live at the home from abuse. Evidence: There is a complaints procedure for Chester Lodge and the manager keeps a written record of any complaints that are received. The records showed that four complaints had been received this year and these had been investigated and acted on where necessary, so people could be confident their concerns would be listened to. Staff have not received training about safeguarding vulnerable people from abuse. Some of the care staff have covered this subject as part of their NVQ training but other staff working in the home have received no training. This means that they may not know how they should deal with any incident or suspicion of abuse. Care Homes for Older People Page 17 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. The home is generally well maintained so that residents live in comfortable, clean and homely surroundings. Evidence: Chester Lodge is located in a city centre area where a lot of redevelopment has been taking place and the area has been considerably improved. During our visit we walked round the home and saw that all areas were clean and tidy. The lounge and dining room were redecorated and refurbished last year and are furnished to a good standard. The garden has been improved and made more accessible for people using a wheelchair. Some corridor lights were out so some areas were dark which means that residents moving around the home may not be able to see properly. We found a toilet that has a missing seat and one of the bathrooms did not have working lock on the door, to make sure the people could use it in private. There is no maintenance person for the home at the moment, which causes a delay in getting tasks such as these completed. Care Homes for Older People Page 18 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. Enough experienced nurses and trained care staff are provided to ensure that the care needs of the people living at the home can be met in full. Evidence: Staff rotas showed that enough nurses and care staff are provided to ensure that the care needs of the people living at the home can be met in full. Most of the care staff have a national vocational qualification (NVQ) in care. The home has not has to use any agency staff recently, which means that residents have received continuity of care from the homes regular staff. Regular training is provided for staff to ensure that they know how to work safely and make sure that residents are safe. Some of the training is due to be updated. There have been no new staff since out last visit; however at out last visit we found that good recruitment procedures had been followed for new staff to make sure they are suitable to work with the residents at Chester Lodge. Care Homes for Older People Page 19 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. Quality assurance systems have not been developed to show that the homes management team consult with residents, relatives and staff to make sure that peoples views are listened to and guide future development. Evidence: The home manager is an experienced nurse who also has a management qualification. Quality assurance systems for the home are poorly developed and have not been used by the management to identify the shortcomings we found in care plans or in the recording of medicines. An audit of the accidents that happen in the home is carried out each month but there was no evidence to show that the information is used for any purpose such as making sure that measures are put in place to reduce the risk of further accidents. We did not find any evidence that meetings are held for residents, staff or relatives to
Care Homes for Older People Page 20 of 27 Evidence: find out their views of the home and suggestions for improvements. The owner told us that a survey had been sent out to all families to check their satisfaction with the home but only one of these had been returned. There is also no system of staff support and supervision. Staff supervision and support would make sure they were providing care for the residents effectively, as well as providing them with the opportunity to discuss their development to improve their skills and competence. The information the manager sent us before our visit was put into an annual quality assurance assessment (AQAA) format which gives the opportunity for the home to tell us about its plans for improvement and development. The AQAA we received from Chester Lodge did not identify any improvements or developments. Small lockers are available for residents to be able to keep small amounts of personal spending money and valuables in. A note book is used for each person to record all transactions and they are double signed to make sure that the entries are accurate so residents money is properly accounted for. Regular fire drills are held to make sure staff know what to do in case there is a fire and there was a record of the names of staff attending. The AQAA gave us details of when equipment in the home had been checked and serviced to make sure that it continues to be safe and effective. There is a resident at Chester Lodge who smokes in their room, although the home is no smoking throughout. The management have sought advice from social services and have asked the residents family not to give them cigarettes and lighting materials but they are not complying. The owner needs to make a decision whether to ask the resident to leave. If the resident continues to smoke in their bedroom, the home is no longer a no-smoking home and this has implications for other residents. They management also need to put together a plan to manage the risk of this resident smoking in their bedroom and it may be advisable to contact a fire officer for guidance. Extra precautions may be taken, for example a fire extinguisher inside or outside the room, a fire blanket on the bed. The bedroom door of the resident who smokes did not close properly into its rebate therefore it was not providing protection from the spread of smoke or fire. There were a significant number of other bedroom doors that were not closing fully. This needed to be attended to so the bedroom doors were effective protection against the spread of smoke and fire. Care Homes for Older People Page 21 of 27 Care Homes for Older People Page 22 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 23 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 1 8 13 Bed rails must not be used 28/11/2008 unless a full risk assessment has been carried out to demonstrate that they are essential for the safety of the person. This is to make sure that bed rails are only used in the best interests of the person and that they are used safely so that residents are not injured by them. 2 9 13 Ensure that there is an accurate record of all medicines that ar carried over from one month to the next. To ensure that there is no misuse of medicines 30/09/2008 3 9 13 When printed instruction are 28/11/2008 not provided with medicines, staff must handwrite all the details from the medicine label onto the medicine administration record sheet. This must then be checked Care Homes for Older People Page 24 of 27 by a second person and both must sign the record. This is so that staff have accurate instructions on how to give the medicines so that residents receive their medicines safely as prescribed. 4 18 13 All staff who work at the home must receive training about safeguarding vulnerable people from abuse. This is to make sure that they are fully aware of their responsibilities and know what to do to make sure that the people who live at Chester Lodge are protected from abuse. 5 33 24 An effective system to 31/12/2008 regularly review the quality of care, including the quality of nursing, must be put into place for Chester Lodge. This is to make sure that the home is run in the best interests of its residents. 6 38 23 Action must be taken to 30/11/2008 ensure that the risks presented by a resident who smokes in their bedroom are properly managed. This is to protect people who live and work in the home from the risk of fire. 20/12/2008 Recommendations Care Homes for Older People Page 25 of 27 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 Clear, full and accurate information about pressure wound care should be recorded in residents care plans so there is up to date information about healing to make sure the resident is receiving effective treatment. 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!
