Inspection on 20/09/05 for Chester Lodge General Nursing Home

This inspection was carried out on 20th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

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

Chester Lodge General Nursing... 14/09/06

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 Announced Inspection 20th September 2005 09:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 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.V249772.R01.S.doc Version 5.0 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 342259 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.V249772.R01.S.doc Version 5.0 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 cateogry PD (physical disability under the age of 65) The registered person must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 19th May 2005 2. Date of last inspection 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. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced visit took place over a period of five and a half hours as part of the Commission for Social Care Inspection’s statutory inspection programme. The home had 34 residents, of whom 20 were receiving nursing care and 14 were receiving personal care. One resident had been admitted to hospital. A tour of the building, including all communal areas and some bedrooms, was completed. Staff training records were inspected. Time was spent in conversation with the registered person and the home manager. A number of residents, staff and a visitor were also spoken with. Some of the information contained in this report is taken from the preinspection questionnaire which had been completed by the registered person. Comments cards were received from three residents, two relatives and a visiting general practitioner. What the service does well: What has improved since the last inspection? An activities organiser has been appointed and a programme of regular social activities is planned for residents. The home has joined the Cheshire Consortium for staff training and is now able to access more training for staff, including NVQ. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 6 Work to improve lighting in the corridors, and to provide a new emergency lighting system, was almost complete at the time of the inspection. There were some new chairs in the main lounge. The new chairs looked better and were more comfortable for residents. 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.V249772.R01.S.doc Version 5.0 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.V249772.R01.S.doc Version 5.0 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, standard 6 is not applicable. Prospective residents are assessed before admission is agreed to establish whether their needs can be met at the home. EVIDENCE: The home had two new residents. The manager described how she had visited one of these people in their own home, and the other in hospital. Assessment information had also been received from their social workers. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 9 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): 8, 9 and 11. Residents’ health care needs are met by the home’s staff and by visiting professionals. Arrangements are in place for the safe handling of medicines, however some shortfalls were identified. The privacy and dignity of residents are respected. Policies and procedures are in place, and staff have the skills, to provide care for residents at the end of their lives. EVIDENCE: At the time of the inspection no residents were terminally ill, and none had complex health needs. One resident who has lived at the home for many years is now very frail and is cared for in bed. Another resident is quite confused but the manager said that at present she is not presenting any management difficulties. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 10 There was evidence of the involvement of a range of healthcare professionals including district nurses, chiropodist, optician and dentist. A choice of GP’s is available. Staff received training in oral and ophthalmic care earlier this year. A medical room may be used when residents need to be examined by a doctor or other health professional. Personal care is carried out in the privacy of the bedroom. During the inspection, residents were treated with patience, dignity and respect by the staff. Arrangements for the ordering, storage, administration and disposal of medicines were inspected. The medicine room is on the ground floor. This room is not kept locked as care staff need to have access to items other than medicines that are kept in there. Also, residents can be seen by doctor or other visiting professionals in this room instead of having to go upstairs to their bedroom. Whilst all of the cupboards were locked, the drugs fridge had no lock. See requirement. There is a medicine trolley on both the first and second floor. The were a small number of gaps in administration records. A new resident had a hand-written MAR sheet. This was not signed by the nurse who had written it, and the quantities of medicines brought in were not recorded. See requirement. Repeat prescriptions are ordered monthly by the home manager. The dispensing pharmacy is no longer able to dispose of unused medicines from the home and the registered person said that she is arranging a contract for the collection and disposal of unused medicines. A small quantity of controlled drugs had been in the controlled drugs cupboard since May awaiting disposal. See requirement. A pharmacist from the local Primary Care Trust visits the home twice yearly. One of nurses employed at the home has recently completed Palliative Care Foundation training at a local hospice. The home has policies and procedures for the care of terminally ill residents. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 11 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 and 15 Residents are supported to exercise choice in their lifestyle and to meet their social needs. Families and friends are welcomed into the home at any reasonable time. Residents have a good choice of meals and individual requests are catered for. EVIDENCE: Residents spoken with were satisfied with daily living routines in the home. Some residents choose to spend most of their time in their own room, however almost all had their lunch in the dining room. A professional entertainer provides a sing-along in the afternoon once a month. The home receives visits from religious groups, from children at a local nursery school and from a mobile library. A hairdresser visits weekly. The hairdresser said she really enjoys coming to the home. Three residents go out to hairdressers in Chester and one resident has her own visiting hairdresser. An activities organiser has been appointed to work 24 hours each week. This person has previously been employed as a care assistant at the home for a number of years and knows the residents well. She has held a meeting with residents to discuss an activities programme. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 12 A number of residents go out on a regular basis either alone or with family members. The resident who is under 65 years of age goes to a Day Centre twice weekly and is going on holiday in the near future. A day trip to Blackpool was being arranged. This had been discussed with the residents and the time planned had been changed to suit them following consultation. Residents are able to receive visitors at any time and can see visitors in private. During the inspection a number of relatives visited, including a visitor who took her mother for a hospital appointment. The first visitor had come at 9 am. Residents vary greatly in their ability to exercise choice and autonomy. The great majority of residents have family members to look after their financial affairs. The other residents are encouraged to use the advocacy service provided by Age Concern. Evidence was seen that all publicly funded service users have an annual review with their allocated social worker. Residents receive three full meals a day, including a cooked breakfast if they wish. The main meal is served at 5pm and a choice of dishes is available. At lunch time there is soup and a light meal of the day. Residents may also choose a baked potato with filling, or snack meals e.g. eggs/cheese/beans etc on toast. The menu for the day is displayed on a notice board in the dining room. A resident who completed a comments card asked for more fresh fruit and vegetables to be provided. This was discussed with the manager and the registered person and they said that they were planning to discuss with the chef how more variety can be introduced into the menu. A part-time chef has been recruited to cover the chef’s days off. Residents, including those who need assistance, are encouraged to take their meals in the dining room. Residents were observed to receive assistance with their meals in a sensitive manner. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 13 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 Complaints are dealt with appropriately. Residents are protected from abuse by the home’s policies and procedures and by staff training. EVIDENCE: One complaint had been received since the last inspection and this was being dealt with appropriately by the registered person following the home’s complaints procedure. A copy of the updated ‘No Secrets’ guidance was readily available for staff to refer to. Records demonstrated that adult protection training has been provided for all staff since the last inspection. The home also has a whistleblowing policy. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 14 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): The home is safe, clean and well maintained. EVIDENCE: Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 15 The home is conveniently situated close to Chester city centre and public transport is easily accessible. The exterior of the building is well maintained and the upper part of the building was painted last year. There is a small, but pleasant, garden area which is accessible for residents to sit in. The home does not use CCTV, but security lighting is in place. A large communal area on the ground floor comprises a dining area, lounge and conservatory. Smaller lounges are situated on the first and second floors. Armchairs in the lounges have been identified as being worn and shabby at previous inspections. There were a number of new armchairs in the main lounge. These had a much better appearance, but more importantly were more comfortable for the residents. The manager and the registered person said that they were planning to further improve the lounge. The home provides an adequate number of bathrooms and toilets to meet the needs of residents, including some assisted baths. The home’s water systems had been tested for Legionella but a report had not yet been received. All areas of the home are accessible for the residents. Aids and adaptations meet the needs of residents and a number of profiling beds were available. A nurse call system is installed in all areas. Some vacant bedrooms were awaiting re- decoration. At the time of the inspection, all areas were clean and were comfortably heated. All bedrooms have a window and natural ventilation. Lighting in the corridors has been improved and a new emergency lighting system was almost completed at the time of the inspection. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 16 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 and 30 Staff are provided to meet the needs of residents. Staff receive training to enable them to meet the needs of residents. EVIDENCE: The home employs nine registered nurses and 24 care assistants. In the morning there are two nurses and five care staff on duty; in the afternoon one nurse and five carers; at night one nurse and four carers. Agency staff had not been required recently. Staff do not work over 48 hours in a week except in exceptional circumstances. The home uses the National Care Homes Association induction programme for new staff. All care staff have recently attended foundation training provided by an outside training agency. The home has joined the Cheshire Consortium and is accessing training through this organisation. Fire training has been booked through them. All staff have been enrolled for a six week infection control training which was due to start on 22nd September. The manager keeps a training record for each member of staff. Two senior care staff have completed NVQ level 3. Nine care staff are due to commence NVQ level 2 in October and a further five are waiting for a start date. The role of the senior care assistant within the home is to be more clearly defined. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 17 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 and 35 The home is well managed by a competent and experienced person. The quality of the service is monitored to ensure that the home is run in the best interests of its residents. Residents’ money is not normally handled by the homes’ staff. EVIDENCE: The manager has been in post for more than two years. She was previously a district nurse and has developed management skills during the course of her employment at Chester Lodge. She has almost completed NVQ level 4 in management. The manager works as part of the team of nurses and has brought her own professional high standards to the home. The standard of record keeping and reporting has improved. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 18 The home does not have a formal quality assurance programme but has its own informal methods of monitoring the quality of the service. Formal surveys have been carried out but the registered person did not consider that any useful information was gleaned from them. The manager works more than her rota’d full-time hours each week and the registered person is in the home either three or four days each week. It was evident that they know all the residents and their families very well. Relatives and residents are encouraged to come into the manager’s office, which is by the main entrance and has a large window into the home. During the inspection it was evident that relatives and residents felt comfortable and confident to come into the office and speak with the manager. One resident has lived at the home since it opened and the registered person finds that this person is a very good source of information about how residents are feeling, including any complaints, as she is not afraid to express her views. A person who had respite care at the home recently is known to the registered person and gave feedback, both positive and negative, following the stay. The manager serves out the meals every day that she is on duty and is able to monitor the quality of the food in this way. The manager audits a sample of care plans monthly and carries out the monthly medicines order, which enables her to monitor stocks and be aware of any non-administration. She works as part of the team of nurses and sees any pressure ulcers or other wounds. The manager sees all accident reports. Reports produced following Commission for Social Care Inspection inspections are made available for staff in the staff room. The registered person handles money for two residents who do not have close relatives and who both have appointeeships through the local authority. One of these residents has their personal allowance paid monthly to the home and has a friend who helps with personal shopping. Personal money belonging to these residents is kept locked in the registered person’s office and can only be accessed by her. No other residents have any money in safekeeping at the home. Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 19 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 x 8 3 9 2 10 3 11 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 x 3 X X X Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP9 OP9 Regulation 13 13 Requirement The drugs fridge must be kept locked. Hand-written medicine administration sheets must be signed, and the quantity of medicines brought into the home must be recorded. Arrangements must be made for the disposal of unused medicines. Timescale for action 30/09/05 30/09/05 3 OP9 13 30/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Chester Lodge General Nursing Home DS0000018715.V249772.R01.S.doc Version 5.0 Page 22 - 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. 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