Inspection on 05/09/07 for Chester Lodge General Nursing Home

This inspection was carried out on 5th September 2007.

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

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

Other inspections for this house

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

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

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 9:45 5 September 2007 th 05/09/07 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.V343453.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.V343453.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 chesterlodge@aol.com 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.V343453.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 14th September 2006 Brief Description of the Service: 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. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 5th September 2007 and took seven hours. The home had 37 residents, some of whom were receiving personal care and some nursing care. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with residents, the manager, one of the proprietors, members of staff and a visitor. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the manager at the request of the Commission for Social Care Inspection. Prior to the visit, Commission for Social Care Inspection comment cards were provided for a number of residents, visitors, social workers and GPs to give their views of the home. What the service does well: Chester Lodge provides care for older people with a wide range of needs and abilities. Some residents require a high level of nursing care; others are independent with some support from staff. A number of residents enjoy going out to the local shops either independently or with a carer, and others go out with their relatives. Residents are encouraged to remain mobile and have freedom of movement within the home. The more frail people 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. Residents spoken with said that they are very happy living at Chester Lodge and receive the care and attention that they require. Comments cards received from relatives contained the following views: I believe that the care home does well generally: I am happy with the way [my relative] has settled in: We have never been concerned about Mum’s care at Chester Lodge, its has always been good. A visitor at the home said my mother has come on in leaps and bounds since she has been here. The home has a strong and stable management team. One of the proprietors is part of the staff team and has been so since the home opened. She works 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. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 6 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: The relative of new resident commented that they would appreciate more information about the availability of services such as activities, chiropodist and optician visits. Recording in the residents’ care plans needs to be improved to show that the care given to residents is planned and is reviewed regularly, and that the health needs of residents are monitored. Risk assessments should be recorded for any risks to residents’ health, safety and well-being and the risk assessments should be reviewed regularly to ensure that they are still relevant and appropriate. Any accidents that residents have should be recorded on an accident form so that a regular check can be made to identify why, when, where and to whom accidents are occurring. The recording of medicines on medicine administration record sheets must be more accurate to show that people always receive their prescribed medication. There must be a record of all medicines currently kept in the home so that there is a clear audit trail of all medicines that have been brought into the home. Personal choices and preferences expressed by residents, such as when they like to get up and go to bed, what food and drink they like and dislike, what activities they like to do, should be recorded so that all staff can be aware of this information. Keep a written record of all complaints that are made, including verbal complaints. The record should include details of how the complaint was investigated and what action was taken. The complaints records can then be monitored and will show whether there are any recurring issues that need to be addressed. Ensure that all staff are aware of their responsibilities with regard to adult protection and know how any allegation of abuse should be reported. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 7 Staff must not be employed until two satisfactory references have been received, and any gaps in employment history must be investigated to ensure that staff are safe and suitable to work with vulnerable people. New staff must have a period of induction training to ensure that they are competent and safe to do their work. A record of the induction process must be kept for each member of staff. Registered nurses must attend ongoing training to keep their skills up to date and to fulfil their obligation to the Nursing and Midwifery Council. The home must have a documented system for monitoring the care provided to residents and this will include care plans, medicines, accidents, pressure sores. This will ensure that the manager is aware of any areas that need improvement. Fire drills must be held more frequently to ensure that all members of staff will respond appropriately in the case of a fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 8 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.V343453.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People interested in going to live at Chester Lodge are assessed before admission to make sure that their needs can be met at the home. 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. They enjoy living near a variety of shops and other amenities, and being able to see traffic and pedestrians passing by. Some of the home’s current residents have a degree of memory loss and/or cognitive impairment however their primary needs are due to physical illness or frailty and their needs can be met at Chester Lodge. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 10 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 people interested in coming to live at the home before they are admitted. Information provided by the proprietor indicated that all residents have a written contract with the home. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 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 care needs of residents are met, but the care plans do not show that the care has been planned and reviewed regularly. The recording of medicine administration does not show that residents always receive their prescribed medication. EVIDENCE: Each resident has a care plan that is kept in the manager’s office. The care plans are written by registered nurses. Three care plans were looked at and these were for a resident who is very frail, and two people who have come to live at the home within the last four months. The overall standard of the documentation was poor. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 12 The nurses writing the care plans had not identified the current needs of the residents and had not devised plans for how the needs should be met. For example, one resident has had a pressure sore for several months and the daily notes showed that dressings were being applied to the affected area. There was no wound care plan to communicate to the staff the size of the ulcer, whether the area was clean or infected, what dressing should be applied, whether the wound was healing or deteriorating. There was no pressure care plan for staff to follow to protect the resident’s other pressure areas from breaking down. A pressure risk assessment had been recorded once in 2004 and once in 2005, and at this time no risk had been identified. It had been recorded in January and February 2006 and was rated low risk, but not again until 7th April 2007, after the ulcer had developed. One resident had been admitted to hospital two weeks ago after a choking episode. On return to the home no risk assessment had been recorded and there was no care plan to advise staff how they should try and prevent another similar incident. For another resident, the daily notes recorded that he had developed a rash on his body. He had been seen by his GP and treatment was prescribed, but there was no care plan for the staff to follow in treating the rash. Residents’ weights were recorded spasmodically. A resident admitted in May 2007 had a care plan that instructed staff to weigh her ‘at intervals’. She was weighed on 15th May and 17th June and had lost almost 2kg in this period. There was no nutritional risk assessment and no weight was recorded since 17th June. A second resident was weighed on 31st July 2007 and 26th August 2007 and had lost 10kg in this period of time. It is likely that one of these measurements was incorrect, but of concern that no-one had followed up this apparent dramatic weight loss and no nutritional risk assessment had been put in place. Where care plans and assessments had been written, they frequently had not been reviewed for six months or longer. Handling assessments were poorly completed and there were no bedrail risk assessments in the care plans looked at. There were some good and meaningful entries in the daily notes, but often they consisted of ‘care as plan’. Staff frequently write ‘dressing renewed’ but make no comment about the progress of the wound that has been re-dressed. Some entries in the daily report were obscure and needed further explanation, for example ‘remains de-motivated at times’, ‘odd behaviour at times observed’. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 13 One record made in the daily notes was that the resident’s daughter wishes to be contacted day or night if her mother’s condition deteriorates. This is important information that needs to be recorded more prominently so that all staff are aware of it. Each of the three care plans contained a sheet to record that the care plan had been discussed with the resident and/or their relatives, but none of these had been completed. All of the residents spoken with were very satisfied with the care that they were receiving and said that they were happy living at Chester Lodge. Comments cards received from relatives contained the following views: I believe that the care home does well generally: I am happy with the way [my relative] has settled in: We have never been concerned about Mum’s care at Chester Lodge, its has always been good. A visitor at the home commented my mother has come on in leaps and bounds since she has been here. One resident was being cared for in bed, others are all able to spend at least part of the day out of bed. The lady being cared for in bed looked very clean and comfortable. She was wearing a nice clean nightdress and her hair had been brushed. She did not appear to be in any pain or discomfort. She had an appropriate adjustable bed with bedrails that were well-protected with padded covers. A pressure relieving mattress was in place. The room was light, bright and warm and a radio was playing. The care plans showed that residents receive regular visits from their GPs as needed. Residents have also received visits from district nurses, respiratory nurse, continence advisor, speech and language therapist. Residents have been asked whether they wish to be patients of an allocated GP surgery that provides a weekly visit to the home by a doctor. They may also choose to stay with their own GP. Information provided by the manager was that during the last year there had been two deaths at the home and four residents had died following admission to hospital. The medicine room is not kept locked as it is also used for other storage, however the medicine trolleys and cupboards were all locked. The storage of medicines was good. Controlled drugs are well managed. There were a significant number of missed signatures on the medicine administration record sheets for the last month. It was not possible to check whether the residents had received their prescribed medication, however the proprietor said that there had been no tablets left over in the blister packs at the end on the month. This would indicate that the staff are giving the medicines but not signing to show that they have done this. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 14 Medicines records need to be improved to show that residents always receive their prescribed medication, or if for any reason an item is not given then the reason why it is not given. One resident was prescribed antibiotic eye drops to be instilled four times a day but staff were only doing this once or twice a day. The manager said that the drops were no longer required to be given four times a day but this was not recorded anywhere. Hand-written medicine administration record sheets were not signed or dated and the quantity received was not recorded. All medicines received are recorded in a separate book but this is not signed by the nurse making the entry. In one of the medicine cupboards there was a significant quantity of analgesics that had been prescribed for a resident. There were smaller quantities of analgesics for other people that were prescribed to be given ‘as required’, so they do not use all of the tablets prescribed within the month. A record must be kept of all medicines that are in the home and this means that any medicines that are kept from one month to the next should be counted, and the quantity recorded on the new medicine administration record sheet. Information provided by the home prior to the inspection indicated that all of the nurses have recently completed a medicines management course. A system of medicines auditing is needed to identify when and why staff are not recording properly. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home are able to exercise choices in daily living but their choices and preferences are not recorded for all staff to be aware of. EVIDENCE: The annual quality assurance assessment completed by the home stated ‘We try at all times to provide a happy, light hearted atmosphere, we like our service users to feel they are part of a larger extended family and look to the staff as friends rather than just carers’. There is an atmosphere of openness and good humour in the home. One resident spoken with has lived at the home since it opened 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. Another resident said that she has made a lot of friends and that there is always something going on in the home. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 16 At present the home does not employ an activities organiser, however the main lounge is lively with residents engaged in conversation. Some residents were reading and most appeared occupied. A good proportion of residents are mobile and a variety of walking aids were in use in the lounge. Three people are able to go out on their own, and others go out with family or with carers. Musical entertainment is provided in the home on a regular basis and a tea dance has booked to take place at the home in September. Local people have been invited to join in. The care plans do not contain any social assessment of the residents or any mention of their past history. They do not record what people like to eat and drink, what time they likes to get up and go to bed, what activities they like to join in, what hobbies or community links they have, what family they have. A cooked breakfast is available and about 16 residents enjoy this each day. The main meal is in the early evening. Residents are encouraged to use the dining room and most do, but a small number prefer to have their meals in their own room. All of the residents spoken with were happy with the food and said that they had plenty to eat. The menu for the day is written on a board in the dining room. A choice is always available. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Any complaints made are taken seriously and acted upon for the protection of the people who live at the home. EVIDENCE: The home has policies and procedures for dealing with complaints. The annual quality assurance assessment stated that one complaint had been recorded since the last Commission for Social Care Inspection visit. The manager said that she is usually able to deal with day to day complaints as they occur to prevent them from becoming more serious. A complaint made by a member of staff had been recorded. The annual quality assurance assessment identified the need for a better system for recording complaints. It is good practice to keep a written record of all complaints that are made, including verbal complaints. The record should include details of how the complaint was investigated and what action was taken. The complaints records can then be monitored and will show whether there are any recurring issues that need to be addressed. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 18 A number of incidents relating to the protection of vulnerable adults have been reported to social services by the home manager or the proprietor following established local protocols. Staff training records showed that not all staff have done training about abuse and some did this several years ago and may need an update. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 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: Chester Lodge is located in a city centre area where a lot of redevelopment has been taking place. The area has been considerably improved. A walk around the home showed all areas to be clean and tidy. One room was vacant and was being decorated. Plans are in place to redecorate all communal areas before the end of the year, starting from the top floor and working down. The dining room will then be re-furnished. There is also a plan to redevelop the garden and make it more accessible for people using a wheelchair. The hot water temperature was checked in one of the bathrooms and was within safe limits. The proprietor said that a number of repairs to the roof have been required during recent months. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 20 Three of the corridor lights were out on the top corridor, giving some dark areas. The maintenance person was asked about this and said that an electrician had been out to have a look and was going to fix it. This needs to be done without delay as one area was very dark and unsafe for residents with poor vision. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Enough qualified and experienced staff are provided to meet the needs of the residents. EVIDENCE: 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. A resident said that all of the staff are very good and she can’t fault them. Another resident said that most staff are very good but some are a bit abrupt. During the visit all staff were pleasant and helpful. At present the home has a vacancy for a care assistant on days and one on nights. Some of these shifts are covered by staff from an agency. There are three staff whose first language is not English, however there was no evidence of any communication difficulties. The annual quality assurance assessment recorded that 90 of care staff have a national vocational qualification in care and this is a very positive reflection on the home. Two of the domestic staff also have a national vocational qualification relevant to their work. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 22 Staff files were looked at for three recently recruited staff. All had completed application forms and all had criminal records bureau disclosures. The first file was for an overseas nurse who had recently completed the adaptation process at another nursing home. Her registration had been checked with the Nursing and Midwifery Council and she had a current work permit. There was only one reference, which was from a senior carer at the home where she was previously employed. The proprietor said that her previous employer had refused to supply a reference as they did not want her to leave. The second file was for a care assistant. He had two references, one of which was unsigned and it was not clear who had written it. This person had been working at Chester Lodge as an agency carer and they were very satisfied with his work. The third file was also for a care assistant. She had two good references, however there was a significant gap in employment between finishing her last job and applying to Chester Lodge, and this had not been investigated. She had brought with her a criminal records bureau disclosure from another care service but had not named this company as a previous employer. A maintenance person was working at the home on a casual basis. He is a member of the proprietor’s family, however he requires a criminal records bureau disclosure to be applied for in the same way as other staff. The manager said that all new staff work for two or three shifts supernumerary, working alongside an experienced member of staff. There is no written record that new staff have completed induction training to ensure that they are competent and safe to work with residents, and that they understand the principles of providing a good care service. The manager keeps an individual training record for each member of staff. This showed that fire safety training had been provided for all staff during 2006; some have attended fire training in 2007 and two more dates are booked in September 2007 for the other staff. Moving and handling training was provided for all staff in May and August 2007. The manager and proprietor said that care staff are very willing and keen to attend further training but there is a problem with some of the registered nurses who are unwilling to attend training. All registered nurses are required by the Nursing and Midwifery Council to keep their skills up to date. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 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 record keeping is not satisfactory and there are no 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 also 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. Her office is adjacent to the main entrance and 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.V343453.R01.S.doc Version 5.2 Page 24 Since the last inspection the home has implemented a quality system called ‘putting service users first’ and satisfaction surveys were sent out but with a poor response from families, however they have been able to address some minor problems. There are no systems for auditing medicines, care plans, complaints or accidents. Staff are able to put forward their views at regular staff meetings. The arrangements for handling residents’ personal money remain the same and are satisfactory. The manager and proprietor expressed their disappointment that some families do not bring in the personal allowance for their relative or use it to buy clothing or toiletries that they need. This is reported to the social workers when the annual reviews are carried out. The home had an inspection by a fire officer this year, and a smoke detector needs to be fitted in the medicines room. An environmental health officer visited in January 2007, and five issues for improvement were identified. The proprietor said that these all have all been attended to. Fire drills were recorded in November 2006, May 2007 and September 2007, and the names of the staff attending were recorded. The fire drills need to be more frequent to ensure that all staff would be able to respond appropriately if there was a fire. Information provided by the proprietor was that portable electrical equipment, lift, hoists, fire equipment, heating system, gas appliances have all been tested in 2007. The care plans looked at for two residents showed that they had both had two accidents since admission but only two of these four accidents had been reported on an accident form. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 25 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 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 3 Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) and (2) Timescale for action Each resident must have a 31/10/07 written care plan that details what their needs are and how the needs should be met. The care plan should be written in consultation with the resident and/or their family and must be kept under review. The care plans should show that the health needs of residents are monitored. Timescale of 31/10/06 not met. Handwritten records of 11/09/07 medicines brought into the home must be signed by the nurse making the record to ensure accountability. Timescale of 30/09/05 20/09/06 not met. and Requirement 2. OP9 13(2) Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 27 3. OP9 13(2) 4 OP9 13(2) 5 OP16 22 6 OP18 13(6) The recording of medicines on the medicine administration record sheets must be more accurate to show that people always receive their prescribed medication. There must be a record of all medicines currently kept in the home so that there is a clear audit trail of all medicines that have been brought into the home. Keep a written record of all complaints that are made, including verbal complaints. The record should include details of how the complaint was investigated and what action was taken. The complaints records can then be monitored and will show whether there are any recurring issues that need to be addressed. Ensure that all staff are aware of their responsibilities with regard to adult protection and know how any allegation of abuse should be reported. 11/09/07 30/09/07 11/09/07 31/12/07 7 OP29 19(1)(b) Schedule 2 8 OP30 18 Timescale of 31/10/06 not met Staff must not be employed until 11/09/07 two satisfactory references have been received and any gaps in employment history have been investigated, to ensure that residents are protected from unsuitable staff. New staff must have a period of 11/09/07 induction training to ensure that they are competent and safe to do their work. A record of the induction process must be kept for each member of staff. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 28 9 OP30 18(1)(c)i 10 OP33 24(1) Registered nurses must attend 31/12/07 ongoing training to keep their skills up to date and to fulfil their obligation to the Nursing and Midwifery Council. The home must have a 31/12/07 documented system for monitoring the care provided to residents (this will include care plans, medicines, accidents, pressure sores). This will ensure that the manager is aware of any areas that need improvement. Timescale of 31/12/06 not met. Fire drills must be held more 11/09/07 frequently to ensure that all members of staff will respond appropriately in the case of a fire. Risk assessments should be 31/10/07 recorded for any risks to residents’ health, safety and well-being and the risk assessments should be reviewed regularly to ensure that they are still relevant and appropriate. Any accidents that residents have should be recorded on an accident form so that a regular check can be made to identify why, when, where and to whom accidents are occurring. 11 OP38 23(4)(e) 12 OP38 13(4)(c) 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.V343453.R01.S.doc Version 5.2 Page 29 2 OP12 Personal choices and preferences expressed by residents, such as when they like to get up and go to bed, what food and drink they like and dislike, what activities they like to do, should be recorded so that all staff can be aware of this information. Chester Lodge General Nursing Home DS0000018715.V343453.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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