Inspection on 18/10/07 for Chorley Lodge Residential Care Home

This inspection was carried out on 18th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Chorley Lodge Residential Care... 29/10/08

Chorley Lodge Residential Care... 07/04/08

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

CARE HOMES FOR OLDER PEOPLE Chorley Lodge Residential Care Home Botany Brow Chorley Lancashire PR6 0JW Lead Inspector Lesley Plant Unannounced Inspection 9:30 18 , 19 and 24 October 2007 th th th 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 Chorley Lodge Residential Care Home DS0000069719.V346992.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. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chorley Lodge Residential Care Home Address Botany Brow Chorley Lancashire PR6 0JW 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) 0845 6037751 www.orchardcarehomes.com Orchard Care Homes.Com Limited Mrs Marie Johnson Care Home 65 Category(ies) of Dementia (65) registration, with number of places Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of people who can be accommodated is: 65 Date of last inspection N/A Brief Description of the Service: Chorley Lodge is a purpose built care home, owned by Orchard Care Homes, situated in a semi rural area just outside the town of Chorley. Local community facilities, including transport links are nearby. Chorley Lodge is registered to accommodate 65 residents who have a diagnosis of dementia. The building is a three story building with bedrooms situated on all floors. All 65 bedrooms are single with en-suite facilities comprising of walk in shower, toilet and washbasin. Bedroom furnishings include a flat screen television and DVD player, a large fitted wardrobe containing a mini fridge and a lockable bedside cabinet. The home has a large passenger lift to all floors. There are three lounge/dining areas, one on each floor, plus a further two ‘quiet’ lounges situated on the ground and first floors. There is space for parking and an enclosed rear garden, with seating areas, a gazebo and a potting shed. Fees charged are dependent upon the type of facility required and the care and needs of the individual resident. Fees currently range from £520.00 to £735.00 per week. The Service User Guide contains details of what is included in the fees. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection since the home registered with the CSCI in May 2007. The site visit took place over two and a half days, with two inspectors present during the first day of inspection. At the time of this unannounced site visit there were 41 people resident at the home. All of the key national minimum standards, plus the standard relating to staff supervision, were assessed. Time was spent talking to and observing people living at the home. All those residing at Chorley Lodge have various degrees of cognitive impairment therefore some conversations were brief and limited. The inspectors spoke to the senior support manager (area manager), the temporary manager, the two deputy managers, kitchen staff, housekeepers, senior care assistants, care assistants and the administrator working at the home. Discussions also took place with a number of relatives, who were visiting and a district nurse who regularly attends to patients at the home. Records were viewed and a tour of the building took place. Time was spent observing staff and people residing at the home, engaged in daily activities. CSCI questionnaires inviting feedback about Chorley Lodge were sent to a selection of people residing at the home, relatives and health/social care professionals with connections to the home. Information was also gained from the Annual Quality Assurance Assessment completed by the head of operations for Orchard Care Homes. Since the home registered with the CSCI in May 2007, two ‘random’ inspections have taken place. (Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards.) Reports relating to these visits in July and September 2007 are held at the CSCI office and will be made available to enquirers on request. What the service does well: Staff interaction with residents appears extremely positive and relatives also gave good feedback regarding the personal qualities of staff and the atmosphere at the home. Comments included; “I have found that Chorley Lodge carers in general treat all residents with care, kindness and ensure their dignity” and “There is a very informal, happy atmosphere, where relatives are encouraged to join in and get involved.” Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 6 Arrangements regarding activities are still being established, however the group activities taking place during the site visits were clearly being enjoyed and there were also some good examples of meaningful individual activities being promoted. Staff work hard to support people to make decisions and choices, within the necessary framework of a residential care setting for people with dementia. People enjoy the meals provided, particularly the cooked breakfast choices, which appear popular with those staying at the home. The accommodation provided is excellent and has been designed to promote the independence of those staying at Chorley Lodge. The layout of the building gives a certain amount of freedom, whilst aiming to also offer the necessary protection. People who prefer to spend their time walking around the home are enabled to do so, with no pressure to sit and join in watching television, for example. The bedrooms all have en suite facilities, are spacious and furnished to a high standard. The quiet lounges provide pleasant and peaceful areas to sit. Robust recruitment procedures are in place. Good induction and training records are maintained and the staff who have remained in post from when the home first opened have received a good level of training. Senior staff have been proactive in keeping the CSCI informed of any changes and incidents. The level of information provided has been good and indicates an open and transparent approach with regard to sharing information with the regulatory body. What has improved since the last inspection? What they could do better: There have been a disproportionately high number of accidents and incidents at Chorley Lodge. Serious shortfalls were found regarding care planning. Risks associated with difficult behaviour, sexual expression and falling are not being managed or minimised. Individual support plans must be put in place and staff must receive clear guidance regarding how to respond to these areas of need. Health care needs to improve. The inspection found an instance of advice from a GP not being followed, confusing recording and poor practices regarding medication. A referral has been made to the CSCI pharmacy inspector requesting that a full audit of medication practices take place. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 7 The staffing arrangements do not adequately address the needs of current residents or acknowledge the additional support that new residents may require. New risks or support needs are often identified during the settling in period. In addition, people may be distressed or confused regarding their change of circumstances and relatives too may need additional time and information from staff. The registered provider must ensure that appropriate staffing levels are maintained. There have been serious management problems and these must be resolved. The lack of leadership has impacted upon the day-to-day support received by the people staying at Chorley Lodge. Effective quality monitoring systems must also be established and maintained. Discussions with both the operations manager and the senior support manager have taken place regarding a temporary hold on admitting new people into the home, whilst understanding that it may be appropriate to honour pre arranged respite arrangements. The CSCI advises this course of action in order to stabilise the rapidly growing service, establish strong management systems and ensure that quality practices become entrenched, prior to increasing the number of permanent residents. The CSCI advice regarding no new permanent admissions remains. 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. Chorley Lodge Residential Care Home DS0000069719.V346992.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 Chorley Lodge Residential Care Home DS0000069719.V346992.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): 3 and 6 Quality in this outcome area is good. Good assessments take place, prior to individuals moving into the home. This aims to ensure that the persons needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service User Guide details how interested people are encouraged to visit the home, look around and get a feel for the atmosphere and ethos of the service. During the two random inspections, relatives were seen visiting the home and discussing the services provided at Chorley Lodge. During this site visit assessment information regarding seven residents was viewed. Senior staff, usually one of the deputy managers, undertake assessments for people interested in staying at the home. A pre admission assessment document is completed. The pre assessment information Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 10 addresses key areas such as, mental health, mobility and physical health. It was evident that relatives had been involved in this process. Social work assessments and information from other health and/or social care professionals were also viewed on files. The pre admission assessment is used to identify if Chorley Lodge can meet the needs of the individual. This is then supplemented by a detailed and comprehensive assessment of each area of need, which is undertaken during the early days following admission. The documentation used gives good opportunity to identify where support is needed, with each section then concluding with whether a care plan for this area is required. Files contain a useful admission checklist, which includes showing the person how to use the call bell and confirming that a photograph for the individuals’ records has been taken. Discussions with both the operations manager and the senior support manager have taken place regarding a temporary hold on admitting new people into the home. The CSCI advised this course of action in order to stabilise the rapidly growing service, establish strong management systems and ensure that high quality practices become entrenched, prior to increasing the number of permanent residents. This advice has been followed, with new admissions being restricted to just honouring pre arranged respite arrangements. The CSCI advice regarding no new permanent admissions remains. Chorley Lodge does not provide intermediate care or short-term intensive rehabilitation. Chorley Lodge Residential Care Home DS0000069719.V346992.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): 7, 8, 9 and 10 Quality in this outcome area is poor. Care planning and review practices do not adequately address identified needs or changes, particularly regarding challenging behaviour, meaning the necessary support may not be provided. The recording of health care input is inconsistent leading to important information not being available. Risk management regarding falls is not being adequately addressed. Medication practices are poor and have lead to some people not receiving their medication as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning information for seven people was viewed in detail, with elements of other care plans also being viewed. Each person has their own file Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 12 containing assessment information, the care plan and the record sheets maintained by staff. Files are split into sections addressing different areas of need, such as personal care, mobility, diet and nutrition. Each section contains assessment information and concludes with a care plan for that section, if required. The care plans are difficult to find as they are placed in different sections of the file, along with corresponding assessment information. It is advised that care plans are more easily accessible to staff. Senior staff carry out monthly reviews of care plans. These reviews are recorded and for some people it was evident that relatives had also been involved in this process. Assessment information is also reviewed each month. The daily records kept by staff are generally good and give a good indication of how each person has been. For some people, files contain good personal histories, completed by relatives, providing a picture of the person’s life, previous employment and past skills and interests. Comprehensive information is gathered during the assessment process, however it was evident that when an area of need was identified, there was not always a corresponding care plan, giving guidance of how staff are to respond. The assessment for one person stated that he would like outings to local shops, museums, garden centres and the countryside but then concludes that no care plan is needed within the social interests section. For another person, the assessment identified that she could get verbally and physically aggressive, but this is not addressed within the care plan. Although regular reviews take place, these do not adequately address changing needs. A review for an individual identified inappropriate undressing but concluded that no care plan was required. The daily records for this person showed numerous instances of sexually disinhibited behaviour, where this individual and/or others at the home, could have been at risk. No support plan was in place. For one person the assessment information regarding rest and sleep indicated that there were no problems, but the daily records kept by staff contained numerous instances where this person was up and dressed during the night. The review process had failed to address this issue, with no care plan in place. For another person the daily records state that there had been behavioural changes, with the individual becoming snappy, but again there was no care plan guiding staff in how best to help this person. No care plan regarding cultural needs was in place for an individual, with a non-British heritage. This person had been teaching staff some words from her native country, which should have been included in her care plan and formally Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 13 encouraged. The assessment for another person says that he used to attend mass, yet no cultural needs are identified on the care plan. The random inspection carried out in September also identified that care planning needed to be improved. Behavioural changes, incidents of aggression and the potential risks of someone with dementia spending time alone in their room were not being addressed. There have been a number of serious incidents regarding uninhibited or difficult behaviour, which have posed personal risks to some people at the home. Behavioural management/support plans must be developed, in order that individuals receive appropriate support. Staff need to have clear guidance regarding personalised approaches and interventions. There have been a high number of accidents and falls at the home. Care plans are in place regarding mobility and the risk of falling, these however are not robust enough. Records showed that some people had had a number of falls, but care plans had not been reviewed or updated to reflect this increase in risk of falling. Records indicate that health care input is accessed on behalf of residents. This was also confirmed during discussions with a district nurse who regularly visits the home. It was confirmed that staff contact the GP or nursing service if they have concerns, and that staff are gradually building up confidence and skills regarding skin pressure care/assessment of tissue viability. A relative commented that; “ the staff have acted promptly in calling in GP when needed.” Assessment information regarding health care is good but instances were found where health care needs were not being met. For one person the GP had requested a urine sample but there was no record of this happening and following discussion, it could not be ascertained if this action had been taken. Not following the advice given by a medical professional could have a serious impact upon the wellbeing people staying at Chorley Lodge. The recording of health care appointments make it difficult to ‘track’ the health care being provided. Files contain a record sheet for recording any multidisciplinary input, but some of this information is being recorded in the daily record. For one person the records of a GP visit and blood tests were in different parts of the file and the outcome of the blood tests was not apparent. The random inspection in September found similar shortfalls, regarding an individual attending a hospital appointment, with no details of where, why, or who the appointment was with or the outcome. The problems regarding the recording of health care appointments have continued and make it difficult for health to be minored. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 14 Staff who have responsibility for administering medication have undertaken training in this area. Medication is safely stored in a locked trolley in a dedicated medication room, which is kept locked when not in use. A lockable fridge is available for any medication requiring cold storage. The random inspection carried out in September identified problems regarding medication, with an instance of medication running out and therefore not being administered. This site visit found serious shortfalls in how medication is being managed at Chorley Lodge. For three people, the records showed medication had not been administered for several days, as stocks had run out. Medication administration records were not being consistently completed, with medication being administered but not signed as such. There were no directions regarding medication, which was prescribed to be administered ‘when required’. There should be specific guidance regarding under what circumstances this medication should be given. The records regarding the spare stock cupboard did not tally with the actual contents. Handwritten records contained errors and did not include a record of the amount of medication received. There was no checking of these handwritten records. The medication record for one person, who had had a recent change in medication, was confusing for staff, with the change being poorly recorded. A relative of this individual informed the inspector that she had had to step in to stop staff administering incorrect medication on three occasions during the past two weeks. A discrepancy was evident regarding a controlled drug. It appeared that this had been administered but not recorded on the controlled drug register. A referral has been made to the CSCI pharmacy team, requesting that a CSCI pharmacist inspector carry out a full audit of medication arrangements at the home. During the inspection staff were observed responding to people in a quiet, calm and sensitive manner. Staff interaction with residents was extremely positive, including during some potentially difficult situations. It was also noted that the majority of people staying at the home appeared bright and willing to engage with the inspectors, staff and visitors. People were nicely dressed and staff were trying hard to support people in maintaining a smart appearance, such as trying to gently persuade one gentleman to shave. The large bedrooms and separate quiet lounges provide opportunity for people to meet with their visitors in private. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 15 Feedback from relatives included; “I have found that Chorley Lodge carers in general treat all residents with care, kindness and ensure their dignity.” And in response to the question ‘what does the home do well’ a relative stated, “Respects the elderly, shows affection to all residents. Are very thoughtful and considerate.” Feedback from relatives raised concerns regarding the laundering and care of clothing. The following comments were received. “Very concerned that ******’s clothing/shoes go missing – even though all items are labelled and her room door is kept locked. Outer clothes going to the laundry seem to be washed on too high a temperature, which leaves them unwearable.” “I am not satisfied with the laundry system as some of my ******’s clothes appear on other residents and items not ironed.” “The laundry is not running as smoothly as it should. I have made my concerns known. My ****’s clothes are all marked with her name but the constant disappearance of nightdresses and undergarments is a mystery to me. Someone needs to get their act together.” It is clear that improvements need to be made. Residents should always wear their own clothing and clothing should be maintained and laundered with care. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 and 15 Quality in this outcome area is good. Activities are arranged, visitors are made welcome and staff support individuals to make choices where possible. Meals are varied and nutritious, with options available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a printed monthly programme of activities, which include craft sessions, exercises, sing-a-longs and ‘no oven’ cooking sessions. During the first day of the inspection a music and movement session was observed taking place in the ground floor dining/lounge. Two staff supported this activity; with 12 residents joining in and all appeared to be enjoying this. A record is kept of these group activities, detailing who joined in. Activities on the first floor appear to be carried out on a more individual basis, as a senior member of staff explained that it is harder to engage the current residents in group activities. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 17 Some good examples of meaningful individualised activities were found. A special block has been made for one person, with an interest and skill in working with tools. This allows him to ‘mend’ things, using a screwdriver to tighten the screws. Another individual is encouraged and supported to carry out her desire to clean and tidy, and a hand push carpet sweeper has been purchased for her. During the visits, this lady was clearly very happy engaging in certain domestic tasks and spending time with the housekeepers as they went about their duties. The home has a hairdressing salon, with a hairdresser attending on a weekly basis. The hairdresser appeared popular and worked in a supportive and sensitive manner, as did the staff who were in attendance. There is a good range of activity-based equipment and games available and newspapers are delivered each day. Senior managers are keen to improve and extend the activities provided and are currently looking at engaging outside agencies to come into the home to provide certain sessional activities, such as arts and crafts. Feedback from relatives regarding suitable activities was mixed. One relative spoken to, who visits regularly, said that she had seen very few activities taking place. Another, who completed a CSCI feedback questionnaire stated; “I assumed that there would be trips out run by the home, but to my knowledge nothing has been organised.” The minutes of the relatives meeting held in September also showed some dissatisfaction with the activities on offer and feedback from a social worker in contact with the home included; “when I have asked about enabling a SU (service user) to go out for walks etc, been advised they do not have the staff.” Chorley Lodge is not yet achieving the range and regularity of activities as detailed in the Service User Guide. Whilst acknowledging the difficulties in providing activities to suit everyone, improvements could be made and increased staffing levels would provide more opportunities for individualised activities to take place. The home has a policy of visitors being welcome at all reasonable times and this is detailed in the Statement of Purpose and the Service User Guide. The provision of large bedrooms and the additional quiet lounges mean that people staying at the home can receive visitors in private should they wish to. During the site visits it was clear that visitors are made welcome by staff. A relative who completed a CSCI feedback questionnaire commented; “There is a very informal, happy atmosphere, where relatives are encouraged to join in and get involved.” All the people staying at Chorley Lodge have some degree of cognitive impairment and therefore may require support in making choices or may need certain decisions making on their behalf. For most people, this means that a Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 18 relative or other nominated person will take responsibility for their financial affairs. The layout of the building does give a certain amount of freedom, whilst aiming to also offer the necessary protection. People who prefer to spend their time walking around the home are enabled to do so, with no pressure to sit and join in watching television for example. Staff try to support individuals to make decisions regarding day to day living. One person staying at the home explained that she preferred to stay in bed until late morning and this was being respected. Individuals are asked to select their meal preferences each evening, for the following day. Staff are aware that people may forget or change their mind and as meals are served from the dining areas people are able to see the options and make a choice on the day. During the visit a number of meal times were observed and staff were seen presenting different meal options for people to choose from. This is good practice, however consistency should be monitored as one relative spoken to said this does not always happen. The menu board in one of the dining areas had not been written up on one day of the inspection and again consistency in providing this information would aid decision-making regarding meals. People are able to bring in personal possessions for their bedrooms. Although televisions are provided in each bedroom, one person had brought in her own television, as she was familiar with the controls. Many bedrooms contained personal possessions, pictures and ornaments brought in by the individual. A number of bedrooms had personal pictures on the door to aid recognition. Following consultation and signed agreements from relatives some bedrooms are kept locked when not in use. It was observed that people were still able to access their bedroom, such as for an afternoon rest and were supported by staff to do so. Staff work hard to support individuals to make decisions and choices, within the necessary framework of a residential care setting for people with dementia. The main kitchen is sited on the ground floor of the home. Each day there is a cook and an assistant cook on duty, although one kitchen assistant post is currently vacant. A four-week menu is in place for autumn/winter and one for spring/summer. Orchard Care Homes have developed extremely well organised menu arrangements with each meal option having a picture and accompanying recipe kept in a file in the kitchen. The cook spoken to explained that some changes are made, such as adapting a recipe to create the ‘Lancashire’ version, more familiar to those staying at the home. Cooked breakfasts are available each day and are prepared to order. This allows for a great deal of flexibility regarding the timing of breakfast, with people being able to have a lie in if they wish. This individual preparation and Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 19 serving of cooked breakfasts was observed during the inspection. A number of people spoken to were very complimentary regarding this arrangement and stated that they really enjoyed having such breakfasts as poached eggs. The main meal is served at lunchtime, with a choice of starters and a choice from, two main hot meals. Options such as salads, jacket potatoes and omelettes are also provided and during the meals observed a number of people were supported to exercise this choice and select something different from the two main hot meal options. Each afternoon fruit platters and cakes are served and the cook explained that special birthday teas are arranged, with a buffet, cake and chocolates. The cook also confirmed that she was aware of any special requirements including one person who had an allergy to fish. Tea consists of a light meal, with choices available, or soup and sandwiches. The people spoken to and feedback from questionnaires confirmed that people are happy with the meals provided at Chorley Lodge. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 20 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): 16 and 18 Quality in this outcome area is good. Policies and procedures are in place regarding dealing with complaints and responding to concerns or allegations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both the Statement of Purpose and the Service User Guide contain a copy of the complaints procedure. Feedback from relatives and those using the service indicates that people know how to raise concerns. Comments from relatives included; “Overtime the required changes have been put in place by the carers following up on my concerns. The carers do always take note of all concerns when raised.” A record is kept of all complaints received by the home, detailing the concern raised, action taken and outcome and these records were viewed. Two complaints have been made directly to the CSCI, these being referred to the Chief Executive of Orchard Care Homes for investigation. These have not yet been resolved, however the CSCI has been kept informed of progress. It is important that these are concluded as soon as possible. The provider organisation Orchard Care Homes has developed comprehensive policies and procedures. These include policies regarding; abuse, protection of vulnerable adults, managing aggression and missing persons. The majority of Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 21 staff have undertaken training regarding the protection of vulnerable adults. This training should be made available to all newly appointed staff. Senior staff are clearly aware of their reporting responsibilities, with four incidents being referred to the local authority under agreed safeguarding protocols. (One being dealt with by social services as a safeguarding issue, the others being addressed within the commissioning and review role of the local authority.) Issues regarding protection and risk management have been addressed elsewhere in this report. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 22 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): 19 and 26 Quality in this outcome area is excellent. Chorley Lodge is clean, well maintained and decorated and furnished to a high standard, making it a pleasant environment for those staying there. This excellent accommodation has been designed to promote the independence of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chorley Lodge is a purpose built home providing excellent accommodation for those staying there. Local community facilities, including shops and transport links are nearby. The furniture, fittings and decoration of the home are of a very high standard. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 23 All bedrooms are single with en-suite facilities comprising of walk in shower, toilet and washbasin. Each bedroom has a flat screen television and DVD player, a large fitted wardrobe containing a mini fridge and a lockable bedside cabinet. The main bathrooms and shower rooms are equipped to a high standard and are suitable for people with disabilities. There are three lounge/dining areas, one on each floor, plus a further two ‘quiet’ lounges situated on the ground and first floors. The home has a fully equipped hairdressing salon and designated locked rooms for the storage of medication and cleaning products. Externally there is space for parking and an enclosed rear garden, with seating areas, a gazebo and a potting shed. Areas are environmentally adapted to maximise independence and so meet the needs of the people staying there. External doors of the home are keypad locked to provide security and safety, however other doors, including those leading to the enclosed garden area are unlocked, to maximise independence. The home is light and airy with all bedrooms having natural light; additional low lighting is used on corridors. The home has a large passenger lift to all floors. Specialist equipment is in place. A part time maintenance worker is employed; whose role includes making checks and minor repairs to the home. The home is clean. Two housekeepers are on duty each day and night staff also undertake some domestic tasks. Feedback from relatives and those living at the home, confirms that a good standard of cleanliness is maintained at Chorley Lodge. The laundry is sited on the second floor and is well equipped. There is a sluice room on each floor. There is a good system in place regarding the hygienic washing of soiled items. Infection control procedures are in place and staff undertake food hygiene and infection control training. During the inspection staff were observed wearing protective aprons when carrying out certain duties. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 24 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. Staffing arrangements are not robust enough to ensure that needs can be met. Good recruitment procedures and training opportunities for staff are helping the home to build up a competent team of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team consists of two deputy managers, senior care assistants, care assistants, housekeepers, kitchen staff, an administrator and a maintenance worker. At present there is a temporary manager at the home. At the time of these site visits there were 41 people resident at the home, with the second floor of the building not being used. The inspector was informed that the current staffing arrangements consists of 4 staff on the ground floor and 3 staff on the first floor, plus a manager, from 8 am to 8 pm. During the night there are two working night staff on each of the two floors occupied. The inspection found that the staffing arrangements are not meeting all the needs of the current residents. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 25 A relative informed the inspector that recently there had only been two staff on duty on the first floor, during the early evening and that she felt this was inadequate. One staff member was an experienced member of the team however the other was an agency worker. The inspector received feedback that during this period an individual kept using the lift and it was difficult to provide the support or supervision that the residents required. The current computerised rota was viewed, but it was not possible to ascertain who had been on duty that evening. Details of agency staff are not clear, nor are the details of staff who work extra hours to cover for staff absence. There must be a clear copy of the duty rota, which confirms the actual hours worked and the post of each worker. During the first day of inspection there was a period of time when the first floor was staffed by an experienced member of the team, plus a new staff member on his first shift and two agency workers. One agency worker had never worked at the home and the other had worked there just once previously. It was clearly observed that this staffing arrangement was inadequate, as for short periods the experienced member of the team had to leave the main lounge/dining area, leaving three inexperienced new staff without support. This situation came about because of mismanagement of available staff. The minutes of the relatives meeting held in September also showed dissatisfaction and concern regarding staffing levels at the home and feedback from CSCI questionnaires confirmed that these concerns remain. Comments included; “management staff are available but you feel they are too busy to be approached”, “staff are not always available to talk”, “I do feel that the carers seem so busy with domestic duties i.e. washing up, cleaning up after an accident” “ the home should ensure, that there are enough staff i.e. carers on a shift. Therefore if two are needed to ‘hoist’ a resident, there will always be at least 2 carers around and this I feel makes all happy and not confused.” Accident and incident records also indicate that staffing levels may not be appropriate. A high number of accidents have occurred, with the majority of these taking place during the evening/night/early morning and the majority being not witnessed. Chorley Lodge is a new home and therefore during the past few months there have been a high number of new admissions, very close together. New residents require intensive support and supervision, particularly during the first few weeks of their stay. New risks or support needs are often identified during this period. In addition, people may be distressed or confused regarding their change of circumstances and relatives too may need additional time and information from staff. The current staffing arrangements are not adequately addressing the needs of current residents or acknowledging the additional support that new residents require. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 26 A review of staffing levels and roles and responsibilities of staff, including night staff should take place. The registered provider must ensure that appropriate staffing levels are maintained. Chorley Lodge has a policy whereby all care staff, who do not already hold a qualification, register for and achieve a minimum of NVQ level 2 in Care. There are currently 20 staff who provide care support. Eight of the team have achieved NVQ (National Vocational Qualification) level 2 or above. Five staff are working towards gaining NVQ awards. Due to a number of vacancies, agency staff are used, as was evident during this inspection. Not all agency staff have achieved NVQ level 2. Good efforts are being made regarding qualification training for staff. Progress should be monitored, particularly as there are posts to be filled and new staff may not hold a relevant qualification. The provider organisation has recruitment and training managers based at their head office, who take a lead role in recruitment matters. Due to the number of vacancies and the need for swift recruitment, the management team at Chorley Lodge is now undertaking some of these tasks. This does not appear to have impinged upon good recruitment practices. Recruitment records for four staff were viewed. Documents include an application form, record of the interview, references; CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) register checks. The records of interviews include observations of the applicant when introduced to people living at the home, with comments regarding their attitude and ability to communicate. Staff who commence work following receipt of the POVA check, but whilst awaiting the full CRB disclosure, work under the supervision of a senior staff member and do not work alone. Good induction and training records are maintained and the inspector was provided with a copy of the training matrix for the staff team. The majority of staff have undertaken training regarding communication, protection, food hygiene, health and safety, infection control, continence, pressure care, dementia, nutrition, medication, fire safety, first aid, control of substances hazardous to health, alzheimers, challenging behaviour, and bereavement. Most of this training took place prior to the home opening and during the first few weeks of opening. New staff receive an induction pack, which is worked through during the early stages of employment at the home. This system has not been followed for some recently appointed staff, possibly due to management changes at the home. Some newer staff have yet to undergo basic training and there are also a number of staff vacancies, which means that more new staff will be appointed within the near future. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 27 The staff group who have remained in post from when the home first opened have received a good level of training, including training regarding dementia and person centred care. Staff changes have taken place and more recently appointed staff have not all had such good training opportunities. All staff must undergo a thorough induction and be appropriately trained. A great deal of positive feedback was received in relation to the personal qualities of staff. One relative commented; “The staff are always caring, helpful and friendly,” and another reported that “the staff are lovely and I am always made welcome.” Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 28 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): 31, 33, 35, 36 and 38 Quality in this outcome area is poor. Inadequate and inconsistent management arrangements have resulted in some people receiving a poor service at Chorley Lodge. Quality assurance systems are not being effectively applied, meaning that areas for improvement are not identified or actioned. Good arrangements are in place regarding health and safety training for staff, however some work practices could pose risks to people staying at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 29 The manager registered with the CSCI in May 2007 as part of the registration of the service. Unfortunately the manager has been absent from her post since July. A number of temporary management arrangements have been put in place, including the more recent appointment of a temporary manager for the home. This individual is registered with the CSCI in respect of her management responsibility for another Orchard home. This is a recent management change, with this person not yet familiar with the home or the staff team. There are lines of accountability within the organisation and senior managers have been spending time at Chorley Lodge offering management support and guidance. The two deputy managers have been working hard in an attempt to provide continuity, stability and guidance to the staff team. The lack of sustained and consistent management input has had a major impact upon the smooth running of the home, resulting in some poor outcomes for some people staying there. The issues highlighted within this report are clearly management issues, which require urgent improvement and must be addressed by the registered provider. The provider organisation Orchard Care Homes has developed a range of quality monitoring systems. These include meetings with relatives and internal audit arrangements, consisting of monthly reviews of different areas of service provision. Freepost pre addressed feedback cards are available on the main corridors of the home, which when completed, go directly to the organisations head office for scrutiny. These quality monitoring and quality assurance systems are not being effectively applied meaning that service deficiencies are not being highlighted and addressed. The inconsistent management arrangements mean that the internal monthly audits are not taking place and feedback, such as from the relatives meeting, has not all been responded to appropriately. The relatives meeting raised concerns regarding activities and there are plans to improve in this area, however the concerns regarding staffing levels have not been responded to. The accident records had recently been audited and action planned to review the care of certain individuals who had sustained a high number of falls. This review should have taken place some time ago and action taken to minimise risks to people using the service. The registered provider is carrying out the required regulation 26 visits and reports are being sent to the CSCI. These must continue and be used to monitor progress with the issues highlighted in this report. The CSCI has also been kept informed of accidents and incidents. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 30 Effective quality monitoring systems must be established and maintained, showing a clear link between gaining feedback about the quality of service being provided and the action being taken to make improvements. There are good procedures regarding the management and safekeeping of individuals’ money. A relative would usually take responsibility for financial matters, however there are arrangements in place for a small amount of money to be held in safekeeping for each person, for such things as hairdressing costs and incidental items. Money is safely held, with good records maintained. The account and money held for two people was viewed and checked, with the balances held being correct. Each person living at the home has an account maintained on a computer system. People are given a receipt for any money they leave for their relative. A record is kept of all income and expenditure. Staff meetings have been taking place. The computer system used by the home highlights when staff supervisions are due to take place. Records show that although some supervision meetings are occurring, these are not consistently happening for all staff. All staff should receive management supervision at least six times each year. This is particularly important, as Chorley Lodge is a new service. Regular and effective staff supervision would give opportunity to discuss work performance, approaches and any behaviour management plans developed for individual residents. Robust staff supervision arrangements would help to establish consistency and give a clear direction to the staff team. The maintenance worker carries out regular checks within the home. Records regarding the checking of wheelchairs, window restrictors, the call bell system, the lift, fire equipment and water temperatures were viewed. There are risk assessments in place regarding the use of certain equipment. Written policies address a variety of health and safety matters. Staff have recently undertaken fire evacuation training and fire drills take place. The core training programme addresses health and safety training, with staff undertaking training programmes which address, fire safety, first aid, moving and handling, food hygiene, infection control and COSHH. (Control of substances hazardous to health.) It is important that all staff, including new starters undertake this core-training programme. The inspection highlighted a concern that some potentially dangerous products are not being safely stored. The cleaning trolley was left unattended, for short periods of time, on both day one and day two of the site visit. It appears that this is too cumbersome to take into the bedrooms. Bubble bath had been left in one of the bathrooms. Cleaning substances and toiletries could pose significant risks to the people staying at Chorley Lodge and must be stored safely. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 31 The lift is easily accessible to people staying at the home and allows for people to spend time in different areas of the building. It was observed that some people liked to visit the lounge area on a different floor and it is good that people have the freedom to do so. However, the use of the lift must be risk assessed and risk management/risk reduction plans put in place. For some people, using the lift or accessing other parts of the building, without staff support, may pose dangers. On the first day of the site visit an individual residing on the first floor accessed the second floor of the building via the lift. The second floor is not currently in use and this person could have been in a vulnerable situation, alone and unsupported on an empty floor of the home. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 32 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 1 9 1 10 2 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 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 2 X 2 Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 33 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 (2) (b) Timescale for action Care plans must be reviewed and 01/12/07 amended to reflect any changes in needs. (previous timescale not met) Care plans must address any behavioural issues and behavioural management plans must be put in place. Care plans must address the risk of falling and support plans must be put in place. Accurate records must be kept of all healthcare appointments and interventions. (previous timescale not met) 01/12/07 Requirement 2. OP7 13 (c) 3. OP7 13 (c) 01/12/07 4. OP8 13 (1) (b) and 17 Schedule 3 (k) (m) 13 (1) (b) 01/12/07 5. OP8 Advice/treatment recommended 01/12/07 by medical professionals must be followed. The registered person must 01/12/07 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines. (previous timescale not met) DS0000069719.V346992.R01.S.doc Version 5.2 Page 34 6. OP9 13 (2) Chorley Lodge Residential Care Home 7. OP27 18 (1) (a) The registered provider must ensure that appropriate staffing levels are maintained. 01/12/07 8. OP27 17 (2) and schedule 4. 18 (1) (i) There must be a clear copy of 01/12/07 the duty rota, which confirms the actual hours worked and the post of each worker. All staff must undergo a thorough induction and be appropriately trained. The registered provider must ensure that adequate management arrangements are in place. 28/02/08 9. OP30 10. OP31 8 9 and 10 01/12/07 11. OP33 24 Effective quality monitoring 01/12/07 systems must be established and maintained. Hazardous substances must be safely stored. A risk assessment must be conducted regarding the lift and risk management/risk reduction practices put in place. 01/12/07 01/12/07 12. 13. OP38 OP38 13 (4) (c) 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. 2. Refer to Standard OP10 Good Practice Recommendations Improvements should be made to the laundry, care and storage of clothing. The provision of individualised activities and activities DS0000069719.V346992.R01.S.doc Version 5.2 Page 35 OP12 Chorley Lodge Residential Care Home outside of the home should be improved. 3. 4. 5. 6. OP18 OP27 OP28 OP36 All staff should undertake training regarding POVA (Protection of Vulnerable Adults) A full review of staffing levels, roles and responsibilities, including night staff, should take place. At least 50 of care staff should be qualified at NVQ (National Vocational Qualification) level 2 or above. All staff should receive supervision at least six times each year. Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Extracts may not be used or reproduced without the express permission of CSCI Chorley Lodge Residential Care Home DS0000069719.V346992.R01.S.doc Version 5.2 Page 37 - 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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