Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Chorley Lodge Residential Care Home Botany Brow Chorley Lancashire PR6 0JW The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lesley Plant Date: 2 9 1 0 2 0 0 8 Information about the care home
Name of care home: Address: Chorley Lodge Residential Care Home Botany Brow Chorley Lancashire PR6 0JW 08456035489 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Orchard Care Homes.Com Limited care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia 65 Over 65 0 Conditions of registration: 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 Brief description of the care home Chorley Lodge is a purpose built care home, owned by Orchard Care Homes, situated 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 Care Homes for Older People Page 2 of 11 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. The Service User Guide contains details of what is included in the fees. Care Homes for Older People Page 3 of 11 What we found:
The focus of this visit was to monitor progress with the requirements and recommendations made at the last key inspection in April 2008 and to look at areas of service provision which had been the cause of a recent concern notified to the commission. The Statement of Purpose and the Service User Guide have been reviewed and updated, with the photograph of a conservatory at another Orchard Care Home, removed. The photographs within the new documents are of Chorley Lodge and so give more accurate information and will not mislead the reader. Six care files were viewed. The new summary of care needs, giving an overview of the individuals preferred routines, is useful and will be of particular use to new staff and agency staff. A new index is also in place, making information easier to find. Time was spent looking at care plans addressing mental well being and particularly regarding individuals who have specific needs relating to their behaviour. The care plans viewed were all being reviewed regularly. Incidents of challenging behaviour are recorded, looking at what happened before the incident, then describing what happened and then a record of what the staff did or what happened next. This way of recording can be useful as patterns may be identified and best working practices or individual strategies developed. It is important that staff sign these records. A number of people have been reassessed and have moved to a different care service, where it is felt their needs can be better met. The current care plan reviews do not seem to be incorporating a review of the incidents, as recorded on the incident charts. Some care plans do not give clear guidance to staff regarding how they should respond to certain situations or how to avoid difficulties arising. For one person who came into the home in February 2008, there were over 40 incident charts, but this information did not appear to be informing the care plan. Staff are very diligent in their recording, however the information could be used more proactively, which is a key reason for keeping such records. Regular reviews indicate that the person can be angry, agitated, confused, aggressive/confrontational and also for five months inappropriate undressing has been recorded. Records showed that there had been discussion with both the GP and the relatives, which is good practice. However, on one incident chart the staff member had recorded that the individual had been asked to apologise, which could possibly be interpreted as confrontational. Staff need to have clear guidance regarding how to best support this person and the way that staff respond needs to be monitored. The information within the incident charts needs to be considered and the best ways of working with this person clearly laid out. For another person there were 12 incident charts in the file. The majority of these related to difficulties regarding personal care giving. The community psychiatric nurse was involved and medication had been reviewed and changed. The care plan reviews Care Homes for Older People Page 4 of 11 gave a good update of how the person had been for the previous month, but the guidance for staff needs to be improved. The care plan contained some useful personalised information regarding avoiding watching violence on TV, however the information from the incident charts did not appear to be being used to make a clear plan for staff to follow. Night care support for this person was discussed with the deputy manager. There were also some good examples of care planning in relation to mental well being. One guided staff in how to respond if the person became distressed, in that if she was taken to her room, helped to look at the familiar things she had brought from home, then this would help her to become calm and more settled. Much good practice was observed such as a staff member sitting with an individual, chatting whilst waiting patiently for her to take her medication. During lunch staff provided calm and sensitive encouragement to those who needed support. Files give clear information regarding family contact details. There are details of the next of kin and also details of the first contact in the case of any emergency. A relative spoken to confirmed that she is kept informed of important events. The staff spoken to all confirmed that they were aware of the need to send a bag with essential items, should anyone be admitted to hospital. A small number of people like to lock their bedroom door, from the inside when they are in their bedroom. This does not cause any safety issues as staff are able to enter with a key, should they need to. A small number of people like to hold their own room key, which is documented on their records. There have been two incidents when physical restraint has been used by staff at the home. Guidance regarding the legal and ethical considerations has been given to the manager, who must ensure that the information within this guidance is put into practice. Some of the issues involved were discussed with the manager. The last key inspection recommended that any medication not supplied in blister packs, such as liquids, is dated when it is opened. This is now being put into practice and means that medication will not be given after its use by date and that more accurate auditing can take place. The manager carries out weekly checks regarding medication arrangements at the home and records of these were seen. The last inspection highlighted problems with the care and laundry of clothing. Care staff were responsible for laundry tasks. A laundry worker has been appointed, who works three days each week, with another person soon to commence work who will cover the other days. Already this appears to be having an impact. A relative spoken to said that although there were still problems, there had been improvements in the care of clothing. The staff spoken to also stated that they had not had so many concerns passed to them by relatives, regarding clothing and laundry.The clothing stored in six bedrooms was looked at. Items were stored tidily, however one item of clothing was seen to be in the wrong bedroom. An external therapist now comes into the home each week to lead exercise sessions, which take place on both floors of the home. Arrangements are being made for a volunteer to visit the home and provide hand massages to those living there. The Care Homes for Older People Page 5 of 11 manager explained that staff are continually trying to improve the activities provided. Plans have been made for Christmas events and photographic displays are being out up on the walls to enable relatives to see what has been going on at the home. The activities that took place during this visit, included, bingo and armchair exercises. One person was supported to take a short walk and two people helped a member of staff to clean out the budgie cages on the ground floor of the home. It appears that now care staff are not having to spend as much time carrying out laundry duties, more individual time can be spent with the people living at the home. Work should continue regarding the provision of meaningful activities. The key worker role could be expanded to help in this area. Lunch was a calm and pleasant event and the food served was tasty and nicely presented. Two choices were available. The manager explained that daily monitoring of meals takes place as staff eat with those living at the home and so are in a good position to give regular feedback to the cook. The staff spoken to stated that the food is very good. There are now policies in place regarding sexuality and relationships, consent and mental capacity. This information needs to be cascaded to staff as it will provide guidance and direct work practice. Training sessions are due to be held regarding the Mental Capacity Act, which will provide good knowledge for staff. Some staff have yet to undertake training regarding abuse and protection. On the day of this visit there were 31 people resident at the home. The manager, deputy manager and seven care staff were on duty. At night there are either four or five staff on duty. These staffing levels may be suitable to meet the needs of the current people living at the home, but will need to be kept under review as more people enter the home. The review of staffing has resulted in laundry staff and night care managers being appointed. The staff spoken to all felt that this had made great improvements to the running of the home. Care staff can now focus on the support needs of those living there and not have to keep going up to the second floor to carry out laundry tasks. Once the second laundry worker is in post, this will mean that there is a dedicated laundry person working each day. The arrangement of staff working on different floors was discussed with staff and seems to be affecting the continuity of care. The relative spoken to had concerns about the staff swapping between floors. At present staff work two days on one floor and one day on the other floor. Staff work in three day blocks and a better arrangement might be for staff to work their three days on one floor and then change areas. It is advised that this is discussed and given consideration. The handover records were viewed and discussed with staff, who felt that this area had been improved. The handover sheet states who is responsible for different tasks such as dealing with medication or supporting activities. It also details who is carrying out laundry tasks if the laundry worker is not working on that day. The appointment of the second laundry worker will eliminate the need for care staff to keep leaving the unit to visit the laundry.The handover sheet is used as a prompt for the verbal handover at the change of shifts, when important information about each person on that floor is shared. Care Homes for Older People Page 6 of 11 The staff spoken to felt that communication had greatly improved. Each floor now has a communication book and staff meetings are now taking place. Staff also stated that the team now felt more settled. A part time administrative worker is soon to start work at the home. At present a worker from the head office provides administrative support approximately one day each week. Agency staff are still being used. The manager tries to keep this to a minimum and is working hard to fill the current staff vacancies. Exit interviews were discussed with the manager, who explained that she does ask staff who give in their notice, why they are leaving. The manager is not sure if exit interviews are still carried out by staff from the head office and this will be clarified. The home now has a permanent manager in post who has registered with the commission. The manager has been in post for six months and has been working hard to address the requirements and recommendations made at the last key inspection in April 2008. The manager is currently undertaking training regarding dementia, although she does have previous experience in this area of social care. The monthly audits required by Orchard Care Homes are being carried out. Accidents and incidents are monitored and more attention is now being given to the time that these occur. The number of accidents does appear to be reducing. The manager explained that following any accident the individual is closely monitored for the next 24 hours and these records were seen. A telephone conversation took place with the Area Manager who confirmed that the recommendations made by the fire consultancy firm who carried out the fire risk assessment for the home, are being addressed.The area manager carries out regular support visits to the home and completes reports on her findings. This monitoring is helping to progress the improvement programme for the home. Staff meetings are now being held and the minutes of these were viewed. Relatives support and information sessions have taken place with speakers from organisations such as the Alzheimers Society being involved. Relatives meetings are also now established and minutes of these were viewed. The minutes for last weeks meeting showed that relatives felt that laundry services had improved. The organisations head office continues to send out questionnaires to relatives and some feedback from these was seen.The manager was advised to discuss this feedback with the area manager and clarify when action plans are required. Staff supervisions are now taking place and the new manager has met individually with each member of staff. Supervisions are now carried out by either one of the deputies or the manager and records were seen of regular supervisions taking place. This is another area of improvement and provides opportunity to discuss work performance and training needs with staff. Care Homes for Older People Page 7 of 11 What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set.
No. Standard Regulation Requirement Timescale for action 1 8 12, 13 and 15 Effective care plans must be in place, which minimise risks and promote safety. 01/05/2008 2 27 12, 13 and 18 Accidents and incidents must 01/05/2008 continue to be monitored, with remedial action, including revising staffing levels, taken as necessary. 24 Effective quality monitoring 01/05/2008 systems must be maintained. 3 33 Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 12 The use of restraint must be reviewed. Only safe and appropriate interventions must be used. 07/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 18 The new policies regarding sexuallity and relationships, consent and mental capacity should be read by all staff and the manager should ensure that staff understand the content. Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
