Inspection on 07/04/08 for Chorley Lodge Residential Care Home

This inspection was carried out on 7th April 2008.

CSCI found this care home to be providing an Adequate service.

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... 18/10/07

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 Key Unannounced Inspection 09:20 7 9 and 10th April 2008 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.V358983.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.V358983.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 Care Home 65 Category(ies) of Dementia (65) registration, with number of places Chorley Lodge Residential Care Home DS0000069719.V358983.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 18th October 2007 Brief Description of the Service: 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 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.V358983.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The site visits for this key inspection took place over three days and included spending time at the home during the evening. 43 people were resident at the home. All of the key national minimum standards, plus standards relating to information provided by the home and 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 temporary manager, the two deputy managers, kitchen staff, housekeepers, senior care assistants, care assistants, night staff and the administrator working at the home. Discussions also took place with a relative, who was visiting and telephone contact was made with two more relatives at their request. Records were viewed and a tour of the building took place. CSCI questionnaires inviting feedback about Chorley Lodge were sent to relatives and staff, with 17 being returned by relatives and nine being returned by staff. Since the last key inspection in October 2007, three ‘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 November and December 2007 and January 2008, are held at the CSCI office and will be made available to enquirers on request. What the service does well: Staff were observed approaching individuals in a gentle and sensitive manner and there were numerous occasions when staff were seen to respond professionally and sympathetically to potentially difficult situations. The CSCI questionnaires returned by relatives contained many positive comments regarding staff. These included; “A very friendly staff/resident relationship. Always treating residents with respect and dignity.” And “they always listen to what you have to say. They also really care how the residents feel. I find the staff very helpful and they put the residents needs first.” Staff were also observed working extremely hard and again the feedback from relatives endorsed that this is the case. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 6 Good recruitment procedures are in place and these include gaining all the necessary checks and references. Training records are clear and detailed, showing exactly what training staff have undertaken and when this took place. There is a strong focus on qualification training for staff, with all staff expected to register for NVQ (National Vocational Qualifications) programmes following their induction. This means that a capable and skilled workforce is being developed. Chorley Lodge is a purpose built home, providing excellent accommodation. The building was designed to promote the independence of those staying there. The layout gives a certain amount of freedom and 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 and the main bathrooms and shower rooms are well equipped. The quiet lounges provide pleasant and peaceful areas to sit. Staff keep good records of accidents and incidents and senior managers at the home have been proactive in keeping the CSCI informed of important matters. 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? Following the last key inspection Orchard Care Homes produced an improvement plan and representatives met with the CSCI to discuss the improvements required. Three random inspections then took place, in order to monitor progress with the improvement plan. Those visits and this full key inspection have found that improvements have been made in many areas. The temporary manager has worked hard to bring about changes and also to provide leadership, stability and consistency. Good progress has been made with care plans and risk management plans, which have been strengthened and personalised, with regular reviews taking place and this information, which all care staff must read to direct them in their work, is now easier to find. Senior staff have been working hard in this area and are now responding in a more proactive way when difficulties arise. The recording of health care has improved and this means that any changes can be monitored and the health care being received can be more easily ‘tracked.’ Medication procedures and practices have been reviewed and significant improvements have been made. The regular auditing of medication procedures has meant that the improvements seen at the last random inspection have been maintained and built upon. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 7 Since the last key inspection the lift has been fitted with a keypad, ensuring that those living at the home are not put at risk by using the lift without assistance. Following a review of nighttime staffing levels, there are now five staff on duty each night, meaning that more direct support is now available. Excellent progress has been made with qualification training for staff, with the majority of care staff now holding an NVQ qualification. What they could do better: There are still issues regarding risk management and safety. Care plans are clearly identifying needs, which staff are unable to meet. Staffing levels, the diverse responsibilities of care staff, which include laundry and domestic tasks, and the fact that a high number of residents are extremely physically active, mean that the close supervision and support required is not always possible. Records indicate that there are still a high number of accidents and incidents occurring within the home. A review of staff numbers, roles and responsibilities should take place. The registered provider must ensure that appropriate staffing levels are maintained and accidents and incidents must continue to be monitored. Feedback from relatives showed that there is clear dissatisfaction with the care of clothing and also with the range of activities and stimulation provided. The review of staffing needs to take into account the improvements required in these areas. The inspection also found problems regarding staff communication and the ways in which information is shared and passed between different shifts. Effective communication systems should be established, to ensure that staff are aware of the needs of the people in their care. Regular staff meetings and supervision sessions should also take place. Staff turnover has been high and the development of a stable staff team must be a priority. A new permanent manager is soon to commence in post and an application to register with the CSCI should be submitted. There have been improvements to many areas of service provision. These need to be sustained and built upon in order to ensure that the people living at Chorley Lodge experience good outcomes. Senior managers within Orchard Care Homes need to provide the resources needed to meet the needs of residents and progress needs to be monitored. Effective quality monitoring systems must also be maintained, in order that further progress can be made. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 8 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.V358983.R01.S.doc Version 5.2 Page 9 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.V358983.R01.S.doc Version 5.2 Page 10 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): 1, 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 reception area of the home contains information about the service provided at Chorley Lodge. A Statement of Purpose and Service User Guide are also available but these contain some out of date information and need to be reviewed and amended. As pointed out on a previous inspection the Service User Guide contains a photograph of a conservatory, taken at another Orchard Home. There is no conservatory at Chorley Lodge and this photograph should be removed, as it could be misleading. The inspector was informed that a DVD was being produced about the home and that this would be made available to prospective residents and their relatives. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 11 A detailed pre admission assessment form is completed prior to the person moving into the home. This includes information regarding physical care, diet, sight and hearing, oral and foot care, mobility, history of falling, and continence. One of the deputy managers or the temporary manager of the home carries out the assessment. 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. Care plans are then developed for any area of need identified. The records for two people who have recently been admitted to the home were viewed and showed that this assessment process had been carried out. For one person, it had been noted on the assessment that she did not like to get up too early stating; “to take breakfast in as difficult to get up in the morning” and the daily records showed that this was happening and the individual was having breakfast in her bedroom. Relatives are encouraged to provide a life history for the individual, giving staff information regarding the persons past working and family life. The temporary manager explained that the pre admission process is thorough and that a person would not be admitted if the home could not meet their needs. Three examples were cited where this had been the case and the person was not accepted into the home. Chorley Lodge does not provide intermediate care or short-term intensive rehabilitation. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 12 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 adequate. Care planning and risk management processes are in place, however there are still problems in meeting the needs identified. Medication is generally being well managed, with good systems for monitoring practices. The poor laundry arrangements compromise the dignity of those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care planning information for six people was viewed in detail, with elements of other care plans also being viewed. There is a file for each person, containing assessment information, care plans for different aspects of need and the daily records maintained by staff. Following the pre admission assessment, further Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 13 more in depth assessments take place, during the first few days of admission. These address areas such as mobility, continence, religious and social needs, with a care plan being drawn up if an area of need is identified. Care plans are being regularly reviewed, normally by the senior care assistants, who have responsibility for this task in relation to a set number of residents. A general overview is written and then individual plans of care are amended as necessary. The actual care plan sheets are now kept together and not, as before, in different sections of the file. This means information, which all care staff must read to direct them in their work, is easier to find. The temporary manager of the home audits care plans, to check that reviews are taking place. Some good examples of care planning were viewed. For one person there was guidance in place for staff regarding an individual who could become fearful and also guidance regarding her being resistive when receiving personal care. The care plan included guidance regarding the influence of the TV and media on this persons’ mental state. The care plan was personalised and had been developed in a very individual way and the community psychiatric nurse had been contacted when her behaviour and distress had worsened. There were several instances of care plans being amended as a result of the review process, such as when mobility had deteriorated and the person now needed to be reminded to use their zimmer frame when walking. Senior staff have been working hard to strengthen risk management and behaviour support plans. Files show that risk assessments and risk management plans are in place and that these provide guidance for staff in responding to behaviour which may be challenging or pose risks for the individual or others at the home. This area has greatly improved and staff now have specific record sheets where any incidents are recorded. These records allow for staff to record what happened before the incident and how they dealt with it. It is important that this information feeds into the review process and that when senior staff review the care plan they carefully review these records to see if triggers can be identified or certain approaches highlighted, which may help the person concerned. A review had taken place for one person who had been displaying behaviour, which posed risks to himself and to others. The outcome being that a medication review had taken place, a social work review requested, a referral for support from the community psychiatric nurse made and a meeting held with the family to look at ways of helping the person concerned. This shows that senior staff are now responding in a more proactive way to circumstances such as this. Although care planning has clearly been strengthened, particularly regarding behaviour and risks, there is still work to do in this area. There are a number Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 14 of individuals whose risk management plan states that they require close monitoring, yet observation during the inspection visits found that this was not always possible. Staffing levels, the diverse responsibilities of care staff, which include laundry tasks, and the fact that a high number of residents are extremely physically active, mean that such close supervision and support is not always possible. Records indicate that there are still a high number of accidents and incidents occurring within the home. Comments from CSCI questionnaires completed by relatives included; “When the staff have time, they are very generous with the care to residents. They try their best with limited resources.” Changes to support plans are not being effectively communicated. For one person, a clear support plan had been agreed as a result of a safeguarding referral. Yet no new written care plan or risk management plan was in place. Three members of staff were spoken to and asked if they were aware of the agreed guidance, put in place to help to keep this person safe, and only one staff member was able to confirm this. Two members of staff, one working during the day and one working during the night stated that they were not aware of the specific agreed guidance, just that the individual required closer monitoring. Feedback from the questionnaires completed by staff clearly indicates that there are problems with communication within the team. Comments from three staff included; “not all information gets passed between opposite shifts due to our deputies never working the same day.” “It is not always possible to read all about the residents after days off.” And “There could be an improvement on how to continually pass information on, it tends to tailor off after a couple of days. Therefore someone being away for 4-5 days does not always know what went on after their last shift.” A relative spoken to stated that generally she was very happy with the care her father received, saying that staff worked very hard, he was treated in an individual and respectful manner and that any suggestions by the family had been responded to. The relative did feel that improvements could be made to the laundry system and that more staff would improve the situation and allow for more time for activities. The recording of health care has improved and this means that any changes can be monitored and the health care being received can be more easily ‘tracked.’ Records are kept of district nurse and GP visits. Records were viewed in relation to one person who was being cared for in bed, due to ill health. These records clearly showed the care he was receiving including fluid intake and personal care. At the time of the inspection a small number of residents had been affected by stomach upsets. These individuals were being cared for in their bedrooms, the Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 15 environmental health agency and the infection control nurse had been informed and staff were following the advice given. The menus were changed to ensure that all residents were eating a light and easily digestible diet. The medication storage and administration procedures were looked at. Each floor has a separate medication trolley and medication room for storage. Senior staff, who have undertaken training administer medication. The medication administration records viewed had all been completed correctly, with staff using the code system, such as if medication was refused or not given for any reason. Each medication record contains a photograph of the person concerned and there were good details of when medication, prescribed to be given when required, should be administered. The controlled drugs register on one floor was seen and showed that two staff sign this record. Two staff also check and sign any medication received and any handwritten entries on the medication records. Regular medication audits are now taking place, with all records and medication held being checked at least once each month. Significant improvements have been made to the arrangements for handling medication at the home. It is recommended that any medication not supplied in blister packs, such as liquid, is dated when it is opened. Staff were observed approaching individuals in a gentle and sensitive manner. When one person became upset a member of staff supported her to ring a relative, which appeared to help this person become more relaxed in their environment. Privacy and dignity are addressed with new staff during the induction period and is also addressed during NVQ (National Vocational Qualification) programmes. People can receive visitors in one of the quiet lounges situated on each floor, or they can entertain visitors in their bedroom, whichever is preferred. The problems with the laundry and care of clothing have continued and seriously compromise the dignity of individuals at the home. Feedback from relatives indicates that clothing is not well cared for and that it is not unusual for people to wear clothing belonging to another person. Seven of the CSCI questionnaires completed by relatives showed dissatisfaction with the laundry and care of clothing. Comments included; “One of the things that needs to be improved is the laundry, at least it is in my mind a priority because other members seem to be wearing each others clothes. Action is needed.” Feedback from questionnaires distributed via the organisations head office also shows that this is an area needing attention and it is one of the issues identified at the last inspection that has not improved. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 16 Care staff have been allocated a certain number of bedrooms each, which they are then responsible for checking that clothes are being stored correctly and that the right clothing is in the correct room. This may help the situation. However, at present laundry duties are carried out by care staff, night staff and cleaning staff, with no one staff member having overall responsibility. Appointing separate laundry staff would help to address the problems raised in this report. The inspector was informed that this is going to take place in the future, but was not possible at present. It is clear that improvements need to be made. Residents should always wear their own clothing and clothing should be laundered and stored with care. There have been improvements to many areas of service provision relating to personal care and health. These need to be sustained and built upon in order to ensure that the people living at Chorley Lodge experience good outcomes. Senior managers within Orchard Care Homes need to provide the resources needed to meet the needs of such an active group of people and progress needs to be monitored. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 17 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. Group activities take place but do not meet the needs of all individuals at the home. 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: Each person’s file contains a sheet where staff record any involvement in a social activity or contact with friends or family. Staff are also starting to record when they have tried to encourage someone to join in but the offer has been declined. Newspapers and magazines are delivered and passed around the home and some people have their own paper delivered for their personal use, such as an Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 18 individual who has a local paper from the area where they used to live. A hairdresser visits each week. Posters displayed in the home showed that a singer had been booked to perform and also a demonstration/display of ballroom dancing was planned. Group activities, such as quizzes, sing-along and soft ball games take place. Staff informed the inspector that some people respond better to individualised activities, but that staffing levels do not allow this. Comments from the questionnaires completed by staff included; “It is very hard to provide stimulation all day, when we have profiles to update, medication rounds, laundry, cleaning etc.” and from another member of staff; “staffing levels mean that we are not always able to use our skills as the majority of the day is taken up with housekeeping jobs, bed making, laundry, meals and the cleaning up after.” Staffing levels, the diverse responsibilities of care staff, which include laundry tasks, and the fact that group activities are not suitable for all residents, mean that some residents are not receiving appropriate stimulation. 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. The inspector was informed that a representative at Orchard Care Homes head office was looking at arranging for external therapists to come into the home and run certain sessions. Relatives are able to visit at any time. The good range of communal lounges and dining rooms, plus the large pleasant bedrooms, mean that individuals can choose where to spend time with their visitors. During the inspection individuals were supported to use the telephone, to keep in contact with relatives and a number of people have a private telephone line installed in their bedroom. During the site visits it was evident that visitors are made welcome by staff. 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 relative or other nominated person will take responsibility for their financial affairs. People are able to bring personal possessions into the home and a number of the bedrooms viewed, contained pictures and ornaments brought in by the individual. 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. During the visit a number of meal times were observed and staff were seen presenting different meal options for people to Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 19 choose from. Staff work hard to support individuals to make decisions and choices, within the necessary framework of a residential care setting for people with dementia. Meals are prepared in the main kitchen and then brought to the dining rooms on each floor, in heated trolleys. Staff then serve the meals. The main meal is served at lunchtime and there is always a choice of two hot meals. The teatime menu also includes choices, such as soup, sandwiches, salad and a hot meal option. The assistant cook who was spoken to explained the menus and also said that he had got to know the residents and their particular preferences. Particular options are made available for people who have diabetes. Morning, afternoon and evening snacks are provided and include, fresh fruit, cakes and cheese and crackers. In general the feedback from relatives regarding meals was positive, however some responses stated that meals were not always good, with vegetables and meat being too hard to eat. The inspector ate two meals during the inspection visits and both were of a good standard, with plenty of choice available. There needs to be some management monitoring of the food provided to ensure that it is consistently of a good standard. Chorley Lodge Residential Care Home DS0000069719.V358983.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 the questionnaires completed by relatives indicates the majority know how to raise concerns. One person commented; “I have made observations in the past in the first instance to the home, which were dealt with promptly and on another occasion to head office, which was dealt with promptly.” A record is kept of all complaints received by the home, detailing the concern raised, action taken and outcome and these records were viewed. One formal complaint was recorded as having been received since January 2008 and this was regarding poor laundry standards. Written policies and procedures are in place regarding; abuse, protection of vulnerable adults, managing aggression and missing persons and training records show that the majority of staff have undertaken training regarding the protection of vulnerable adults. It is important that all staff receive training in this area. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 21 There is no written policy at the home regarding sexuality and relationships and this should be attended to. Issues of consent and protection need to be included within this guidance for staff. Senior staff are clearly aware of their reporting responsibilities. Since the last key inspection four issues have been referred to the local authority and dealt with under agreed safeguarding protocols. Chorley Lodge Residential Care Home DS0000069719.V358983.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 appears clean, well maintained and decorated and furnished to a high standard, making it an attractive environment for those staying there. 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. 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 Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 23 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 and specialist equipment is in place. Since the last key inspection the lift has been fitted with a keypad, ensuring that those living at the home are not put at risk by using the lift without assistance. A smaller garden area has now been fenced off so that the occupants of four ground floor bedrooms now have direct access to a garden. Although this was done to improve the facilities available, this garden area slopes very steeply and is not safe for people with any sort of mobility difficulty. The occupants of these rooms cannot use this area independently. A part time maintenance worker is employed; whose role includes making checks and minor repairs to the home. The home is clean; with housekeepers 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. At the time of the inspection visits there were two rooms which it was difficult to keep smelling clean and fresh. A different cleaning product was going to be tried and the temporary manager confirmed that if necessary new carpets would be provided in these rooms. It may be necessary to consider alternative flooring, which is more easily cleanable. This should be discussed with the residents concerned and their relatives, to find a solution agreeable to all. 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. At the time of the inspection visits there were a small number of residents with stomach upsets. Staff were following guidance given by the environmental health agency and the infection control nurse. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 24 The laundry is sited on the second floor and is well equipped. There is a sluice room on each floor and a good system in place regarding the hygienic washing of soiled items. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 25 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 the needs of those staying at Chorley Lodge can be met. Good recruitment procedures and opportunities for qualification training mean that competent staff are employed at the home. 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 the inspection visits there were 43 people staying at Chorley Lodge, with the ground and first floors in use. The second floor is not yet being used. From 8 am to 8 pm there are seven care staff on duty, split between the two floors. One of the deputy managers is also on duty, sometimes carrying out care duties and sometimes working as an additional member of staff, to oversee the work of care staff. Rotas show that the deputy manager is often included within the basic number of seven care staff required for the home. Separate housekeeping and kitchen staff are also on duty. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 26 From 8pm to 8 am there are now five night staff on duty. The staffing levels have increased from four to five for the night time period, following a review of night time staffing levels which has taken place since the last key inspection. From general observations during the three visits to the home and from feedback from staff and relatives it is clear that a further review of staff numbers and staff roles is required. The lack of dedicated laundry staff means that care staff have to spend time away from residents, which impacts upon their caring role and also affects the activities which can be offered. At present laundry is carried out by care staff, night care staff and the housekeeping staff. Having a dedicated member of staff responsible for this task may improve standards in this area and would minimise the risk of cross infection. At present care staff carry out laundry duties, attend to personal care tasks and also serve meals. The risks of cross infection are raised by this arrangement, even though staff receive training and wear appropriate protective clothing. Seven of the nine questionnaires completed by staff, raised concerns regarding the staffing arrangements at the home. “I don’t know who made up the ratio but it is not suitable for dementia care. On the occasions when we are ‘fully staffed’ we can meet everyone’s’ basic needs i.e. up washed and dressed, fed and medicated but its hard to run activities and provide a sense of wellbeing when everyone is taken up assisting people to the toilet or the never ending washing up of pots or constant profile updates. To fully provide person centred care we need more staff so you are not rushing people or making choices for them.” The people staying at Chorley Lodge all have some degree of dementia. A large number of the current residents are extremely mobile and benefit from the open design of the communal areas, which allows for people to wander and spend time in different parts of the home. However there are also a high number of accidents and incidents, which suggest that closer monitoring is required and behaviour plans often state that close monitoring is needed. Current staffing arrangements do not allow for this or allow time for individual activities to be promoted. On the second inspection visit, two staff were still working at the home, writing up reports etc, an hour and a half after they should have finished duty. The current staffing arrangements do not take into account the diversity within the role of care staff and the needs of the current residents. Changes had just been introduced, whereby staff would work on different floors, as previously staff had been based on one floor. This change needs to be closely monitored as feedback from staff indicated that this was confusing. Four of the questionnaires completed by staff also said that there were problems regarding ‘reading up’ on what had been happening following their Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 27 days off and that the handover and general communication systems were not allowing for all the necessary information to be shared. Staff rotas and direct observation also showed that agency staff are regularly being used, due to the number of staff vacancies at the home. On one night during the inspection there were three agency staff on duty. The high use of agency staff does not promote consistency or continuity for those living at the home and the problem of staff retention must be addressed. There has been a high turnover of staff at the home, with seven care staff leaving since January 2008, four of these being night staff. The temporary manager explained that Orchard Care Homes had a policy of conducting telephone ‘exit’ interviews, whereby someone from head office would telephone any staff member who left the company, to gain feedback regarding their experience as an employee and their reason for leaving, but that these had not been taking place. It is recommended that some form of ‘exit’ interview be carried out, particularly when such high numbers of staff are choosing to leave the company, as feedback could lead to making changes that would improve staff retention. Records show that the number of accidents and incidents remain high, indicating that staffing levels and the way that staff are deployed needs further attention. The registered provider must ensure that appropriate staffing levels are maintained. A new permanent manager is soon to commence in post and the development of a stable staff team must be a priority. The CSCI questionnaires returned by relatives contained many positive comments regarding staff. These included; “A very friendly staff/resident relationship. Always treating residents with respect and dignity.” And “they always listen to what you have to say. They also really care how the residents feel. I find the staff very helpful and they put the residents needs first.” There are 26 care staff, including the two deputy managers, employed at the home. 19 staff have achieved NVQ level 2 or above. A number of those with level two are working towards the level 3 award. Three staff have commenced the level two award and the three staff who have only recently commenced duty will also be registered for NVQ programmes. Excellent progress has been made with qualification training for staff. Orchard Care Homes have developed good recruitment procedures. The recruitment files for two staff, including one recent recruit, were examined. Records show that appropriate pre employment checks are made. These include gaining a Criminal Records Bureau disclosure, three references and Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 28 checking the person against the Protection of Vulnerable Adults list of people deemed unsuitable to work with vulnerable people. Applicants complete a detailed application form and a record is kept of the applicants interview performance. A detailed staff-training matrix was provided for the inspector. This shows each staff member and the training undertaken. Good records are kept of all training, which has taken place. Since the last key inspection the majority of staff have undertaken training regarding challenging behaviour. New staff have a structured induction, which includes a one-day introductory training course, three days working alongside an experienced member of the team and an internal induction to the home. A checklist is used for the internal induction, which includes fire procedures and is carried out by one of the deputies or senior care staff. Completed induction checklists were viewed on staff files and the day of induction training for new staff was planned. Other staff were also going to attend this as a refresher. There is also a rolling programme of refresher training, covering the main areas of health and safety. A member of the team has now completed accredited moving and handling training and will be responsible for the moving and handling training for staff at the home. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 29 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 adequate. The temporary manager has worked hard to make improvements at the home, providing some stability and consistency. Staff training and maintenance checks promote the health and safety of staff and residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chorley Lodge has had a temporary manager in post since October 2007. These temporary management arrangements were put in place to cover for the Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 30 absence of the registered manager of the home, who has now left the organisation. A new manager has been appointed and is soon to commence work. The temporary manager is going to remain for some weeks in order that a good handover occurs. It is essential that this takes place and that once the new manager has settled into her post an application to register with the CSCI is submitted. The temporary manager has worked for Orchard Care Homes for seven years, firstly as deputy and then as manager of another home within the company and has gained NVQ level 4 and the Registered Managers Award. During the last six months the temporary manager has worked hard to bring about improvements at the home and to provide stability and leadership to the staff team. A senior manager within the organisation has also been spending time at the home, offering support and guidance. Orchard Care Homes has developed a system of quality monitoring and auditing that is now becoming established practice at Chorley Lodge. Each month different elements of service provision are audited and there are systems whereby certain checks take place, with the outcomes being notified to the head office. Each audit record shows how the checks took place, such as by checking records, speaking to staff or observation. An action sheet is then compiled to address any shortfalls identified. The regular auditing of medication procedures has meant that the improvements seen at the last random inspection have been maintained and built upon. The area manager caries out regular visits to the home and produces a written report. Copies of these were viewed during the inspection, however copies are not being sent to the CSCI on a regular basis as required. Following the last key inspection Orchard Care Homes produced an improvement plan and representatives met with the CSCI to discuss the improvements required. The regulation 26 reports are seen as a vital part of this monitoring and also as a commitment to further improvement. Relatives meetings take place and such a meeting will be arranged when the new manager commences duty. A meeting had been held with night staff although there have been no general staff meetings for some time. Regular staff meetings should take place and would strengthen quality assurance at the home. The responses from questionnaires sent to relatives twice a year by Orchard Care Homes, also need to be more closely examined as the responses from the two surveys sent to relatives since the home opened show an increasing dissatisfaction with the laundry service and the activities offered at the home. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 31 Little progress has been made in improving the situation, as confirmed by feedback from relatives who completed CSCI questionnaires. The high number of accidents and incidents remain a cause for concern. Information regarding accidents and incidents is collated every week and monthly audits also take place. The audits should include a focus on the time of the accident, which had been done for the month of January, but not for subsequent months. The quality assurance auditing taking place, could be better used to affect changes and improvements to the service being received. Effective quality monitoring systems must be 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 arrangements in place for the safekeeping of spending money for those living at the home. 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 of income and expenditure is maintained and the balance of money held was checked for one person and was correct against the record held. Regular checks are made of the money held. Staff supervisions are being established and most of the team have had at least one supervision meeting with a senior member of staff. This needs to be maintained and built upon so that all care staff undergo regular supervision at least six times each year. 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 also help to establish consistency, give a clear direction to the staff team and support the quality monitoring at the home. Written policies address a variety of health and safety matters and there are risk assessments in place regarding the use of certain equipment. 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) A senior care assistant has completed an accredited training course regarding moving and handling and will be providing all training in this area to staff at the home. A maintenance worker is employed at the home and is responsible for carrying out some routine health and safety checks. These include some fire safety related checks, the checking of wheelchairs, window restrictors and emergency Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 32 lighting and the random testing of water temperatures. Care staff also check the temperature of bath water prior to use and records are maintained. A fire risk assessment was carried out by a consultancy employed by Orchard Care Homes. As part of this assessment the consultancy firm recommended that certain improvements should be made to the arrangements for fire safety, including fitting self-closures on the lounge door on the first floor. These recommendations were forwarded to Orchard Care Homes head office in November 2007, but have still not been attended to. There was discussion with the temporary manager of the home, regarding if these changes are necessary, as the building was new and had passed all building control regulations, which include fire safety requirements. The local fire and rescue service should be contacted for advice with this matter. Staff keep good records of accidents and incidents and senior managers at the home have been proactive in keeping the CSCI informed of anything which has affected the well being of individuals at the home. This open communication should continue, with such incidents being reported to the CSCI, as required in Regulation 37 of the Care Homes Regulations. Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 33 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 34 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. 2. 3. 4. Standard OP1 OP7 OP8 OP27 OP27 Regulation 6 12, 13 and 15 18 12, 13 and 18 Requirement The Statement of Purpose and the Service User Guide must be reviewed and updated. Effective care plans must be in place, which minimise risks and promote safety. The registered provider must ensure that appropriate staffing levels are maintained. Accidents and incidents must continue to be monitored, with remedial action, including revising staffing levels, taken as necessary. The registered provider must have a manager in post and an application to register with the CSCI be submitted. Effective quality monitoring systems must be maintained. Reports of Regulation 26 visits must be sent to the CSCI. Timescale for action 31/07/08 01/05/08 01/05/08 01/05/08 5. OP31 8, 9 and 10 24 26 31/08/08 6. 7. OP33 OP33 01/05/08 01/05/08 Chorley Lodge Residential Care Home DS0000069719.V358983.R01.S.doc Version 5.2 Page 35 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. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Refer to Standard OP7 OP9 OP10 OP12 OP15 OP18 OP18 OP27 OP27 OP27 OP33 OP36 OP38 Good Practice Recommendations Effective communication systems should be established, to ensure that staff are aware of the needs of the people in their care. Any medication not supplied in blister packs, such as liquid, is dated when it is opened. Residents should always wear their own clothing and clothing should be laundered and stored with care. Activities and appropriate stimulation should be provided for all residents. The quality of the food being provided should be monitored to ensure that it is consistently of a good standard. All staff should undertake training regarding POVA (Protection of Vulnerable Adults) A written policy regarding sexuality and relationships should be in place. This should address issues of consent and protection and include guidance for staff. A review of staff numbers, roles and responsibilities should take place. Exit interviews should take place when staff leave the company. Consideration should be given to employing dedicated laundry staff. Regular staff meetings should take place. All staff should receive supervision at least six times each year. Advice regarding the recommendations made by the firm, which undertook the fire risk assessment for the home, should be sought from the fire and rescue agency. Chorley Lodge Residential Care Home DS0000069719.V358983.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.V358983.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. 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!