Inspection on 17/08/09 for Cleveland Lodge

This inspection was carried out on 17th August 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cleveland Lodge 22/08/07

Cleveland Lodge 18/07/06

Similar services:

Fairfields Country Rest Home

Fairfax House

Claremont Nursing Home

Doveridge Care Home

Dunmore

Chatsworth

Dunraven Lodge

Eastleigh Care Homes, South Molton

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cleveland Lodge Cleveland Lodge Church Lane Figheldean Salisbury Wiltshire SP4 8JL     The quality rating for this care home is:   two star good 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. Lead inspector: Sally Walker     Date: 1 7 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Cleveland Lodge Cleveland Lodge Church Lane Figheldean Salisbury Wiltshire SP4 8JL 01980670584 01980670584 clevelandlodge@dementiacarehome.freeserve.c o.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cleveland Lodge Ltd care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home Cleveland Lodge is a private care home registered to provide care and accommodation to 29 older people with dementia. The home has been extended to provide extra accommodation. The property is a former Victorian vicarage situated in the small village of Figheldean near Amesbury. The home is accessed via a private drive and has large enclosed gardens for peoples safety. The accommodation is all single bedrooms to the first and ground floors accessed via a passenger lift or staircase. There are two sitting rooms and two dining rooms, one in each of the newer and older parts of the building. The staffing rota provided for a minimum of a senior carer leading the shift of 6 Over 65 29 Care Homes for Older People Page 4 of 35 Brief description of the care home 4 carers during the waking day. At night there are 2 waking night staff with Mr Foreman or his wife carrying out the sleeping in duty from their adjacent house. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key inspection took place on 17th August 2009 between 9.05am and 6.40pm. Mr Foreman, registered manager, and Mrs Brenda Mason, responsible individual, were both present during the inspection. Mr Foreman and Mrs Mason are both directors of Cleveland Lodge Limited. We asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. Care Homes for Older People Page 6 of 35 The last Key inspection was on 22nd August 2007. We looked at all the information we had received since the last Key inspection so that we could decide which areas to focus on during the inspection. We spoke with people who use the service and staff. We looked at care plans, risk assessments, medication, menus, activities, staff training and recruitment records. We looked around the building. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? Continence records were no longer kept in the dining room, but securely in the care office. A policy on the provision of intimate personal care by staff of a different gender to people who use the service is now in place. Care Homes for Older People Page 8 of 35 Rather than more trips in the locality as we suggested at the last inspection, more entertainment groups come to the home for people to be involved with. Some progress is being made in reducing the amount of frozen ingredients used in preparing the meals. The quality of the meals is improving. 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from good detailed assessments of their care and support needs before they move in. Evidence: Either Mr Foreman or Mrs Mason carried out the pre-admission assessments with people who were thinking of moving in. They visited people in their own home, in hospital or in other care homes. Care management assessments were obtained when a local authority was funding the placement. Information was gained from the person themselves, their family, those already involved in caring for them and healthcare professionals. This meant that as much as possible was known about people, so an initial care plan could be written. Information was also gained when people moved in in an emergency. Mr Foreman told us that they still needed to know as much as possible about people, so that they could plan for their care, even if they were moving in quickly. We saw that the assessments were detailed and care plans available when people moved in. Local services were told about any specialist treatments that people Care Homes for Older People Page 11 of 35 Evidence: might need, so that their healthcare was continuous. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having all their care and support needs set out in their care plan. Peoples healthcare needs are being met. People have good access to healthcare professionals. Evidence: People had individual care plans that set out their current care and support needs and how they were to be met and monitored. There was a summary of the care plan in the front of the file. The care plans were reviewed every month and as needs changed. Staff wrote a monthly review of peoples care which showed peoples progress and any change in need. In the AQAA Mr Foreman told us that the home planned to make the care plans more person centred. Care plans identified how people wanted their care and support to be provided. Care plans identified their preference of the gender of staff who provided intimate personal care. Where people had not been able to express these wishes, the home had sought confirmation from their relatives. Records were kept of when the GPs and district nurses visited and any advice given. This information was then put in the care plan. Care Homes for Older People Page 13 of 35 Evidence: Care plans identified whether people had been given a medical diagnosis of dementia. We saw that one person spent some time having bed rest as advised by the district nurse. Staff kept records of when they helped the person change their position on their bed, to minimise their risk of developing pressure sores. We also saw that the person spent some time in the afternoon with other people in the quiet area. We asked one of the senior staff about the persons care. They showed us the immediate care plan for reducing the risk of pressure damage. They told us that this was not kept in their room with the turning charts, because it was a confidential document and the person may not wish visitors to see it. Pressure relieving equipment was in place for those people assessed as at risk of developing pressure damage and details noted in their care plan. We saw that records of any wounds or marks were not as detailed as expected and that the home relied on the district nursing notes. Staff were able to tell us about the condition and healing of wounds, as they accompanied the district nurse when any treatments were carried out. No one had pressure sores. We said that the home should keep their own records of wounds, treatment and healing. Body maps may help with recording the date of wounds, their location, size, colour and whether the skin was broken. One of the people we spoke with told us They look after me well. People had nutritional risk assessments. People were weighed when they moved in and every month after that. The results were analysed by Mrs Mason and any significant weight loss was referred to the persons GP. Some people had prescribed food supplement drinks. We saw that people also had whole milk flavoured drinks to increase their fluid intake. People had this as well as their mid morning hot drink. One of the senior staff told us that if people needed to drink more, a fluid intake chart would be used so that staff could make sure they were well hydrated. One person told us I get a milk shake now, and then we have coffee after that. I also have cranberry juice. We saw that people were given drinks when they asked for them during the day. People had other assessments of risk including falling, moving and handling and bathing. Care plans were detailed and showed how identified risks were minimised. Individual records were kept when people had falls so they could be monitored better. Bathing assessments showed when people preferred to have their bath. We saw that personal care was given in private. Action had been taken to address the good practice recommendation we made that the continence records should be stored securely to protect peoples confidentiality. The book was retained in the office. We Care Homes for Older People Page 14 of 35 Evidence: saw that not everyone was automatically listed in the book, only those people who could not manage their own continence for whatever reason. One person told us how the district nurse supported them with catheter care. Their care plan showed details of how they were supported to manage their catheter. One of the senior staff told us that all the senior staff had been trained by the district nurse to carry out blood glucose monitoring with people who had diabetes. They said that the latest guidance from the district nurse was that testing was only to be done if there were concerns about peoples health. The district nurses visited the home twice a week. Peoples care plans showed details of how people with diabetes had their condition managed and monitored. The home had a strategy for managing any outbreak of swine flu. People could retain their own GP when they moved to the home if they were local. People had good access to other healthcare professionals. There was evidence on some files that prompt referrals were made when concerns in peoples mental or physical health were noted. We saw that relatives were informed if peoples needs changed or they saw the GP. In the AQAA Mr Foreman told us We always ask for assessments from the residents doctor and mental health team if a residents care needs change. In a survey form, in answer to the question about what the home did well, one of the healthcare professionals told us Report any concerns promptly. Action had been taken to address the requirement we made that a gender working policy is produced. We saw that the policy should be amended to include further details about the boundaries for staff when providing intimate personal care for people of a different gender. We saw that peoples prescribed medication was checked with their GP when they moved in. Those people who could tell us, said that staff gave them their medication. Care plans identified when medication that was prescribed only to be taken when needed was to be given. We saw that care plans stated whether people were able to say that they were in pain. We saw one care plan where a medication was to be given only after different anxiety reducing strategies had been tried. We saw staff use calming techniques when one person was shouting. Each care plan had a list of peoples current medication, why it was prescribed and Care Homes for Older People Page 15 of 35 Evidence: any side effects. Staff had a copy of the British National Formulary (published by the Pharmaceutical Society) to read about different medication that people were taking. We said that where some medication had special weekly prescribing instructions, these should be recorded in the care plan, rather than highlighted on the data sheet provided with the medication. The care plan should give guidance on what to do if the person is not awake to receive the medication and what to do if they refuse it. There were no controlled drugs prescribed. The home had installed a new controlled drug cabinet which met current legislation. Staff gave medication at mealtimes. Staff signed the medication administration record after each administration. Mrs Mason regularly reviewed the medication administration records to ensure that they were satisfactorily completed. We have not had any notifications of medication errors. We saw that prescriptions were filled on the day the GP wrote them. The medication administration record sheets were amended by the pharmacist when the new medication was prescribed. This meant that it was rare for staff to write any prescribing details in the medication administration record. All medication was checked as it was received into the home. There was separate guidance about some people having topical creams or food supplement drinks. In the AQAA Mr Foreman told us that The local Primary Care Trust pharmacist [visits] to check our medication system. In a survey form one of the relatives told us Looks after my [relative] very well. Both management and care staff have all patients welfare at heart. Another relative told us Clean and tidy, kind carers. In a survey form, in answer to the question about what the home could do better, one of the staff told us Talk to resident about care plans, dont assume they dont have the mental capacity to understand or sign as some do. Another staff said I feel that the home is institutionalised in some ways, i.e. toileting times, bath lists, allocated times for smoking for residents that smoke. This may benefit some residents, but not all. One of the healthcare professionals told us [Does well] Support people with specialist EMI needs. Caring staff. Another healthcare professional told us This home is efficiently run and the management and staff are always happy and caring in spite of some of the difficult clients they have to deal with. Very clean. One of the GPs told us They deal with a sometimes difficult to manage group of clients very well. Cope well with clients who are in terminal stage of life. Seems to be Care Homes for Older People Page 16 of 35 Evidence: a happy working environment. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home asks people about their interests and hobbies before they move in. People are offered a variety of things that they like to do. People are encouraged to have some control over their daily lives. The quality of the meals continues to improve but some frozen vegetables are still used. Evidence: We saw that not everyone was up and dressed when we arrived at the home just after 9.00am. Mrs Mason told us that people could stay in bed and get up later if they wanted. During the morning two people said they did not want to talk to us because they were having a rest. People are asked about what they like to do and their hobbies before and after they move in. We saw that some family members had given information about peoples social history where people could not talk about their lives themselves. Action had been taken to address the good practice recommendation we made that the progress in improving activities with more outside visits should be built upon. In the AQAA Mr Foreman told us We have two big display boards in the communal areas detailing forthcoming entertainment. We have purchased new games and puzzles for activity times. Care Homes for Older People Page 18 of 35 Evidence: The person who was providing two hours a day for activities had left. The post had been split amongst staff who now provided activities on weekdays. Staff wrote information about what people had been involved in in the daily diary. Mrs Mason then transfered this information into a record for each person. There was a list of different activities for staff to provide. Mr Foreman told us that it was guidance only, as sometimes people did not necessarily want to do what was on the list and another activity was provided. There were different entertainers that came to the home. These included singing and dancing, armchair aerobics and musical workshops. One of the staff told us that people really responded to the music sessions. Music from the 1940s and 50s was playing in one of the sitting rooms. One of the senior staff told us about the two different churches that visited to provide services and Holy Communion. They said that they also took people to the local church. We saw photographs of different activities that people were involved in. Some staff had brought in their pets. One staff was training to register their dog as a PAT dog. This is an organisation which provides dogs that visit homes for people to pet. Other activities included ball games, drawing and painting, cooking, bingo, music quizzes, board games and jigsaws. Most of the activities were group sessions. Although one staff told us they read to someone with a visual impairment and discussed what they had heard on the radio. Another staff told us they were qualified in beauty massage and provided hand massages for individual people as well as nail painting sessions. We saw one staff with a group of people doing a jigsaw in the dining room and another staff doing a jigsaw with one person in one of the sitting rooms. We saw two glass cabinets in each of the sitting rooms. They contained different items from times gone by which people may recognise. Mr Foreman told us they were regularly given to people for them to look at and promote discussion. We said that other items could be provided which people could access more easily and take away if they wanted, rather than kept in a display case. We referred to the homes collection of ornaments around the home that people could move and take to their bedrooms if they wanted. The home had a toy cat which lots of people responded to. Mr Foreman told us that he regularly took three people who had shown an interest to help him when he went to the recycling depot. He said they would also go for a drive around different villages. We saw that there was a risk assessment for peoples safety when riding in Mr Foremans people carrier. Care Homes for Older People Page 19 of 35 Evidence: One of the people we spoke with told us about how they had enjoyed a recent party. This was the homes annual summer party with barbecue to which relatives were invited. In a survey form, in answer to the question about what the home could do better, one of the healthcare professionals told us Another activities co-ordinator for giving one to one activities. Action has been taken to address the good practice recommendation we made that visual prompts are used so that people who smoked may know when their next allocated cigarette was due. Only one person smoked now and they did so outside under an awning. Staff had a smoking area outside. Mr Foreman told us that a policy on a no smoking environment was to be put in place and the home would no longer consider people who smoked moving in. We said that the statement of purpose should be amended to reflect this. Agreements had been reached with staff which would mean that they could not smoke on the premises in a years time. Those people we spoke with told us they enjoyed the meals. One person who had all their meals in their room told us they would like to have a menu list each day so they knew what they were having for each meal. We looked at the menus. There was a three week menu that was regularly updated to reflect what people liked and the seasons. There was a main course and pudding for lunch. At the weekends the evening meal was sandwiches. We established that a hot meal was not provided because the chef left at 1.30pm and staff had to wash up after the evening meal. During the week there was a kitchen assistant from 4.30pm to 6.30pm. The lunch was shepherds pie with carrots and green beans. The pudding was pineapple sponge with custard. Both dishes had been prepared by the chef. The meal was well presented, people had good portions and it looked appetising. Quiet background music was being played at lunchtime. We saw that some people were having their meal liquidised so they were able to eat it better. We saw that all the vegetables and main course were liquidised together and the meal did not look very appetising, although people seemed to enjoy it. One of the staff and the cook told us that in places that they had worked before, the different vegetables and main dish had been liquidised separately. The cook told us that they would now do this so that people could taste the different flavours. Most of the cakes were baked by the chefs. People had a specially decorated cake when it was their birthday. Care Homes for Older People Page 20 of 35 Evidence: We saw that staff were standing rather than sitting next to those people they were supporting with eating their meal. They were not always engaging with the person to encourage them to eat what was offered. One person was having toast and jam. The chef told us that if the person did not like the meal they asked for this. They went on to say that sometimes they would eat shepherds pie. The chef told us that they had different alternatives if people would not eat the meal, for example, ravioli or a sandwich. There was a vegetarian alternative listed on the menus. The chefs cooked a batch of separate meals that were frozen and included: nut roast, vegetable casserole, quorn pie, shepherds pie and lasagna. There were also vegetarian sausages. One of the relatives in a survey told us, in answer to the question about what the home could do better: Better standard of food. Some action had been taken to address the good practice recommendation we made that the progress in providing more fresh ingredients in the meals was built upon. We looked at the menus and spoke with the chef. We saw that fresh vegetables, identified on the menus, were provided on a Sunday and a Wednesday. At other times the vegetables used were frozen. Mr Foreman told us that potatoes, tomatoes and runner beans had been grown in the garden and included in the meals. We saw that fresh milk was used for the milky drinks, yet powdered milk was made up in quantities for teas and coffees. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives are encouraged to make comments or complaints about the service. Staff are confident and knowledgeable about referring any concerns or allegations of abuse to the local safeguarding procedure. Evidence: The home had a complaints procedure which was given to people who use the service, or, more usually to their families. A log is kept of all complaints but there were no entries since 2007. Mr Foreman told us that they had recently introduced a suggestions box in the front entrance so that anyone could raise issues. He went on to say that as he and Mrs Mason were always in the home, he hoped that relatives would approach them directly so they could sort out any issues when they arose and deal with them immediately. In the AQAA Mr Foreman told us We feel that we can positively learn from complaints and suggestions. We saw that an IMCA (Independent Mental Capacity Advocate) had been sought for those people who had no family to act in their best interests. The home was not involved in peoples finances or held any money on their behalf. The administrator told us that Mr Foreman would pay for any chiropody or hairdressing, then invoice peoples family, solicitor or court of protection officer. We asked three staff about how they would respond to any abuse in the home. All of Care Homes for Older People Page 22 of 35 Evidence: them told us they had received safeguarding training and talked about different things that were abusive. We asked them what they would do if they came across any of these things. They were quick to tell us that they would tell a senior staff or the providers. We also asked them what they would expect the providers to do. They could not tell us about the local safeguarding reporting process. One staff did however know that they needed to tell us about any safeguarding issues. We saw that the safeguarding reporting process was displayed prominently in the care office and Mr Foreman said in the AQAA Copies of the booklet entitled No Secrets in Swindon and Wiltshire were available in the main office. We said that although it was not staffs immediate responsibility to report any abuse, they should still be aware of the process, so they could report directly if they needed to. One of the staff we spoke with told us they had been given the local booklet on safeguarding. They had also completed training and seen a film whilst working in another part of the country. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The providers continue to find ways to update and improve the environment for peoples comfort. Consideration is given to ensuring a better environment for people who have dementia, using advice from dementia specialists. People benefit from a clean, bright and homely environment. Evidence: Some of peoples bedroom doors had been replaced with a door that was similar to a front door of a house. They were painted different colours, had the number, a door knocker and letter box attachment. One of the senior staff told us that this idea was from a course in dementia care. Mr Foreman told us that he was gradually getting photographs of people that they would recognise as themselves to put in picture frames by their doors. More pictures and photographs had been put up around the home. Mrs Mason told us they had been brought down to eye level so that people could see them more easily. There were old photographs of Salisbury and farming activities. There were signs showing the location of the bathrooms, toilets and dining rooms. In the AQAA Mr Foreman told us We have continued with our internal decoration programme, including redecorating both communal lounges and the dining room. We Care Homes for Older People Page 24 of 35 Evidence: have also redecorated the entrance porch to make it more welcoming for relatives and visitors. We have purchased more pictures, some bedroom furniture, towel rails and shelves (so residents can see their toiletries) and large umbrellas for the garden. Also a retracting sun blind for the patio. We have replaced most of the chairs with armchairs. Mr Foreman also said that he planned to install sun pipes [highly polished tubes which reflect light into the space below] in those corridors which do not get much natural light. Non slip flooring had been fitted to the entrance hall and stairwells. The gardens had been landscaped to provide two sitting areas and raised beds for growing vegetables. People could walk out into the enclosed garden in safety. As a result of the responses to the quality audit, the old dining room had been changed into a more quiet area where music could be played. Part of the sitting room had been changed to a dining area. The other part of this room had been changed to make an area for watching TV. Mr Foreman told us that people found this more relaxing as the television and music centre were not competing. One of the old toilets was in the process of refurbishment to a hairdressing and chiropody treatment room. Staff told us that the items that were stored in the room were moved when the room was in use. One of the people we spoke with told us that they liked their room because it was quiet. They said they liked having their own toilet. They told us they had all their meals in their bedroom and liked their own company. They said Im rather spoilt arent I. They said they could easily get to the call alarm system either by their bed or in their ensuite, if they needed staff. They said they were pleased with the laundry service and cleaning of their bedroom. The local Environmental Health Department had carried out an inspection of the kitchen in May 2009 and awarded 4 stars. Mr Foreman told us that the recommendation to reroute the ventilation in the kitchen to the outside had been actioned. The use of a rope across the bottom of the stairs to dissuade people from using the stairs unaided had been agreed with the local Fire and Rescue Service. We saw from the risk assessment that the rope was unclipped by staff if the fire alarms sounded. The bathrooms had guidance to staff on making sure that the water temperature was Care Homes for Older People Page 25 of 35 Evidence: below 43 degrees centigrade. There was instruction that people were never to be left in the bath alone. We also saw that peoples individual care plans stated that they were never to be left alone when bathing. The home was clean and fresh and we did not notice any unpleasant odours at any time during the visit. People that could tell us, said that they were pleased with the cleaning of their bedrooms. Two housekeepers work from 7.30am to 1.30pm Monday to Friday. At the weekend there is one housekeeper working the mornings. We saw that at lunchtime one of the housekeepers was mopping one of the sitting room floors with a strong smelling disinfectant whilst one person was eating their meal. The housekeeper told us that the person did not normally eat in this room. They recognised that this was unacceptable and said this was the only time that the room could be cleaned as people were using it at other times. The housekeeper said they were finishing their shift soon. We looked at the cleaning rotas. They were very detailed and showed a good cleaning regime to infection control standards. We said that there should be some balance between achieving the cleaning standards during the time allocated without compromising peoples quality of life. We looked at the laundry. The area was clean and well managed. There were facilities to deal with soiled or infected linen. Delicates were put in separate bags in the machines so they did not get tangled. There was a system for making sure that peoples own items were returned to them washed and ironed. In a survey form one of the healthcare professionals told us The only criticism I would have is the very loud call bell system. Patients appear to tolerate this but I do wonder if this would be changed to reduce the volume which is very loud in the lounge area. Another healthcare professional told us [Do better] Decor of home needs more soft decorations. Call bell system could be changed. Care Homes for Older People Page 26 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are available at different times of the day and night when people need them. A robust recruitment process means that people are protected from anyone who is unsuitable to work with them. Staff have good access to training. Evidence: We looked at the staffing rota. On the day we visited there were four care staff and a senior carer during the morning, with two housekeepers and a cook. During the afternoon there were three care staff and a senior carer. At night there were two waking night staff and either Mr or Mrs Foreman on call from their adjacent house. This had been agreed with a previous regulator many years ago. There was also another member of staff identified as on call on the rota. If Mr and Mrs Foreman were on leave, a member of staff would sleep on the premises. The shifts were planned so that staff could take advantage of a taxi service provided by the home. In the AQAA Mr Foreman told us We have employed an extra member of staff to work over the teatime period to help dish up teas, hence freeing up other staff to attend to the needs of the residents during this time. One of the staff told us that they had received a period of induction. They had shadowed a more experienced member of staff for some of the shifts. We looked at the induction records. They covered different areas but were not signed by the new staff or dated. We saw that new night staff worked as a third person until their Care Homes for Older People Page 27 of 35 Evidence: Criminal Records Bureau certificate had shown that they were suitable to work with vulnerable people. We looked at the recruitment records. All of the information and documents we require by regulation were on file. Staff had received training in care planning, equality and diversity, first aid, medication and food hygiene. Mr Foreman sent us the training matrix for the rest of the year, the day after the inspection. There was one training session planned for each month. Subjects included: moving and handling, deprivation of liberty, person centred care, communication, first aid with a further session on moving and handling in December 2009. Training material was purchased from a company which externally marked staffs work. Mrs Foreman provided the training sessions. Mr Foreman told us that she kept herself up to date with current good practice with seminars and conferences. One of the senior staff told us they had NVQ Level 4 and that their senior colleagues were also doing the award. They told us they had received training in safeguarding vulnerable people, both in house and an external course, first aid and moving and handling. They showed us the list of training which was on the staff notice board. This included dementia, diet and nutrition, infection control, coping with aggression and death and dying. They said that some of the training was in the form of a questionnaire that was externally marked. They went on to say that they had also received training in palliative care at a local hospice, diabetic care from the district nurse and sight awareness at a local college. Another staff told us they had received training in health and safety, fire prevention, dementia, medication, food hygiene and NVQ Level 2 in care. In the AQAA Mr Foreman told us that eleven staff had NVQ Level 2 or above and the three chefs had NVQs in catering. One of the people we spoke with told us They look after me even though they are very busy. In a survey form, in answer to the question about what the home could do better, one of the staff told us Provide more training for staff in dementia care. Cleveland Lodge isnt a bad place to work. Residents are well cared for but I feel that a few courses would benefit all staff and residents. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is run as a small family concern. The home is run in the best interests of people who live there. Staff are well supervised. Systems are in place to ensure regular checking and maintenance of services and equipment for people and staffs health and safety. Evidence: Mr Foreman is the registered manager and Mrs Mason is the responsible individual. They are two of the directors of Cleveland Lodge Limited. Mr Foreman and Mrs Mason took joint responsibility for the day to day running of the home. In the AQAA Mr Foreman told us The management team have worked hard to put in place a more detailed audit and quality control system to enhance the running of the home. This is helping to ensure that no aspects of our responsibilities as manager are overlooked. We discussed the Leadership and Management for Care Services qualification with Mr Foreman. He told us that he was awaiting the publication of the registration compliance criteria of the Health and Social Care Act 2008. Mrs Foreman, the homes Care Homes for Older People Page 29 of 35 Evidence: training manager, had the Registered Managers Award. We asked Mr Foreman and Mrs Mason about their own training that they had undertaken. They told us they attended regular seminars with a trainer to discuss aspects of managing a care home. Two of the seminars were with experts on providing dementia care. They attend all of the local care homes association seminars. Mrs Mason showed us her training record. She was a qualified nurse but not employed in that capacity. Mrs Mason was an NVQ assessor, had a certificate in nutrition and health and had trained in using the MUST (Malnutrition Universal Screening Tool). Mrs Masons recent training had included first aid responsible person, sight and hearing awareness, the Mental Capacity Act 2005 and deprivation of liberty safeguards and care planning. She also had a certificate in dementia care. The home had reorganised the quality assurance system. Questionnaires had been sent to some people who use the service, relatives and others involved in their care. Results had been analysed and action taken were highlighted in a final report. We asked staff about supervision. They told us they received supervision sessions with Mrs Foreman every six weeks. We saw that records of supervision were kept in staff files. Mrs Foreman and Mrs Mason completed observations of different staff involved in different tasks on a regular basis. Outcomes of these observations were discussed at supervision. Mrs Mason told us that staff were now receiving more structured supervision. In the AQAA Mr Foreman told us Our training manager has attended a course on staff supervision and appraisals and she had completely redesigned our supervision and appraisal system. Contracts for supervision had been implemented. Staff told us there were staff meetings every few months and that they could contribute to the agenda. Environmental risk assessments had been reviewed and rewritten in a different format. Assessments were carried out on use of chemicals, safe window openings to the first floor, tasks that people and staff were involved in and use of equipment. A yearly check list had been implemented so that all checks and tests of the building, services and equipment could be carried out on the due date. The home used external contractors for services, maintenance and repairs. There was a record of when any work had been completed. We saw one person being lifted from their chair by pulling them up by their hands. We asked the staff about this and they said that it was the way this person was lifted. We said that this was poor practice and risked damage both to the person and staff. We saw that the moving and handling risk assessments identified that equipment such as a hoist, moving straps and slide sheets were available and should be used for moving Care Homes for Older People Page 30 of 35 Evidence: people. We saw that there were records of staff training in moving and handling. In a survey one of the staff told us I feel that staff and residents would benefit from a practical manual handling course as manual training is mainly paperwork. We saw that some policies, procedures, guidance, protocols and immediate care records were not always signed or dated for monitoring purposes. Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 35 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 13 Medication with specific 30/10/2009 prescribing instructions, for example to be taken weekly, must be detailed in peoples care plans. So that staff know how it is to be given. 2 7 17 The home must keep their own records of healing of wounds and not rely on those kept by the district nurse. For the homes own monitoring of healing. 30/10/2009 3 38 13 The home must make sure 30/09/2009 that staff are putting the moving and handling training into practice and not use unsafe lifting. So that people and staff are not injured by poor moving and handling. Care Homes for Older People Page 33 of 35 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 2 3 4 8 15 15 15 Body maps may help with recording location, size, colour of any wounds and whether the skin is broken. More fresh vegetables should be provided with meals and the amount of frozen vegetables reduced. Fresh milk should be used rather than powdered. Those people who have their meal liquidised should have each of the ingredients liquidised or mashed separately, so that they can savour each flavour, rather than have an unappetising looking meal. Although it is not staffs direct responsibility to report any allegations of abuse to the local safeguarding procedure, they should still know about the process. People must be able to eat their meals without a room being cleaned with strong disinfectant. Mr Foreman should progress his plans to undertake the Leadership and Management for Care Services qualification. All documentation should be signed and dated for monitoring purposes. 5 18 6 7 8 26 31 37 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) 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. 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