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Inspection on 11/12/07 for Colton Lodges Nursing Home

Also see our care home review for Colton Lodges Nursing Home for more information

This inspection was carried out on 11th December 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

All residents now receive a robust assessment prior to moving into the home. They are also consistently offered the opportunity to visit and look around as well. The home provides residents with a good standard of care planning. All those inspected showed a person centred care approach is taken. Evidence was seen to show there was a consistent attempt to involve people with their care documentation. The care planning systems are reviewed on a regular basis. The home operates a good recruitment procedure that helps protect people that live in the home.

What has improved since the last inspection?

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Colton Lodges Nursing Home 2 Northwood Gardens Leeds Yorkshire LS15 9HH Lead Inspector Sean Cassidy Unannounced Inspection 11th December 2007 10:00 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 Colton Lodges Nursing Home DS0000001332.V355334.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. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Colton Lodges Nursing Home Address 2 Northwood Gardens Leeds Yorkshire LS15 9HH 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) 0113 2645288 0113 2326676 brownch@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Christine Mary Brown Care Home 120 Category(ies) of Dementia - over 65 years of age (48), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (90), Physical disability (4) Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Garforth, Elmet and Whitkirk Houses - Old age (30 beds each house) Newsam House - Dementia and Mental Disorder over 65 years of age (30 beds) Whitkirk House - Physical disability age 21 , who are three named service users with chronic brain injury. Specific dementia (age over 65) service users as identified in Bupa Care Homes letter dated 28 October 2003 Garforth House 7 places, Whitkirk 6 places and Elmet 5 places) The fourth PD place is specifically for the service user named in the variation application dated 27.6.05 11th January 2007 Date of last inspection Brief Description of the Service: Colton Lodges is in a residential area of Colton, close to local amenities and public transport routes. There is a car park to the front of the home and gardens are accessible to residents. The home is registered as a care home with nursing for 120 older people. Three places are registered for residents with a physical disability who are under pensionable age. Colton Lodges is purpose built comprising of four bungalows- Newsam, Garforth, Whitkirk and Elmet, each accommodating 30 people. Newsam provides nursing care for older people with dementia. Each bungalow provides 30 single rooms, a communal lounge and dining area and three communal bathrooms. There is level access throughout the bungalows. Kitchen and laundry facilities are located centrally, although each unit has its own kitchenette for making drinks and light snacks. The fees charge by the care home at the time of the inspection were: £434.77- £786.02. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. An unannounced visit to the home was conducted by two inspectors and lasted two days. The majority of this time was spent speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, health and safety details. The information required from the provider in the form of the Annual Quality Assurance Assessment was provided prior to the inspection and information from this is also included in the report. One inspector in the specialist dementia unit carried out a Short Observational Framework Inspection. This provided evidence to measure the direct experience of people with dementia living in a care home, particularly focussing on the standards concerned with privacy and dignity. What the service does well: What has improved since the last inspection? Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 6 • The Statement of Purpose contains all the necessary information needed to ensure people are enabled to make an informed choice whether to move into the home or not. All new residents are now appropriately assessed prior to moving in. Residents are now provided with a care planning system that identifies the care needs and provides staff with clear person centred details as to how these care needs should be met. Improvement has been made with the staffs’ understanding of safeguarding issues. Evidence was seen to show appropriate checks on equipment used in the home now take place. • • • • What they could do better: • All residents that have wounds must have care plans in place to assist staff with providing the appropriate care. This will promote the healing process and provide evidence to show the correct care was administered. All residents that are identified as losing significant amounts of weight must be correctly monitored. Staff must fill in the records that have been developed to monitor nutrition and hydration. This will ensure appropriate action can be taken when identified. Staff must adhere to the risk assessment guidance when a potential nutritional problem has been identified. This will ensure that residents receive the correct care at all times and that they are not placed at unnecessary risk of harm. All residents that are identified as at potential risk of developing a wound must be correctly monitored. Staff must fill in the records that have been developed to monitor pressure area care. This will ensure appropriate action can be taken when identified. Staff must ensure that when a resident is prescribed and administered new medication then they are monitored for potential side effects and ill DS0000001332.V355334.R01.S.doc Version 5.2 Page 7 • • • • Colton Lodges Nursing Home effects on their condition. This will ensure that the individual is not placed at unnecessary risk. • Closer attention must be paid to the individual right and choices of people living in the home. Clear evidence must be in place to show proper consultation has been taken with individuals about how they wish to run their lives. Particular attention must be given to those residents that have dementia. The social and recreational service provided to people living in the home is poor and must be reviewed. Particular attention must be paid to those residents that are unable to leave their rooms and also those residents that have dementia. This will help ensure that those people living in the home receive a good standard of holistic care. The manager should review the complaints process to ensure that when a complaint is verbally presented to staff in the home it is dealt with according to the internal complaint procedure. This will provide all stakeholders with confidence in this process. The manager must ensure that when a safeguarding referral has been presented then the internal and local safeguarding procedures are correctly followed. This will ensure people are being properly protected from the risk of unnecessary harm. The cleanliness and tidiness of the home environment must be improved. This will improve the well being of people living there and provided confidence to relatives also. There must be sufficient numbers of staff on duty, in all parts of the home, at all times. This will to ensure the care needs of all people living there are met at all times. All care staff providing care to people with dementia must receive training in this specialist area. This will ensure they have a good understanding of peoples’ care needs. The management systems and processes adopted by the manager of the home must be reviewed to ensure they are in the best interest of the people living there and that they will assure the quality of the care provided. • • • • • • • Colton Lodges Nursing Home DS0000001332.V355334.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. Colton Lodges Nursing Home DS0000001332.V355334.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 Colton Lodges Nursing Home DS0000001332.V355334.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality outcomes in this area. People receive good information that informs them about the services that are provided by the home. Each person is fully assessed prior to admission. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The home has a Statement of Purpose and Service User Guide that provide the reader with a good understanding of the services that are offered within the home. People confirmed that they were provided with a copy of the terms and Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 11 conditions. One person was able to produce this document for inspection and it was signed and dated. The files of the most recent admissions contained evidence to show both were appropriately assessed prior to moving into the home. Both said they were asked if they wanted to look around first but they declined. Colton Lodges Nursing Home DS0000001332.V355334.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 poor. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. Although the care plans and risk assessments are robust, people are not receiving the care that is needed to keep them safe. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The home has introduced a new care planning system throughout all of the four units. Staff have received training prior to this implementation. Those spoken to said that they thought it was a difficult change but they are becoming more used to the system. The care files of three people were case tracked in Garforth house and three care files in Newsam house. Each file contained a robust comprehensive set of Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 13 care plans and risk assessments that set out how each persons’ care needs were to be met. Many of the documents were person centred in their approach and provided the reader with a good picture of what the care needs for each individual were. Evidence was seen to show the care plans and the risk assessments were reviewed on a monthly basis. A daily record was made about each individual. These provided the reader with little information as to how each person spent their day. Although there was clear care guidance in the care files there were large gaps in the evidence that showed the correct prescribed care was not being administered. Four residents nursed in bed had records kept in their rooms to record that they were receiving correct fluids, nutrition and that they were being turned. In all four cases the records were either only partly filled in or they were missing. Staff spoken to in Garforth Unit said they sometimes forgot to fill them in because they were so busy. Staff spoken to said they do write in the daily records as to what they did with individuals that day, however, they said they had little time to look at the care plans themselves and weren’t aware of their content. One person said that she relied on information from other staff or nurses about peoples’ needs. Another care worker confirmed this and said that information is passed by word of mouth from other people. Someone else said, she/he hadn’t had time to read the care plan of someone who had been in the unit for 3 weeks and went on to say, “People’s needs are not being met because we are rushing about.” This over reliance on verbal information means that there is a very real risk of people’s needs being overlooked. One visitor said that since admission her relative had deteriorated and lost his remaining skills and abilities, another said, “People seem to go down quickly after admission.” The care files of two people that had wounds were inspected. One person did not have a wound care plan in place even though he had been in the home for a over two weeks. Another care plan stated the wounds were to be redressed every three days. The records showed that there were gaps of six days before the wound was redressed. No explanation could be given for these omissions. These omissions do not ensure people are receiving the correct care. The nutritional risk assessments used by the home provided staff with instructions as to what they were to do if a resident was identified as losing significant amounts of weight in short periods. One resident’s records showed she had lost four kilograms in weight in just over one month. The care records stated that the GP or the Dietician should be involved with this person’s care. No evidence could be provided to show this happened. Another person’s care plan showed a weight loss of 9kg between August and November 2007. Although there has been GP and Speech and Language involvement in his care, there was no information in his care plan about the home accessing dietetic advice. This is poor practice. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 14 One person’s care records showed that since June 2007 he has had 15 falls, the biggest majority of these occurring between 6pm – 9pm. There was no evidence in the plan that the home had recognised this pattern, contacted the falls team for advice or had taken any action to prevent or minimise further falls. This person’s care plan and risk assessment showed that he considered people who were sleeping to be dead and tended to cover them with pillows. His risk assessment was unclear as it referred the reader to other policies and procedures such as RPC 48 ‘coping with wandering’, RPC 01 ‘abuse of resident’ and RPC 30 ‘monitoring resident at night’. Staff need to be able to consult a risk assessment and have access to clear and precise instructions without being referred to a range of other documents. This person’s care plan said that staff should observe his whereabouts. During both days of this inspection visit this person was seen wandering up and down corridors, unseen and unsupervised by staff, and at the time some people living at the home were asleep in their bedrooms and were therefore placed at risk. During the course of the inspection, staff were observed to be pleasant in their approach to the people they were providing care to. They knocked on residents’ doors before entering and those people that able to communicate said they were treated well overall by staff. There were a number of dignity issues identified in both units during the inspection. Visitors to Newsam House raised several concerns. One person said that she has seen her relative wearing different coloured socks and wearing trousers with buttons missing, another said her relative sometimes has greasy hair and food spills on his clothing. Another person said that she has seen people being taken to the dining table without first having their wet clothing changed, and that ‘soaking wet’ cushions have been left in chairs. She went on to describe how recently she had visited the unit at 11am and found her relative wearing a pyjama jacket and a pair of jogger bottoms on ‘back to front’. On both days at breakfast people had their clothing protected by white plastic aprons, which are undignified. People were dressed properly, but one person who had been outside of the unit to the hairdressers had no protection against the bitterly cold day. She was not wearing a coat or protected with a blanket. Other issues included people being put to bed as early as 5.30pm. Care staff said that they put people to bed early to help those working on night shifts. The night shift also get people up early and leave a list for those they have got up and washed. On the morning of the first inspection staff said there were seventeen people on the list that were got up. There are thirty people living in the Garforth unit and the majority of those are unable to give their consent to being put to bed early or to being got up early. Two residents said that night staff had wakened them to get them up. They were able to tell them that they did not want to get up this early. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 15 At least four people said they had to wait too long for people to answer buzzers, which caused them distress. The white board in the dining room had the term ‘Feeders’ written on it. This was the word used to describe people who needed assistance with their food. People were being left in dark rooms with the curtains pulled. They were unable to agree to be left for this length of time due to the nature of their condition. One individual was left in a darkened room until 11.50am before he was assisted with a wash. Lunch was just about to be served at this time. The systems for the storage and administration of medication were reviewed. The recording of administration was good. However, two main concerns were identified in this area. • It was recommended that controlled drugs be destroyed as soon as possible when they are no longer needed. A large number were found to be stored unnecessarily. Concerns were raised by two relatives about the administration of medication to their relatives living in the home. One said that she was angry about the medication her relative had been prescribed. She had to point out the negative effects it was having on her relative and had to fight to get it changed. She was very concerned that this had to be pointed out to the staff and they had not picked up on it themselves. Since then the person has been showing improvement. Another was concerned about the effects of the medication prescribed to their relative due to its negative effects on their well-being. • Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. The social and recreational needs of people living in the home are not met. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People spoken to said that they were happy with the visiting times within the home. They were able to more or less ‘come and go as they pleased.’ The home is supposed to have four activities coordinators that are able to provide each unit with a service eighteen hours per week. There have only been two coordinators working in the home for the last three months. Due to a recent resignation, there will only be one in post from January. This has left people living in the home with a service in this area that is well below standard. The activities coordinator said that they try hard but they are very stretched. It was noticed on both units that the coordinators involved Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 17 themselves only with those that were able to physically join in with activities. This was confirmed by speaking to the coordinator in Garforth Unit who said they only had time to involve themselves with this group. During the inspection of the specialist dementia unit it was observed that only people with a lesser degree of dementia were involved with activities and the majority of others were not. This was also the case in the Garforth Unit, where a large proportion of people living there also have dementia needs. The staff spoken to provided a lot of evidence to say that activities and social provision for people is a lot less than it should be. Comments included, “We don’t have the time to get involved with activities and one to ones because we are so busy.” “I try my best to do what I can with activities but I have very little time.” When staff were asked who was responsible for ensuring residents enjoyed a variety of physical and social activities they said it was up to the activities coordinator. They were not aware of their own important role in holistic care. All visitors spoken to during the two days were unhappy with the level of activities provided in Newsam House. One visitor said, “People seem to go down quickly after they are admitted. I think it is because there is no stimulation. The lack of activities has got worse since the last inspection. The activity organiser only focuses on the more able, others are just left to sit in a chair all day.” Another said that the activity organiser usually takes the same people on outings, and that people less alert are left to sit in their chairs all day either asleep or looking into space. She said, “The only time staff come to them is when they are offered food or to take them to the toilet. Staff don’t sit next to people just holding their hand. Other comments from visitors included: • • • “It is the little things that are missing that could improve people’s quality of life, such as stimulation.” “The activity organiser seems to spend time with the same people, it is always the same people playing dominoes. To compensate I try and go round the lounge and speak to people. “Activities are only for the more able, there is no stimulation for some people.” One of the methods used during this inspection was to observe a small group of people over a period of time. This is called a SOFI (Short Observational Framework Inspection). A group of five people were observed over a 1½ hour period of time. For 51 of the time that these five people were observed they were either asleep, withdrawn or in a negative state of well-being. The activity organiser was working at a dining table with a group of people but there was no stimulation for any of the people observed other than at times when care was given. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 18 In the communal lounge there is a small portable television, which is totally inappropriate for the setting. There was background music of Xmas songs in the lounge during the two days but one visitor said that this was not always the case because sometimes inappropriate ‘pop’ music is playing. A BUPA policy about inappropriate music was displayed in the unit, but on a tour of the unit one person was asleep in bed with a radio channel playing ‘pop’ music. This practice was also very prevalent in the Garforth Unit. One relative said that almost twelve months ago when she looked around the home she was told about a sensory ‘snoozelan’ room, aimed specifically at people with dementia. She is now disappointed that this room is still not ready for use. This room was being developed at the last inspection One visitor said that she felt that staff did not have the time, patience or energy to spend with people and said, “Everybody in this unit is someone’s mother, father, brother, sister, wife or husband and should be treated with respect, not just be seen as a body in a chair.” During the 1½ hours that five people were observed there were only 17 staff interactions mostly when people were offered a drink, repositioned or taken to the toilet. Of these interactions 11 were good, 4 were neutral and 2 were poor. Those that were poor included 2 staff giving care but talking to each other and not the person being observed. Other poor practices included staff assisting someone to drink, and taking away cups and a coffee table without speaking to the person or giving an explanation of what was being done. Good interactions included the unit manager speaking to someone and using his name as she passed by, and one carer explaining what he was going to do. The unit manager said that she spends time with staff explaining good practice in dementia care and encourages staff to sit down next to people to provide some sort of stimulation. A member of staff who was very clear about good practice in dementia care said, “There is no time to put it into practice. Staff don’t have time to spend with people, which means people are noisy and agitated, like today.” Staff described the rights and choices of people in Newsam House, but if they do not consult care plans there is no sure way of knowing that they are respecting people’s individual likes and dislikes. One visitor described how her relative had been given a drink of tea with a ‘lot of milk’ when in fact he likes the opposite. Another time she had visited and found her relative in bed at 6pm when in fact he prefers to go much later. Menus are varied and there is a good choice available, but staff in Newsam House missed opportunities to provide additional fluids and calories to people, particularly those at risk of dehydration and poor nutrition. People were not always offered a second cup of tea or another helping of food. Staff started to serve lunch at 12.10pm but some people were assisted to the dining table at Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 19 11.30am. This resulted in one person leaving the table several times and being told by staff to ‘Sit down’. Visitors said that this was a regular occurrence. The meal served in Garforth could also have been made a more social occasion. Staff put plastic aprons on all residents. They said they did have more appropriate cloth ones, but they didn’t know where they were. One relative said, “Mum would be really annoyed if she knew they were putting a plastic apron on her.” Only those people that could communicate were assisted to the table for their meals. Everyone else stayed in the seats they had been sitting in most of the morning and had side tables to rest their food. One lady spoken to said, “I’d like to sit at the dining table but no one asks me.” Colton Lodges Nursing Home DS0000001332.V355334.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. The systems used for ensuring complaints and safeguarding issues are correctly dealt with do not ensure people are properly protected. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The complaints procedure is displayed in the central office and also at the entrance of each unit. People are also provided with a summary of the complaint process within the information packs they are provided with on admission. Those people spoken to in Garforth Unit said they knew how to complain if they needed to and they said they were confident that their complaint would be properly dealt with. Visitors in Newsam house knew how to make a complaint and said that the home responded when complaints were made. The manager does keep a record of complaints and these showed that they were investigated following the internal procedure. However, because of a breakdown in communication the registered manager is not made aware of all Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 21 complaints. For example nurses in both Newsam and Garforth house staff said that not all complaints are recorded and they were unable to locate the complaints book. This means that there is no accurate means of monitoring the actual number of complaints made. The home has its own internal safeguarding adults procedure. Recent safeguarding adult issues have been identified and dealt with as per the policy. However, a safeguarding issue was identified during the inspection and the internal policy was not adhered to, which placed people at risk. One visitor described how her relative had left the unit unnoticed by staff and was found outside under some bushes. His care plan and risk assessment had not been updated and there were no systems in place to make sure that this did not happen again. Staff on duty in both units knew about the different types of abuse and how to report any suspicions relating to safeguarding (abuse). However, as identified earlier in this report poor recording on risk assessments and lack of knowledge about people’s whereabouts creates the potential for people living at the home to be at risk. Colton Lodges Nursing Home DS0000001332.V355334.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 adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. Improvement with the environment of the home is needed to improve outcomes for people living there. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: People spoken to said they were generally happy with the environment in Garforth House. They said they felt it was kept clean and tidy. One domestic was on duty during the inspection. She provided a good knowledge of infection control and COSHH. She said she had recently received training in these areas. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 23 When asked, staff had a good understanding of measures to prevent infection spreading in the Newsom House but some soiled and used incontinent pads were seen in bins that were not double wrapped. This resulted in an offensive odour when the bin was opened. Garforth has undergone a recent improvement programme and some of the rooms have been redecorated and some new furnishings have been put in. Two residents spoken to were unhappy with the bedrooms that they were living in. Both said they would like more storage as their rooms were becoming cluttered with nowhere to store things such as books. Another person said her room had recently been decorated but it didn’t suit her disability needs due to the restrictions of the layout. A random check of the bathrooms in Garforth House provided evidence that improvement is needed to ensure they are more suitable for the needs of the people living there. They are very clinical environments, with no homely touches added to them. All the window blinds were closed due to being broken. Two of the four bathrooms were used to store wheelchairs and hoists. Shoes and slippers belonging to people were lying on the floor. Someone’s facecloth was lying on a wheelchair and personal washing accessories were lying around. Bathrooms in Newsam House were also clinical and did not provide an environment that would reassure and relax people with dementia. Some were also used as storerooms. Several issues of concern were noted in Newsam house. Some storerooms that had signs saying, ‘Fire door keep locked shut’, were capable of being opened when bolted. Other storerooms were open giving access to Steradent tablets, and other hazardous products, thereby posing a serious risk to the people who were wandering up and down corridors unsupervised by staff. There was an odour in the entrance and in some of the bedrooms in Newsam House. One visitor said that this unit was not always clean. A further three visitors all made similar remarks and were particularly upset about the lounge carpet which was marked and stained. Some bedrooms looked basic because there was no bed valance and the metal bed frame could be seen. Many of the duvet covers in Garforth were of a poor standard. They were ripped in places and all those inspected had no fastening buttons. Staff said this made the duvets look ‘Shoddy.’ In some bedrooms the walls had been scraped or knocked and paint and plaster was missing. Some rooms looked dingy because overhead lighting was poor and unsuitable for older people with sensory or sight loss. One resident in Garforth said that she liked to read at night but the light was too poor to read on its own. She had to get night staff to turn the light on above her sink to help her read. Some beds had mattresses that were longer than the bed. This creates the risk of falls, particularly if someone sits on the end of the bed. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 24 In Newsam House there were signs on peoples’ bedroom doors to help orientate them, but these did not tend to be relevant to the individual and there were only a few with pictures of things that they could relate to. When asked, staff had a good understanding of measures to prevent infection spreading in the Newsom House but some soiled and used incontinent pads were seen in bins that were not double wrapped. This resulted in an offensive odour when the bin was opened. Colton Lodges Nursing Home DS0000001332.V355334.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 poor. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. The numbers and skill mix of the staff are poor. This means peoples’ care needs are not always met. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: There were major concerns raised by all who were spoken to about the staffing levels of both Garforth and Newsam. Examples of comments made were: • • Staff take their breaks together. There is not enough staff and the turnover is high. There is not enough staff, particularly at weekends. When staff are in toilets, bathrooms or doing jobs there is often nobody in the lounge. It feels as though visitors are left to look after people. DS0000001332.V355334.R01.S.doc Version 5.2 Page 26 Colton Lodges Nursing Home • There is not enough staff and turnover is high. I am worried about the planned extra beds in the extension. There should be a lot more staff. I have asked for a meeting to express my concerns, but I didn’t get any real satisfaction. There aren’t enough staff to meet the personal care needs of the people who live here. • The information provided in the Annual Quality Assurance Assessment showed that the home had lost nearly 60 of the full time and part time staff in the last eleven months. This has been a significant loss and it has not gone unnoticed by those that use the service. The staffing rotas in Garforth House were inspected. There were many shifts when the unit was understaffed. There were at least five recent shifts where only one registered nurse and one carer were on duty to care for thirty highly dependent people. On the night of the inspection a registered nurse who worked for an outside agency and was not familiar with the unit or the residents managed the unit. This is poor practice. There were many other day shifts where the staffing levels were poor. In Newsam House one carer said that the unit is often short staffed because people do not turn up for shifts. She felt that morale was low and that was the reason behind the high absence levels. She went on to say because of staffing levels people’s needs are not always met and gave the example of someone not being assisted to wash and shower until mid-afternoon because staff did not have time to assist him. Another person said that inadequate domestic staffing levels results in care staff having to clean rooms and carpets, which means less time spent with people living at the home. This person went on to say, “People’s needs are not being met because we are rushing about.” Evidence was seen to show staff are provided with induction and good training facilities. Four members of staff said they received a three day induction and that they have had recent mandatory training in areas such as moving and handling, infection control and safeguarding vulnerable adults. Some staff have had training on dementia care, but others said that the only dementia care training they have received was as part of their two day induction programme. This is unacceptable because dementia care is a specialist service and staff need knowledge and skills to be able to work effectively with people. Conversations were held with many staff regarding their understanding of the specialist needs of people with dementia. The evidence obtained showed a significant shortfall in this area of care. The recruitment files were not inspected on the premises due to the time restrictions. The Annual Quality Assurance Assessment provided by the Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 27 provider stated that they recruited people to work in the home following the correct procedures. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service experience poor quality outcomes in this area. The management systems and processes used do not ensure people receive quality care outcomes. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The management processes and systems adopted by the manager have not improved since the last inspection and have deteriorated. There was no Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 29 evidence to show the manager is actively auditing the care practices carried out in the home. There has been breakdown in communication between what is going on in each unit and what the manager is aware of, this is mainly in relation to complaints, safeguarding and personal care provision. The manager has not been auditing the standards of personal care in the home or other areas such as falls sustained by vulnerable people living there. This has left people living in the service more vulnerable and less protected. Regulation 26 visits are carried out and these are provided monthly. However, these documents provide little detail and provide the reader with little detail about the standard of quality assurance in the home and do not provide the evidence to show how quality of care is assured for people who live there. Most visitors in Newsam House said that the unit manager supervises and organises other staff properly, but other senior staff in the unit do not follow her strict standards. Staff on the Garforth unit said that they do not receive supervision and this was evidenced through speaking to the unit manager. The home does have internal and external tools for assuring the quality of care for people living in the home and the results of these processes are made available to all stakeholders. However, it is unclear how these tools have benefited people living in the home as outcomes for them are poor. One visitor said that the overall manager of the home is not ‘visible’ and doesn’t seem to know what is going on in Newsam House. This would appear to be the case, as stated previously in this report not all complaints are recorded so that there is no way the overall manager of the home is aware of people’s concerns, or of the views and opinions of visitors to the unit. Important issues affecting the safety and wellbeing of people living in Newsam House, such as one person leaving the unit and being found under bushes, have not always been reported to the Commission for Social Care Inspection, in line with the Care Homes Regulations 2001. One visitor said that she feels health & safety issues are not identified and gave an example where she pointed out a hazard during the on-going building extension to the unit. The annual quality assurance assessment that was completed for this inspection provided the CSCI with information to say they meet standards 35 and 38. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 30 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 x x 2 Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12(1)(a) Requirement People with wounds must have the correct documentation in place to ensure the correct care is provided to promote healing. These records must be filled in correctly to ensure care is administered. People who have been identified as losing significant amounts of weight must be referred to appropriate health care professionals. This will ensure the correct action is taken to manage the situation. Evidence must be provided to show those people that are identified as being nutritionally at risk are being correctly monitored in this area. This will help identify problems that can be acted upon. Evidence must be provided to show those people that have been identified as at risk of developing a pressure sore are provided with the appropriate intervention to manage this problem. This will help identify problems that can be acted Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 32 Timescale for action 31/01/08 2 OP8 13(1)(b) 31/01/08 3. OP8 12(1)(a) 31/01/08 upon. 4 OP9 13(2) All people that have been 31/01/08 prescribed new medication must be correctly monitored. This will help to ensure the medication has no ill effects on the individual. Peoples’ privacy and dignity 28/02/08 rights must be respected at all times. Evidence is needed to show how they are assisted and enabled to exercise their choice in these areas. One example of where this has been compromised is, putting people to bed and getting them up at unacceptable times. People must be provided with 31/03/08 social and recreational activity that meets their specific individual needs. They must be involved with decisions regarding the social and recreational provision provided. Specific improvement must be made for those people that have dementia. This will help to improve the holistic care needs of the individuals. All complaints must be recorded and dealt with in accordance with the homes internal policy. This will help to ensure confidence to stakeholders in the service. All safeguarding concerns must be dealt with in accordance with the internal policy and local authority guidelines. This will help protect people living in the home. People living in the home must DS0000001332.V355334.R01.S.doc 5 OP10 12(4)(a) 6 OP12 16(2)(m) 7 OP16 22(2) 30/01/08 8 OP18 13(6) 30/01/08 9 OP19 23(2)(d) 28/02/08 Page 33 Colton Lodges Nursing Home Version 5.2 be provided with an environment that is clean, tidy and free from offensive odours. All furnishings and linen must be maintained to a good standard. 10 OP27 18(1)(a) The registered manager must ensure that suitable numbers of staff are on duty at all times. This will help to ensure all holistic care needs can be met. 31/03/08 11 OP29 18(1)(a) The registered person must 31/03/08 ensure carers receive appropriate training in dementia care. The training should be clearly evidenced in every day practice in all areas of the home where dementia care is provided. People living in the home must be provided with robust management processes and systems. This will help to ensure they are provided with assured quality care. 30/04/08 12 OP31 24(1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations It is recommended that a referral chart for adult protection is developed and placed in each unit. Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Colton Lodges Nursing Home DS0000001332.V355334.R01.S.doc Version 5.2 Page 35 - 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. 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