Inspection on 02/05/09 for Colton Lodges Nursing Home

This inspection was carried out on 2nd May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Colton Lodges Nursing Home 04/06/08

Colton Lodges Nursing Home 11/12/07

Colton Lodges Nursing Home 11/01/07

Colton Lodges Nursing Home 25/01/06

Colton Lodges Nursing Home 19/07/05

Colton Lodges Nursing Home 07/12/04

Colton Lodges Nursing Home 20/07/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Colton Lodges Nursing Home 2 Northwood Gardens Leeds Yorkshire LS15 9HH Lead Inspector Sean Cassidy Key Unannounced Inspection 2nd June 2009 09:00 DS0000001332.V375570.R02.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Colton Lodges Nursing Home DS0000001332.V375570.R02.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 Jennifer Mary Gillham Care Home 138 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (110) of places Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th April 2009 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 people who use the service. The home is registered as a care home with nursing for 138 older people. Three places are registered for people 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 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 charged by the care home at the time of the inspection were: £463.89- £825.00. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero star – poor service. This means the people who use this service experience Poor quality outcomes. 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 people who use the service, relatives, staff and other health care professionals. Two inspectors and an Expert by Experience conducted an unannounced visit to the home and it lasted two days. An “Expert by Experience” is a person, who because of their shared experience of using services or ways of communicating, visits with an inspector to help them get a picture of what it is like to live in a service. The majority of time was spent speaking to people who live in the home, management, staff and relatives. A number of documents were looked at and some areas of the home used by the people living there. The information required from the service in the form of the Annual Quality Assurance Assessment (AQAA) was obtained before this report was written. Feedback was provided at the end of the inspection to various members of the home’s management team. This home is currently undergoing a safeguarding investigation that started at the beginning of April. This was brought about after concerns were raised about the standard of care in certain areas provided at the home. The investigation involves all the health and social care professionals involved with the service. The West Yorkshire Police and the Coroner’s Office are also involved. The commissioning department of Leeds Social Services have informed BUPA that they will not be placing any people in the home until further notice. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 6 The CQC carried out an Unannounced Random inspection in response to the concerns raised by the safeguarding investigation. This inspection identified two breaches of the Care Homes Regulations 2001. What the service does well: People receive a robust assessment before moving into the home. They are also consistently offered the opportunity to visit and look around as well. Good person centred care within the care planning documentation provides the staff with a good understanding of the care needs of each individual. Some positive comments about care were received from people spoken to, examples of these are, “All staff are very kind and look after all the residents well.” “People who work there do their jobs pretty well to say they are always in demand. I’m pleased with the care they give my cousin” “I am happy that my mum is here. The staff know how she reacts to things.” “There seems to be more staff on duty than before. There seems to be more anyway.” “Yes, the staffing levels have seemed to improved recently.” Robust policies and procedure for the smooth running of the home are in place and reviewed regularly. Good Quality Assurance tools are in place to assist the manager with maintaining and improving the care provided within the home. What has improved since the last inspection? Improvement has been made with the administration and recording of the medications within the home. The Statement of Purpose and Service User Guide have been reviewed and are more available to interested parties. There have been a number of environmental improvements made throughout the units since the last inspection. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 7 People have memory boxes outside their rooms. Old pictures of Leeds and old movie pictures are also placed around Newsam House, all of which help with reminiscence therapy for people with dementia. It is positive that BUPA have responded quickly and positively to the concerns that have been highlighted by the safeguarding team and they have an ongoing action plan to assist them with the planned improvements. It is acknowledged that the home has made significant improvements since the safeguarding concerns were identified and they are continuing to work closely with the safeguarding investigation. What they could do better: The care plans and risk assessments must provide evidence to show, where possible, people living in the home or their representatives have been involved with developing the care plans and risk assessments. This will ensure agreement to provide the care package has been gained. All care plans and risk assessments must be reviewed regularly and changed to reflect the care needs of the person receiving the care package. This will help ensure the appropriate care is provided. People living in the care home must receive a package of care that does not compromise their privacy or dignity at any time. People must be provided with social and recreational opportunities that help stimulate their well-being. All planned activities should be based around the needs and choices of each individual. Particular attention must be paid to the people in the home who have specialist dementia needs. This will help to improve the holistic needs of the individuals. People must be provided with a complaint policy and procedure which they are confident in. Complaints must be dealt with following the home’s internal policy and procedures. This will help improve the quality of care provided in the home. The staff working in the home must ensure people are properly protected from any harm. The internal safeguarding policies and procedures must be implemented when the need is identified. This will help ensure people are protected. People living in the home must be provided with an environment that is clean, tidy and free from offensive odours. The numbers of staff allocated to work in each unit must be sufficient to the care needs of the people who live there. They must be suitably qualified and have the necessary skills and experience to meet people’s care needs. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 8 All new employees must be employed following the home’s internal recruitment and selection procedures. This will help protect people living in the home. All carers working in the home must be provided with specialist dementia training that provides them with a good understanding of the specialist dementia needs of people living there. This will help ensure people receive the correct package of care that meets their needs. Quality assurance systems must be robust and correctly implemented. All incidences of pressure sores that are Grade 2 or above must be sent to the CQC. The monthly Regulation 26 visit reports performed by the Responsible Individual must be sent to us until further notice. This will help assure and improve the quality of care people living in the home receive. 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 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. Colton Lodges Nursing Home DS0000001332.V375570.R02.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.V375570.R02.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are provided with good information that assists them when making their choice about taking a place in the home. The staff ensure people are properly assessed before they are admitted. EVIDENCE: People said they were able to come and look around the home before they made a choice about taking a place. They said they were provided with enough information by the home to assist them with making their choice. Some comments made were, “I was invited to come and look around the home before we made our decision.” “We visited on two occasions to look around and the staff were quite helpful.” Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 11 The care files showed evidence that people are assessed by staff at the home before they can be admitted. The assessment documents make up part of the care plan documentation that belongs to each person and this is known as QUEST. Each pre-assessment document looked at showed that the dates of these assessments were carried out before each individual was admitted. This is good practice as it helps the person performing the assessment to identify whether the staff working in the home have the ability to meet each person’s needs. Intermediate care is not provided for at this service and therefore Standard six was not inspected. Colton Lodges Nursing Home DS0000001332.V375570.R02.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement is needed to ensure the health and personal care needs of all people living in the home are provided for. Particular attention must be paid to promoting people’s privacy and dignity needs. EVIDENCE: We looked at the care files of eleven people living in the home. Each file contained up to date information on each individual. BUPA have implemented a care planning system called QUEST covers all the care needs and risk assessments needed to provide each person’s care package. Each person had their care needs assessed and care plans were written to assist staff with ensuring this care is given. Staff were asked about their involvement with the information kept in each care file. The majority said they are encouraged to complete the record of what Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 13 care they have provided to each person on the day they worked. However, when they were asked about the content of the care plans they were unaware of what care was needed to ensure care needs were met. They told us, “The documents are too big and I don’t have the time to read them.” “I have been encouraged to read them but there is too much information in them for me to read.” “It would be good to have the time to read them but I don’t.” The care plans in both units provided good person centred care that informed the reader about the exact care needs of each individual. They contained a ‘Map of Life’ care plan which had good information about the previous life history of each individual. Evidence was also seen that showed families have also been asked to contribute to these documents. In the care file of a recently admitted person to Garforth House there was excellent information from the family who clearly wanted to assist the staff to care for their mother by letting them know what kind of person she had been before her illness. The staff had written a brief but informative social history, which included dietary preferences. This is good practice. People were risk assessed in areas such as falls, pressure area care, continence care, manual handling and nutrition. The majority of these documents were reviewed regularly and were up to date. We looked at three care plans of people who had pressure damage to their skin. The care plans were well written and they provided staff with the correct detail needed to ensure the wound was managed correctly. A care plan was also in place that highlighted what care was needed to prevent further deterioration. A record was kept of the type of pressure relieving mattress that was used to prevent further skin breakdown. The care plans and risk assessments did not show consistent evidence that people or their representatives have been consulted about the care provided by the home. People spoken to said, “I haven’t seen his care plan for about 18 months” Another relative said “I would like to see the care plan, but I am not sure who to ask”. One relative said it was only after she had discussions with the manager she is now kept up to date about changes in her mother’s condition such as illnesses or accidents. A relative said, “I would like to be told about my husband’s bed sores. Whether they are improving etc. without having always to ask. I think if once a month or every six weeks the manager of the unit could have a one to one meeting with each relative for mutual discussion, if problems, if any , can be talked over.” Good evidence was contained within the care planning documentation that showed staff responded quickly to the changing health needs of individuals. General practitioners visit the home regularly and visit the units individually to review people’s care. This is good practice. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 14 A safeguarding investigation is currently taking place as a result of serious concerns raised by visiting health and social care professionals to the home. During the inspection we identified a lady who was nursed in bed. On further inspection we found that she was nursed on a pressure relieving air mattress but this mattress was switched off with no reason provided by the staff who were questioned. There was no written evidence to show this lady was being turned regularly and there was no record to show what fluid or nutritional intake she was receiving. This is poor practice. This was fed back to management at the end of the inspection. Two care files contained nutritional risk assessments for two people. Both documents assessed each person as being at risk in this area and that a certain programme of care was to be followed. This had not taken place and was confirmed by speaking to two registered nurses on duty at the time. It was positive to see that there has been a significant improvement in the documentation since the safeguarding investigation commenced. The manager of the home and the BUPA quality officers have been reviewing all the care planning documentation of people who live in the home. Auditing systems are now being properly implemented to monitor the documentation. This will help ensure people are receiving the correct care. Staff were observed providing the care to people living in the home. There were many examples of good practice seen. Examples of this were, staff getting down to the eye level of people when they were speaking to them, staff providing people with time to answer questions, staff being polite and helpful when interacting with people living in the home. On the whole the majority of carers were respectful. Some positive comments were made about the staff group and the care they provided: “All staff are very kind and look after all the residents well.” “People who work there do their jobs pretty well to say they are always in demand. I’m pleased with the care they give my cousin” “I am happy that my mum is here. The staff know how she reacts to things.” There were some concerns raised that compromised the privacy and dignity of people. These were: - Many people in Newsam House were seen to have no teeth. There was no explanation for this when we asked why. One relative said that her mother had lost her teeth two weeks ago. A member of staff had taken a set of dentures out of a drawer with her mother’s first name on them. They did not fit and she was sure they weren’t her mum’s. The staff have still not done anything about Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 15 getting new teeth. Another relative said his mum’s teeth went missing several months previous and no action was taken. - Some people appeared unkempt and had stains on their clothing. Relatives had to ask staff to change clothes. - People’s hair looked greasy and unkempt. A person emptied her drink on her knee, the cup was taken away but it was twenty five minutes before she was taken to be changed. - One person had an electric razor in his room that did not belong to him. It was not clear whether this razor was used to shave this person. - One gentleman was sat in his chair in the lounge and his shirt was unbuttoned exposing his chest. This was the case for four hours until a member of staff assisted him to button it up. - One person was being fed in a task orientated way. There was no dialogue, the person being fed was just opening and closing her mouth on demand. One relative said when asked what the service could do better, “Ensure the people they are looking after are fed if they can’t feed themselves. Often food is left in front of people for quite a long time. Sometimes it appears patients requests are not met as quickly as they could be. Some of the staff seem quite unsympathetic and seem unable to cope with mum’s dementia.” The Annual Quality Assurance Assessment provided by the Provider states that, ‘Resident care is focussed on being person centred, supported by the Personal Best Programme.’ Although we observed some good practice that supported this we identified more evidence that showed this is not done well. Medication sheets in Garforth House and the controlled drug records were checked against the medication held and were found to be in order. The medication records include a photograph of each person alongside their medication sheet. Additional food supplement drinks are provided on prescription and were readily available. The nurses in Newsam House were observed administering medications correctly and the administration charts we checked were found to be in good order. The controlled drugs in the unit were recorded and administered correctly. One person who was on an end of life care pathway had his controlled medication changed from oral to liquid administration to make it easier for him to take. This was done quite quickly and showed people responded well to people’s changing needs. This was good practice. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 16 Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not provided with structured activity programmes that meet their needs. This is particularly relevant to those people requiring specialist dementia care. The systems in place for ensuring all people living in the home receive a nutritious diet are not robust. EVIDENCE: We looked closely at the care documentation of twelve people during the inspection. These showed that each person’s social interests are assessed at the beginning of their stay at the home. Families are involved with writing pen pictures of their relatives. These pictures help staff to understand the previous life history of the person they are caring for and what their likes and dislikes are in relation to things such as activities and food. However, not all care staff were aware that this information was contained within the documentation and therefore it could not be used when providing the care package. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 18 The manager wrote in the Annual Quality Assurance Assessment that there is a structured activities programme, with a dedicated activities organiser. Little evidence was found during the inspection that this was the case. The manager said that they have a number of vacancies in the home and this was having a detrimental effect on the activities programme. People in the Newsam unit have specialist dementia care needs. We observed no activities provided to this group in the home during the inspection. Relatives expressed concerns about the provision of activities in Newsam house. They said: “There’s nothing for them to do except sit in their chairs” “The most activity you can expect is mealtimes!” “The last activity person they had was very good, but since she’s left there isn’t much going on” “My relative can’t join in the activities, so she has to sit in her chair all day” “I haven’t seen anyone going out into the garden in the good weather. They did last year.” “There is very little going on here. There is no structured programme of activities in the unit.” “Dad loves to sit outside on a bench in good weather. The garden area outside his bedroom is ideal for this but it is unusable as it’s full of weeds.” “The activity programme is poor. There was an activity person here yesterday. She took one person out of the home and when she came back it was time to leave. The manager said that the previous manager attended a BUPA course for the provision of activities in the home and no further work has been implemented from this. The daily life of people living in Newsam House was observed. Many were sat around in chairs with little interaction other than staff providing for a care need. Some staff did interact with people in a way that received a good positive response. Some staff spoken to about their roles with providing activities said: “If there were more of us we could spend more time with people. We don’t have the time to spend with people. We need more staff to meet all their needs.” “We don’t have many structured activities for people.” “We don’t have enough time to interact with people.” Observations of activities in the Garforth House were similar. There was some information in some care files to show peoples’ interests but in one lounge no activity was seen other than the television being on. Magazines and daily newspaper were seen in the unit. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 19 One person spoken with felt that the staff struggled to maintain topics of conversation with people living in the home and felt this area could be developed further. We observed the activities provided in Garforth House. People were observed as being unmotivated. People who could do for themselves seemed to receive more staff interaction than those who could not communicate their needs. There were good examples of staff taking people out of the home on a one to one basis. This was often to visit the local shopping centre nearby. The manager of the home and senior management acknowledged that there are problems with the provision of activities in the units and this was being acted upon at the time of the inspection. The AQAA stated that BUPA have developed the menus to allow for resident choice and preferences. They have implemented a new system called Menu Master that helps ensure the menu is nutritionally balanced. The mealtimes were observed in both Garforth House and Newsam House. In Garforth and Newsam the menu for the day was clearly shown on the board and tables. This offered choice and sufficient to allow for second helpings. Unfortunately the meal highlighted in the menu in Newsam House did not match the meal that was offered. In Garforth House, people said the quality of the meal had improved. One person spoken with said they were still waiting for the chef to meet with them to discuss the choices of meals. Staff were attentive during the meal assisting and encouraging people to eat in an appropriate manner. People living in Newsam House were observed during three mealtimes. There were some very positive interactions seen between staff and people who needed assistance. Staff were being helpful and careful. Most staff explained what they were doing when assisting people and most people were given time to swallow mouthfuls before being offered another. However, the meal times were disorganised activities and did not have good outcomes for everyone. Examples of poor outcomes were: - A lady was given a cup of tea by a nurse who asked if she needed help. I asked the nurse if she normally needed help but she was unsure. She left the lady with the cup of tea which she then spilt over her lap and had to be taken away to get changed. - One lady was asked by a carer if she wanted some soup. She did not respond. The carer stood over her and gave her one spoonful and then walked away. Another carer came to her and put a protective apron on her and then walked away. Forty five minutes later a carer came back and removed the bowl of soup that had not been touched. This is poor practice. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 20 -Three people needing assistance with their meals did not receive any. They were left with plates of food that had been pureed. They all proceeded to eat the food with their fingers. This left them with food stuck to their faces and on their clothes. This is poor practice. - Two people had meals left in front of them and then removed with hardly any food being eaten. The Expert by experience observed two meals being served in Newsam House and the following are some of her observations. “I had lunch at a table in the dining area. The food portions and quality looked good and choice of drinks were given. Those who were at the tables ate all their food and seemed to enjoy it. One person was being fed in a task orientated way. There was no dialogue, the person being fed was just opening and closing her mouth on demand. She became aggressive when the member of staff took her hand away from her face, this interrupted her meal and she didn’t want any more. Another person was being shouted/asked a question from a distance by a member of staff about their choice of food. Other people, who were more able, enjoyed eating their meal at the dining table. One person admired his food greatly but was unable to do anything with it; despite being asked if he still wanted it, he received no help in being helped or encouraged to eat it, so eventually left it.” “It seemed that staff limits were being stretched and not everyone was being given the required assistance to eat their meal. There were also three relatives in that day feeding their own relative. From my observations more staff interaction is required when feeding people. There did not seem any system in place for who was feeding who. Only five tables seating 2/3 people were in use and as people were sat in easy chairs at all corners of the room it wasn’t easy for staff to assess who had eaten. I made this observation because one person left the dining room before lunch to visit the toilet and when she came back some 20 minutes later no one noticed that she’d had no lunch. I brought this to the attention of a staff member. A system needs to be adopted to ensure that everyone has had a meal and drink.” Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have been placed at risk by poor implementation of the homes complaints and safeguarding policies and procedures. EVIDENCE: We saw a complaints procedure displayed in the two units we visited. There was a complaints procedure in place in the unit. People said that they knew what to do and who to speak to if they had any concerns. One person living in the home said ‘what’s the point of complaining we did once and the person was dismissed as a carer however they returned to still work in the home in the laundry and kitchen’. A relative said she has complained about things going missing from her mother and does not feel they have been looked into. Another relative said when she complained to the previous manager she was told she could find another home for her relative. There has been a change of manager at the home from 6 April 09. Since then a more comprehensive approach has been taken with managing complaints. The management team said that there is an ongoing review of the complaints procedure in the service. They now offer people an open surgery every Thursday between two and eight in the afternoon. The organisation recognises that there have been significant problems recently with ensuring complaints Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 22 are dealt with correctly. The senior management team said some complaints have not been put through the correct BUPA procedures. This has contributed to the loss of confidence in the organisation by some relatives. Concerns about the complaints process were raised by people before our inspection and during the visit. People told us they had lost confidence in the management of the home to deal with their complaints. The following comments were made by relatives on Newsam House: “We have not had a great response to complaints that we have made before.” “I have not been happy with the way our complaint was dealt wit in the past.” “With the last new manager things did get better for a short while, but now it’s as bad again”. “There is never enough staff” “Staff always seem to be coming and going, always new faces, or it could be agency staff”. “The last relatives’ meeting was last October, but not a lot of people feel happy in making complaints to management, we all feel vulnerable.” Not all staff had received safeguarding vulnerable people training. However, all staff spoken to showed a good awareness of the safeguarding procedure. Not all were aware of the ‘whistle blowing policy’ and said they would be uncomfortable using it for that reason. One incident was identified on Newsam House during the inspection that the staff had not identified as a safeguarding concern. They were advised to refer this immediately following their internal procedures. This was carried out. There have been a number of referrals made to the safeguardingteam at Leeds City Council and these are part of an ongoing investigation. BUPA is working with the safeguarding team and all health and social care professionals involved with the service. It is acknowledged that the home has made significant improvements since the safeguarding concerns were identified and they are continuing to work closely with the safeguarding investigation. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not provided with an environment that meets their needs. EVIDENCE: The layout of the home was designed so that all bedrooms are on the ground floor. People said this was an attraction for them when they looked around the service for the first time. Each of the four units have ample dining and lounge facilities for people and their relatives to use when they wish. There is an ongoing refurbishment programme for the home which ensures the environment is improved continually. Newsam House has ample space for people with dementia to wander if they wish to. The corridors have pictures in place that can assist people with reminiscence therapy. These included old Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 24 pictures of Leeds and old Films and stars. Memory boxes are also in place outside people’s bedrooms that include pictures of themselves and family members and events. This is good practice, however, we did not observe staff using these pictures or boxes to engage people when they were in the corridors. There has been an increase in housekeeping staff in Newsam House where improvement in the cleanliness of the home was needed. People said they have seen some improvement with the cleanliness standards in recent weeks but they also said improvement was still needed. The bedrooms appear to be clean some need high cleaning. The management said there are issues that still need addressing and plans are in place to do this. Cleanliness problems were evident in some of the bedrooms inspected. Some were in need of maintenance. Skirting boards were scratched and had paint peeling. A water leak had caused a corner of a skirting board to come loose and an area of the wood laminate floor to lift. The bed bumpers at the side of the bed were peeling of the plastic coating and some were left lying on the floor. The laminate floors were marked, with either spillages or dirty marks. One person’s room had three pressure pads under the bed to alert staff when he was attempting to get up. These were all dirty and sticky and needed cleaning. The bed rail protectors in a person’s room were in a state of disrepair and were a potential infection control hazard. This was pointed out to a member of staff who acted upon the observation. On most of the beds there were extremely thin polyester/cotton sheets used to cover people up, even though the weather has been it didn’t seem sufficient. Some of the radiators were still on in bedrooms and these made them fell very hot. The person in charge told me that there were difficulties with the heating system. The expert by experience observed, “The bathrooms looked well equipped although clinical in appearance, which could appear quite frightening to people with dementia.” This was highlighted at the last inspection. In the AQAA document the manager has identified that plans for the next twelve months to improve the cleanliness. Bedrooms we were well decorated with private belongings present. Two relatives were not happy with the room’s décor as they said the paintwork was in need of updating. One relative said the staff had just changed the curtains in the room and that she was not consulted. The unit manager acknowledged that there was a strong odour in one of the corridors. This was identified by relatives who said it was a long term problem in this area. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 25 The AQAA document sent by the manager stated that BUPA has a team of experts that help and support the home with maintaining the environment. They also have robust policies and procedures that help to manage the infection control issues within the home. The home has notified us of any incidences of infections. These have always been managed appropriately and the relevant health professionals have been involved at the time. This has helped to reduce further spread of infection. The home has good supplies of specialist beds, hoists and pressure relieving cushions. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels of the home do not ensure the care needs of people are being met. Improved recruitment procedures are needed to ensure people are properly protected. EVIDENCE: The manager and Responsible Individual were clear that the staffing levels for all units are provided on the basis of the care needs of the people in each house. Staff were observed to be confident in the roles they performed and the majority appeared to be confident and knew the roles they were expected to perform. We spoke to people who live at the home that raised concerns about the staffing levels provided. Three people told us that it took a long time to answer the call system. Two people were concerned about the way staff work. They said, “You have to tell staff what to do, they don’t seem to work on their initiative.” “It takes two care staff to attend to me at night but I only get one.” Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 27 Staff were busy performing various care tasks during the inspection. They had little time to spend with people in small group or one to one sessions. People were sat in the lounge area of Newsam House in a semi-circle of chairs. They were asleep a lot of the time and only appeared to have the interaction of another person when the meal times came around. Relatives said that they had recognised an improvement recently with the staffing levels as they thought there were more of them on duty. They said: “There seems to be more staff on duty than before. There seems to be more anyway.” “Yes, the staffing levels have seemed to improved recently.” Some negative comments made were: “If there were more of us we could spend more time with people.” “We don’t have time to spend with people. We need more staff to meet all their needs.” “We need to work more as a team. It’s not necessarily all to do with staff numbers.” “We need permanent regular staff. Staff need to know the people and what their needs are. When you have the right team on and in the right numbers then everything is fine. This doesn’t happen very often.” “We don’t have enough time to interact with people.” “There aren’t enough staff on duty. They say there is but there isn’t!” “There aren’t enough staff to manage the dementia needs of the people who live here.” “There is never enough staff” “Staff always seem to be coming and going, always new faces, or it could be agency staff”. There were people who needed their clothes changing due to staining and being wet but these were not attended to by staff. Two relatives were observed having to ask staff if they could change clothes as the ones their relatives were wearing were dirty. Not everyone was observed receiving the correct diet as staff did not seem to have the time to be able to provide assistance with eating meals to those that needed it. One relative said, “They should ensure people they are looking after are fed if they can’t feed themselves. Often food is left in front of people for quite a long time.” This was seen at the inspection. The Expert by Experience noted: “In this main lounge, which was quite full, I saw some verbal abuse going on between people sat around in too close a confinement for each other. When Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 28 speaking to a relative she told me “On more than one occasion I have had to break up fights between the residents”. Another lounge down the corridor was rarely used, this could be utilised more, but I understand it is difficult due to lack of staff supervision.” The above evidence indicates that there are problems with providing sufficient numbers of trained staff or that the staff are not fulfilling their roles and responsibilities. The home has developed a training matrix. Staff are provided with a good variety of training in areas such as infection control, food hygiene, abuse and personal best. Staff said they knew about training and how to access different courses. A significant number of staff have received introductory training in dementia care. The staff spoken to on the day said they felt they needed more training in this area to provide them with a better understanding of people’s needs. The manager recognises that more robust specialist dementia training is needed and there are plans to ensure this training is introduced, especially in Newsam House. There are also plans to provide carers with training in the Mental Capacity Act so that they are more aware of their roles in this area. Since the safeguarding investigation has commenced, nursing staff have attended wound care training provided by the community Tissue Viability nurse. The recruitment process was discussed with the manager. The ongoing safeguarding investigation highlighted a concern about the procedure followed by the home in relation to a Criminal Record Bureau check for a carer. On investigation the manager identified several others where this procedure had not been correctly implemented. This placed people at risk. The manager has now ensured all those cases have been correctly checked and put through the correct procedure. One person has been suspended pending the completion of an investigation. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems and quality assurance tools used by the home to protect people who live here have not been correctly implemented and have placed people at unnecessary risk. EVIDENCE: The home has had a change of manager since the last inspection. The registered manager resigned in April and has been replaced by an experienced manager from within BUPA. BUPA’s own investigation has identified that internal policies and procedures had not been correctly followed by the previous manager in areas such as safeguarding, complaints, care planning, Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 30 risk assessment and provision of the necessary equipment needed to manage care. These omissions placed people’s care at risk. Monthly visits completed by the Responsible Individual did not identify any of the concerns that have been identified at this inspection or any of the main concerns of the ongoing safeguarding investigation. We have asked BUPA to provide us with copies of these monthly reports until further notice so that we can assess how the home is being monitoered by the provider . People have expressed concerns about the overall management of the home and the management of Newsam House. Two relatives said that there was a lack of confidence in the way the home is managed. Five people spoken to said that there had been recent improvements with the way the home is managed and that they hoped that this continued to improve. One person said, “My family has lost confidence in the way things have been run. It will take time to get that confidence back.” Staff also expressed concerns about the leadership and management of the home, particularly in Newsam House. The home looks after some personal monies for a significant number of people living there. Receipts are kept for all transactions that are made and they receive interest on the money the home keeps for them. The AQAA clearly indicated that the home has robust systems in place for regularly monitoring and maintaining the health and safety of people and the environment. It is positive that BUPA have responded quickly and positively to the concerns that have been highlighted by the safeguarding team and they have an ongoing action plan to assist them with the planned improvements. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 31 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 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x 3 x x 3 Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement The care plans and risk assessments must provide evidence to show, where possible, people living in the home or their representatives have been involved with developing the care plans and risk assessments. This will ensure agreement to provide the care package has been gained. All care plans and risk assessments must be reviewed regularly and changed to reflect the care needs of the person receiving the care package. This will help ensure the appropriate care is provided. People living in the care home must receive a package of care that does not compromise their privacy or dignity at any time. Timescale for action 31/07/09 2 OP8 15(2)(b) 31/07/09 3 OP10 12(4)(a) 31/07/09 4 OP12 16(2)(m) People must be provided with 31/08/09 social and recreational opportunities that help stimulate their well-being. All planned activities should be based around the needs and choices of the DS0000001332.V375570.R02.S.doc Version 5.2 Page 33 Colton Lodges Nursing Home people living in the home. Particular attention must be paid to the people in the home who have specialist dementia needs. This will help to improve the holistic needs of the individuals. 5 OP16 22(2) People must be provided with a complaint policy and procedure which they are confident in. Complaints must be dealt with following the home’s internal policy and procedures. This will help improve the quality of care provided in the home. The staff working in the home must ensure people are properly protected from any harm. The internal safeguarding policies and procedures must be implemented when the need is identified. This will help ensure people are protected. People living in the home must be provided with an environment that is clean, tidy and free from offensive odours. The numbers of staff allocated to work in each unit must be appropriate in relation to the care needs of the people who live there. They must be suitably qualified and have the necessary skills and experience to meet people’s care needs. All new employees must be employed following the home’s internal recruitment and selection procedures. This will help protect people living in the home. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 34 31/07/09 6 OP18 12(1)(a) 31/07/09 7 OP26 23(2)(d) 31/07/09 8 OP27 18(1) 31/07/09 9 OP29 19(1)(a) 31/07/09 10 OP30 18(1)(a) All carers working in the home must be provided with specialist dementia training that provides them with a good understanding of the specialist dementia needs of people living there. This will help ensure people receive the correct package of care that meets their needs. Quality assurance systems must be robust and correctly implemented. All incidences of pressure sores that are Grade 2 or above must be sent to the CQC. The monthly Regulation 26 visits performed by the Responsible Individual for the home must be provided to the CQC until further notice. This will help assure and improve the quality of care people living in the home receive. 31/07/09 11 OP31 24(1) 37 31/07/09 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 OP7 Good Practice Recommendations All carers should be encouraged to be more involved with the care planning and risk assessment documentation. This will enable them to have a more thorough awareness of the care needs of the people they are providing a care package to. Colton Lodges Nursing Home DS0000001332.V375570.R02.S.doc Version 5.2 Page 35 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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