Inspection on 04/06/08 for Colton Lodges Nursing Home

This inspection was carried out on 4th June 2008.

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

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

Other inspections for this house

Colton Lodges Nursing Home 02/05/09

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

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Hawkhills

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Colton Lodges Nursing Home 2 Northwood Gardens Leeds Yorkshire LS15 9HH Lead Inspector Sean Cassidy Key Unannounced Inspection 4th June 2008 09:00 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.V366069.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.V366069.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 Manager post vacant 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.V366069.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 December 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 charged by the care home at the time of the inspection were: £448.20- £786.00. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The 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. Two inspectors and one pharmacy inspector conducted an unannounced visit to the home and it lasted two days. A third inspector carried out a Short Observational Framework Inspection on the second day of the inspection. The majority of this time was spent speaking to residents, management, staff and relatives. A number of documents were looked at during the visit and some areas of the home used by the people living there were also looked at. A proportion of time was spent speaking to the manager, the area manager, staff and visitors. The information required from the service in the form of the Annual Quality Assurance Assessment was obtained before this report was written. Feedback was provided at the end of the inspection to the manager and area manager. What the service does well: The home ensures that they pre assess prospective service users before making a decision as to whether they can meet their care needs. People said they are offered a warm welcome into a friendly homely environment. People were quick to point out that the staff working in the home were very helpful and friendly. The complaints policy is well displayed around the home. This helps make people more informed about the process. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 6 The home has a good programme in place for improving the standard of the environment. This means people will continue to live in a safe and comfortable environment. The standard of staff recruitment and induction is good. This helps to ensure people receive a good standard of care. What has improved since the last inspection? What they could do better: Staff must make sure that the care plans are fully implemented and effectively reviewed. This will help to ensure people receive the care that is prescribed. Evidence must be provided to show people have been involved with the assessment and planning process for meeting their needs. This will provide people with a sense of ownership of the process and that their choices have been promoted. People’s privacy and dignity rights must be respected at all times. Issues regarding personal cleanliness were identified on Newsam house that must be addressed. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 7 People must be provided with social and recreational activity that meets their specific individual needs. They must be involved with decisions regarding the social and recreational provision provided. Specific improvements must be made for those people that have dementia. This will help to improve the holistic care needs of the individuals. 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. All medication must be administered as prescribed and be available to administer from stock. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. People living in the home must be provided with an environment that is clean, tidy and free from offensive odours. Carers must be provided with specialist training in dementia care. This will help them understand and provide for the care needs of people living in the home. Requirements and recommendations can be found at the end of the report. 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.V366069.R01.S.doc Version 5.2 Page 8 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.V366069.R01.S.doc Version 5.2 Page 9 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, 2 and 3. People who use the service experience good quality outcomes in this area. People spoken to said they were provided with enough information to help them with the decision making process of taking a place at the home. People are appropriately assessed prior to being admitted. This process enables the home to identify whether they can meet that person’s needs or not We have made this judgement using available evidence including a visit to the service. EVIDENCE: ‘Welcome packs’ are available to all. We were given one to look at as an example of what was available to people and their families. The range of information was satisfactory but not all of it was up to date, current information. Care should be taken to make sure that information given to people is up to date and relevant to the unit. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 10 We looked at the assessment information obtained by the home for three people who have recently been admitted. The files showed evidence that a full assessment was completed for each person before an offer of a room at the home was made. A further robust assessment was carried out after admission. Obtaining this information helps the home ensure they are able to meet an individuals needs. It was noted on one file, that a person had been admitted three days previously and was identified as being at high risk of falling and of developing pressure sores. No care plans had been developed to help staff manage these high-risk areas. This was duly noted by the unit manager and manager and assurances were given that this would be dealt with as a matter of urgency. The home provided us with an Annual Quality Assurance Assessment. The home’s admission assessment was described in this document and evidence was found that showed the admission assessment was followed in each case. People were provided with information about the home prior to moving in. (Some of this information was not up to date and a recommendation was made to ensure it was altered.) People were invited to look around the home and stay for a period of time to get a feel for the atmosphere. One person spoken to said she came and stayed for the day prior to making a decision to move in. Evidence was seen to show people are offered up to date terms and conditions of their stay at Colton lodges. People spoken to were unaware of the inspection reports written after each key inspection. They expressed an interest in viewing these documents as they felt they would be informative. These are kept at the main entrance but not on each unit and are not readily accessible to all. It was recommended that these documents are made available at the entrance of each unit so that people can read the most up to date inspection report for the home. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 11 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. People who use the service experience adequate quality outcomes in this area. People living at the home do not always have their care needs consistently met. Accurate administration of medication is not consistently done. This means some people are not getting their medication as prescribed, which may affect how their medical condition responds. We have made this judgement using available evidence including a visit to the service. EVIDENCE: We visited Newsam House and Garforth House and looked in detail at how people are looked after. In Garforth House we saw that people have their care needs reviewed and reassessed on a regular basis. We saw that everyone was individually assessed on admission and care plans were written for areas where there was an Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 12 identified need. The care plans were well written and could be clearly understood. A good person centred care approach was seen within the care plans. This is good practice as it provides the reader with a more individualised picture of the person they are providing a care package for. We spoke to staff on that unit. They said they read the care plans regularly and are now encouraged to write in the daily care records of those people they have cared for over the course of each day. It was clear from speaking to two key workers that they had a good awareness of the content of the care plans of those people they were caring for. We saw little evidence to show people or their representatives are involved with the assessment and care planning process. This is poor practice as it means people are not asked for their consent to the provision of the care package. We saw that care files contained evidence that each individual had been risk assessed in areas such as pressure area care; nutritional assessment; falls; continence care and moving and handling. Evidence obtained from a dietician who visits the home regularly showed that there has been a recognised improvement in the area of nutrition and that she now works much closer with the home in this area. She still highlighted some areas where there is still work to do and has planned more training for staff in this area. The manager told us that staff are also receiving training from the tissue viability team that visit the home. This is a rolling programme that is being provided to all staff. The care files of two people with wounds were inspected. These were well written and provided the reader with a clear plan of care to treat the wound. A picture was taken of the wounds and a record kept of when it was dressed. This has improved since the last inspection. The care files showed good evidence that there is regular contact made by other health care professionals such as GPs, dieticians, chiropodists and social workers. Professionals who returned surveys as part of the inspection said they were actively encouraged to write in the care documentation when they had visited a client to provide a care package. A record of relative visits was also kept. We saw staff looking after groups and individuals over the course of the inspection. This was carried out in a manner that was respectful and dignified. Staff were pleasant at all times and took time when administering care. Visitors said they have seen an improvement in the overall standard of care provided in the home. They said, “There is more staff on duty to meet mum’s needs. They are now able to take her for a bath which is great!” “There seems to be more staff on duty and things are a lot calmer. They have more time to get involved with mum which is nice to see.” “There are now clean towels and face cloths provided daily. This didn’t happen before.” Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 13 People who live in the home gave positive comments about the staff who provided their care package. “ They can’t do enough for me. “ The girls are great.” “ The staff are very friendly and helpful.” In Newsam house we saw that people have their care needs reviewed and reassessed on a regular basis. This identifies specific areas where detailed care plans are needed. Records included a relatives contact sheet that contains good, detailed information. There are also good records of visits made by other healthcare professionals such as general practitioners (GP). Personal plans were detailed and included good personal detail. However, information detailed in plans did not always reflect what was actually happening. Care should be taken to make sure that the records are working documents and that actions detailed in care plans are fully implemented. For example, one person’s plan detailed how he spent his time moving furniture around and suggested that he ‘will benefit from activity that involves mechanical parts’ and that staff should ‘liaise with activity organiser to organise some plastic mechanical parts for him to work on’ – which would have been good practice. However, what we saw was this person wanting to move furniture around and staff constantly telling him to stop. He was not offered any alternative and became frustrated and agitated. A short-term care plan was in place following a skin tear to his left arm which detailed the type of dressing, how often it should be renewed and to record observations of the condition of the wound. The only entry on this plan was the day of the injury; there was no update on dressing changes or the condition of the wound. We also saw that this person actually had dressings to both arms. Overall, we saw good detail about personal preferences but staff need to make sure that the plans are fully implemented and properly and effectively reviewed. Risk assessments were completed and included nutritional risk assessments. The care plan for one person who had a very low weight was not detailed enough just stating that ‘full assistance with eating’ was needed. There was no reference to snacks between meals or to nourishing fluids. Over the two days of the visit the availability of snacks and drinks was limited with no morning drinks offered on one day and no home baking on either day. We saw one person trying to lick the inside of the cup. This could have been a sign of thirst but was not acted upon by staff. The completion of fluid charts and food diaries was not consistent and those that were completed were not accurate. For example, there were no entries in one food diary for three days out of five from 31st May to 4th June. The fluid chart for the same person was not fully completed every day and had wildly differing quantities recorded calling into question the overall accuracy. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 14 We saw a number of people in stained clothing that was not always changed in a timely fashion. Relatives of two people provided information in surveys that raised issues about the standard of personal care provided. They said, “My husband does not get well shaved as his face is often red and angry looking. Not all carers attend to his personal care needs well after he uses the toilet.” “Staff do not always meet dad’s personal care needs. He often is unshaved, has food stains on his clothes and has greasy hair. When you raised the issue with staff they say that dad is uncooperative. This is not the case.” Staff did not always seem to understand what people were trying to communicate. On one day one person was stood at the door constantly pushing at the door. The majority of the staff walked past him taking no notice of him and what he was doing. The nurse approached him and used distraction to bring him away from the door. He was offered a cup of tea and when he would not sit down staff realised his trousers were wet and took him to be changed. The Short Observational Framework Inspection found some staff worked in a very person centered/sensitive way, whilst others appeared to work in a more task orientated way. The current Medication Administration Record (MAR) charts were looked at on each unit. The quantity of medication from one monthly cycle to another is not recorded on the new MAR. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. The standard of handwritten entries has improved. This helps to make sure there is an accurate record from which the staff administer medication. The code ‘F’ was frequently used on the MAR charts on the Newsam unit without an explanation. There must be an accurate record why medication was not administered to provide information about how a person’s medical condition is being treated or if a medication review is required. One person on the Garforth unit self-administers their medication. A review of the risk assessments for this person has been done. This will identify if people are happy to continue to administer their own medicines and to do so safely. The administration of medication is not always done accurately. For example one person on the Newsam unit had 28 tablets prescribed and supplied. The MAR chart showed that 10 records of administration had been made but 23 remained in the box. It is important that medication is given as prescribed so that a person’s medical condition is not affected. On both units there is now a thermometer to record fridge temperatures. This means there is now an accurate method for checking fridge temperatures. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 15 Fridge temperatures should be checked to make sure medications are stored correctly and safe to use. The controlled drugs (CD) cabinets and registers on all units are suitable for use. One person on the Newsam unit had a Fentanyl patch to be administered every 3 days. The CD register and MAR chart recorded that one administration had been 1 day after it was due. It is important that such medicines are administered correctly as they provide strong pain relief to people. Colton Lodges Nursing Home DS0000001332.V366069.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): 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. There has been identified improvement with the provision of social activities provided within the home. Further development is needed in this area to improve people’s sense of well being. We have made this judgement using available evidence including a visit to the service. EVIDENCE: We saw that relatives are welcomed on both units at any time with some choosing to spend long periods of time with people, helping them at mealtimes, taking them out into the grounds or just sitting together. The manager told us that the home is in the process of employing one other activity coordinator and then they will have full complement. This will mean that each unit will receive 30 hours input from an activity coordinator. Garforth unit had a programme of entertainment displayed at the entrance. This was written in large print to assist those who were partially sighted. The Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 17 notice board had a few photographs displayed that showed residents involved in activities provided. We saw the activities coordinator interacting well with those people who could communicate well and also those who could not. People were assisted to get involved with activities that were provided during the inspection. This included accessing the grounds outside the units. This appeared to be enjoyed by all those that were assisted to get involved. The activity coordinator was very enthusiastic and had many ideas that would help improve the well being of people living there if they were implemented. The activity coordinators on both units we visited have received little or no training in this area. The absence of training limits their role, particularly with people who have dementia. We did not see staff getting actively involved with the activities and there was a view that this was the role of the activity coordinators. Providing activities must be the role of all carers and time must be available to get involved with this provision. Relatives of people who were nursed in their bedrooms raised some concerns about ‘lack of contact.’ They expressed fears of lack of interaction between their relative and the staff when they were not there. There was no evidence in the rooms to show staff had attended to the needs of those people that were isolated in their rooms. The care files that were followed up as a result of these showed only daily updates that needs were met. These relative concerns were passed to the manager to look into. People were observed sitting in a circle in the lounge area of the unit. The television was on but no one was observed watching it. Five people said that they would love to go outside the home but there is never anything offered. This was followed up with the manager who said some people do access areas outside the home on a one to one basis but as yet they have not planned group outings. She said they are trying to improve the activities provided inside the home first and then they are planning to improve access to the local community and other areas of interest. Four people spoken to on the unit said they did have the opportunity to visit other units where activities were being provided, however they said they didn’t take these opportunities often. Local religious representatives do come to the home to provide spiritual support to those who want it. One resident from the local Jewish community who has lived in the home for around seven months was feeling low as a result of not having contact with a local rabbi. This was highlighted to the registered manager and unit manager who said they would look into it for her. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 18 One person wanted to speak to the inspector to talk about the improvements that had been made to her room since the last inspection. She said that alterations had been made that now enabled her to be more independent than she was. The area manager said that these room alterations would be made in all future BUPA developments so that they comply with the Disability Discrimination Act 2004. Two meal times were observed during the inspection. Only four people who were able to get to the dining area did so. No one else was encouraged to get to the dining area. They received their meals in their bedrooms or sat at the chair in the lounge where they had been sitting the rest of the day. Those people that needed assistance were seen to receive it in a dignified and respectful manner. People were given time to eat each mouthful and regular drinks were offered. People spoken to as part of the inspection gave positive feedback with regards to the food. A dietician that visits the home said that the pureed food that is offered could be improved to make it look more attractive and appetising. Pureed portions were not seen during the inspection. The activities organiser in Newsam House had only been working in this capacity for a short time. She has had not had any specific training for the role to help her understand the needs of this particular client group. There was a second newly employed activity person ‘shadowing’ her. This person was new to this type of work and did not have any experience of activities for the elderly or of people with dementia. The absence of this training means their roles will be restricted. The Short Observational Framework Inspection found one main activity was taking place but this was for 4/5 people only. The manager tried to engage another resident with pictures etc at one point. Other people sat in the same chair throughout and had little or no interaction from staff. Some were asleep, others withdrawn. Peoples agitation was not picked up on or responded to promptly. One person who was in need of the bathroom was not assisted when he said he wanted to go so he was incontinent. Staff did not notice his trousers were wet despite one staff taking him to have his bandage redressed and he was in the same trousers when the short inspection ended. When the activities person arrived some people were still having breakfast and a significant number were sleeping in their chairs or were not engaged – just staring into space. Music was put on and then the two activities people tried to get a small group of people together to play a board game. On the second day of the visit they got the same group of people together for a ball game. This left a significant number of people unoccupied and sleeping. By lunchtime some people had not moved at all and some remained asleep all morning. The Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 19 activities programme was limited and some individual abilities and skills were not being addressed. Examples of comments made by relatives in relation to activities in this unit were: “The dementia unit doesn’t have a consistent approach to activities and seems to draw the short straw. There is a lack of imagination when it comes to providing activities. They seem to think that making a great deal of noise is entertainment for people with dementia!” “The activities are not always appropriate, but we should be thankful of some improvement here. Entertainment is often provided in other homes but people can only go if staff accompany them. There isn’t enough staff to go with them.” Entertainment is arranged on a regular basis. The new home manager is trying different acts out to find out which people enjoy the most. On the first day of the visit there was live music and singing and some people joined in by dancing to the music. One person was more relaxed on the second day and taking part in a ball game – it was not what he really wanted to do but he appeared better for being occupied initially although the game went on too long. One person was making noises constantly but no one took any notice. The teatime meal was observed on the first day and the lunchtime meal on the second day. The teatime meal was reasonably well organised with plenty of food available for people. One person moved from table to table but each time he sat down staff just gave him more food, which he ate. This was good practice. A new member of staff was given the task of helping someone to eat. She was new to care and was not given clear instructions and initially stood over the person. She was later seen sitting next to them helping the person in an appropriate way. Drinks of tea or juice were not offered and people were thirsty with one person asking for tea saying ‘we are all gagging’. People wore tabards to protect their clothing. The Short Observational Framework Inspection found people were not offered a drink until lunchtime. One visitor got a resident a drink and he drank it straight away. Another person did the same with his own lunchtime juice and that of the person sharing the same table with him. The room was warm and the atmosphere quite dry yet no one else was offered a drink before lunchtime. This suggests people are not provided with sufficient drinks in this unit. The lunchtime meal was rather disorganised. Several people arrived to help their relatives and there were not enough chairs around. Staff spent time looking for chairs and side tables before they could get on with helping people. The telephone was constantly ringing which meant that one staff member kept Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 20 breaking off from assisting someone to eat to answer the phone. When he returned his chair had been taken for someone else. Some staff took time to tell people what they were being given to eat but others just put the food down without doing so. Juice was given with the meal and people were offered a hot drink afterwards. People seemed to enjoy their food although some had to wait between courses. The Newsam unit has introduced a ‘protected mealtimes’ system in place. This has been viewed by relatives and professionals visiting the home as good practice and has had a positive outcome for people living there. Two professionals said they thought this would be better implemented throughout the home. In the light of the rather busy and disorganised lunchtime we saw it was suggested that the manager should review how the mealtime is protected. This is to make sure that everyone gets the attention and support they need and the mealtime is relaxed and enjoyable experience. Colton Lodges Nursing Home DS0000001332.V366069.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use the service experience good quality outcomes in this area. The people who live in the home are appropriately protected by the complaints and safeguarding systems used by the home. We have made this judgement using available evidence including a visit to the service. EVIDENCE: The complaints procedure is displayed around various parts of the unit. It is also contained within the Service user Guide provided to people in each room. The registered manager has reviewed the way in which managers in each unit record complaints. They are now encouraged to record all complaints on a complaints record held in each unit. These are closely monitored by the registered manager and dealt with following the complaints procedure for the home. The manager carries out regular audits of the complaints. The area manager also audits the complaints as part of the Regulation 26 visits. All complaints seen were investigated following the correct procedure. The feedback received from people about complaints was generally positive. Three people said they had recently seen a positive change in the way the home responded to complaints. One person said, “ They seem to be more responsive and get things done. I was happy with the outcome I eventually Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 22 had to my response. The new manager got things done which is good. The standard of care has improved since she investigated the complaint” People spoke positively about the actions regarding complaint investigation taken by the new manager. They said they were glad to see the setting up of a relatives support group in the specialist dementia unit. It was recommended the manager look to develop this service throughout the units. The home has a clear safeguarding process in place and staff spoken to gave a good account of what is meant by adult abuse and what action they would take as a result of abuse taking place. The manager monitors all safeguarding issues very closely and has developed good relationship with the local safeguarding team. Improvement has been made in referring safeguarding issues to this team. The safeguarding incidents were seen and were managed correctly. However, there was one complaint made in the Garforth unit that was a clear safeguarding issue and was not referred to the appropriate professionals. This was discussed with the manager who promptly acted upon this information and gave assurances she would contact us with the outcome. Colton Lodges Nursing Home DS0000001332.V366069.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the service experience good quality outcomes in this area. People live in a safe and comfortable environment. We have made this judgement using available evidence including a visit to the service. EVIDENCE: People spoken to said the environment of the home was suited to their needs. The environment within the Garforth unit has been altered in attempt to make better use of the communal space to promote better social interaction. Comments made by relatives about the environment were; “ The lay-out of this home is very good for people who can mobilise. There is plenty of space outside with high fencing.” There is a rolling programme in place for redecoration within the home. Part of this budget allocates monies for the purchasing of equipment. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 24 We noticed an unpleasant odour on arrival at Newsam unit and in some bedrooms. The carpet in the communal lounge and dining room is badly stained. The home manager has provided an explanation for this and there are plans in place to address this through refurbishment. Memory boxes have been fitted outside every bedroom and many contain photographs and other memorabilia. There are pictures of old Leeds and film posters along the walls but these are too high to be of interest to the majority of the people living there. Some rooms have been comfortably personalised while others are rather bare. Soap and paper towels are provided throughout the unit. A Parker bath has been installed in the Garforth unit. People spoken to gave positive feedback about this new facility, especially those whose relatives are now able to bathe in a safer environment. There are communal bathing and showering facilities although one bathroom on Newsam House was out of order. All these rooms are clean and tidy but clinical in appearance. The manager said that plans are in place to redecorate all bathrooms so that they are given a more homely feel. This process will involve consultation with residents and relatives. Domestic staff spoken to gave a good understanding of their role in relation to good hygiene and infection control. They were happy with the job they were doing and said they felt well supported. However, in Newsam, there have been shortfalls in the domestic support for staff through sickness. When this happens cleaning staff said that it was hard to keep up with the demands of this particular client group, for example, keeping areas clean and odour free. Colton Lodges Nursing Home DS0000001332.V366069.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. People who use the service experience good quality outcomes in this area. Overall, trained and competent staff look after people. People are protected by robust recruitment practices. We have made this judgement using available evidence including a visit to the service. EVIDENCE: The home has a staffing rota that is found on each unit. The home manager now monitors the staff sickness and staffing levels very closely. The staffing levels on both units appeared to be appropriate for the needs of the people being cared for. The home has experienced a very difficult time recently with employing staff. This has improved over the last five months and the manager provided evidence to show how this has improved. People spoken and contacted as part of the inspection gave mainly positive comments about staff but there were also some negative issues raised. In Garforth all the staff spoken to said they were very positive about the staffing levels. They said, “Things have really improved since the last time you visited. We are working very well together as a team.” “ There are more of us now. There is not as much sickness. I think that’s because people look forward to coming to work now. That’s a big change.” Some comments highlighted Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 26 problems with staff training/experience and numbers. One professional visiting the home said, “There are a variation of skills, experience and competencies of care staff. Some are excellent but others need more training. Staff would benefit from having more training in communication with people with dementia.” The manager has said there is a planned programme of dementia training being provided for staff working in the Newsam unit. This will be delivered by the Alzheimer’s Society. Some practices of staff were observed to be abrupt and disrespectful in manner. This training will help staff better understand the care needs of people with dementia. The manager provided evidence that showed there was a structured training programme that was ongoing. Staff spoken to said training in the home was consistent and beneficial, as it helped them understand their roles more. The training matrix was seen which showed all the training each member of staff has undertaken. Induction programmes for staff are in place and new staff spoken to said they had attended this programme before they started on the units. The manager said that they do not yet have 50 of the care staff trained to National Vocational Qualification Level 2 standard yet, but they are working towards this. Care staff were knowledgeable about the people they were looking after and understood ways of engaging them in tasks to occupy them. Staff were keen to do training and many had completed some basic training in dementia care and were keen to do NVQ in care. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 27 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. People who use the service experience good quality outcomes in this area. The management systems and processes used in the home help to assure and improve the quality of care provided to people in the home. We have made this judgement using available evidence including a visit to the service. EVIDENCE: The new manager has been employed since March 2008. She is an experienced manager from within the organisation and she has given firm commitment to improving the standard of care provided within the home. The manager is in the process of completing her registration with the Commission for Social Care Inspection. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 28 The home looks after some personal monies for a significant number of people living there. The records were randomly inspected and they all appeared to be in order. Receipts were kept for all transactions that were made and there was evidence that people received interest on the money the home kept for them. The quality assurance systems used by the home were reviewed. The manager provided good evidence that showed regular audits take place and that regular meetings with managers and staff also occur. Staff spoken to said they regularly speak with the manager and find her very approachable. This was also the view of some relatives and residents that have been involved with her. Relatives told us about a recent meeting they had with the home manager and a representative from BUPA. They said they had discussed concerns about Newsam. They were hopeful that these would be regular and that their concerns were now being listened to and acted upon. It was recommended that these meetings be implemented on all units to improve communication. People did feel that things had improved on Newsam. They had more confidence that they would be listened to. They were glad that there would be good leadership on night duty when a senior nurse completes his time on days and starts his role on nights. Prior to this inspection site visit we had received no information about any inappropriate health and safety practices within the home. The AQAA sent by the home to the CSCI clearly indicated that the home has robust systems in place for regularly monitoring and maintaining the health and safety of people and the environment. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 29 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 30 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 OP7 14(2) Regulation Requirement Care Plans must be fully implemented and effectively reviewed. This will help to ensure people receive the care that is prescribed. Timescale for action 31/08/08 15(1) 2 OP9 13(2) 3 OP10 12(4)(a) 4 OP12 16(2)(m) Evidence must be provided to show people have been involved with the assessment and planning process for meeting their needs. This will provide people with a sense of ownership of the process and that their choices have been promoted. All medication must be 31/08/08 administered as prescribed and be available to administer from stock. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. People’s privacy and dignity 31/08/08 rights must be respected at all times. Issues regarding personal cleanliness were identified on Newsam house that must be addressed. People must be provided with 31/08/08 DS0000001332.V366069.R01.S.doc Version 5.2 Page 31 Colton Lodges Nursing Home 5 OP19 23(2)(d) 6 OP30 18(1)(a) 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. (The previous timescale of 30/04/08 was not met). People living in the home must 31/08/08 be provided with an environment that is clean, tidy and free from offensive odours. Carers/ Activity workers must be 30/09/08 provided with specialist training in dementia care. This will help them understand and provide for the care needs of people living in the home. (Previous timescale of 31/03 08 was not met.) 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 OP1 Good Practice Recommendations People should be provided with up to date inspection reports that are more accessible. The information provided to people living at the home must be reviewed so that it is up to date and reflects all services provided. Staff should make sure that the care plans are fully implemented and effectively reviewed. This will help to ensure people receive the care that is prescribed. The religious and spiritual needs of people should be assessed and provided for to promote a sense of well DS0000001332.V366069.R01.S.doc Version 5.2 Page 32 2 3 OP8 OP12 Colton Lodges Nursing Home 4 OP15 5 6 OP18 OP30 being. It is recommended that people should be enabled and encouraged to use the allocated dining facilities whenever possible. This will provide people with an opportunity to be involved in a social event in the home. All safeguarding concerns should be dealt with in accordance with the internal policy and local authority guidelines. This will help protect people living in the home. It is recommended at least 50 of the staff group are trained to NVQ Level 2 Standard or above. Colton Lodges Nursing Home DS0000001332.V366069.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V366069.R01.S.doc Version 5.2 Page 34 - 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. 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