Inspection on 02/06/05 for Courtlands Lodge

This inspection was carried out on 2nd June 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Courtlands Lodge 01/06/07

Courtlands Lodge 05/05/06

Courtlands Lodge 12/09/05

Courtlands Lodge 13/01/05

Courtlands Lodge 12/07/04

Courtlands Lodge 19/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Courtlands Lodge 25 Langley Road North Hykeham Lincoln LN6 9RH Lead Inspector David Bacon Unannounced 2 June 2005 09:00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Courtlands Lodge Address 25 Langley Road North Hykeham Lincoln LN6 9RX 01522 693800 01522 687628 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Kalaria - Lifecare (UK) Ltd Care Home with Nursing 29 Category(ies) of MD Mental Disorder Both 24 registration, with number MD (E) Mental Disorder over 65 Both 5 of places Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: A Condition of Registration is that the maximum number of service users in the home with Nursing needs does not exceed 24 (MD) and the maximum number of service users with Personal Care needs only, does not exceed 5 (of which 2 are under the category of MD and 3 are under the category of MD(E)). Date of last inspection 13/01/05 Brief Description of the Service: Courtlands Lodge is situated in North Hykeham, approximately three miles from the centre of Lincoln. The home is located on a bus route to Lincoln and North Hykeham has a range of amenities, such as the Post Office, shops, church, pub and food outlets. The home is of single storey construction, and accommodation comprises 11 single rooms and 9 double rooms. It is registered to provide accommodation for 29 service users with a mental disorder, including 3 service users over 65 years of age. The home’s philosophy of care states that the aim of the home is provide residents with a secure, relaxed and homely environment in which their care, well being, comfort and development are of prime importance. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours. A tour of the premises was conducted, care records and staff records were inspected. Five staff members, five service users and the manager and deputy manager were interviewed. What the service does well: What has improved since the last inspection? What they could do better: The staff spoken with said that all staff work well as a team but that morale overall was poor. Staff were of the opinion that the home running costs were being cut to the detriment of the service and that their concerns, when expressed to the proprietors were largely being ignored. Sufficient staff must be on duty at all times to appropriately meet service users care needs and to maintain health and safety within the home. An immediate requirement was served upon the home regarding this. The homes communication systems are inadequate to afford staff sufficient information to appropriately meet the service users care needs, which put Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 6 service users and staff at risk. An immediate requirement was served upon the home regarding this. Service users must be offered a choice of foods at each meal time, including, cooked breakfasts and have their individual likes and dislikes met. 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. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 Procedures for the assessment and admission of service users to the care home are mostly being followed. However, the home is not meeting the needs of one service user with challenging behaviour needs and other service users are also being put at risk due to this. EVIDENCE: Courtlands Lodge has a service users guide and a statement of purpose, which detail the services provided by the home and its terms and conditions. These documents are made available to prospective service users prior to admission. Service users are issued with terms and conditions of occupancy, which gives some information about the home. The manager said that service users are allowed to visit the home prior to admission and the service users spoken with were satisfied with admission arrangements. All the records viewed do not fully document that service users had been notified that the care home was able to meet teach individuals care needs. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Care plans contain sufficient information to ensure that the care needs of service users are met during their stay, but require evidence of the involvement of service users or their representatives. One service user having challenging behaviour is not having their needs met, this is having an impact on their care and is also having a detrimental effect on other service users residing in the care home and also staff members by putting them at risk of harm. EVIDENCE: A care plan is devised for each service user, which document the care needs of each individual and a risk assessment is undertaken as part of this. Care plans are reviewed each month and as changes occur although the records inspected did not fully document that individual service users had been consulted regarding this. It is acknowledged that some service users attend regular review meetings and that each individuals care is discussed as part of this. The six service users spoken with were positive about the care they received and confirmed that they were treated with respect and supported to make decisions regarding their day to day lives. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 10 Staff members, during the visit were observed to be offering and promoting choice throughout the day. The staff members spoken with were aware of individual likes and dislikes, and these were documented on service users files. The home is currently providing care to one service user who, on occasion displays aggressive behaviour to other service users and staff. The home is unable to meet this service users care needs and is not registered to meet this category of need and action must be taken to safeguard other service users. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Some of the homes provision of meals is does not promote service users choice. EVIDENCE: The service users and home cook said that cooked breakfasts were not available. Service users confirmed that they would like these to be provided on occasion. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 21 The health needs of service users are met overall by the home staff and through other supporting healthcare services. EVIDENCE: The service users spoken with said they were satisfied that their healthcare needs were met and that they were supported to maintain their independence regarding this where possible. The service users care records viewed further evidenced this. Throughout the inspection staff were observed to ensure that service users dignity and privacy were maintained especially when personal care was carried out. Information regarding service users heath needs and any specific requests regarding death arrangements are recorded and procedures are in place regarding this subject matter giving guidance to staff. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The home seeks service users views about the care provided and systems are in place for dealing with complaints and any allegations of adult abuse. Staff were aware of the appropriate action to be taken in the event of an issue of abuse occurring. EVIDENCE: Complaints and abuse policies and procedures are in place for service users and giving guidance to staff. The care staff spoken with were aware of these and abuse awareness training has been undertaken. The service users spoken with were aware of complaint policies and said that they felt able to discuss any concerns with the home staff. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 30 The standard of the environment within this home is clean and tidy, providing service users with a comfortable place to stay. EVIDENCE: On the day of inspection, the home was found to be clean and tidy with no malodour evident apart from within the main smoking lounge which currently is used extensively by some residents and also some staff. Records, discussions and observation indicate that the care home is accessible, safe and well maintained. All furnishings are of a domestic nature although the bathroom areas require personalising further to make them less clinical in appearance, which was identified during the previous inspection visit. The provider employs domestic staff and the home was clean and pleasant apart from the smell of smoke in one corridor coming from the staff room. None of the residents mentioned this as a problem. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 15 The service users spoken with were satisfied with the physical environment and their own personal accommodation. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 Staff attend training to give them the skills to carry out their role although there are insufficient staff on duty during evening meal times. The homes communication systems are inadequate to afford staff sufficient information to appropriately meet the service users care needs, which put service users and staff at risk. EVIDENCE: Only nursing staff receive a handover at the start of each shift. The homes care staff said that they either come in early in their own time or start work without receiving any information regarding service users needs and wellbeing. An immediate requirement was placed upon the home regarding this. The staff members and management of the home confirmed that are not enough staff on duty to meet the needs of service users during early evening times when meals are served. An immediate requirement was placed upon the home regarding this. The service users spoken with said that staff were kind, supportive and helpful but that there were not always enough staff on duty, particularly during meal times. This matter was initially raised during the previous inspection visit. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 17 The staff files inspected contained the required records to demonstrate that appropriate training was being undertaken. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 43 Staff morale is low and systems to enable staff to express their views regarding the home inadequate. EVIDENCE: All of the staff spoken with said that all staff work well as a team but that morale overall was poor. Staff were of the opinion that the home running costs were being cut to the detriment of the service and that their concerns, when expressed to the proprietors were largely being ignored. The homes staffing arrangements were checked, which identified that there were insufficient numbers of staff on duty during some busy periods. Also, residents were not being provided with a fully suitable variety of foods. For example, cooked breakfasts had been removed from the menu although residents said that they enjoyed these. The inspector spoke with the home proprietor said that these concerns would be acted upon. Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 x x x x x x 2 Standard No 31 32 33 34 35 36 Score 3 1 1 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Courtlands Lodge Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score x x x x x x x C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 20 Are there any outstanding requirements from the last inspection? 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 YA3 Regulation 14 (1) (d) Requirement The regisered person must confirm in writing to the service user that the home can meet the care needs. Action must be taken to minimise identified risks to the safety of service users and staff from any service user and the home must meet the needs of all service users who reside in the home. The home must provide and document a variety and choice of foods to service users injcluding cooked breakfasts. Staffing numbers must be sufficient at all times to meet service users care needs. Procedures must be in place for all staff to receive a handover prior to each shift. Procedures must be in place to enabe staff to voice their views regarding the home. Timescale for action 20/7/05 2. YA9 12 (1) 30/6/05 3. YA17 16 (2) (i) and 12 (3) 18 (1) (a) 18 (1) (a) and 12 (1) 21 20/7/05 4. 5. 6. YA33 YA36 YA38 06/05/05 Immediate 20/7/05 Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 21 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 Good Practice Recommendations Courtlands Lodge C53 C04 S2618 Courtlands Lodge V230692 020605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 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. 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