Inspection on 19/04/05 for Downshaw Lodge Nursing Home

This inspection was carried out on 19th April 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Downshaw Lodge Nursing Home 18/07/07

Downshaw Lodge Nursing Home 06/06/06

Downshaw Lodge Nursing Home 22/10/05

Downshaw Lodge Nursing Home 17/11/04

Downshaw Lodge Nursing Home 13/05/04

Similar services:

Chirnside House

Emmaus House

East Croft Grange

Craignair

Croston Park Nursing Home

Conifers Nursing Home

Cloisters

Elmsdene Care Home

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

CARE HOMES FOR OLDER PEOPLE Downshaw Lodge Downshaw Road Ashton-under-Lyne Tameside OL7 9QL Lead Inspector Fiona Bryan Unannounced 19th April 2005 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 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. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Downshaw Lodge Address Downshaw Road, Ashton-under-Lyne OL7 9QL 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) 0161 330 7059 0161 339 4112 Execeler Health Care Group Plc (Organisation)Sun House, 79 High St, Eton, Windsor, Berkshire, SL4 6AF N Care home with nursing 45 Category(ies) of Up to 45 DE Dementia Up to 45 DE(E) Dementia registration, with number - over 65 of places Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No more than 45 service users with dementia can be admitted to the home No service users under the age of 55 years to be admitted to the home. Two registered nurses to be on duty over each 24 hour period. The home manager must be a first level Registered Mental Nurse and supernumerary to the stated staffing levels for 37.5 hours per week. Date of last inspection 17th November 2004 Brief Description of the Service: Downshaw Lodge is a purpose built, two-storey building that accommodates up to 45 service users from the age of 55 years with dementia who require nursing care. The home is owned by Exceler Health Care Group plc, which is a subsidiary company of Ashbourne Health Care, and is under the control of a general manager who is also a qualified nurse. Service users are accommodated in single rooms, 26 of the rooms having ensuite facilities. Rooms without en-suite facilities are provided with vanity units incorporating washbasins. Within the home there are six communal rooms offering a variety of settings for service users to socialise, entertain family or friends and participate in activities. A pleasant garden is designed to ensure that service users can enjoy being outdoors whilst maintaining their safety and security. The home has access to a mini-bus and service users who are able to, are taken for trips out to a number of local destinations. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took 7.75 hours and was an unannounced inspection. Time was spent talking to 4 residents, 4 staff and one visitor. The care for four residents was looked at in detail, looking at their experience of the home from the time of their admission to the present day. Records of care were examined. Staff duty rotas, personnel files, financial records and medicine records were also looked at. Since the last inspection the manager has left and the company has assigned a registered nurse from another home to spend 36 hours per week at the home to offer management support to the staff. In addition to this, senior managers within the company are overseeing the running of the home until a new manager is appointed. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments were not always checked often enough meaning that residents needs could change but be overlooked. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 6 Although residents generally looked neat and tidy, staff need to pay attention to minor areas of personal hygiene, such as the cutting of fingernails. The home is staffed to the minimum levels required but the high dependency of many of the residents leaves staff little time to encourage them to participate in their care or explore ways of increasing mental and physical stimulation. Food portions were ample but residents were not offered any choice of meal. Information about residents’ dietary needs had not been given to the chef meaning that some residents were not being given the correct diet. Other specialist diets were substandard, leading to residents being at risk of poor nutrition. Further staff training is needed so staff can recognise forms of abuse and to ensure that they can deal properly with the needs of residents who are aggressive. 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. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Detailed assessments are undertaken prior to a resident’s admission to the home. This led to staff appreciating each resident as an individual. EVIDENCE: Staff were able to give clear and detailed accounts of the care each resident needed. They were aware of the residents’ particular likes and dislikes and their preferred daily routine. Staff knew each resident’s family and friends and the amount of involvement they wished to have in planning their care. Staff said they obtained information about the residents from the assessments completed prior to their admission. Four residents were looked at in detail. Examination of their care files showed that full assessments had been completed for all of them, which had been reviewed and updated during their stay with extra information, as it became known. All of the files had comprehensive information about the residents’ backgrounds, family contacts and involvement, interests and hobbies and Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 9 previous occupations. Details were available about residents’ preferred routines and likes and dislikes. It was clear that both the residents and their families had been involved in completing the assessments which is good practice, as many of the residents at the home have communication difficulties and memory impairment, making it especially important that all relevant information is available to staff to enable them to care for the residents properly. Healthcare problems had been clearly identified and enough information was provided to ensure that the care needed for each resident could be established without difficulty. Residents said that staff understood their needs and knew them well, indicating that staff had access to and utilised information about residents well. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Shortfalls in the evaluation of residents care plans and risk assessments have the potential to place them at risk. Residents’ healthcare needs were met. Improvements in the laundry arrangements have enhanced residents’ dignity, but some personal care details are sometimes overlooked. Procedures for handling medication were appropriate. EVIDENCE: The care plans for 4 residents were available and had addressed the needs identified in their assessment. Risk assessments had been undertaken and appropriate care plans developed to reduce identified risks. Care plans had not always been reviewed monthly which could lead to changes in health care and personal needs not being identified and addressed. One risk assessment had not been updated after the resident had fallen so possible alternative strategies to prevent future falls had not been explored. Care plans and risk assessments must be regularly reviewed and updated for all residents to ensure that their needs are continuously identified and addressed. Residents said that they received visits from the chiropodist, dentist, optician and their GP. One resident said she had been taken to a hospital appointment. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 11 Records of visits from healthcare professionals provided further evidence that appropriate services were accessed for residents. No residents were able to manage their own medicines. Medicine administration procedures were observed and were satisfactory. Residents said that staff were “very nice” and they were treated well. Personal care was observed to take place behind closed doors, either in the residents’ own rooms or in the bathrooms. Some female residents preferred to have personal care undertaken by female carers and this wish was recorded in their assessment and upheld as much as possible. Residents’ clothing was labelled to ensure it was not mixed up. A small number of residents had long fingernails, which needed cleaning. Staff must make sure that all aspects of residents’ personal hygiene are maintained. Staff were seen to deal with the residents skilfully and showed a lot of patience and acknowledgement of each resident as an individual. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,.13,.14 and 15 Residents are not always able to exercise choice and make decisions but are able to maintain contact with family and friends. Limited choice and poor provision of special diets led to residents being at risk of poor nutrition or deterioration in their health. EVIDENCE: Residents said that they were able to get up and go to bed when they wished. Staff were knowledgeable about residents’ preferred routines when they were unable to express themselves. Some residents were able to go out of the home with relatives and friends. One resident went out independently. Although the home has a new activities organiser who knew the residents very well and had been developing activities to suit individual resident’s interests, on the day of the inspection most residents were observed sitting in the lounges for long periods, with little opportunities being provided to offer mental or physical stimulation. The activities organiser said that she had been to another home to discuss ideas for activities but was waiting for training to help her plan activities specifically for residents with dementia. Staff were very busy and had no time to sit and talk with residents for any significant time. Staff felt that whilst staffing levels had improved to some extent, no real consideration was given to the dependency of residents and Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 13 this had an impact on the time they could spend with residents and the levels to which they could foster independence and choice. A small number of visitors were at the home during the inspection and had been made welcome by staff. A light meal of mushroom soup followed by scrambled eggs and baked beans was served at lunchtime. The main meal of the day is served at teatime. Although the meal looked unappetising, portions were generous and all the residents asked said they enjoyed it. No choice was offered and one resident who did not like the soup or eggs only had the dessert of stewed apples and custard. The liquefied meal was unrecognisable- staff said it was soup and bread. It looked unappetising and was not nutritious. Food provided for residents requiring a liquefied diet must be presented in a manner which is attractive and appealing in order to maintain residents’ appetites and nutrition. Four residents within the home were diabetic. The chef was not aware of this and no diabetic desserts were available. A previous requirement specifying the need to ensure that suitable special diets are provided remains outstanding. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure ensured that all interested parties were aware of how to complain and the process that would be undertaken. Limited staff training led to the possibility that staff may not recognise some types of abuse. EVIDENCE: A satisfactory complaints procedure was displayed in the reception area of the home. One relative said he was aware of the complaints procedure and any concerns he had raised in the past had been dealt with promptly and effectively. Staff were aware of the procedure to follow if residents or visitors wanted to make a complaint. Residents said that they felt safe living at the home. Some staff said they had received training in dementia care, which covered topics such as how to deal with residents who are aggressive, but some staff said they had not had much training in this area and not all staff were able to describe signs of potential abuse. All staff said that if they suspected abuse they would report their concerns to the nurse in charge. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 26 The home is purpose built and designed to meet residents’ needs and maintain their safety, but did not provide all residents with a clean and comfortable living space. EVIDENCE: The garden was very well maintained, safe and secure enough for residents to enjoy being outdoors with minimal risk. Keypad locks on each of the floors ensure that residents are safe to move independently if able, around the units. The paintwork in the ground floor dining room was chipped and dirty and needs to be redecorated. A malodour was detected in the conservatory. The senior general manager stated that the carpet had been scheduled for replacement. A malodour was also detected in some bedrooms. Only one cleaner was on duty on the day of the inspection, who had to divide her time between two floors. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Minimum staffing levels led to residents’ needs not always being met. Suitable people were employed at the home. EVIDENCE: Three staff personnel files were examined, which all contained all the records and information required to ensure that the staff members were fit to work in the home. Staff duty rotas showed that minimum staffing levels were met. However, staff said that many residents were highly dependent and they had difficulty in encouraging residents to do things for themselves independently because it took too much time. Residents were left sitting in the lounges for long periods of time. Sufficient staff must be provided to ensure that the needs of the residents can be met. Residents and one visitor said that at times there were not enough staff on duty and one resident said that the atmosphere in the home was “different” when staff were very busy and it “wasn’t as nice”. One visitor said that he often had to phone the home two or three times in the evening as staff were too busy to answer. Staff said that the workforce was stable and there was little use of agency staff, ensuring that staff who knew the residents cared for them most of the time, who were aware of the needs of those who had difficulty communicating. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38. The health and safety of residents and staff was safeguarded by the policies and procedures in place. Residents’ finances were dealt with appropriately. Quality assurance measures were insufficient to provide opportunities for the families of all residents to offer their views on the running of the home. EVIDENCE: It is company policy that regular checks are made and recorded of the environment and equipment in respect of health and safety. Staff were observed to be working using safe practices. None of the residents were able to manage their own money but were mostly assisted by their families. Many of the residents had a small amount of money in safekeeping at the home. Records are maintained of all transactions. The financial records for the four residents who were case tracked were examined and in good order. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 18 There have been a number of relatives/residents meetings since the last inspection, the last one being before Christmas prior to the previous manager’s departure. One resident and one relative recalled attending a meeting, but no one could remember receiving any surveys or questionnaires seeking their opinions about the home. Further strategies must be put in pace to ensure that opportunities exist for all interested parties to give feedback about the home. Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 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 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A 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 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION 2 3 x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 x x 3 Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 20 yes 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 7 Regulation 15(2) Requirement The registered person must ensure that care plans and risk assessments are reviewed at least once a month and updated to reflect changing needs. The registered person must ensure that all aspects of residents personal and oral hygiene are maintained The registered person must ensure that special therapeutic diets are provided when advised by healthcare and dietetic staff. (Previous timescale of 31 December 2004 not met) The registered person must ensure that residents requiring a soft/liquefied diet receive food which is attractive and appealing in terms of texture, flavour and appearance in order to maintain appetite and nutrition. The registered person mus ensure that the dining room on the ground floor is redcorated. The registered person must ensure that sufficient staff are on duty to meet the needs of the residents and promote independence and choice. The registered person must Timescale for action 31 May 2005 2. 8 12(1) 31 May 2005 31 May 2005 3. 15 13(1) 4. 15 16(2) 31 May 2005 5. 6. 19 27,14,12 23(2) 18(1) 30 June 2005 31 May 2005 7. 33 24(1) 30 June Page 21 Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 ensure that systems are in place 2005 to obtain feedback from residents or their representatives about how the home is meeting their needs. 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 15 Good Practice Recommendations The registered person should ensure that residents are offered a choice of meals in written or other formats to suit the capacities of the residents which is given read or explained to them. The registered person should ensure that contigency plans are made in the event that cleaning staff are absent from work, to ensure that the hygiene of the home is consistently maintained. The registered person must ensure that all staff receive training in recognising abuse. 2. 26 3. 18 Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton-under-Lyne OL7 9QL 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. Extracts may not be used or reproduced without the express permission of CSCI Downshaw Lodge F54-F04 s25432 Downshaw Lodge un v221788 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!