Inspection on 06/06/06 for Downshaw Lodge Nursing Home

This inspection was carried out on 6th June 2006.

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

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

Other inspections for this house

Downshaw Lodge Nursing Home 18/07/07

Downshaw Lodge Nursing Home 22/10/05

Downshaw Lodge Nursing Home 19/04/05

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 Nursing Home Downshaw Road Ashton-under-Lyne Tameside OL7 9QL Lead Inspector Mrs Fiona Bryan Unannounced Inspection 6th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Downshaw Lodge Nursing Home DS0000025432.V298319.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. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Downshaw Lodge Nursing Home Address Downshaw Road Ashton-under-Lyne Tameside OL7 9QL 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) 0161 330 7059 0161 339 4112 Exceler Health Care Group Plc Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (45) of places Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 45 Dementia No services user under the age of 55 years to be admitted to the establishment. 2 registered nurses on duty 24 hours; The Home Manager shall be a First Level Registered Mental Nurse and be supernumerary to the stated staffing levels for 37.5 hours per week. 22nd October 2005 Date of last inspection 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 Southern Cross Health Care, and is under the control of a general manager who is also a qualified nurse. Fees for accommodation and care at the home range from £465.35 to £475.35 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Details of the facilities provided by the home are contained in the service user guide, which is displayed in the reception area of the home. 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. The home is located on the main Oldham Road with good access by public transport. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection started at 10.00am Tuesday 6th June 2006 and continued the following day. Time was spent talking to residents, relatives and staff and observing the home’s routine and staff interaction with residents. As the majority of service users were unable to offer in depth responses the inspector took note of nonverbal signals and the overall ambience of the home and the effect that it had on the service users. Four residents were looked at in detail, looking at their experience of the home from their admission to the present day. A tour of the building was conducted and a selection of staff and residents’ records was examined including records of care, medication records, employment and training records and staff duty rotas. Since the last inspection a new manager has been appointed who is in the process of applying for registration with the CSCI. What the service does well: What has improved since the last inspection? The manager has worked hard since her appointment in November 2005 and feels that some progress has been made although improvements were needed in most areas of the home. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 6 At the time of the inspection the reception area of the home was being redecorated and the hallway on the ground floor had been repainted. Efforts have been made to present a more homely feel, with new pictures for the walls and new curtains on order for some of the communal rooms. The overall appearance of residents has improved since the last inspection with most residents looking clean and well presented. Efforts have been made to introduce a wider variety of activities and leisure pursuits for residents although further work is needed to identify and plan for individual needs and interests. The general consensus from staff and visitors was that staffing levels had improved and there has been less reliance in recent months on agency staff, which has led to more consistent care for the residents. What they could do better: The home is in the process of changing the paperwork used for assessment and care planning to meet Southern Cross Healthcare policies and procedures. Although allowances were made for some inevitable deficits in information during the transition process it was still evident that assessments of residents lacked detail and care planning was also vague at times and did not address all the residents’ needs. Care plans and risk assessments need to be reviewed more thoroughly to ensure that changes to the residents are identified. Some fairly minor changes must be made to the home’s medicine procedures to ensure that risk of errors is minimised. The mealtime observed during the inspection appeared better organised and the food looked and smelled appetising. However consideration still needs to be given to the choice of foods provided to residents. More effort could also be made in promoting residents’ autonomy and choice, even in simple things such as their choice of music on the radio. Some improvements have been made to the environment but further investment is needed to ensure that the fixtures and fittings are of good quality. Cleaning schedules and routines also need to be reviewed to ensure that areas are left clean and tidy after residents have used them. Please contact the provider for advice of actions taken in response to this Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Downshaw Lodge Nursing Home DS0000025432.V298319.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 Downshaw Lodge Nursing Home DS0000025432.V298319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is adequate. The home’s Statement of Purpose and Service User Guide does not provide sufficient information for prospective residents or their representatives to be clear about the services the home provides to meet their needs. Residents do not receive sufficient written information regarding the terms and conditions of their stay; therefore residents may not always be clear about the services the home provides. More rigour is required in completing assessment records; information was not always readily accessible to staff and residents’ needs may not be clearly identified. This judgement has been made using available evidence including a visit to this service. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 10 EVIDENCE: The homes statement of purpose and service user guide is currently being updated. Examination of the current statement of purpose indicated that some information, such as the name and address of the registered person, the age range and sex of prospective residents that the home accommodates and the arrangements for meeting residents’ spiritual needs was not included. It was reported that normally these documents are displayed in the reception area and individual copies are put in the rooms for new residents. Four residents were case tracked. Three of the four residents had signed copies of the terms and conditions of their stay on file; the fourth resident had only been admitted the previous week so the finances were still being arranged. Terms and conditions did not always make clear what part of the fees would be payable by the resident and what part would be paid for by the local authority or other body. It was also unclear what additional charges were made for sundry items not included in the fees. Terms and conditions did stipulate the category of care needed by the resident, the proposed length of stay and the period of notice required. Staff are in the process of changing the documentation to Southern Cross Healthcare paperwork. Some of the residents had lived at the home a long time and full details of their original assessments had not been transferred over to the new paperwork although basic details were included. Two care files included life histories and social profiles for residents that had been written by their families. One resident who had been admitted to the home a week previously had not had risk assessments undertaken for moving and handling, nutrition, pressure areas or risk of falls. Although the blank documentation was available in all the files to undertake nutritional risk assessments using the MUST (Malnutrition Universal Screening Tool) none of these assessments had been completed. Downshaw Lodge Nursing Home DS0000025432.V298319.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The quality of care plans and risk assessments across the home is inconsistent; therefore information may not be readily accessible to staff and residents’ needs may not be clearly identified or addressed. Some procedures in respect of the receipt and administration of medicines put residents at risk. Personal support within the home is offered in such a way as to promote residents’ privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four residents were case tracked. Although some care plans were detailed for example the care plan for one resident with very sensitive skin listed the products that caused reactions, Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 12 many care plans were vague, for example the care plan for one resident identified as being at risk nutritionally advised to ensure “an adequate diet” and a “well balanced diet” and to “document input and output if required” and to “weigh weekly or monthly as required”. Care plans also sometimes appeared to be impossible for staff to realistically carry out for example stating that a resident at risk of falling must be supervised at all times. The daily record for one resident who had recently been admitted to the home indicated that they presented with challenging behaviour and were resistant to care interventions. No care plan had been developed to address theses issues. Care plans and risk assessments had not always been reviewed monthly. One resident who was admitted to hospital for a week did not have their care plans reviewed or updated on return to the home. The wound care plan for one resident did not stipulate the pump setting required for their pressure mattress and inspection of the mattress found that the pump was set incorrectly for the resident’s weight. It was unclear at times if interventions stated in the care plans had been carried out in practice, for example the care plan for one resident at risk of pressure sores stated that turn charts should be completed but examination of these found them incomplete. Evidence was available in the files that residents’ representatives had been kept informed of any changes, and although care plans were not always up to date staff had taken appropriate action where necessary such as contacting the resident’s GP. Relatives confirmed that they were informed of any changes to the resident’s condition. Staff were knowledgeable about residents’ routines and preferences. The majority of residents looked reasonably clean and tidy. One relative said the resident she visited always appeared well presented. Medication records were examined. Some medication administration details were handwritten. These transcribed details had not been signed, dated or validated by an additional member of staff. On occasions where a variable dose of medication was prescribed, for example, one or two tablets to be taken, the actual dose administered was not recorded. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 13 Systems for the storage, recording and administration of controlled drugs were satisfactory. There was a very large amount of old stock awaiting disposal locked in a cupboard in the first floor treatment room. The manager stated that the home was having problems arranging for the company providing the disposal service to collect the stock. One relative who visited the home regularly said that staff treated the residents with kindness and respect. During the inspection it was observed that staff interacted well with residents. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. Efforts have been made to expand and develop the range of activities provided for residents but further consultation is needed to ensure that the home satisfies all of the residents’ social and recreational needs. Meals were generally acceptable but further consideration is needed regarding the provision of choice for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the four residents case tracked had life histories and detailed social profiles. Two residents had only very limited details about their social preferences and care needs, although one had only been in the home for a week. Care plans for residents’ social care needs were limited or non existent. Activity records were maintained for each resident detailing social events that they had participated in. Examples of some leisure pursuits included singing, aromatherapy, being visited by friends and playing board games, story telling, keep fit, trips out with family, crosswords and quizzes. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 15 An activities organiser is employed for 20 hours a week. Since the last inspection the room on the ground floor that was designated for activities has been made accessible at all times and had been cleared out to make it more user friendly. This room has a table and chairs and small groups of residents have been enjoying fish and chip or curry suppers. The room was decorated for the World Cup and it was reported that the home was purchasing set top boxes for the televisions in the communal rooms so digital channels will be available. The manager stated that she was also looking at getting larger televisions as the present ones are quite small and larger ones would improve residents’ viewing enjoyment. It was reported that religious services within the home took place on special occasions but were not arranged as a regular event. One of the relatives said that the resident she visited had enjoyed the last service and could remember some of the words and the tunes of favourite hymns. One relative thought that the provision of activities for the residents had improved. One staff member felt that activities needed to be further developed but said staff were trying to build up the range of activities on offer. Some staff felt that the activities organiser spent more time with residents on the ground floor than she did with residents on the first floor. The manager agreed that this probably was the case but pointed out that as the activities room is on the ground floor staff may perceive that she was downstairs more but residents from the first floor were welcome to come downstairs and join in any events taking place. The manager stated that the key worker system was still in its infancy, although some carers have spent time trying to ensure that residents’ clothing was in good repair and liaising with relatives for replacement clothing if necessary. Development of the key worker system may help to further identify residents’ individual social needs, particularly for those residents that are most dependent. It was noted that the music being played in the first floor lounge was entirely inappropriate, although it was very quickly changed on the arrival of the inspector! (This made the inspector think that staff were very well aware of what type of music residents would probably enjoy but chose to put their own preferences and interests first). Visitors said that they were always made to feel welcome in the home and that staff were friendly. Lunch was served at 12.45pm and consisted of beef stew, chips, cabbage and carrots, which looked and smelled appetising. One resident required a gluten Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 16 free diet and was served turkey salad. No other choices appeared to be available for other residents. One of the carers said that alternatives of jacket potatoes, sandwiches and omelettes were available and those residents who were able to choose were asked what they would like. Many residents had difficulties making choices and carers chose on their behalf based on their knowledge of the resident’s appetite and preferences. One carer said there was sometimes no choice and felt that the food provided and the choices available could be improved. Dessert consisted of coconut sponge and custard or tinned fruit for diabetic residents. One staff member felt that the quality and presentation of the meals tended to vary according to which kitchen staff were on duty. They commented that some of the food was “very bland” but also reported that residents were offered fresh fruit every afternoon and sandwiches for supper. One relative said she sometimes sampled the food when she visited and always found it tasty and appetising. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. The home has a satisfactory complaints system with some evidence that residents’ or relatives’ views are listened to and acted upon. Satisfactory arrangements are in place requiring residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was reported that the complaints procedure would normally be displayed in the reception area of the home, but as this area was in the process of being redecorated it was not actually displayed on the day of the inspection. The complaints procedure included details of the timescales in which complainants could expect a response and a contact address and telephone number for the CSCI. Relatives were aware of the procedure; one relative said she found the manager approachable and had raised concerns with her in the past, which had been dealt with satisfactorily. The whistle blowing policy and a helpline phone number were displayed in the staff room, informing staff of their right to make an anonymous call if they preferred to report any concerns. Staff were aware of reporting procedures for suspicion of abuse. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is adequate. Although some improvements have been made, the standard of décor and the quality of furnishings and fittings in some areas need to be improved to ensure that the home presents as a homely and comfortable environment for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some improvements to the environment were noted since the last inspection and the manager provided a refurbishment plan, which she intends to work through over the next few months. The activities room on the ground floor is no longer locked and had been tidied out, offering more choice to residents and their relatives about where to spend their time. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 19 The lounge/dining room on the first floor had been rearranged. There were fewer armchairs and they were better positioned with more dining tables so residents could eat their meals in comfort. On both floors sensory boards had been placed at strategic positions along the hallways to stimulate residents sense of touch. At the time of the inspection work was in progress to redecorate the reception area and the ground floor hallway had been repainted. There were still a number of areas that continue to need improvement. One small lounge on the first floor remained unchanged, with dirty, worn furniture. The overall feel of the room was one of neglect with chairs being haphazardly arranged, one chair without a seat cushion and an odd slipper in the middle of the room. A television with a very small screen stood in the corner. A second small lounge on the same floor contained better quality chairs and a larger television. The manager stated that 14 new armchairs and 4 recliner chairs had been ordered. Some of the dining tables were old and rickety and should be replaced. Dining chairs had not been cleaned after breakfast and were sticky with the remains of porridge. An unpleasant odour was present in the first floor dining room. Examination of a number of bedrooms revealed badly made beds with very old and stained bed linen. The manager said that new bedding was ordered for rooms as they were refurbished but acknowledged that more was needed. The temperature in the first floor lounge/dining room was nearly 30ºC and residents appeared hot and listless. On the ground floor the conservatory doors were open to the garden and some residents sat outside. The garden was very pleasant, being secure and safe with benches, tables, chairs and parasols. A large game of Connect 4 suitable for outdoor use was standing in the grounds. The laundry room provided 3 washing machines and 2 driers, which were suitable for the purposes of the home. The person working in the laundry stated that they had received training in health and safety and Control of Hazardous Substances. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Progress has been made in addressing staff shortages resulting in better staff morale and more consistent care for residents. Recruitment procedures ensure residents are protected. The percentage of care staff working at the home who have completed NVQ training does not meet the required target but an ongoing In House staff training programme has commenced which will ensure staff have the skills and knowledge to meet the residents’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of staff duty rotas indicated that 1 nurse and 3 carers generally worked on each floor during the day and 1 nurse and 1 carer worked on each floor during the night with a third carer “floating” between floors. Staff stated that staffing levels had improved since the last inspection, especially during the week, although sometimes at the weekend there could be staff shortages. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 21 One relative said she thought staffing levels were satisfactory and there had been a reduction in the number of agency staff used. Three staff personnel files were examined. All the documents and information required in Schedule 2 of the Care Homes Regulations 2001 were provided and POVA checks or CRB’s had been obtained prior to staff commencing employment. One new member of staff was enjoying working at the home. They confirmed that they had been asked to supply 2 references, one from their previous employer and had received a good induction, covering all aspects of the work they were to perform; they had had to complete an induction book, which had been signed off by one of the senior carers. Another member of staff who has been employed since the last inspection said they did not receive moving and handling training during their induction although they had since undertaken the training. It was reported that five of the 23 carers employed by the home had successfully completed NVQ level 2 training and 1 carer had obtained NVQ level 3. Two carers are currently undergoing training and a further 6 are about to enrol. Various training was advertised such as fire safety training on 11/7/06 and food hygiene on 19/9/06. First aid training was due in 2 weeks time and some training on care planning had been undertaken and further sessions were planned. Staff said they had received training in moving and handling, food hygiene and residents welfare (prevention of abuse). Training records confirmed this. Power point presentations for a range of topics had been provided by the company’s training department, which will be delivered by the manager. Much of the training focuses on dementia care and communication. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. The manager has a good understanding of the areas in which the home needs to improve and the home regularly reviews aspects of its performance through a programme of audit. There are opportunities for residents or their representatives to make their views known. Residents’ financial interests are safeguarded via the home’s procedures. Staff are supervised to ensure they are supported to deliver care appropriately to residents. Health and safety policies and procedures protect residents and staff. This judgement has been made using available evidence including a visit to this service. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager is a Registered General Nurse and is in the process of applying to the CSCI for registration. She has successfully completed the registered managers award and is due to commence a dementia care course in September 2006. Other qualifications include a certificate in teaching and assessing in clinical practice and completion of a course in Care of the Dying. One relative said she felt the new manager was “doing her job properly” and had been impressed. She said there had been changes for the better at the home. One relative said there had been several resident/relative meetings held with the new manager where a few issues had been discussed which had since been sorted out. Minutes of the meetings indicated that relatives had been informed about activities and events planned in the home and the arrangements for contacting the manager with any suggestions, concerns or complaints. Attendees were asked for their comments. Notices were displayed around the home advertising a residents/ relatives meeting on 7/6/06. Staff felt that the manager was approachable and listened to their suggestions. It was reported that staff morale was better and this was having a good effect on teamwork. Staff confirmed that staff meetings had been held and minutes were available which indicated that many aspects of the home had been discussed including improvements required to the environment, activities, medicine administration, care planning, accident reporting and working routines. Notices displayed around the home advertised a meeting for night staff and further meetings to specifically discuss the importance of accurate documentation. A working group had been formed to move dementia care forward within the home and identify areas for improvement and development. Monthly audits of all aspects of the home are undertaken by the manager or the area manager. The manager reported that a questionnaire was due to be sent out in June 2006 to all relatives and to any residents who had the capacity to respond. This process is part of the Southern Cross Healthcare system of audit in which questionnaires are distributed in all homes on a rotational basis throughout the year. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 24 The majority of residents are assisted with their finances by their families. A separate bank account is maintained for the use of residents who wish to deposit money. No interest is accrued on the account. Separate ledger sheets are maintained recording how much each resident has in the bank account. Invoices can also be supplied for sundry expenses such as hairdressing and newspaper bills whilst some relatives leave a “float” which is kept in the safe in the office. Records were checked with the corresponding amounts held for the residents and were correct. From receipts it was evident that residents had been charged for their fish and chip or curry teas, which the activities organiser had arranged for small groups over previous weeks. As the residents have already paid for their meals as part of the fees for their residence at the home they should not be charged for these meals as the kitchen would not have had to provide a meal for them. The manager reported that supervision sessions had commenced for all staff and training needs would be identified through discussion with each staff member. Staff confirmed that they had participated in supervision sessions. Health and safety audits are undertaken and meetings are held with health and safety representatives from across all sections of the home to discuss the findings. The home employs a maintenance person for 40 hours per week who is responsible for weekly and monthly safety checks of the building and equipment. Staff were aware of where the home’s health and safety policies and procedures were kept. During the inspection staff were observed to be using safe working practices. Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 25 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 4 Requirement The registered person must ensure that the home’s Statement of Purpose and Service User Guide are up to date and accurate in the information they provide. The registered person must ensure that all residents receive a copy of the terms and conditions of their stay at the home, including all the details stated in NMS 2.2 The registered person must ensure that comprehensive assessments are undertaken for all residents that include all the details stated in NMS 3.3 The registered person must ensure that care plans are detailed, accurate and developed to address all residents’ health, personal and social care needs. The registered person must ensure that actions stated as required in the care plan are carried out properly. The registered person must ensure that care plans and risk assessments are reviewed at DS0000025432.V298319.R01.S.doc Timescale for action 31/07/06 2 OP2 5 31/07/06 3 OP3 14 31/07/06 4 OP7 15 31/07/06 5 OP7 15 31/07/06 6 OP7 15 31/07/06 Downshaw Lodge Nursing Home Version 5.2 Page 27 7 OP9 13 8 OP9 13 9 OP9 13 10 OP12 16 11 OP14 12 12 OP15 12 13 OP19 16 14. OP20 23 15 OP24 16 least once a month or more often if necessary so they reflect residents’ changing needs. The registered person must ensure that handwritten medication details on the medication administration records are clear. They must be signed and dated and validated by an additional member of staff. The registered person must ensure that an accurate record is made of the actual dosage of each medication administered. The registered person must ensure that unwanted prescribed medication is sent for disposal to the appropriate waste disposal company at timely intervals. The registered person must ensure all service users accommodated at the home have a social care plan with recorded interventions that are person centred. (Timescale of 31/12/05 not met). The registered person must review the home’s care practices to ensure that service users are provided with choices in the areas they can influence. (Timescale of 31/12/05 not met). The registered person must ensure that all residents including those on special diets are offered a choice of food. (Timescale of 30/11/05 not met) The registered person must ensure that worn and stained lounge and dining room furniture is replaced. The registered person must ensure that the temperature of the home is suitable for the residents. (Timescale of 30/11/05 not met). The registered person must DS0000025432.V298319.R01.S.doc 31/07/06 31/07/06 31/07/06 15/08/06 31/07/06 15/08/06 15/09/06 31/08/06 31/08/06 Page 28 Downshaw Lodge Nursing Home Version 5.2 16 OP26 16 17 OP28 18 ensure that old and stained bed linen is replaced. The registered person must ensure that suitable standards of hygiene and tidiness are maintained. The registered person must ensure that care staff are supported to undertake NVQ training to ensure that the target ratio is achieved. 31/07/06 30/09/06 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 OP8 Good Practice Recommendations The registered person should ensure that care plans include specific details about the type of pressure mattresses being used and the pump settings if applicable so that staff can ensure they are working properly and set at the correct pressure for the individual resident. The registered person should ensure that regular opportunities exist for those residents who wish to fulfil spiritual and religious needs. The registered person should expand and develop the key worker system to maximise person centred care and assist in meeting residents’ diverse needs. The registered person should consider providing larger televisions in the communal areas to increase viewing enjoyment for residents. The registered person should ensure that residents are not paying twice for meals. 2 3 4 5 OP12 OP12 OP20 OP35 Downshaw Lodge Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Nursing Home DS0000025432.V298319.R01.S.doc Version 5.2 Page 30 - 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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