Inspection on 31/01/06 for Dunnington Lodge Nursing Home

This inspection was carried out on 31st January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Dunnington Lodge Nursing Home 22/07/08

Dunnington Lodge Nursing Home 31/07/07

Dunnington Lodge Nursing Home 22/08/06

Dunnington Lodge Nursing Home 03/05/05

Dunnington Lodge Nursing Home 22/02/05

Dunnington Lodge Nursing Home 08/09/04

Dunnington Lodge Nursing Home 17/03/04

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

CARE HOMES FOR OLDER PEOPLE Dunnington Lodge Nursing Home 34 Church Street Dunnington York North Yorkshire YO19 5PW Lead Inspector Jo Bell Unannounced Inspection 31st January 2006 09:30 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 Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dunnington Lodge Nursing Home Address 34 Church Street Dunnington York North Yorkshire YO19 5PW 01904 488676 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) Mr Richard Hugh Richardson Mrs Gill Richardson Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19), Terminally ill (4) of places Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to 19 (OP) and up to no more than 4 (TI) up to a maximum of 19 Service Users. 55 years plus Date of last inspection 3rd May 2005 Brief Description of the Service: Dunnington Lodge is a large period building situated in the village of Dunnington on the outskirts of York. It can provide care for up to 19 service users that may require nursing care. It is also registered to care for service users at the end of their lives and service users needing respite care. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 31st January 2006.The registered manager was not available and the proprietor chose not to be involved with the inspection. Twenty two standards were discussed with the nurse in charge. However, not all areas could be assessed in detail as some of the information could not be located. A tour of the premises took place, seven residents and five staff were spoken with. Care practices and individual plans, medication, staff issues and environmental areas were inspected. The home in general offers a good standard of care, and staff have a relaxed and friendly approach to caring for residents. However, some of the requirements and recommendations from the previous inspection still remain outstanding. At the inspection ten requirements were made and one immediate requirement. What the service does well: What has improved since the last inspection? What they could do better: Residents needs are not consistently met following initial assessment. The procedure for admitting residents on emergency respite care is not adequate. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 6 The nurse in charge must be aware of where policies/procedures and specific records are kept. Staff should undertake adult protection training. The home should consider having more domestic staff on duty. 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. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 the following standard(s): 3 (Standard 6 not applicable) Resident’s needs are not consistently assessed. EVIDENCE: The initial assessment for a resident is undertaken by the registered manager of the home if the person is self funding. In general the assessments contained detailed information relating to physical, social and psychological needs. The care manager completes an assessment where the resident requires funding. This is then is used to inform the care plan developed by the staff in the home. One ninety six year old gentleman was located on the third floor of the home in an attic room. He was at risk of falling and whilst the home had completed a risk assessment it was evident when discussing his care plan that this room was unsuitable for him. Overnight this person was prone to wandering and had been commenced on medication for agitation. The staff who are situated on the ground floor would need to ascend three flights of stairs to gain access to his room to assist him. The registered mental nurse and care staff on duty were spoken with who discussed their concerns regarding the safety of this individual. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 9 A review had taken place with the care manager (who was spoken with). However an immediate requirement was issued to ensure this individual was moved into a more suitable room closer to the ground floor. Whilst conducting the inspection a Care manager telephoned to ask if the home could accept a lady on emergency respite later in the day. The home did not have any details of this person, and the nurse in charge did not ask for an assessment of this person or request further information. This is not acceptable practice. The home must have sufficient information to decide whether an individual’s needs can be met. This was discussed with the nurse in charge who was unaware of the correct procedure to follow. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9 & 10 Resident’s needs are set out in an individual plan of care. However, care needs are not always fully met. The medication system needs to be more robust. Residents are treated with dignity. EVIDENCE: Four care plans were inspected. The home have made progress in regularly reviewing and evaluating these. All plans had risk assessments relating to the prevention of falls and pressure sores, it was evident that in one case the risk assessment regarding falls for one gentleman needed reviewing. This was discussed. Moving and handling and nutritional assessments had also been completed. Wishes regarding death and dying had been completed with detailed information available. Records showed that healthcare professionals visit the home and advice is sought from a range of sources. These include; the consultant psychiatrist, GP, continence advisor, chiropodist and dentist. The accident book is completed and staff are aware of the Regulation 37 form required by the CSCI. A discussion took place regarding the care of one lady whose room was on the 1st floor. She had been temporarily moved into a respite room on the ground Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 11 floor as she had a fracture to her leg and had a ‘pot’ on. However, the respite room would only be available for another week. Therefore, this person would have to return to her own room. Staff were unsure how they could move her up the stairs as the home does not have a lift. The nurse in charge stated that once this lady was in her room she would not be able to come downstairs until the ‘pot’ was removed. Staff must be able to meet the needs of this individual and have a greater understanding of what her needs will be. The medication system in the home was inspected. An adequate policy is in place. This included a specific policy on self medication. Currently the home is not following the latest guidance regarding waste medicine. Medication charts were assessed, generally these were well maintained. One error related to the dose of one particular medication, this was been dealt with. New charts had been commenced on the day of the inspection and the previous charts could not be located. The nurse in charge stated that stock balances do not take place, fridge temperatures are not taken and she was unsure as to whether a medication audit takes place. The medication cupboard was untidy and it was evident that over ordering of some medication had taken place (i.e Epilim). Checks took place regarding temazepam, and medication in the pre-packed boxes. This was found to be correct. It was evident that oxygen was not stored correctly. This was left in the corridor which residents could access. During the inspection this was moved to a secure place. The home maintains dignity and privacy. Residents spoken with said staff knock on their bedroom door before entering. Residents were smartly dressed in their own clothes and personal possessions were evident in their rooms. It was evident that one room (room 6) has an unlocked door through to the room next door (room 7). One member of staff stated this is often used as a short cut. Staff must not use this room as a short cut as this is the resident’s private room. It would be advisable to have a lock put on this door to avoid either staff or another resident gaining access to this room. The home has one triple room with three residents in. There are privacy screens and individual furniture and commodes for use. However, staff did comment that it is difficult to use a hoist in this room as space is very limited. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 the following standard(s): 13 & 15 The home encourage contact with family and friends. Residents receive a well balanced diet in a choice of congenial settings. EVIDENCE: Residents stated that they can receive visitors at any time. Staff confirmed this to be the case. The home does not currently have a visitors book, this was also highlighted at the previous inspection. Visitors can be received either privately or in one of the communal areas. Visits from the local clergy in Dunnington occur on a monthly basis and residents are able to go to the church in the village if they prefer. The lunchtime meal was observed, this was fishcakes and vegetables. The desert was pears and cream. Residents stated that there is normally one choice of main course. However, if this is not suitable an alternative can be offered. Residents spoken with felt the food was good and the portion size was adequate. The dining room has four tables which seats up to four residents each. Some residents chose to eat in the lounge, assistance was given where necessary by staff in a dignified manner. Plate guards and beakers were available for residents that needed them. The kitchen area was domestic in nature. This was clean and tidy and food in the fridge was dated and stored correctly. At the previous inspection it was suggested that the residents should Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 13 have access to the menu. This would be beneficial as the residents spoken with were unclear what food they were about to be served. The mealtimes are flexible and residents discussed their routines regarding breakfast, lunch and supper. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 the following standard(s): 17 & 18 Resident’s feel safe in their environment and their legal rights are protected. EVIDENCE: Resident’s legal rights are protected. Staff stated that they have the opportunity to vote when necessary. This is normally a postal vote which the registered manager is responsible for organising. The home have an adult protection policy in place. This includes whistle blowing and the ‘no-secrets’ document. Details of the local authority procedure was available. However, all staff spoken with were unaware of the correct procedure and the different types of abuse residents could be subject to. In the office details of a vulnerable course from last November were on the notice board. However, the person in charge said this had never been discussed with the staff and therefore no-one had attended. Staff must receive training in this area. Resident’s spoken with said they felt safe and well cared for, all the staff were kind and they worked as a team. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 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 the following standard(s): 19, 20,21 & 26 Residents enjoying living in this environment. The home is generally clean and adequately maintained. EVIDENCE: The environment was inspected. This was adequately maintained with residents commenting positively about their rooms and the communal areas. A maintenance programme could not be located therefore part of the standard could not be assessed. The home has one triple room which is currently occupied, and five double rooms. The home is not purpose built and therefore access to each floor is by stairs and stair lift only. The grounds are maintained and the home is located in the quiet village of Dunnington. There are sufficient communal areas for the residents to use and an appropriate number of bathing and toilet areas. The bathroom in the main house was inspected and it was evident through observation and speaking with staff that the ambu-lift hoist required attention. The locking mechanism was faulty and therefore staff could not maintain the Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 16 safety of residents when using this piece of equipment. This must be addressed. The staff stated they have received infection control training (this could not be confirmed as training records were not available). Staff were aware of how to use universal precautions. A policy was in place which covered all aspects of infection control. A policy for the laundry was in place. Currently care staff are responsible for washing and ironing resident clothes. The policies cover collection of laundry, the sluice room, disinfectant and clinical waste. The laundry area was examined. The floor covering was adequate and two washing machines and one tumble drier are available. In general the home was clean and odour free. However, in room 6 there was a strong smell of urine, this must be eradicated. The home currently employs one domestic staff Monday to Friday and another member of staff over the weekend. Discussions took place with the domestic staff who stated that when she finishes her shift at 1.30pm there is no domestic cover until the following morning. This must be addressed. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 17 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 & 30 Residents confirmed that staffing levels were adequate and some staff training takes place. EVIDENCE: Staffing levels in the home are satisfactory. On the day of the inspection there was one registered nurse and four carers to care for fourteen residents. Overnight there is one registered nurse and one carer. Residents spoken with stated that when they need assistance staff are always available. Call bells were observed been answered promptly. Staff confirmed that NVQ Level 2 training was available, some staff had already completed this and other staff were due to start this shortly. This could not be confirmed as the records were not available. The nurse in charge was aware that 50 of care staff need to have completed this by 2005. Staff spoken with said that induction training takes place, when new staff commence employment they are asked to shadow a more experienced care worker. A checklist is completed which was inspected. The member of staff have areas of practice which they are supervised in. This is discussed on an informal basis. Recruitment practices in the home were discussed. The nurse in charge thought that all staff have had an enhanced CRB check and that staff have to complete an application form prior to been employed. The nurse in charge did Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 18 not think any records were available to check, as these could not be located. This Standard could therefore not be assessed in detail. As discussed in Standard 18, staff need to have adult protection training. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 19 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): 33,35 & 37,38 (Standard 31 could not be assessed) Policies/procedures/records are not readily available therefore service users safety and welfare needs cannot be consistently maintained. EVIDENCE: The above Standards could not be assessed in detail as the registered Manager was not available and the records pertaining to the Standards could not be located. Therefore, the information available was obtained from discussions with staff, residents and through observation. The Registered Manager is a registered nurse with many years experience caring for older people. However, there was not sufficient evidence available to assess this Standard fully. Therefore this will be revisited at subsequent inspections. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 20 Staff stated that meetings between the staff take place. Residents meetings do not occur. No quality assurance documentation was available, therefore it was unclear as to how the home seeks the views of individuals. Residents could not confirm how the home deal with their monies. No records were available to ascertain this. Health and safety in the home was observed. Residents spoken with said they felt safe. It was evident that doors were propped open by unauthorised means. This practice must cease. No records were available for inspection. Staff did state that they receive fire training, moving and handling and COSHH training on a regular basis. This could not be confirmed. The home must make available all records relating to the inspection process. Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 21 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 x x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 x 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 1 1 3 1 x x x x 1 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 1 x 1 x 1 1 Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 22 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 OP3OP7 Regulation 13 Requirement A review must take place of the falls risk assessment for the service user in the attic room. The service user in the attic room must be moved to a more suitable room (closer to the ground floor) within 24 hours. Immediate requirement issued. Timescale for action 01/02/06 14 2. OP3 14 3. OP9 13 4. OP15 12 The assessment of a service user requiring emergency respite in the home must be obtained prior to admission Daily fridge temperatures must take place. Waste medicines must be disposed of correctly. The correct amount of medication must be ordered. A medication audit must take place on a regular basis. Oxygen cylinders must be stored securely. A copy of the menu must be made available to service users (previous timescale 03/06/05 DS0000028000.V278553.R01.S.doc 01/02/06 01/04/06 01/03/06 Dunnington Lodge Nursing Home Version 5.1 Page 23 5. 6. 7. 8. OP18 OP21 OP26 OP26 18 16 23 18 9. OP37 17 not met) Staff must receive adult protection training on a regular basis The locking mechanism on the the ambu lift must be checked. The smell of urine in room 6 must be eradicated. The home must ensure an adequate number of domestic staff are available to maintain a satisfactory standard of cleanliness throughout the home. The person in charge must be aware of where policies/procedures and specific records are kept in the home. The following records were not available: Maintenance (Standard 19) Staff files (Standard 29) Quality assurance (Standard 33) Residents money (Standard 35) Health and safety (Standard 38) 01/04/06 01/03/06 01/02/06 01/04/06 01/03/06 10. OP38 23 Doors must not be propped open using unauthorised means 01/02/06 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. 2. Refer to Standard OP13 OP28 Good Practice Recommendations A visitors book should be made available 50 of care staff should obtain an NVQ Level 2 or above Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Dunnington Lodge Nursing Home DS0000028000.V278553.R01.S.doc Version 5.1 Page 25 - 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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