Inspection on 22/06/07 for Grace Lodge Nursing Home

This inspection was carried out on 22nd June 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Grace Lodge Nursing Home 05/05/10

Grace Lodge Nursing Home 24/08/09

Grace Lodge Nursing Home 25/06/09

Grace Lodge Nursing Home 02/02/09

Grace Lodge Nursing Home 09/11/06

Grace Lodge Nursing Home 08/12/05

Grace Lodge Nursing Home 07/07/05

Grace Lodge Nursing Home 16/06/04

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

CARE HOMES FOR OLDER PEOPLE Grace Lodge Nursing Home Grace Lodge Nursing And Residential Home Grace Road Walton Liverpool L9 2DB Lead Inspector Ann Connolly Key Unannounced Inspection 22nd June 2007 07:30 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 Grace Lodge Nursing Home DS0000059144.V332651.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. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grace Lodge Nursing Home Address Grace Lodge Nursing And Residential Home Grace Road Walton Liverpool L9 2DB 0151 523 7202 0151 5237203 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) Ocean Cross Ltd Ms Diane Hollingsworth Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 37 Nursing Care and 37 Personal Care in the overall number of 65 One named service user under the age of 65 years in the overall number of 65 9th November 2006 Date of last inspection Brief Description of the Service: Grace Lodge provides nursing and residential care and support for up to sixtytwo residents. The home is purpose built and is situated in a cul-de-sac off a busy residential/shopping area of Walton Vale Liverpool. The home is well served by public transport (bus and rail) and a motorway network is approximately ten minutes away by car. The home is built on two levels, is centrally heated and well maintained. A passenger lift and stairways access the first floor. There is a well-kept garden to the rear of the home. The home is staffed 24 hours each day with both trained nurses and care staff. A representative of the owner visits at least monthly to report on the running of the home. It costs £307-£457 per week to live at the home. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place on 22 June 2007 at 7:00a.m. over five and a half hours. The manager was on duty and provided information about the daily running of the home. During this visit, a selection of care plans, records, policies and procedures were examined. Discussion took place with the manager, the residents living in the home and the staff team. Fourteen residents were spoken to during the visit and discussion took place with them to find out what they thought of the home and what they felt about the way the staff supported them. The manager completed a pre-inspection questionnaire about the way the home is run and managed and some of the information in this documentation has been included in this report. Since the last inspection, which took place on 09/11/2006 the Commission for Social Care Inspection have received one complaint about this home. This was concerning the attitude of a member of staff. This was fully investigated and partially substantiated. Appropriate action was taken by the manager to address the issue. There have been 4 complaints made direct to the manager since the last inspection. There was evidence from records that even minor concerns are taken seriously and responded to within timescales set down in the complaints procedure. The last complaint was concerning laundry. This was address by the manager and resolved to the complainants satisfaction. What the service does well: The manager ensures that prospective residents receive important information about the home so that people can make an informed choice about their future care and support arrangements. Information is provided in a well organised pack. An activity organiser is employed by the organisation to provide a varied programme of planned activities. Residents spoke highly of the opportunities to join in the range of activities. Staff training is good, and staff who were spoken to confirmed that they had access to a wide range of courses and training. This ensures that residents benefit from receiving their support from a well-trained and motivated staff. Residents in the home spoke highly of the staff team, and seemed to have established meaningful relationships. One resident said, “ Staff are very good, Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 6 they do their job very well”. Another resident said, “ I like it here. I like the way they look after you”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 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 Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given sufficient information about the home to help them in making a decision about their care arrangements. Residents’ needs are assessed prior to admission to the home so they are confident their needs will be met, and the home is sure it can meet their personal needs. EVIDENCE: All existing residents and prospective residents were provided with information about the home. The information was made available in a well-presented information pack, which included a Statement of Purpose, and a Service User Guide. The information set down the aims and objectives of the service, and provided details of the range of facilities and services available to residents in the home. This ensures that all prospective residents have important information about the home, before they make a decision to move there. It also provides existing residents with information about what services they can expect to receive whilst resident in the home. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 9 The files examined provided evidence that all residents admitted to the home had a full multidisciplinary assessment, and preparation for the move included a visit from a representative from the home to carry out their own preadmission assessment. The details in the pre-admission assessment included important information about the likes and dislikes of the person admitted, any potential risks and medical history. This information was used by the staff to develop a care plan, so that the right kind of care and support was provided to each individual resident. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans told staff how to care for residents in a way that promoted choice and respect, and ensured that residents had access to appropriate health care support. Some of the procedures for the safe administration of medication were not followed, and could potentially place residents at risk of not receiving correct medication. EVIDENCE: Four care plans were examined during this visit and all contained a detailed assessment of need. The care plan identified each individual care need, and the intervention or support required to meet the need. Risk assessments were also included in the care plan documentation. Some of the daily entries on care plan notes did not correspond to the care plan needs. It is strongly recommended that daily entries make reference to meeting care needs, to show clearly the support provided to the individual resident. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 11 There was evidence that there was a good system in place to carry out regular reviews of the care plans. The review form was detailed and comprehensive and provided information about the reason for the review, a record of significant changes in health care and social/emotional care needs, the outcome and any changes required to the care plan. The manager said that she intended to develop this further and to include a section to document the resident’s views and perception of their care need, and that of any other interested party. The development in this area of the work carried out by the home provides evidence of a commitment to developing a person centred approach, where the resident is central to the care planning process. There was evidence during this visit that residents were supported in having access to healthcare services. Care plan files provided evidence that residents were seen by their G.P and District Nursing services, and during this visit one resident said that she had been seeing the Doctor regularly because of a problem with her mobility. There was a monitoring sheet in place demonstrating that residents have regular contact with health support services. Information received in the feedback questionnaires, which were sent to resident prior to the inspection, provided confirmation that there was access to health care support. A monitored dosage system for the administration of medication was in place, and all staff responsible for administration of medication had received training. Records contained appropriate information including specimen signatures of staff responsible for the administration of medication, and photographs of residents in the home for identification purposes. Observation of staff involved in the process of administering medication highlighted areas of concern. A member of staff was seen administering medication to four people, and signing all four records retrospectively. Staff must sign the Medication Administration Records (MAR) immediately following the administration of medication for the individual person. The manager addressed this immediately at the time of this visit. Some medication was hand written on the MAR sheets. Two members of staff must sign these so that the accuracy of the transcription is checked, to ensure that residents receive the correct medication. Stock levels of medication for three residents were examined. In one case medication had been signed as given, but stock levels showed that the medication was still in stock. In another case, records showed medication had been administered, but the record had not been signed to indicate this. One resident was self-medicating and appropriate risk assessments were in place. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 12 During this inspection visit the staff were observed treating residents with respect by knocking on bedroom door and engaging in meaningful conversations. Fourteen residents in the home were spoken to, and overall they appeared satisfied on the professional approach of the staff. One resident said, “ It’s lovely here, the staff are great. They are so helpful. They understand and do what they can.” Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities are varied and suit the needs of individuals. Meals served to residents were of a high quality providing a well presented and nutritionally balanced meal. EVIDENCE: An activity organiser is employed by the home to provide a varied programme of planned activities. A weekly plan advertises the activities available during the week. Residents were able to name some of the activities they join in, such as bingo, quizzes and keep fit. One resident said, “ We do games and we have quizzes. Visitors can come any time they like. We have trips out. I have been on a trip, but I can’t remember where we went, I enjoyed it though”. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 14 It was evident that residents enjoyed a good relationship with the activity organiser as most people knew his name, and were able to talk about the contact they had with him. One resident said, “ He always pops in to see me” Another resident said there was a trip to Blackpool planned at the beginning of July. There was an extensive varied menu, which was changed regularly to provide variety. Overall there were positive comments about the meals served in the home. One person said, “ I love the food, I can choose what I want for breakfast”. Another person said, “ The meals are good. Very good food and very well put together”. Only one person raised concerns about the food, but felt he could confidently mention it to the staff and they would “Sort it out for me”. It was evidents that residents are encouraged to bring some of their own personal possessions into the home to make their bedroom feel homely and comfortable. Residents who were spoken to expressed satisfaction about the quality of their rooms. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to support residents in making a complaint and to protect them from abuse. EVIDENCE: During this visit there was a positive open exchange of communication between residents and staff, and residents appeared confident in expressing their views openly. There have been 4 complaints made direct to the manager since the last inspection. The complaints record was examined and it showed that the management takes all complaints seriously. There was evidence from records that even minor concerns are taken seriously and responded to within timescales set down in the complaints procedure. The last complaint was concerning laundry. This was address by the manager and resolved to the complainants satisfaction. One complaint was received by the Commission for Social Care Inspection. This was concerning the attitude of a member of staff. This was fully investigated and partially substantiated. Appropriate action was taken by the manager to address the issue. The manager said that all complaints were monitored by the operational manager, so that any patterns could be identified, and any finding used to improve practice within the home. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 16 Staff were confident in explaining the procedures for reporting an allegation of abuse. There was a copy of the local adult protection policy and staff have received training on this subject. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a clean and tidy environment and are provided opportunities to personalise their own personal space. EVIDENCE: During this visit the environment was clean and tidy providing residents and their visitors with a pleasant environment. Since the last inspection visit, the manager had developed an improvement plan, which identified the areas for improvement, redecoration and refurbishment. She said that there would be a schedule to implement any outstanding work. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 18 There had been some improvements made to the dining area on the upper floor. Previously this had been used as a lounge and dining room. This room is now only used as a dining room, and residents have been accommodated in smaller lounge areas, which provides a homely environment. A selection of bedrooms was checked. These areas were pleasant and had been made homely by residents bringing in items from their own homes, such as pictures and ornaments. There were policies and procedures in place on infection control. Staff receive training in infection control and the manager promotes safe working practices in the home by re-in forcing good practice at staff meetings and in one to one supervision sessions with staff. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs were being met by a staff team with a good skill mix and recruitment practices used by the home ensured the health safety and well being of residents in the home. EVIDENCE: During this visit to the home, there appeared to be sufficient numbers of staff on duty to meet the needs of residents. Each member of staff has an individual training plan. There as evidence of ongoing training and development to include mandatory training, e.g. moving and handling, POVA and health and safety courses. The home had policies and procedues on recruitment practices which ensured that the correct checks were made and that staff had the necessary qualifications to meet the needs of residents in the home. The staffing rota shows that there is always a trained nurse on duty. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 20 Three staff files were examined and all contained the appropriate documentation including two written refences and Criminal Record Bureau (CRB) checks. During this visit residents were very positive and complimentary about the support they received from staff. All feedback forms from residents living in the home spoke highly about the support provided by staff. Residents spoken to during this visit to the home expressed satisfaction about the way in which the staff supported them. One resident said, “I like it here. I like the way they look after you, the staff are very nice. Another resident said, “ The staff are very good, they do their job very well”. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership, and systems are in place ensure the home is run in the best interests of residents. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She is a qualified nurse, and holds an appropriate management qualification. During this visit, the manager demonstrated her commitment to developing the service, and ensuring that staff have access to appropriate training. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 22 The manager operates an open management style, and encourages residents and staff to make use of the ‘open door’ policy. Residents spoken to during the course of this inspection expressed satisfaction on the way the home was run and the quality of the services delivered by the staff in the home. All staff spoke highly of the informal and formal support that they received from the manager. There was evidence on staff files to indicate that staff received formal supervision. There was evidence of a monitoring programme for supervision and to review staff work performance, training needs and future targets. The organisation holds pocket money for 6 residents. Records show that family members collect this and sign to say that they have done so. Since the last visit the management of residents finances had improved, and bank accounts had been opened for two residents who manage their own money. Receipts are obtained made on any purchases made for residents. Information in the home’s pre-inspection questionnaire provided confirmation that all health and safety checks were current and up to date. Information confirmed that fire safety training was provided to all staff. A fire risk assessment is in place which is supported by regular checks on the fire alarm system. Quality monitoring systems were evidenced which include feedback forms to residents and their relatives. Information from these surveys were then analysed and enabled the manager to address any concerns and to use the information to develop the service. Discussions with the manager provided evidence of an open and transparent management style where any issues highlighted in the inspection visit were seen as an opportunity to improve the service. There was a strong focus on developing the staff team and an emphasis on consulting with residents informally and formally in order to improve the service. The manager stated that she received support from the company’s operational manager at least once a month, and this was used as an opportunity to discuss areas for improvement. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13(2) Requirement The registered person must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medications at the care home. Staff in the home must sign the Medication Administration Records (MAR) as soon as they have given the individual resident their medicines. When medication is hand written on the MAR sheets, two members of staff must sign the record to confirm that the transcription has been checked for accuracy. Systems must be in place to audit medication, to ensure that residents are receiving their medication appropriately and safely. Timescale for action 21/07/07 Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 25 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 OP7 Good Practice Recommendations Daily entries in care plans should make reference to care needs, to show clearly the support provided to the individual. Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Grace Lodge Nursing Home DS0000059144.V332651.R01.S.doc Version 5.2 Page 27 - 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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