Inspection on 07/07/05 for Grace Lodge Nursing Home

This inspection was carried out on 7th July 2005.

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 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 22/06/07

Grace Lodge Nursing Home 09/11/06

Grace Lodge Nursing Home 08/12/05

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 & Residential Home Grace Road Walton Liverpool L9 2DB Lead Inspector Mr Les Hill Unannounced 7 July 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 3 SERVICE INFORMATION Name of service Grace Lodge Nursing & Residential Home Address Grace Road Walton Liverpool L9 2DB 0151 523 7202 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ocean Cross Ltd Ms Diane Hollingsworth CRH N 65 Category(ies) of OP - 65 registration, with number of places Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 4 SERVICE INFORMATION Conditions of registration: 1) 37 Nursing Care and 37 Personal Care in the overall number of 65 2) One named service user under the age of 65 years in the overall number of 65 Date of last inspection 1 February 2005 Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 5 Brief Description of the Service: Grace Lodge provides nursing and residential care and support for up to sixty two 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. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Grace Lodge took place on Thursday 7th July 2005 over a period of 6 hours. The inspector carried out an examination of records kept in the home, toured the building and spoke with seven residents and five members of staff as well as the manager and her deputy. The inspection was undertaken as part of the Commission’s requirement to visit and report on each registered care home on two occasions each year. What the service does well: What has improved since the last inspection? Wound care management systems have been improved. A record is being maintained of each resident’s involvement in activities. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 7 Identified maintenance matters have been addressed. 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. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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 Standards Statutory Requirements Identified During the Inspection Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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 standard(s) 1, 3, 4, 5 and 6 The organisation provides good information on which prospective residents can make a choice about entering the home. Senior staff undertake assessments of prospective residents to confirm that they are able to manage their care. EVIDENCE: The home’s statement of purpose and its service user guide had been examined on all previous inspections. They contained all relevant information about the role and function of the home and the principles upon which the homes care practices are based. The inspector looked at four resident’s files, all of them contained an assessment of need completed by a senior member of staff at the home. The assessment tool used is comprehensive and covers all aspects of the Roper, Logan and Tierney model of Activities of Daily Living as well as hobbies, social interests and details of next of kin. Past and current medical information is detailed for reference. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 10 Using the pre-admission assessment tool and visiting prospective resident prior to admission the home’s managers are able to determine whether the home can meet the identified needs. Grace Lodge has been providing nursing and residential care for some time and has all the necessary equipment to manage the care and support needs of most, older people. It has good links with general and specialist community health services, with GP’s and with the Primary Care Trust (PCT). Any specialist equipment not already provided in the home is hired or loaned by the PCT. Prospective residents and their families are invited to visit the home, and to speak with staff before they make a decision to move in. There is also the opportunity for a month’s trial period before they make the decision to stay. The home does not provide Intermediate Care. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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 standard(s) 7, 8, 9, 10 and 11. Good care planning and review arrangements were in place that included detailed treatments for nursing interventions. There is a need to reinforce the procedures on signing MAR sheets. EVIDENCE: Care plans were in place on each of the four care files examined during the inspection. They contained detailed information about specific areas of need and gave instructions to staff on how they should be met. Wound care management reports had been significantly improved since the previous CSCI inspection in February 2005. Reports from the manager and confirmed by the resident identified that interventions by staff at the home had supported the healing process for leg ulcers and prevented major surgery. Three of the current residents have a pressure sore. Nursing procedures at the home are supported by community health services through advice on tissue viability, continence, diet and infection control. The homeowners have introduced a number of monitoring arrangements that ensure staff at the home are following acceptable and safe procedures. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 12 District nurses attend to residents not requiring full nursing care and the home has access to optician and dental services. A chiropodist visits the home though there is a small charge made for this service. The home’s new pharmacist has been extremely supportive through regular audits of medicines and advice to staff. The home is also working with the PCT and the GP surgeries on a project to review the medicines prescribed for residents at the home. A contract for the return of medicines prescribed for nursing care residents is in place and the pharmacist collects any unused medicines from residential care placements in the home. An examination of the storage and issue of medicines in the home confirmed that on the whole they were being managed appropriately. However, in one case the MAR sheet contained a signature for a tablet that was still in the blister pack. The manager must reinforce the procedure for staff to sign the MAR sheet only after the medicine has been taken. Staff at the home were observed to interact with residents in a friendly and courteous manner and treated them with respect. Residents who spoke with the inspector said that staff were very good and worked hard. Personal care was given in private and on a tour of the building staff were observed to knock on bedroom doors and wait for a reply before entering. Visiting medical practitioners and other professionals see residents in their own rooms, in one of the offices or in one of the less used lounge areas around the home. On each of the files examined there was a form to identify the wishes of the resident for procedures to be followed upon their death. None of the forms were completed. The manager said she would pursue the completion of the forms over a period of time. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. Activities are arranged for residents, by staff in the home. Residents are encouraged to make decisions about their own life. A balanced diet is provided. EVIDENCE: The home employs an activities organiser and a Health Therapist (two half days each week) to encourage and stimulate the social care needs of residents. The manager told the inspector that records are now being kept to show what activities individual residents have been engaged in. During this inspection the activities organiser was busy with individual residents and so the standard will be examined in more detail at the next announced inspection. Visitors are welcomed at the home at any time and are encouraged to take their relatives out into the community wherever possible. The home is ideally located for access to shops, pubs and cafés and residents who wish to go out to the local shops are supported to do so. Residents are encouraged wherever possible, to make decisions for themselves. They can choose what time to get up and what time they wish to go to bed; whether they wish to join in activities or not; and whether they want the meal being served or an alternative. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 14 The young chef maintains a clean and tidy kitchen. He has recently introduced some changes to the puddings provided at the home to ensure healthier options and is attempting to introduce more variety into the main meals served. Residents who spoke with the inspector were complimentary about the variety, quality and quantity of the food provided at Grace Lodge. The day’s menu is written up in each of the two dining rooms and residents who do not like the meal being served can choose an alternative meal. The home provides for special diets when necessary. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18. Complaints received at the home had been managed appropriately. Residents were registered to vote in local and national elections. Adult protection procedures were in place. EVIDENCE: The home has an appropriate complaints policy and procedures in place. Since the CSCI inspection in February 2005 the home has received three complaints. Two minor matters were partly substantiated and in the third the complainant had refused offers from the home’s managers to discuss the matters they had raised. The homes records contained full information on the process undertaken for all three complaints received. During the course of the inspection one of the residents asked the inspector to explain the contents of a letter she had received. The letter was from the City Council confirming that her name had been included on the Electoral Register. The home has adult protection and “whistle blowing” policies and procedures in place. The home’s manager and deputy manager had attended an adult protection, training event staged by Liverpool City Council that they had found extremely helpful. They have requested places be allocated to the home at future adult protection training events. Staff who spoke with the inspector confirmed that adult protection matters are raised in the NVQ courses that most of them have completed or are currently undertaking. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26. Grace lodge is a purpose built home that is designed and equipped to support older people. It is well decorated and maintained. EVIDENCE: Grace lodge is a purpose built home, registered for 65 older people. There have been no changes to the structure and layout of the building since it was first opened. Three of the bedrooms can take two people but the owners will usually offer them for single occupancy unless the application is from a married couple or friends who wish to share. All of the bedrooms have an en-suite toilet and wash hand-basin. Communal lounge areas are located around the home. One lounge on the ground floor and one on the first floor are allocated as smoking rooms. Corridors are wide with handrails along both sides. Bathroom and toilet areas are spacious and provide adequate room for supporting residents who require Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 17 the use of a wheelchair. The home has “walk in” shower facilities on both floors. The garden is accessible through the downstairs lounge and there is a large patio area where residents can sit outside. The home provides adequate built in wardrobes and drawers for residents but they are also able to bring in their own items of furniture (fire precautions permitting) and other belongings to personalise their room. The home’s handyman was redecorating an empty bedroom at the time of this inspection as part of an ongoing programme of redecoration. Corridors have been redecorated and provide bright colour identifiable areas to assist residents to recognise their own bedrooms. The programme of redecoration is to continue and include lounge areas. The manager told the inspector that she has ordered a new electric, hoist and is expecting to receive some new chairs to replace ones showing signs of wear in various locations around the home. Carpeting had been replaced in one of the bedrooms seen. The home was clean, bright and well cared for. A housekeeper has taken responsibility for ensuring the general upkeep and cleanliness of the building and has completed the replacement of net curtains and ensured the regular laundering of curtains with the maintenance of their fire resistant qualities. She has also written COSHH assessments for all the cleaning products used. The home uses specialist, washing powders to deal with any confirmation of MRSA. Offensive odours were not noticeable in general areas of the home, and were being contained in the rooms of some residents who have problems with continence management. Since the CSCI inspection in February 2005 the home has isolated electric hand-dryers in toilets and provided disposable paper towels. One of the bedroom doors was not closing properly onto its rebated frame. The manager said she would ask the handyman to repair it. The manager is experiencing great difficulty in getting the wheelchair service to accept responsibility for the repair of their wheelchairs in the home. She was advised to put her concerns in writing. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. Appropriate numbers of trained nurses and care staff are on duty throughout the day and at night. EVIDENCE: The home is staffed by both full and part time trained nurses and experienced and recently recruited care staff. Agency nurses are used from time to time but the home attempts to employ the same ones from the agency that they use. Of the 35 care staff in post 18 have an award at NVQ level 2 or above and three more staff have enrolled on the course. The home is therefore meeting its requirement to have at least 50 of care staff qualified to NVQ level 2 or above, by 2005. The home’s recruitment and selection procedures will be examined at the next announced inspection. The home employs some European workers to support the staff team. The manager, with support from the owners is keen to promote training and develop care practices within the home. The deputy manager is a trainer for moving and handling and the handy man arranges fire prevention training in the home. Trained nurses are encouraged to maintain their registered status by keeping up to date with current nursing practice. Training had been provided on the management of medicines and the pharmacist was supporting the home with regular updates on the effects of some medicines. The manager Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 19 had received information about some free training in first aid and food hygiene that she intended to pursue. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 37. Management and administration procedures are being strengthened by the introduction of regular quality assurance checks. EVIDENCE: The manager of the home is a registered nurse who has several years experience of working with older people in managerial position. She has an NVQ level 4 in care and is a trained assessor for NVQ training in care practice. The manager’s office is by the front entrance to the home and visitors are encouraged to call in to speak with the manager at any time. Both the manager and her deputy have direct contact with residents and during this inspection were extremely knowledgeable about the circumstances of each resident. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 21 Staff meetings are held in the home and a record is made of the agenda and any actions to be taken as a result of matters discussed. Staff who spoke with the inspector said that they have regular one-to-one supervision sessions with a senior member of staff and felt that this helped them in their day-to-day work with residents. They also said that they had enjoyed the NVQ training and were considering whether they should apply to undertake an award at NVQ level 3. The service manager, who is the owners representative and visits the home at least monthly, has introduced a range of quality monitoring tools to ensure the home is meeting its responsibilities to provide good standards of care. The service manager also undertakes the required monthly monitoring visits and prepares a written report on his findings. A copy of the report is sent to CSCI. Resident’s meetings have been held at the home but with little response. The home’s managers should consider how they might get feedback on the performance of the service from residents and their relatives. The management of resident’s monies will be examined during the next announced inspection. The home’s policies and procedures are maintained in the manager’s office and staff are able to have access to them at any time. The home also had copies of a care assistants’ handbook and other similar documents that gave detailed information about the principles of privacy and dignity and described the ways in which staff should provide support to residents in the home. The homes equipment safety certificates will be examined at the next announced inspection. Regular testing of the fire alarms is carried out and during the course of this inspection the fire alarm was accidentally activated by an aerosol. All of the staff on duty responded appropriately. The source was identified and the alarm was re-set. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x 3 x 3 Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation None Requirement Timescale for action 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. 3. 4. Refer to Standard OP9 OP11 OP19 OP33 Good Practice Recommendations The manager should reinforce the procedure for the MAR sheet to be signed only after the medicine has been given. The manager should ensure that the wishes of residents upon their death are recorded. The manager should ensure that the bedroom door identified during the inspection is repaired so that it can close onto its rebated frame. The manager should consider ways of including comments from residents and their families in the homes quality assurance systems. Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc Page 24 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS 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 Grace Lodge Nursing & Residential Home Version 1.30 F52_F02_s59144_GraceLdge_v236714_070705_Stage 4.doc 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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