Inspection on 08/12/05 for Grace Lodge Nursing Home

This inspection was carried out on 8th December 2005.

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

The inspector 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 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 Les Hill Announced Inspection 8th December 2005 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 Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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.V265021.R01.S.doc Version 5.0 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 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.V265021.R01.S.doc Version 5.0 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 7th July 2005 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. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection of Grace Lodge was undertaken on Thursday 8th December 2005. It involved the completion of a pre-inspection questionnaire by the manager, the examination of some records, a tour of the building, meeting with the manager, her deputy and the Regional Manager from Ocean Cross Ltd. The inspector spoke with eight of the residents, one visitor and received seven completed comment cards from residents and/or their family. The inspection was undertaken as part of the Commission’s responsibility 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? Medicine records are being kept appropriately. Residents and their relatives are being consulted for their opinions about the quality of care provided at the home. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 6 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 Home DS0000059144.V265021.R01.S.doc Version 5.0 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.V265021.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5 and 6 Good information is provided on which prospective residents can make a choice about entering the home. Comprehensive assessments are in place to confirm the appropriateness of placement and to form the basis of care planning. EVIDENCE: There have been no significant changes to the home’s structure or to the ways in which services at Grace Lodge are managed and therefore the Statement of Purpose has remained appropriate and unaltered since it was last examined. The inspector examined six resident’s care 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 contains information about the health and welfare needs of individual residents. Past and current medical information is detailed for reference. All of the residents have a contract in place that sets out the conditions of residence. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 9 From the information gained through pre-admission assessments and meeting prospective residents, senior staff are able to determine whether or not the home is able to meet the identified needs. Grace Lodge has been providing nursing and personal 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. Any specialist equipment not already provided in the home is leased or loaned by the Primary Care Trust (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 is not contracted to provide Intermediate Care. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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 and 11 Good care planning and review arrangements are in place, which include details of treatments for nursing interventions. Care practices respect the rights of residents to be treated with dignity and respect. EVIDENCE: Care plans were in place on each of the six care files examined during the inspection. They contained information about specific areas of need and gave instructions to staff on how they should be met. Separate care plans were in place for two residents who had a pressure sore. The home’s activities organiser had spent time with each of the residents to prepare a social history of their family, work and leisure experiences and these were prominently located on the file to give all staff a better understanding of the resident’s background. Nursing procedures at the home are supported by community health services through advice on tissue viability, continence, diet and infection control. The homeowners expect managers to complete monthly monitoring forms to confirm that all essential and safe procedures are being followed. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 11 District nurses attend residents who are not identified by the placing authority as needing full nursing care and the home accesses optical and dental support. A chiropodist visits the home though there is a small charge for this service. An examination of the storage and issue of medicines in the home was undertaken and confirmed that they were being managed within appropriate guidance. The home has a contract in place for the disposal of unused medicines and the Regional Manager gave an assurance that a policy and procedure for the destruction of “Controlled Drugs” was written and would be provided to the home by the end of the inspection day. During a tour of the building it was noted that bed rails were being used without a confirmed risk assessment and without the appropriate “bumpers” for safety. The home’s manager must ensure that whenever bed rails are used a risk assessment, confirmed by the resident or their relative is in place and that the appropriate “bumpers” are used to prevent any accidental injury. Residents and relatives who completed the Commission’s Comment Cards were complimentary about the standards of care provided at Grace Lodge. During the process of the inspection the inspector was able to observe that staff interacted with residents in a friendly and courteous manner and treated them with respect. Personal care was provided in private and staff knocked on resident’s bedroom, bathroom and toilet doors and waited before entering. GP’s, district nurses and other professional visitors can attend to residents in their own room or in one of the staff offices around the home. On each of the files examined there was a section that would identify the needs and wishes of residents for procedures to be followed at the time of their death. None of the forms had been completed. The inspector discussed the need for the home to maintain this kind of information and the manager said she would ensure the matter was addressed. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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): 12, 13, 14 and 15 A range of appropriate activities is provided. Residents are encouraged to make decisions about their own life. A balanced diet is available with a choice of foods at each mealtime. 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. Records are kept of the activities individual residents have been involved with. In the afternoon of this inspection a group of residents were playing Scrabble and other were gathering for the exercise session. Visitors are welcomed 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 cafes. Residents who wish to go out to the local shops are supported, wherever possible, to do so. Residents are encouraged to make decisions for themselves. They can choose what time they get up and what time they go to bed, whether to join in activities or whether to spend time on their own. They also have a choice of foods at mealtimes. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 13 The young chef maintains a clean and tidy kitchen. He has introduced some changes to the menus that have produced a more balanced and healthy diet. It is difficult in any care home to provide a menu that will please all of the residents all of the time. However the responses included in the CSCI comment cards and feedback from residents during the inspection confirmed that on the whole, food provided at Grace Lodge is well received. Residents who don’t wish to take the main meal on offer can choose an alternative and special dietary needs are met. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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): 16, 17 and 18 Complaints were being managed appropriately. Adult protection policies were in line with the local authority’s procedures. EVIDENCE: The home has a complaints policy and procedures in place that welcomes the opportunity to deal with any matters of concern. An examination of the complaints log held in the home confirmed that complaints made had been managed appropriately. All of the residents are listed on the Electoral Register and have the opportunity to vote in national and local elections. The home has adult protection and “whistle blowing” policies and procedures in place. Staff are provided with training through NVQ courses and the home is to extend the opportunity for further in house training on adult protection matters. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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, 22, 23, 24, 25 and 26 Grace Lodge is 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 registered. Three of the bedrooms can be used for married couples or friends who choose to share, but are generally available for single occupancy. All of the bedrooms have en-suite WC 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 the use of a wheelchair. The home has a “walk in” shower on both floors. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 16 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 redecorates bedrooms as they become vacant and ensures that all areas of the home are kept in good order. On the day of this inspection the home was clean and well cared for. A housekeeper is responsible for the general upkeep and cleanliness of the building. COSHH assessments are in place for al cleaning materials. There were no offensive odours noted during a tour of the premises. No essential maintenance matters were identified during the inspection. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 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 and 30. Appropriate numbers of trained nurses and care staff are on duty throughout the day and night. Employment procedures ensure as far as possible, that competent and reliable staff support the residents. EVIDENCE: The home is staffed by full and part time trained nurses and by experienced and/or recently recruited care staff. The numbers of agency staff hours has been reduced considerably since the CSCI inspection in July 2005. Of the 35 care staff in post 21 have an award at NVQ level 2 or above in the care of the elderly. The home is therefore meeting the standard of 50 staff with an appropriate NVQ level 2 by the end of 2005. The home’s recruitment and selection procedures were examined and found to be in good order. Some of the staff are recruited overseas and the appropriate paperwork had been completed. The manager has arranged training in Adult protection, COSSH information, Nutrition, Information Governance – Medicines Review, Fire awareness, manual handling, Palliative care, first aid and food hygiene. Training in fire prevention and moving and handling involved larger numbers of staff. A record is kept of the training undertaken by each member of staff. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 18 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, 32, 33, 34, 35, 36, 37 and 38 Management and administration procedures are in good order. EVIDENCE: The manager of the home is a Registered Nurse who has several years experience of working with older people in a 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 door of the home and visitors are encouraged to call in and speak with her at any time. Both the manager and her deputy have direct contact with residents and are extremely knowledgeable about the current circumstances of each resident. Staff meetings are held in the home and a record is made of the agenda and any actions resulting form discussions held. Regular one-to-one staff supervision sessions are held and the manager is seeking to develop the role Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 19 of senior members of the team in taking on some of the responsibilities for staff support. The Service Manager from Ocean Cross Ltd visits the home and completes monthly Regulation 26 reports, a copy of which is sent to CSCI. In addition the home’s manager is required to complete regular returns to ensure the routine responsibilities of a homeowner are being carried out. More recently the home has requested residents and their relatives complete a questionnaire to gain their opinion of the services provided at Grace Lodge. The inspector was shown some of the responses that indicated a general appreciation of the staff and the care provided in the home. The financial accounts for Grace Lodge were not examined on this occasion but are made available to the Commission. The inspector is not aware of any financial matters that would affect the continued operation of the home. The home does not manage the personal money of residents. The home’s policies and procedures are kept in the manager’s office and staff can access them at any reasonable time. The home also has a care assistant’s handbook and other documents that give information about the principles of privacy and dignity and describes the ways in which staff should support residents. Information to support the regular and routine maintenance of equipment was provided by the home’s manager and confirmed during the inspection. The fire alarm system is tested on a regular basis and the temperature of hot water delivered to resident’s rooms is taken and recorded to confirm it is safe. In the kitchen the chef records the temperatures of fridges and freezers and takes the temperature of particular foods as they are being cooked. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 20 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 2 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 3 18 3 3 3 3 3 3 3 3 3 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 3 3 3 3 3 3 3 Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 21 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. Standard Regulation 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. Refer to Standard OP8 OP11 Good Practice Recommendations The manager should ensure that the use of bedrails is supported by a risk assessment and that they are always used with the appropriate “bumpers”. The manager should ensure that the wishes of residents upon their death are recorded. Grace Lodge Nursing Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 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 Home DS0000059144.V265021.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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