Inspection on 23/08/05 for Guide Lane Nursing Home

This inspection was carried out on 23rd August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Guide Lane Nursing Home 10/05/07

Guide Lane Nursing Home 15/03/06

Guide Lane Nursing Home 31/01/05

Guide Lane Nursing Home 04/08/04

Guide Lane Nursing Home 05/02/04

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

CARE HOMES FOR OLDER PEOPLE Guide Lane Nursing Home 232 Guide Lane Audenshaw 36 M34 5HA Lead Inspector Fiona Bryan Announced 23 August 2005 - 09:00 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. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Guide Lane Nursing Home Address 232 Guide Lane, Audenshaw, Tameside M34 5HA 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) 0161 335 9989 0161 335 0948 Southern Cross Home Properties Limited Mrs Julie Richardson Care Home with Nursing 41 Category(ies) of PD - Physical Disability - 41 registration, with number PD(E) - Physical Disability over 65 - 41 of places OP - Old Age - 41 Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 41 OP, PD (E) and PD. 2. No service user under the age of 55 years to be admitted to the home. 3. Two registered nurses tob e on duty throughout the 24 hour period. 4. The manager to be supernumerary to the stated staffing levels. Date of last inspection 31st January 2005 Brief Description of the Service: Guide Lane is a purpose built home situated in the village of Audenshaw. The home provides nursing and personal care for up to 41 service users.The home is owned by Southern Cross Home Properties Limited, a private company, and is under the day-to-day control of a full time manager who is also a registered nurse.Accommodation is provided over two floors and consists of 37 single rooms, four of which offer en-suite facilities, and two double rooms for service users wishing to share accommodation. Two lounge/dining rooms and a smaller “quiet” lounge are provided offering choice to service users for socialising.A pleasant, well-tended garden is accessible to all service users. The home is on the main bus routes to Audenshaw, Ashton-under-Lyne and Manchester and is also close to Guide Bridge and Ashton-under-Lyne railway stations. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken by one inspector who spent time talking to residents, relatives and staff. Five residents were looked at in detail, looking at their experience of the home from their admission to the present day. A selection of staff and residents’ records were examined including records of care, menus, staff duty rotas, staff personnel files and training records. Prior to the inspection the home provided information by completing a preinspection questionnaire and comments cards were sent to some GP’s and other healthcare professionals who visit the home to see their patients. Three have responded to date who were satisfied with the overall care given to residents in the home. Comments cards were also sent to the home for residents and relatives to use. Five relatives had responded at the time of writing this report who were all happy with the overall care provided by the home. One relative felt there was not enough staff on duty but this view was not held by the other four. What the service does well: Residents are always assessed thoroughly before they come into the home and staff have a very good understanding of what each resident can do for themselves and what they need help with. Visitors are made to feel very much at home and staff said they felt they communicated well with relatives and had a good rapport with them. One resident said her family and friends were always made welcome and staff made them a hot drink when they visited. The home has a good management structure in place with two groups of residents being cared for by separate teams of nurses and carers. Residents and care staff have a lot of confidence in and respect for the nurses, who are knowledgeable, experienced and well supported by the manager. Residents were very complimentary about staff at the home. One resident said staff work well as a team and she “couldn’t fault them”. When asked what was the best thing about living at the home one resident said there was “nothing bad about living here – (the) people are so kind. The staff are wonderful”. One resident said the atmosphere was friendly and sociable and residents and staff have a good laugh. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 6 One resident could not think of anything that could be done better and said it was a well run home. One relative said the home was nice and clean and they were pleased that staff did not seem to leave and if they did they often came back to work at the home again. Two relatives said they were very satisfied with the home, had no problems and staff were “wonderful”. 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. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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) 3 Residents are assessed before entering the home to be certain that the home can meet their needs. EVIDENCE: Examination of five residents’ care files showed that very detailed assessments had been completed for each resident prior to their admission to the home. Following admission, assessment continues and the files set out the normal routine for residents and their additional care needs. Staff said the manager undertakes the pre-admission assessments and an individual’s care needs would be discussed and explained to staff before they arrived at the home. Staff are also encouraged to read the care plans, and receive a handover from the nurse in charge at the beginning of each shift so they are updated with any changes to care. Staff spoken to knew the residents well, understood their care needs and were able to describe their usual routine. Residents and relatives spoken to stated that staff were aware of what they could do for themselves and what they needed help with. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 The majority of care plans set out the health, personal and social care needs of the residents but more rigour is needed to ensure that full details are provided and systems are in place to monitor residents properly. The health care needs of the residents are met. Residents feel that they are treated with respect. EVIDENCE: Examination of five residents’ care files showed that care plans had been developed to meet residents’ assessed needs. Care plans had been reviewed monthly and residents’ care reviews had been held, in which relatives and the advocacy service had been involved. Occasional care plans were vague, for example one care plan said that the resident’s intake and output and weight should be monitored, but did not say when or how this should be done and no record of the resident’s weight was available. Risk assessments had been undertaken for pressure sores, moving and handling, bed rails, nutrition and falls. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 11 Relatives’ communication records provided evidence that relatives had been updated on changes to the health of residents. Residents stated that they had been seen by GP’s, chiropodists, urologists and opticians and had attended outpatient appointments at the hospital where necessary. Two GP’s who returned comments cards stated that staff had a clear understanding of the care needs of residents. Another health care professional who visits the home commented that care plans had not always been followed but felt this was when agency staff had been on duty. Wound care plans were detailed and photographs of wounds had been taken to help staff evaluate the effectiveness of treatment. A small number of female residents do not like their personal care being carried out by male carers and this was recorded on their care plans and their wishes adhered to. One resident said staff were very caring and one resident said staff treated her well but tended to rush her when they were busy. All residents spoken to felt that their privacy and dignity were maintained by staff. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 and 15 The lifestyle needs of some of the residents are not always met. Residents are helped and encouraged to maintain contact with family and friends and are supported in exercising control over their lives. Meals are enjoyed by residents but the food provided at teatime and the timing of this meal should be reviewed as some residents wait too many hours between tea and breakfast. EVIDENCE: All of the residents and staff agreed that the provision of activities was an area that needs improvement and the manager also acknowledged this. Although the home has a mini bus there have been very few trips out of the home for residents. One resident sometimes went out of the home with relatives and one resident had been for a week’s holiday to stay with relatives. One relative said the home arranged entertainers to sing for residents about once a month. One resident said she was visited by a minister from the church and had received communion whilst at the home. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 13 Recreational activities records for residents contained very few entries and one resident said it could get boring at times. The home’s activity’s organiser is currently on maternity leave and the manager is advertising for a replacement. In the meantime one of the relatives has been undertaking activities with the residents on a voluntary basis. Consideration could also be given to expanding the role of the key workers to include provision for them to spend time carrying out one to one activities with residents. Visitors said they were made very welcome at the home and a good rapport was noted between staff and relatives. One resident had a visitors’ book in her room in which friends could record their visit and make any comments. The resident’s family liked to read this as they lived a distance away and liked to see who had visited. One resident had a phone in her room so she could keep in contact with friends and family. Residents said that they were able to choose how to spend their day and were free to move around the home as they wished. One resident who did not wish to have further active treatment had these wishes recorded in their care plan and their family and GP had been involved in the decision. Comments were mainly positive regarding the food provided by the home. One visitor said his relative thought the food was delicious and it had improved since a new chef had been appointed. One resident said she definitely liked the food and as a diabetic found that sugar free desserts were particularly good. Cold drinks were readily available and one resident said she could ask staff at any time for a hot drink and someone would make her one. One resident said the chef was very obliging and tried to make specific dishes she liked. Lunch was liver and onions or pork casserole. Residents were offered the choice at the time of the meal as it had been found that if they were asked to make a choice earlier some residents forgot what they had asked for. Menus and the meals served at teatime in particular must be reviewed, as a typical meal at teatime would be soup and sandwiches, which is served about four times a week. The soup is not always homemade (further consideration must be given to its nutritional content) and no other hot choice is available. The meal is served at 4.30pm, which leads to the possibility of some residents who go to bed too early for supper, fasting for many hours before breakfast. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Residents and relatives are confident that any complaints will be dealt with satisfactorily. Further training is required to ensure that residents are protected from abuse. EVIDENCE: Residents said they would complain to the manager or the deputy manager and were certain their complaint would be dealt with fairly. All residents had a lot of confidence in the senior staff in the home. Two complaints were recorded together with the actions taken to address the complaints. The home has policies and procedures in respect of preventing adult abuse, which refers to the local authority procedures. Staff said they would report any suspected abuse to the manager, but had not had any formal training in this topic. Staff have also not received training in dealing with challenging behaviour. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 standard(s) 19 and 26 The home is well maintained and suitable for residents to live in. EVIDENCE: The majority of this section was not assessed at this inspection. However it was very pleasing to note that the two main lounges had been redecorated and were awaiting carpets. It was also reported that new furniture had been ordered and delivery was expected later in the week. The redecorated lounges were bright and homely and furniture had been repositioned to create more cosy, informal sitting areas. The hallways had also been redecorated. Residents and relatives stated that they were happy with the standards of hygiene in the home and no odours were detected. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 16 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, 29 and 30 The numbers and skill mix of staff ensure that the needs of the residents can be met. Recruitment practices ensure the protection of residents. Training on a variety of topics has been provided, but staff need further training in some areas. EVIDENCE: Staff and residents felt that staffing levels were sufficient to meet the residents’ needs. Staff said that agency staff were very rarely used which led to better continuity of care. Examination of staff duty rotas indicated that the home was continuing to staff to levels previously agreed. Examination of three staff files indicated that new staff had undergone thorough recruitment procedures. Files contained criminal disclosure certificates from the CRB and checks had been made against the POVA list. Files also contained references, job descriptions, contracts, records of supervision and certificates of training. However two of the three files did not have proof of identity on record. One voluntary worker should apply for a disclosure certificate from the CRB. Training records indicated that staff had received training in mandatory health and safety topics such as moving and handling and fire safety, but there was less evidence of training in other topics specific to the care the home has to Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 17 provide to residents. The manager reported that training in the care of dementia was being accessed through Tameside consortium. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 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) 33 Residents are consulted about how the home is run. EVIDENCE: Minutes of staff meetings showed that different groups within the staff team had met regularly. Handover sessions are also held at the start of every shift and staff felt they had opportunities to discuss changes that they may feel were necessary. Residents meetings had been held in June and August 2005, although in August no one attended. The manager regularly works alongside the nurses and carers and maintains a visible presence around the home, so residents, relatives and staff felt she was approachable and accessible. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 19 Resident opinion surveys had been distributed randomly – ten had been returned recently with the majority positive. Where comments or suggestions had been made, the manager reported that those had been addressed. Residents had been consulted about the décor of the lounges when they were redecorated. Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 4 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x x x Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 21 yes 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 7 Regulation 15 Requirement The registered person must ensure that care plans set out in detail the actions which need to be taken to ensure that all aspects of the health, personal and social care of the residents are met and must ensure that the care stated is carried out as planned. The registered person must ensure that residents are consulted about the programme of activities arranged and must provide facilities for recreation which are flexible and varied to suit residents expectations, preferences and capacities. (Timescale of 31/3/05 not met). The registered person must ensure that the content of the teatime meal provides adequate nutrition for residents and must review the timing of the meal and the provision of a supper snack to ensure that residents do not wait for longer than twelve hours without being offered food. The registered person must ensure that staff receive training in the prevention of abuse and Timescale for action 31/10/05 2. 12 16 30/11/05 3. 15 16 31/10/05 4. 18, 30 13, 18 28/2/06 Guide Lane Nursing Home F54-F04 Guide Lane s25434 v236427 230805 Stage 4.doc Version 1.40 Page 22 5. 29 19 6. 30 18 dealing with challenging behaviour. (Timescale of 31/5/05 not met). The registered person must ensure that staff files contain proof of identity including a photograph. The registered person must ensure that staff receive training in topics that are specific to the residents and the care that they are providing to them. 31/12/05 28/2/06 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 12 29 Good Practice Recommendations The registered person should ensure that consideration is given to the role of the key worker when determining how residents social care needs can be met. The registered person should ensure that any voluntary workers apply for criminal record disclosure certificates from the CRB. 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