Inspection on 20/01/06 for Halstead Lodge Nursing Home

This inspection was carried out on 20th January 2006.

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

Halstead Lodge Nursing Home 30/10/06

Halstead Lodge Nursing Home 02/11/04

Halstead Lodge Nursing Home 07/06/04

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

CARE HOMES FOR OLDER PEOPLE Halstead Lodge Nursing Home Hedingham Road Halstead Essex CO9 2AE Lead Inspector Ray Finney Unannounced Inspection 20th January 2006 09:00 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 Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Halstead Lodge Nursing Home Address Hedingham Road Halstead Essex CO9 2AE 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) 01787 478473 01787 478550 Care UK Community Partnerships Limited Mary Ruth Logan Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (3), Physical disability (30), Physical disability of places over 65 years of age (30), Terminally ill (7) Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 7 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) One named person aged 42 years, whose name was made known to the Commission in November 2005, who requires nursing for palliative care The total number of service users accommodated must not exceed 30 persons 28th April 2005 Date of last inspection Brief Description of the Service: Halstead Lodge Nursing Home is registered to provide nursing care for up to a total of 30 service users. This home does not offer care for older persons with dementia. The home is a purpose-built, two-story building in the grounds of Halstead Hospital. It has 30 beds within 26 single and 2 double rooms. The double rooms have en suite toilet and basin; the single rooms have basins only. There are a variety of communal areas, including a sitting room on the ground floor and a dining room and sitting area on the first floor. The home has attractive, well-kept gardens and ample car parking is available. The home is located close to Halstead town centre. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 20th January 2006 over a period of 6 hours. The inspector was given every assistance on the day by the Registered Manager Mary Logan. During the inspection care staff and residents were spoken with and one visiting health professional. The inspection also included a tour of the premises, evidence gathered from samples of records and observations of interactions between residents and members of staff. The visiting health professional spoke well of the home and residents appeared happy and relaxed. Interactions between residents, staff and Manager were observed to be good. What the service does well: What has improved since the last inspection? What they could do better: Although the home was clean and the décor throughout was of a reasonable standard, some of the carpets were shabby and showed signs of distress. The home would benefit from replacing old floor coverings. There was evidence that the home sought the opinions of residents, however it would benefit from Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 6 developing the Quality Assurance system to ensure that residents’ views underpinned the annual development plan for the home. 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. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 is not applicable) The needs of residents were assessed before admission to the home. EVIDENCE: The home had policies on ‘Pre-admission assessment’ and ‘Assessment of Service Users’. The policies clearly set out the responsibilities of the company, the manager and staff. Three residents’ files were examined. One file of a long-standing resident did not contain a pre-admission assessment but more recent files did. A number of nursing tools were used in the assessment process. The ‘Barthel’ assessment system was used to assess levels of dependency and was reviewed monthly. Mental status was reviewed threemonthly. The home used the ‘Waterlow’ pressure area assessment tool and there was evidence of regular three-monthly review. The home also used nutritional and manual handling assessment tools. The manager informed the inspector that pre-admission assessments were carried out either by her or one of the qualified nursing staff. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 9 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): 8, 9 and 11 The home ensured that the health care needs of residents were met. Residents were protected by the homes policies and procedures for dealing with medicines. The home’s procedures around dying and death ensured residents and their families were treated with care, sensitivity and respect. EVIDENCE: He manager said they were looking at continence issues overall in order to ensure that residents’ continence needs were being met in the best possible way. One member of staff who had completed a course around continence was conducting a survey of continence needs throughout the home with a view to implementing a programme of continence care that met the needs of each individual resident. The manager said that only one resident had a pressure area and that had been ongoing for a long time. Every available treatment was being used to deal with the matter. The inspector spoke to a visiting optician who saw residents in there own rooms. The optician had not had any difficulties at the home. The homes procedures around medication were examined. Medication was stored in locked metal cupboards or a locked fridge. Controlled drugs were Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 10 stored in a locked metal cabinet fixed to the wall and in addition the treatment room was kept locked. The controlled drugs register was examined and found to be in order. Fridge temperatures were checked and recorded; open medications were appropriately marked with the date of opening. Since the last inspection the responsibility for ensuring medications were current had been undertaken by one qualified member of staff. The medication of one deceased resident were being kept for the required period before being sent for disposal. An outside company had the contract for disposing of unused/unwanted medication and the manager said that there were no difficulties with the arrangements. The home used a monitored dose system. The Medication Administration Sheets were examined and found to be in order and correctly signed. MAR sheets contained photographs of residents. At the time of the inspection there were no residents self-medicating. Staff spoken with showed a good awareness of requirements and procedures around medication. The manager said that although care staff did not administer medication, senior carers had completed a medication awareness course. Policies and Best Practice Guidelines on Dying and Death were examined. The manager explained how the home supported residents with terminal illnesses. The emphasis was on privacy, dignity and meeting the personal needs and wishes of both the resident and relatives. Records examined showed that residents received appropriate medication for pain relief and this was reviewed regularly. The G.P. visited the home three times a week. Some members of staff had completed a course run by the Hospice. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 The home encouraged contact between residents and family, friends and the local community. Residents were supported to make choices and retain control over their lives. EVIDENCE: The manager informed the inspector that relatives and visitors were always welcome. On the day of the inspection a number of visitors were seen. The home ensured good links with the community were maintained. Someone came on a regular basis to play the organ. Two pantomimes had been organised to entertain the residents and local carol singers came in to the home. On a tour of the premises, the inspector saw evidence of personal possessions in residents’ rooms and some had brought in smaller items of furniture. Records examined showed that inventories of personal possessions were kept on file. The home did not manage the financial affairs of residents. The manager said that this was usually carried out by family members or a solicitor. One resident’s financial affairs were managed by an advocate. The home had insurance cover for resident’s personal items. There was a small bar in the communal lounge so that residents could have a drink if they chose. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 12 Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 13 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): These standards were not inspected on this occasion. EVIDENCE: No evidence was examined for these standards at this inspection, however all three were examined at the last inspection and the standards were met. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 14 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 The home ensured that residents lived in a safe, well-maintained environment. EVIDENCE: A tour of the premises showed that the home was well maintained. There were no unpleasant odours throughout the home. Although overall the standard of hygiene was good and the décor throughout the home was acceptable, some of the carpets, particularly upstairs, were a little shabby and showed signs of distress. However, the manager was aware of the need to replace the carpets and it was to be part of the continuing programme of routine maintenance and renewal. Throughout the home the décor and furnishings were domestic in nature. There was a variety of comfortable, domestic seating in the communal lounge, including recliner chairs. The grounds were well maintained and were accessible to residents. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 15 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 and 30 The home had appropriate staffing levels to meet the needs of residents currently living in the home. Staff had the skills to ensure residents were cared for safely. Staff were trained and competent to do their jobs. EVIDENCE: The manager told the inspector that a four weekly rolling rota was in place. The home employed a good mix of skilled staff – qualified nurses, carers, cleaning and domestic staff. Domestic staff were sufficient to ensure the home was clean and hygienic. All staff providing care were over 18 years old. On the day of the inspection staffing levels were seen to be appropriate. The manager had not used the Residential Forum to calculate staff numbers required, but said she would do this to double check that staffing levels in place met requirements. There were a total of 14 out of the 18 care staff in the home who had either completed NVQ qualifications or were estimated would be finished by the end of March. A total of 3 staff had completed level 2 and 4 staff had completed level 3; a further 5 staff had almost completed level 2 and 2 had almost completed level 3. Although at the time of the inspection the ratio of trained care staff was below the minimum set in the standards of 50 , by the end of March this figure should be 77 . The training plan for the current year was examined and showed that statutory courses such as Manual Handling, Health & Safety, Fire Safety, Protection of Vulnerable Adults and Food Hygiene were all in place. There were also courses Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 16 planned for ‘Swallowing and Communication Awareness’. The manager informed the inspector that four of the qualified nursing staff had recently completed training around diabetes. One member of staff had completed a course on ear syringing. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 17 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, 33, 36 and 38 The home was run and managed appropriately. Overall the home was run in the best interests of the residents, although there was not an adequate quality assurance system in place. Staff received appropriate supervision and the home ensured the health, safety and welfare of residents and staff were promoted. EVIDENCE: The registered manager had a background of a number of years experience in management and in addition was a Registered Nurse. The manager informed the inspector that she was working towards the Registered Manager’s Award to ensure compliance with regulatory requirements. Some work had been carried out on the Quality Assurance process. The home had given out questionnaires to residents and received some responses. The home had also carried out surveys on the food provided to ensure peoples’ Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 18 likes and dislikes were being met. One resident liked spicy food but this was not generally wanted by other residents, so the chef ‘batch cooked’ curry for this resident and it was frozen in individual portions. However, in general the information gathered from completed questionnaires had not been collated and presented as a report. The home would benefit from developing their Quality Assurance system to ensure that residents’ views underpinned the annual development plan for the home. The results of residents’ surveys should be published and made available to residents, prospective residents, relatives and the Commission for Social Care Inspection. Since the last inspection the system of supervision had improved. Supervision records were examined and showed that supervisions were being carried out two-monthly and staff meetings were held monthly. A wide range of Policies and Best Practice Guidelines were in place covering infection control issues. On a tour of the premises appropriate facilities were seen for the disposal of medication and ‘sharps’. Personal protective clothing such as gloves and aprons were available. The manager showed an awareness of responsibilities and procedures around RIDDOR. Records of water temperature were seen in bathrooms and also guidelines for care staff around safe bathing procedures. Fire extinguishers examined had been safety checked within the last year. The manager produced evidence of Health and Safety checks for Legionnella, Pest Control, Health & Safety and Gas Certificate. During the tour of the premises a cleaning trolley had been left unattended and a key left in the door of the cleaning store. The Manager dealt with the problem promptly and appropriately. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 3 Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24(1)(a) (b)(2) Timescale for action The manager must ensure that 30/06/06 information obtained through the home’s quality assurance system is collated into a report, which is made available to residents and a copy of which is sent to the Commission for Social Care Inspection. Requirement 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 Refer to Standard OP27 OP28 OP31 Good Practice Recommendations The manager should use a system such as the Residential Forum for determining the ratio of care staff to residents. The manager should ensure that carers complete NVQ awards. This refers to the recommendation that 50 of care staff should hold an NVQ qualification. The manager should complete the Registered Manager’s award. Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 21 Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Halstead Lodge Nursing Home DS0000015334.V274865.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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