CARE HOMES FOR OLDER PEOPLE
Harrogate Lodge Care Home Harrogate Road Chapel Allerton Leeds Yorkshire LS7 3PD Lead Inspector
Valerie Francis 13
th Unannounced Inspection & 14 September 2007 10:00a
th 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 Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Harrogate Lodge Care Home Address Harrogate Road Chapel Allerton Leeds Yorkshire LS7 3PD 0113 2392173 0113 2392174 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) www.fshc.co.uk Tamaris Healthcare (England) Ltd Ms Patricia Lynne Donaldson Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st September 2006 Brief Description of the Service: Harrogate Lodge Care Home is situated in the Chapel Allerton Area of Leeds. This establishment is part of Four Seasons Health Care. A national provider with over 300 services. Harrogate Lodge is situated off the main Harrogate Road in easy walking distance to the local bus stop, shops, post office and other services. Parking is provided for any visitors. The establishment is built for the purpose of providing nursing and personal care to up to 50 older people. Six beds are currently contracted to provide respite care and short stays for individuals recovering from ill health. The home is situated on two floors and a passenger lift is fitted within to meet the needs of individuals who are unable to manage stairs. There are fifty single rooms with en-suite facilities and each floor has a number of communal dining and lounge areas as well as a choice of assisted bathrooms and showers. Additional to the en-suite facilities there are adequate numbers of communal toilets in close proximity to communal rooms. The reception provides for visitors seating, facilities for visitors to have refreshments and information leaflets that may be of interest to those who use the service and their visitors. The managers and administrators offices are conveniently located here. The current scale of fees is £375 to £565 weekly. Additional charges are made for chiropody, hairdressing, newspapers and personal items. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk One inspector carried out a key inspection looking at the standards, which is highlighted in the report. The inspection was carried out over two days the 13th and 14th of September 2007 at 10 am on each day over 14 hours. The purpose of this inspection was to make sure the home was providing a good standard of care for the people living there. And to monitor progress on the requirements and recommendations made at the key inspection on the 26 September 2006. The people who live at the home will be refered to, as the people who use the service; therefore this will be used throughout the report. The methods used at this inspection included looking at care records, observing working practices and talking with people who use the service, visiting relatives, staff and members of staff from the intermediate care team. Information gained from AQAA (Annual Quality Assurance Assessment) and the service history records were also used. Before the visit, survey questionnaires were sent out to the home for visiting relatives and people who use the service. Five returned from people who use the service and six from relatives, this information has also been used in this report. Four were given to visiting health care professionals. However to the time of writing this report none had responded by sending completed forms to the CSCI area office. Feedback was given to the manager at the end of the visit. Thank you to everyone for the pre-inspection information, returned survey cards and for the hospitality and assistance on the day of the visit. Requirements and recommendations made during this visit can be found at the end of the report. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
Since the last inspection there has been changes in the home recording systems and information for people now show how their care needs are being met, ensuring that there are no unmet needs. Efforts are being made to address the shortfall in meeting people’s cultural needs.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 7 Since the last inspection the manager has reviewed the home’s statement of purpose and service user guide to make sure it meets the requirement of the of the legislation. A new document to record care assessment is now in place and people now have a care plan which is person centred to ensure that people is cared for in the way they wish, with sufficient information relating to the individual’s specific care needs, and all assessed care needs. People and or their representatives had signed care plans agreements to indicate their involvement; this was also confirmed during discussions with visiting relatives. Regular reviews of care plans takes place, visiting relatives and surveys information indicated that they are invited to attend people’s care review meetings. Any risk or risk in the nutritional assessments identified is now linked to a care plan and monitored using a nutrition monitoring tool to make sure that all people’s identified risks are managed and minimised. From discussion with the activity organiser and from some social assessment documentation seen people’s cultural and religious needs were being started to be addressed and responded to, ensuring that peoples’ life before they came to the home when possible continues. Care review meetings gives people a forum so far as is practicable to make decisions with respect to the care they receive and their health and welfare. Since the last inspection a key worker has been matched to people and the employment of Asian activity organiser to ensure that due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of the people who use the service is given attention. Some work has started to address this with plans and written information in place to make sure that people’s wishes concerning terminal care and arrangements after their death are discussed and carried out. The home has a programme of replacement and refurbishment in so much as new carpets and furnishing has been bought for some of the bedrooms which the manager said will continue for those people who have not brought their own furniture with them to the home. Person centred care plans are in place for people for all their needs with monitoring forms for their personal care and toiletry needs, to make sure that all peoples needs do not get missed. There are systems in place for regular audit of medication to make sure that nurses are administering medication in line with the NMC (Nursing and Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 8 Midwifery Council) and the RPS (Royal Pharmaceutical Guidelines) for safe handling of medication. There is on going training for nursing staff relating to safe handling of medication; senior care workers have had training with the pharmacy company used by the home for medication. The social assessment tool is used to assess people’s social needs, people or their relatives are involved in putting the information together, and the activity organisers monitor this process. It was apparent from discussion with one of the organisers that work had started for People to have a recreational activities plan in place which takes into account their background and their interests past or present. There is now a training matrix which reflects the training needs of the home staff or individual which has been highlighted from their personal development plan, that would enable people living in the home to have access to staff that are trained to meet their specialist care i.e. Dementia and people recovering from illness. There are now over 50 of staff with an NVQ qualification and others undertaking the course and several others have registered to start the course, Audits are carried out during the recruitment process and when employment is offered a check list is completed to ensure that no one taking up employment before a satisfactory CRB (Criminal Record Bureau) and POVA (Protection Of Vulnerable Adults) check is carried out. All staff have regular six weekly one to one supervision where they could discuss their personal development. People have been advised of the service user guide in their room, that gives them information of the service as a resident in the home. The manager said all staff have been made aware of the availability of care plans. People’s care is discussed at the beginning of each shift during handover. Staff working with the people receiving intermediate care receive handover from the named nurse after her meeting with the Liaison nurse from the intermediate care team, to make sure they have information to meet the care needs of people in their care. An assessment is carried out for people who wish to self medicate. Safes are provided in people’s room where medication is stored for those wanting to self medicate. Work has been carried out to the garden to the rear of the building; fencing has been erected to make it safe for people to walk around without leaving the grounds. The manager said there is still ongoing plans to further develop this area which would enable people to sit out independently in the good weather.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 9 A record sheet is available for people to sign and duplicate invoices are given to people when they receive money held on their behalf. Staff have had training on person centred care, care plans for all people are now person centred which takes into account the person and not only their identified illnesses. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 10 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 Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is careful only to accept people after thorough assessment. This approach ensures that people are placed appropriately, with a realistic expectation that their care needs will be met. EVIDENCE: Information about the home is available to current and prospective people who use the service. There is a statement of purpose, service user guide and home brochure. A welcome pack is provided in every bedroom. The manager said the contents are discussed with people and their representatives on their admission to the home. The statement of purpose and service user guide, recently been reviewed to meet the requirement made at the last inspection. This information provides people who use the service and others with information about the service the home provides.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 12 People who use the service who responded to the survey said they had enough information to make a choice. And was given a copy of the home’s welcome pack. Since the last inspection the organisation has put in place a new assessment tool (DART) Dependency Assessment Rating Tool, which when fully completed with information about the person and their care needs, provide staff with good information about the person wanting to use the service and enables them to complete a comprehensive care plan. The manager or deputy carries out pre-admission assessments of prospective people who want to use the service, so that they can be sure that their care needs can be met at the home. In addition to the home’s assessment, information is gathered from other sources for example hospital discharge letters. Information is also collected on who was involved in the assessment, where it took place and how long it took. Three of the six relatives who responded to the survey indicated that home meets the needs of their relative’s living at the home. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide detailed instructions for staff on how to meet the care needs of the people who live at the home. People living at the home are protected by safe medication practices. The staff respect the privacy and dignity of the people living at the home. EVIDENCE: Care plans are in place for all the residents. Four people’s care records were looked at. All the records have clear photographs of the individual. Since the last inspection the home has reviewed care plans and how they were recorded. There is a commitment from the manager to improve the records with the intention of addressing any shortfalls in recording; the provider has introduced new documentation, to make sure people’s plan of care is clear with an action plan for staff to follow how people’s care needs will be met. Care plans are now person centred, the manager said staff have had training on person centred care.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 14 Each person has an individualised plan of care, developed initially from the pre-admission assessment and other related assessments carried out, such as falls risk assessment and one for the risk of skin damage. The manual handling risk assessment includes a management plan with instructions about the input needed from staff, the equipment needed and the number of staff required to safely assist people. The care plans provide clear instruction for staff for example; a care plan was in place for the management of a person who was high risk of choking. There was also information on how food must be served and what assistance is provided by staff at meal times. Turn charts were available for people who needed to be turned when they we in bed. A record was also kept for people who were totally dependent on staff for drinks. During the inspection it was noted that drinks were available to people, and there were bottles of water and glasses on tables in communal areas. However it was not clear if people who were less dependent than others to help themselves could get a drink, these people should be monitored to make sure that they are drinking enough and they do not become dehydrated. Although people’s cultural need is a priority at the home, a care plan seen for a black person did not reflect how their cultural needs would be met, to ensure that cultural need is given due attention. There was however, some good evaluation of care plans seen and there were also some good social care plans seen. Discussion with visiting families and from information from surveys they indicated that they were involved in the care planning process and any reviews taking place. Two people who use the service spoken to said they were involved in the care planning process where they can have their say about the care they want. The named nurse reviews care plans monthly with key workers. People who use the service for intermediate care, have a care plan in place drawn up with the intermediate care team about their rehabilitation about how they would be supported by the staff at the home with intervention from the intermediate support staff. There is handover in place to make sure information about people’s care is passed on from staff on each shift. Information is shared on a need to know basis. There are daily meetings with the intermediate liaison nurse to make sure that both the home staff and the intermediate team are working together to ensure that there is consistency in the care provided to people using this service. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 15 The deputy manager carries out a weekly audit and the manager carries out monthly checks of the medication system. The medication administration record (MAR) sheets and any gaps in recording are brought to the attention of the nurse involved. The medication room on Churchill suite is a rather cramped area but was clean and tidy. The manager said there is a plan to move the medicine room for more room. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has made efforts to provide people with meaningful social activities that meet their cultural needs, giving the opportunity to exercise choice in their daily lives, and supporting them to maintaining contact with family and friends. The food served does not meet the different cultural needs of the people living at the home. All effort has been made to provide people with pleasant surroundings to have their meals. EVIDENCE: Since the last inspection there has been improvement in people’s social activities, of the four files audited, three people had a completed social assessment, which the manager said was written by the person and/or their relatives. The home provides care to a diverse group of people from different cultures. This is reflected in the staff team such as polish and Caribbean. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 17 Two activities organisers have recently been employed for all together 24 hours, which has been agreed with line management to the home to increase the hours. They were beginning to develop a regular programme of activities for people as a group or individually. Plans are in place for each person to have an action plan of activities to meet their personal needs. One of the activities organisers was able to support the Asian people; the manager said this has been really helpful, as people no longer looked isolated. Staff spoken to said if they had any concern they were able to contact the activity organiser. Asian people who use the service were able to listen to music they could relate to, the activity organiser said she was working to provide people with films that they could understand. One African Caribbean man said he had done some cooking with the activity organiser in the small kitchen. The manager said care staff were also involved in activities to make sure people did not get isolated. Plans were being put in place to provide people with activities that were cultural sensitive to meet their needs. One relative who was visiting said “My mother never liked going out or playing board games, but since she has been here she has been out and she plays board games with other people living at the home. Three people who responded to the survey said they take part in what activities they wanted and felt that the two new staff were really helpful, one person said, “ I even went to church.” During the inspection several people were engaged by the activity organiser in board games, one person enjoyed looking on, on what was going on even though he did not take part. The manager is working with the staff with regard to record keeping on activities, and she was also trying to arrange training for the two staff on activities. People are supported to spend their time how they wish and some had chosen to stay in their rooms while others spend their time in the lounges. The lunchtime meal was observed on both floors. It was noted that people were waiting for sometime to be assisted with their meal by care staff, which would be cold by the time staff got to them. The manager said she was aware of this and training was being started with the domestic staff to assist the catering staff with giving people their meal, which would free up care staff time to assist people with their meal. The organisation’s menu does not reflect the dietary cultural needs of the diversity of the people living at the home. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 18 Although it is acknowledged that the catering staff have put together an additional menu of different type of meals, none were related to the people’s cultural needs at the home. Each person had a list of their likes and dislikes, which was in their care file and a copy in the kitchen, however more planning and discussion is needed with people on the type of food they really want to eat. People are encouraged to drink plenty and are offered nourishing snacks between meals, including home baking. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 19 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The adult protection and complaints policy and procedures make sure that people are listened to and are protected from abuse. People are protected from abuse with staff having an increasing awareness of adult protection. EVIDENCE: There have not been any complaints since the last inspection. There is a complaints procedure displayed in the home. People at the home and relatives spoken with, were clear about who they would speak to if they had any concerns. All those spoken with were confident that they would be listened to and that any issues would be dealt with appropriately. The manager and her deputy have a visible presence in the home and actively encourage the people at the home, their relatives and staff to discuss any issues or concerns. People have access to the complaint procedure from the information in the service user guide, which is found on the back of the door in people’s bedrooms in the welcome pack. The manager said a recent safeguarding issue highlighted that possibly more training was needed for staff, and instigated further training for staff on adult protection, despite people having had the training quite recently.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 20 All new staff have a POVA and a satisfactory CRB check before taking up employment with the organisation. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 21 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People live in a safe and well-maintained environment. EVIDENCE: Since the last inspection some refurbishment of bedrooms and redecoration and replacement of carpets has been carried out. Bedroom furniture has been replaced and specialist beds provided where needed. The manager said the plan is that all bedrooms will have new furniture and carpets. Some of the sitting areas have been redecorated with new furnishings, carpets and curtains. One room that had been damaged in a recent flood in the home has had new furniture and soft furnishing bought. Plans are in place for the entrance hallway to be redecorated in the rolling programme of refurbishment.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 22 The garden area has been made safe with a perimeter fence and furniture so the people can sit out in the good weather and not able to leave the grounds without staff being informed. Some people said they were now able to sit outside. There were photographs of events that had taken place in the garden during the summer. More work is planned to improve this area, so that people could best use the area more regularly if they so wished. The areas of the home visited were clean. Bedrooms are furnished to a good standard and many residents have brought their own items into personalise their rooms. The communal sitting and dining areas are comfortable and reasonably spacious. The manager said one of the sitting rooms on Churchill has been designated for people who smoke. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 23 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff were sufficient to meet the needs of the people who use the service. People are protected by the staff recruitment procedures. Staff are trained and competent to do their jobs. EVIDENCE: The duty rotas indicated that there are enough staff to meet the needs of the people. An established team of domestics, laundry and maintenance staff, as well as an administrator provide support for the nurses and care staff. The home is split into three areas. On the top floor is Nightingale where twelve of the rooms are designated for intermediate care. Two senior care staff and a named nurse has been designated to provided care to these people in this area, six care staff and two nurses are available to the other people during the day. At night two nurses and four care staff, one of which is designated for the twelve people who receive intermediate care. Information provided in advance of the visit states that over 50 of all grades of staff have achieved a National Vocational Qualification (NVQ) level 1, 2 and 3 with the other 50 of staff registered or awaiting to start their course. Ten staff was said to be completing in the near future.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 24 The deputy manager shows a clear commitment to the continual development of the training programme, She provides a high level of support for staff working at the home and to the manager. New staff have a two day intensive induction course before starting work at the home. They then continue their learning by working through the induction workbook which they complete within twelve weeks. There is a comprehensive training Matrix that identified and prioritised areas of training. The training provided makes sure that staff are equipped to properly meet the needs of the people at the home. Care staff caring for people on the intermediate care wing have been given training by the PCT (Primary Care) intermediate team to make sure that they can meet the needs of these people. A sample of staff recruitment files was looked at and the recruitment practices were found to be satisfactory. The layout of files was somewhat confusing the manager said she was introducing a new system to resolve this. Staff records are audited regularly by the manager, to make sure there is no omission of information. The records of recently employed staff demonstrated that all the required checks are carried out before staff start work at the home. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides clear leadership; guidance and direction to the staff to make sure that the people at the home receive a good level of care. The interests of the people at the home are very important to the manager and her staff and are safeguarded at all times. EVIDENCE: The registered manager is an experienced nurse. She has been in post for four years and has the necessary management qualifications. She is enthusiastic and committed to the continued improvement of the service and facilities at the home. The manager provides clear leadership to the staff and is supported by the deputy manager who also demonstrates a high level of commitment to the home.
Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 26 The manager has an open approach with the people who use the service and staff and is a good communicator. Staff spoken to and some people who use the service and their relatives described the manager as helpful, understanding and supportive. There are regular meetings for different grades of staff and groups, meetings for all staff and health and safety group, where issues’ relating to the delivery of care, food, health, and safety is discussed. Meetings with people living at the home are held monthly and relatives meeting planned to be held every eight to twelve weeks. Minutes are kept of all meetings. There is a well established programme of ongoing audit, for example, monthly audits are carried out of the care plans, medications and of kitchen practices. Monthly returns are sent to head office regarding, for example, accidents and complaints. Satisfaction surveys are also sent out on an annual basis through the organisation quality audit system the Team Auditing Process (TAP) that involves people who use the service, staff relatives and other involved with the home. The manager said outcomes are shared through the home’s newsletter that provides people and others with news of any event in the home and out come of any quality audits. Clear records are kept of any transactions of money kept on behalf of people. The financial records are subject to external audit. A safe is provided to people who wish to handle their own finances and their medication. Money that is deposited by people for safe keeping it kept in a bank account which is jointly shared with others, this account in none interest bearing. However, discussion is taking place with the bank to resolve this. Mandatory training provided to all staff, includes manual handling and moving, and fire safety training. One of the Registered Nurses is the in house manual handling trainer, which makes manual handling training more accessible and flexible. There was evidence from records audited that all the required health and safety and maintenance checks are carried out at the home. Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 2 X X 3 Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 28 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 OP11 Regulation 12 & 15 Requirement The registered manger must makes sure that people who uses the service and their family and friends are involved (if that is what the residents wants) in planning for dealing with increasing infirmity, terminal illness and death. So that people have the care the want at the end of their life. The last timescale given to address this issue 30/08/06. A further timescale is given to give the home time to commence training and work with people to discuss this matter. It was apparent that peoples like and dislikes are recorded on their plan with a copy kept by the catering staff in the kitchen. However the registered provider must work closely with the manager and catering staff at the home to provide people at the home from a different cultural group to have food offered to them that meet their cultural needs.
DS0000044506.V351436.R01.S.doc Timescale for action 31/12/07 2. OP15 12(4) 30/12/07 Harrogate Lodge Care Home Version 5.2 Page 29 3. OP15 12 The manager must ensure all staff are vigilant and monitor the fluid intake of people who are dependent on staff. A record should be kept to ensure people fluid is regularly monitored. The registered manager must ensure that risk assessment is carried out for the glass bottle for water available in all areas of the home, to make sure they d not become a safety hazard to some people. 05/10/07 4. OP38 13 05/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations It is recommended that staff at all levels receive training in recognising and responding to the diverse cultural and religious needs apparent. The manager should ensure that residents wear their own clothing and when items are laundered they are retuned to the named person. The registered provider should give due consideration to have the sound level of the nurse control system lowered or replaced, so that other people living at the home is not disturbed by the noise. 2. OP10 3. OP19 Harrogate Lodge Care Home DS0000044506.V351436.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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