Inspection on 14/07/05 for Harrogate Lodge Care Home

This inspection was carried out on 14th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harrogate Lodge Care Home 19/10/09

Harrogate Lodge Care Home 13/09/07

Harrogate Lodge Care Home 21/09/06

Harrogate Lodge Care Home 28/03/06

Harrogate Lodge Care Home 26/01/05

Harrogate Lodge Care Home 18/05/04

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

CARE HOMES FOR OLDER PEOPLE Harrogate Lodge Harrogate Road Chapel Allerton Leeds LS7 3PD Lead Inspector Valerie Francis Unannounced 14 July 2005 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. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Harroget Lodge Address Chapel Allerton Leeds LS7 3PD 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) 0113 2392173 0113 2392174 Tamaris Healthcare Ms Patricia Donaldson Care home with nursing 50 Category(ies) of Old age (50) registration, with number of places Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Harrogate Lodge Care Home is a large purpose built building, which is situated in the Chapel Allerton area of Leeds. It is in close proximity to a local shopping area and recreational facilities. The location offers a good bus route to Leeds City Centre and to Harrogate.There is an enclosed parking area at the front of the building.The home is registered to Four Seasons Health Care.Harrogate lodge is registered for 50 older people having nursing or personal care needs.The accommodation is on two floors, 50 single rooms all with en-suite facilities.There are enough bathing facilities that are appropriate for the service users living at the home. Bathrooms and communal WCs are strategically placed throughout the building; service users have a choice of bathing facilities.Service users have access to the second floor via a passenger lift. Communal sitting rooms are strategically placed around for service user easy access. There are trained nurses, experienced care staff and ancillary staff available to service users 24 hours. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced visits. The last inspection was unannounced and took place on the 26th January 2005. There have been no further visits until this unannounced inspection. Copies of previous inspection reports can be accessed via the Commission for Social Care (CSCI) website. The people who live in the home use the term resident; therefore this is the term that will be used throughout this report. During the inspection, records were looked at, some areas of the home were seen, such as bedrooms, kitchen, lounge, dining room, laundry, toilets and bathrooms; nurses and care staff were seen carrying out their work. Discussions were held during the day with the registered manager, members of staff, visitors and residents. This inspection started at 10.05am to 5.15 pm carried out by two inspectors. What the service does well: The manager makes sure that people who move into the home are properly assessed; residents at the home receive good healthcare support and healthcare professionals. Staff members treat people with respect, and are caring and friendly. The staff team is given training to deliver appropriate care to residents. Lots of people spoke very positively about the manager, comments related to ‘ her commitment and hard work’ and ‘a good understanding of the residents’ needs’. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The main areas of concern from this inspection were around information in care plans, some of the care plans are prewritten and do not reflect the individual whose plan of care it is, there is not always a plan of care for assessed care needs which relate to improvement and more information being recorded on care plans. Because of the vacancy of the deputy manager and administration staff the registered manager is not always able to manage the home as efficiently and effectively. When a deputy is in place management supernumerary time should be given to support the manager and to carry out the management tasks allocated as part of the job description. The organisation must have a statement of purpose and service user guide that meets the requirement of the legislation and provide prospective with good information about the home and service provided at the home. All service users paying for their care privately must have an up to date contract. A number of requirements and recommendations have been made to address these issues. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 7 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. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 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 Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 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) 1,2,3 &5. although plans were in place for intermidate care;standard 6, this did not apply to this home at the time of the inspection. Prospective residents and others did not have access to information on the home to enable them to have informed choice. Residents had not signed a written contract of tenancy. The home’s assessment does not provide enough information for a care plan to be developed; therefore potential needs could be overlooked. Residents said they had EVIDENCE: The home statement of purpose and Service Users Guide was not available for inspection the manager said at the time it was being reviewed by management to the home. She was advised that a copy must be sent to the CSCI area office to make sure it met with the requirement with the regulation and it provided people wanting to access the home information. Although the inspector was told that new written contract for tenancy was available no resident had been issued a copy that would give them clear information on their rights as a resident and what is expected of them by staff. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 10 Six residents care files were inspected, there were no pre admission assessments on one of the person file who was an intermediate admission, the manager said she did not do pre-admission assessments for people being admitted to step down beds (intermediate) One resident said she had been at the home for a six-week trail before becoming a permanent resident Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,,8 & 9. The care planning system continues to improve although staff and service user involvement is limited. Further developments are still needed, to ensure consistency is applied. The home provides good healthcare and works effectively with healthcare services EVIDENCE: Of the six of care plans were seen one had a photograph but the consent to photo had not been signed. In one file the information regarding death wishes said the family did not want resuscitation, there was no evidence that proper consultation had taken place Pre-printed care plans with tick sheets that do not give a picture of individuals’ needs and how they will be met. Some for example catheter care do not give details of how catheter care should be done and contain phrases such as “universal hygiene” Waterlow assessments used to identify the risk of pressure sores but no care plan to say what will be done in response to identified risk. Nutritional assessments done but not linked to care plans. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 12 One resident identified as needing help with eating had no care plan for this. Risk assessments in place for use of bedrails. Moving and handling assessments done and give details e.g. type of hoist and sling to be used No records of visits from multi-disciplinary team other than GP and no records of chiropody or eye tests There was evidence of consultation with family in any of care plans, however in one case there was no evidence of consultation with the resident although he was capable of expressing his views Issues relating to residents care recorded in daily records but not always linked to care plans e.g. sore under breasts Care plans had been reviewed monthly No social care plans although a social assessment done in three of the files Record of social activities showed residents attended BBQs in the home and sat out in the garden Overall residents and relatives spoke with at the time of the inspection and from comments made in comment cards were satisfied that care needs were being met. However, one relative said that there is not always enough attention to detail, on occasions she has found her relative in a wheelchair without the proper cushion. All the required policies and procedure were available in the home and the home has a copy of the recommended national guidelines from the Royal Pharmaceutical Society. There were no residents who were self-medicating. Records are kept of medicines received and returned and the majority of medication record sheets had been fully completed. The controlled drugs records were accurate. The fridge in the first floor medicine room was not maintaining the required temperature; the manager had already identified a problem with the ventilation in this room and was taking action to remedy the problem. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. More structure and choice is needed for social activities in the home. EVIDENCE: Comments made in comment cards from five relatives and visitors indicated that care appears to be basic and there were no real attention to social actives or any stimulation for residents as they were bored. A programme of planned activities is displayed in the home however the records seen suggested activities were limited to sitting out in the garden and attending BBQs organised by the home. When asked about how residents spend their time staff said they have visitors, sit in the garden and go to BBQs, they also said someone came from the church but were not sure how often. One resident said she was not aware of any activities going on in the home, she said there was no one to talk to in the lounge so she stayed in her room. Relatives said they were not aware of residents having the opportunity to take part in outings and felt that the activities programme was not as good as it had been. Staff said that residents could choose what time they got up and went to bed. Visitors said they could visit at any time and visits can take place in private. One relative was concerned that no progress had been made on plans for a memorial garden, money for which had been donated to the home, with his permission this information was passed onto the manager. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 14 Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. The home complaints procedure is accessible at the point of entrance of the building. All complaints are taken seriously and acted upon. EVIDENCE: Residents and other have access to the home’s complaint procedure, which is displayed on the notice board in the entrance of the home. The information gives people information on the process and the address and telephone number of the CSCI local area office. Residents and relatives said they were aware of how to raise any concerns they might have and were confident that the manager listened to their concerns and acted on them. There was, however some comments from relatives and visitors in Comment cards that they were not aware of the availability of the procedure. A recommendation relating to this issue has been made. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Cleanliness in the home needs attention so that infection control is not compromised. EVIDENCE: Not all of the standards were inspected at this time. The manager said that the is a redecoration schedule for bedrooms and communal areas, the inspectors were also told that there was a programme of installation of locks to bedroom doors, at the time of the inspection ten bedroom doors had a lock fitted. There was an unpleasant smell in some parts of the home, most noticeably on the first floor. The manager said that the floor covering was going to be replaced in five bedrooms. One relative commented that the home is not always as clean as it should be, most noticeably at weekends. Some pedal bins were broken, pedals not working. Comments made from relatives on comment cards indicated that some relatives felt that the home needed clean especially bathrooms and resident ensuites. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 &30. The registered provider needs to look at improving the staffing levels, because of the high care needs of the people living at the home. The training provided for new staff ensures that they are competent to carry out their work with residents. EVIDENCE: It was evident from the staff rota and from comments made by relatives and residents that the staffing level at the home needs to be looked so that residents have access to enough staff during the day and night. At the time of this inspection the deputy manager post was vacant the manager said this post was to be filled in the fort coming weeks of the 1st September 2005. There was also 1 qualified nurse fulltime and one fulltime night nurse posts vacant. However although there were no care staff vacancy it was clear that some consideration needs to be given to increase the staffing level, in the home to make sure that residents have enough staff to administer good standard of care 24hours that is appropriate to meet the individual needs of people living at the home. One member of care staff have been designated the person in charge of intermediate care residents. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 18 It was evident that there has been a great push with regards to staff training since the last inspection, so that staff are appropriately trained to meet the care needs of residents. All new staff have written induction training, several staff have undertaken infection control, care of the dying. There is a training Matrix 2003,2004/5. outside agency is used for staff training, all qualified nurses has undertaken wound care, gastric feed. Staff have had moving and handling training, fire safety, key workers role and record keeping, adult protection, customer service and Dementia. Discussion with staff reviled that there is substantial amount of training is given. Residents and relatives said the staff were friendly, residents said they felt well cared for and safe in the home. One relative said that there seemed to be less staff available at weekends. Staff said they are actively encouraged by the manager to take part in training, training sessions are held on a range of topics including safe working practices and privacy and dignity. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 19 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) 32 & 38. It was evident that the manager needs more support in the home to enable her to fulfil her role as registered manager. Health and safety checks recording systems must improve. EVIDENCE: Resident, visitors and staff, spoke of the readily availability of the manager. No deputy, someone appointed but not starting until 6 Sept., no admin staff in the home, has not had permanent admin support since Jan 04, three have started and left within a short time. The registered provider should give some consideration to give the person in the deputy post time way from hands on, to enable that person to share the management role within the home. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 20 Insurance Certificate expiry date June 2005, manager said she had received the new one It was noted that a resident had had an accident last week and the form could not be found and CSCI had not been notified of the incident, which involved a head injury. Although Health and safety checks were being carried out and records kept, the records showed that the checks were not regular as per the home policies. Fire safety check were carried regular, the manager said plans were in place to carry out Schedule 2 recommendations made by West Yorkshire Fire Service. A repair log is kept, which is available to the handy person. Hot water outlet in staff wc was found to be subjectively hot. Weekly wheelchair checks are carried out and recorded on the wheelchair inspection form however the last date was the 11.04.05. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 21 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 2 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x x x 2 Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 22 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 OP1 Regulation 4 Requirement The organisation must have a statement of purpose and service user guide that meets the requirement of the legislation. residents must be given a contract of terms and conditions. a copy to be sent to the CSCI area office. An assessment of care needs must be carried out for all prospective residents. The registered manager must ensure service user plans contain sufficient information relating to the individual specific care needs, and all assessed care needs. A plan of care must be in place for all identified risks. Any risk identified in the Nutritional assessments must be linked to a care plan residents or/and their representative must be involved in care planning process. A record should be kept of any visits from multi-disciplinary team and GP and other health care professionals. J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Timescale for action 5th November 2005 5th November 2005 14th July 2005 5th November 2005 2. OP2 5(1) 3. 4. OP3 7 14 15(1) 5. 6. 7. 8. 7 8 7 8 13 & 15 15 15 13 5th November 2005 5th November 2005 5th November 2005 5th November 2005 Page 23 Harrogate Lodge Version 1.40 9. 10. 11. 19 27 27 23 18 13 & 18 The issue of the cleanlines of the home must be address. staffing level at the home must increase, and all vacant postions filled. The registered manager must ensure that there is enough domestic hours to meet the requirement of the home. There must be sufficient management staff allowing supernumerary hours for the manager so that she can manage the home effectively. recomendations made by the West Yorkshire Fire Service must be resloved. All matters relating to health and safety in this report must be address to enasure that the health and safety of residents are not compromised. 5th November 2005 5th November 2005 5th November 2005 5th November 2005 5the November 2005 12. OP27 18 13. 14. OP38 OP38 23(4) 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 7 27 Good Practice Recommendations written consent should be sought from resident for photographs The Registered manager should have support from a deputy who has supernurmery hours to assist her. Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP 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 Harrogate Lodge J52 S44506 Harrogate Lodge V238256 140705 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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