Inspection on 21/09/06 for Harrogate Lodge Care Home

This inspection was carried out on 21st September 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Harrogate Lodge Care Home 19/10/09

Harrogate Lodge Care Home 13/09/07

Harrogate Lodge Care Home 28/03/06

Harrogate Lodge Care Home 14/07/05

Harrogate Lodge Care Home 26/01/05

Harrogate Lodge Care Home 18/05/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Harrogate Lodge Care Home Harrogate Road Chapel Allerton Leeds Yorkshire LS7 3PD Lead Inspector Valerie Francis Unannounced Inspection 21 September 2006 10:00 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 Harrogate Lodge Care Home DS0000044506.V310934.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.V310934.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) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) 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.V310934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th March 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, 12 of these beds are now contracted with the North East PCT to provide intermediate short stays for individuals recovering from ill health. The home is situated on two floors and a passenger lift is fitted for the needs of individuals who are unable to manage stairs. There are fifty single rooms with en-suite one of the 12 bedded wing is designated for the Intermediate care. There is a designated sitting/ dining area. A kitchen with laundry facilities has been fitted for rehabilitation process. On each floor there are 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 area 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. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Survey cards were distributed to relatives/ visitors and residents in order to give people the opportunity to comment on the services provided by the home. At the time of writing this report no residents or relatives had responded to the CSCI survey. The Commission for Social Care Inspection (CSCI) inspects homes at a frequency determined by the assessed quality rating of the home. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a visit to the home. All regulated services will have at least one key inspection before 1st July 2007. This is a major evaluation of the quality of a service and any risk it might present. The process focuses on the outcomes for people living at the home. All core National Minimum Standards are assessed and this provides the evidence for the outcomes experienced by residents. At times it may be necessary to carry out additional visits, which might focus on specific areas like health care or nutrition and are known as random inspections. This visit was unannounced and carried out by two inspectors over one day. It started at 9.30am, finished at 6.45pm on the 22 September 2006 with feedback given to the management team at the end of the inspection. During the course of the inspection the regional manager was visiting the home and discussion was had with her about the findings of the inspection. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents and to see what progress had been made meeting requirements made at the last inspection. Information to support the findings in this report was obtained by looking at the pre inspection questionnaire (PIQ). Examples of information gained from this document include details of policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Records in the home were looked at such as care plans, staff files, and complaints and accidents records. Residents, their relatives and visitors were spoken to as well as members of staff and the management team. CSCI comment cards and post-paid envelopes were sent to the home to be given to residents and their relatives four weeks before the visit was made. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 7 Information on all the services the home provided must be included in the home’s information that is available to prospective residents and other interested parties. Staff should make residents aware of the service user guide in their room, so that they are fully informed of the service a resident in the home can expect. Staff undertaking the assessment process must get enough information about the individual. The manager must make sure that staff providing the care to residents have access to care plans, which would provide them with information about the care needs of residents and what action to be taken to meet all their care needs. The home must have person centred care plan for all residents taking in account the individual person not only their identified illnesses. People living in the home must have access to staff that is trained to meet their specialist care i.e. Dementia and people recovering from illness. Residents should be given the opportunity to self medicate. The home should carry out a risk assessment for residents who wish to administer their medication. The nurse administering medication must make sure that the administering of medication is in line with the Nurses and Midwifery Council (NMC) and the (RPS) Royal Phermersuitcal Society guidelines for safe handling of medication. Residents must have their social needs assessed and met. Recreational activity plans must be in place for all residents’, which takes into account their background and their interests past or present. Support should be given to residents who have no contact with family or friends to have bedrooms that are personalised. 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 Care Home DS0000044506.V310934.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 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 the following standard(s): 1, 3 & 6. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home provides prospective residents and relatives with good information, but there was no evidence about the home providing Intermediate care. Staff undertaking the assessment process do not always get enough information so that there is enough information about the person to put together a care plan that is specific to the individual. EVIDENCE: The Statement of Purpose (SOP) and Service User Guide (SUG) were reviewed. Both documents are very thorough and informative. The SOP is available to all on request at the home. On inspection, it was noted that this document needed updating so that it included the relevant up to date information regarding the changes with the provision of rehabilitation care provided by the home. Those residents’ rooms that were inspected did have the SUG available to the residents and their visitors. However one new resident receiving shortterm care could not confirm whether she had a SUG or not. On further inspection, it was found hanging behind the bedroom door. This amused her as she said she would not have been able to reach it due to her condition. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 10 All the residents whose care plans were tracked as part of this inspection had all been assessed prior to admission to the home. These documents were then used to plan care for the resident when they were admitted. However there were gaps in recording that were seen and therefore not all the necessary information was obtained. This is poor practice, which could mean that vital information is missed about a new resident which would result in their needs not been met. The manager was advised that the person carrying out the assessment must make sure that the assessment form is fully completed with detailed information, so that a comprehensive care plan with action to be taken to meet the needs of the individual is in place. In the last three months prior to this inspection the home had been contracted with the North East Primary Care Trust (PCT) to provide Intimidate care to twelve older people who need assistance for them to return home. There is a dedicated area in the home with bedrooms and sitting area. At the time of the inspection work had started for a kitchen/ laundry area for these residents. There is also a designated sitting/dinning area, which is near the bedrooms. The intermediate care team staffs along with physiotherapist, occupational therapist and a Geriatrician come into the home to support these residents. Within the staff team at the home there are two designated care staff that have access to a named nurse for support. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9 & 10. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The lack of care staff access to care plans, creates an opportunity for misunderstanding and staff not knowing the resident. Care staff do not have the opportunity to write the daily notes on the care they delivered to residents on each shift. Although there is good information in care plans, the plans are not person centred, which is specific to/about that person and their life. The actions to be taken to meet the care needs of residents are not always clear. Medications are not always given as prescribed. Resident’s independency and choice are not always considered in relations to administration of medication. The residents receiving intermediate care get support from the intermediate care team coming into the home and designated care staff from the home’s team. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 12 EVIDENCE: The care plans for six residents were looked at. They contained evidence that the home does attempt to identify the care needs of the resident and also risk assess each individual in areas such as pressure area care, falls, moving and handling, nutrition and continence. Evidence was also seen to show other health care professionals are involved with a residents care when needed. This was evident from the care file seen from a resident who receive intermediate care. It was recognised that the home have made improvements in the above areas, however, there is still work to do. The care plans examined were written on an individual basis and in most cases they contained large numbers of instructions for the carer to do over the course of each shift. The inspector spoke to two carers about the care plans that were written for the residents that were case tracked and they confirmed that they knew little about what was contained within the care plans as these were mainly the remit of the nurses. They did say that they were able to look at them but they seldom had the opportunity. The inspectors attempted to triangulate the evidence available within some of care plans in an attempt to ensure that the actual care prescribed was actually happening. The evidence found showed that this was not always the case. For example, two care plans stated that the resident was to be turned two hourly. When the “turns charts” were examined it was clear that this was not happening and gaps as long as eighteen hours were identified in the care provided. Two residents nutritional care plans stated that they were supposed to be weighed every week and referred to dietician/GP if needed. This did not happen when the records were examined. One residents’ nutritional care plan stated that the carer were to record daily what the resident had eaten and drank each day. There was no evidence that this was done. Continence care plans informed the carer to provide appropriate continence care but did not inform them what exactly that was. Continence care plans did not highlight which continence aid was to be used and what size. Pressure area care plans stated “ All staff to work within the guidelines and policies of Four Seasons Healthcare for the prevention of pressure sores”. When care staff were asked what that was they were unsure. One resident with a pressure sore had a care plan in place that was in need of review. The bank nurse on duty found the plan of care for this wound very unclear and could not provide the inspector with an up to date wound care plan that highlighted how often the wound was to be dressed or what it was to be dressed with. There was evidence in two service user files that risk assessments had been carried out for the use of bed safety rails with an agreement signed by the relatives. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 13 Those residents whose care plans were inspected that had dementia, had very little reference made with regards to their condition and the specialist needs that come with it. No person centred care approach was identified. The medication charts examined showed that some medicines were not being correctly administered. Two residents who had been prescribed pain relief four times per day had not received it for long periods. The nurses were treating this medication as “when required” as opposed to “must be given”. There were unexplained gaps identified in a number of medication charts. The home does have a self-medication policy in place. However, one lady who had been admitted as a short stay rehabilitation resident was having her medications administered by staff when she was quite happy to continue self medicating as she had done at home. This is poor practice, as they did not promote her independence. The staff were observed to be very caring and courteous at all times. Residents and relatives alike commented upon this. They were observed to knock and wait before entering a resident’s room. From discussion with visitors one person said that she was involved in the care of her friend and she was informed of any changes and always attended any review meeting held. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15. The quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Social activities for residents are limited and provide little variety, thus creating the opportunity for boredom. Residents from a different background do not have their cultural dietary needs met by the home. EVIDENCE: Some residents’ files showed some information or very little, if any, evidence that their social and leisure interests were recorded and provided for. Residents were observed sitting around in lounges, wander or stay in their room. There were no activities planned for that day and no information was observed to inform residents as to what activities were planned for the coming weeks. Staff spoken to said the home needs to put more effort into leisure and activity provision. A carer has been recently identified as an activity Coordinator. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 15 This individual is new to the role and needs appropriate support and training if the resident group are going to benefit. One member of staff spoken to said that at the present time, activities were being provided on a “want basis.” Those spoken to said that they were encouraged to maintain links with their families whenever possible. The visiting times are not restricted and relatives and friends felt that they were always made welcome. There were a lot of issues about not meeting the cultural dietary needs of some of the residents. A Jewish lady living in the home only had recorded that she didn’t eat pork. The cook said that she only had a soft diet and that he would mince up whatever meal was cooked that day. There were no safeguards in place to ensure Pork was not in that meal. The care records showed no evidence that this lady did not eat Kosher food. This was also identified with a recently admitted Muslim lady. Her family were bringing in her Halal meals but no one in the home had attempted to arrange this as part of the food provision by the home. An African Caribbean man was buying in his own bread and relatives and friends were also bringing in food. These residents’ fees are paid for them to receive meals and not have them brought in by the family. This is an organisational problem. A polish gentleman stated that he would definitely like to see some polish food provided. This gentleman used to be a chef and was quite able and willing to assist with the menu in this respect. The practice of residents buying their own food to meet their cultural need is poor practice unless this has been asked for by the service user. Residents are not consistently offered a snack at suppertime. This is very important to this vulnerable group as the gap between teatime and breakfast is longer than twelve hours. One resident was observed being fed in her room. She was lying flat on the bed whilst she was fed. Her care plan did not suggest any reason for this and the staff spoken to said that there was no reason why she was unable to sit out and have her breakfast. This was poor practice. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents feel safe and are confident that any concerns they might have will be taken seriously and acted upon. EVIDENCE: The complaints procedure is displayed in the reception area of home as well as being included in the Service User Guide. It is clear, detailed and easy to understand. Resident’s surveys showed that they knew who to speak to if they had any concerns and residents spoken to confirm this. Residents and visitors said that they were confident that any concerns raised would be dealt with promptly and properly. Records of complaints received are kept and audited monthly. The Pre inspection Questionnaire (PIQ) said there have been 2 complaints made in the last twelve months all of which were partially substantiated and responded to within the 28 day timescales. Adult protection policies and procedures are in place. Staff have been issued with copies of the adult protection and whistle blowing procedures. Most staff have attended training sessions around adult protection and abuse awareness and plans are in place to make sure it is given to all. Care staff spoken to provide a good understanding of adult protection issues. They were aware of the signs that may indicate possible abuse. Staff were Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 17 confident with regards to the procedure they should follow if an incident of abuse was identified. They would not hesitate to report suspected or actual abuse to a unit manager or the manager. Care plans showed that where bed safety rails are used there was risk assessments and agreements between all involved wherever possible. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 18 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): The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The location of the home offers the people living there good access to outside recreational and shopping facilities. There is on going redecoration and replacement of bedroom furniture. New residents have the opportunity to bring with them furniture and have their room decorated to their taste. The noisy buzzers was causing some problem for residents. EVIDENCE: The location of the home gives residents the opportunity to use the local shopping centre and recreational facilities independently or with staff or families. One of the areas of the home is set a side for people who have intermediate care. The home is position in large grounds, which appeared from residents comments, is not been used effectively, more thought should be taken to look Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 19 at the best way to use the space that would allow residents to sit out in a safe and secure area. During the inspection it was highlighted that the outside of the home is not used as much. Members of staff said that more could be done to make it more accessible to residents. Two residents stated that it would have been nice to be able to get out into the garden more regularly during the summer. It is acknowledged that there has been several improvements within the premises, some areas has been redecorated within the rolling programme of redecoration and replacement. New assisted baths and showers have been fitted, many bedrooms have been redecorated with new furniture and fitments. One of the residents who showed the inspector their rooms said he was given the opportunity to bring in his double bed and his furniture and had personalised his room with pictures and other memorabilia. In general it was clear that people coming to live in the home are offered the opportunity to bring their own furniture and fitments and when possible the opportunity to have their room decorated to their choice. This is good practice. Despite this one resident’s bedroom seen was sparse, in need of redecoration, the carpet dirty and stained with marks from previous spillage, there was nothing in the room that reflected a homely environment. It was apparent that some bedrooms still need redecoration and appropriate furniture and fitments in place. The level of personalisation in bedrooms was very different in most case. Some were personalised to a high standard whilst it would appear others who had no contact with their relative or any visitors their rooms were not. Residents are assessed for equipment to meet their needs. Specialist equipment for the people having intermediate care is also provided. The manager said that she and her staff work hard to provide residents with dementia with a calm environment. However during the course of the inspection although it is acknowledged that the residents have a access to a call system this was found to be noisy, some residents said it was noisy 24 hours and they are woken by this noise during the night. The noise was said to be” piercing.” During the course of the inspection no malodour was detected throughout the building. The laundry is a good size, suitably equipped and staffed to meet the laundry needs of the home. The staff said that they had received training around health and safety related topics and infection control and that they felt well supported by the management team. Resident’s clothes looked well laundered. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 &30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Staff working with residents receiving intermediate care did not have appropriate training to meet the needs of the people they were working with. EVIDENCE: Residents and relatives said that staff worked very hard and were very pleasant. Some staff spoken to felt that they could benefit from getting extra help on the units as they felt they did not have enough time to sit down and chat or get involved with activities with residents. One issue of concern identified was the length of time it took staff to deal with the buzzers when they went of. The manager and staff said it was a constant problem. The buzzers were very noisy and nearly constant during the visit. Residents and relatives commented upon this. This may be evidence that staffing levels are not appropriate or that the system for answering buzzers needs reviewing. Staff appeared confident and competent in their roles and this was confirmed by talking to the residents and the relatives. The staff spoken to over the course of the inspection said that they did get an induction when they started their jobs. Staff said they received regular mandatory training over the course of the year. Staff said that they get little Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 21 training in the areas of care need that are relevant to the resident group such as diabetes, pressure area care, continence care and dementia care training. The home has been providing intermediate care for three months and the designated staff had not yet received any training in this area. This lack of training could have a detrimental effect on the rehabilitation of those clients needing the care service. One resident spoken to said that in her opinion, although the staff were very pleasant, they were not able to assist her meet her needs. The resident said that she felt that this was a lack of understanding of her needs. The manager said there are plans in place for staff to have the training to meet the needs of the intermediate residents, the intermediate team had not carried out training for staff working with these people, advice was given that this training should have taken place before residents admission and this must be addressed immediately. Residents must get the care and attention in accordance with their plan of care by staff that are competent to carry out the task. Twenty four percent of the care staff (5) has an NVQ qualification the manager said that all effort has been made for staff to undertake NVQ training, and other training. Two staff files inspected did not contain all the necessary information needed to ensure the resident group was thoroughly protected. One had a reference with a Criminal Record Bureau (CRB) from the previous employer, and there was no evidence in the file of a recent CRB check carried out by the registered provider. The organisation makes sure that checks are carried out for people who carry out work in the home that are not carers, i.e. electrician. The organisation’s works department has a list of agencies who carry out work for them ensuring that they all have a CRB check before carrying out any work within any registered establishments. This is good practice. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 22 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, 35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Staff supervision is not held at regular intervals to ensure that staff have the support and time to discuss issues on a one to one with the designated person in the home’s management team. EVIDENCE: The manager holds the relevant qualification to run a care home. The homes management team comprises of the manager and a deputy manager. Relatives, residents and staff are aware of the management team who they said were approachable and supportive. Training is not always given when identified. Not all staff have had training on identified care issues. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 23 The PIQ said that the home do not act as an appointee for any of the residents. At the time of the inspection there were eleven people who look after their financial affairs. The resident monies were inspected and these were managed appropriately. The inspector did advise that when monies were given to a resident that that resident signs for it wherever possible. The organisation is pooling resident’s monies in a none interest bearing account. One individual had as a large sum of money but was receiving no interest on this money. Staff spoken to felt that the management of the home had improved quite a lot in recent times. They said they felt well supported and lead by the current management team within the home. The manager was said to be very approachable and that they were confident that issues raised at team meetings would be dealt with. Improvements are needed with the provision of supervision, as this was an area that staff said they did not receive on a consistent basis. Improvements are needed to ensure all staff receive up to date mandatory training. Records showed that there were gaps in the fire and moving and handling training; some staff had not received updated training. An incident was identified where a member of staff had inappropriately handled a resident, even though an investigation took place and the member of staff was found to use inappropriate techniques, there was no evidence that further training had been identified or given. This poor practice leaves other residents at risk as well as the member of staff. This matter was discussed with the manager. There is an employed maintenance person who will carry out all maintenance checks for the premises. The PIQ stated that maintenance and servicing of equipment is carried out as required, all checks are up to date and records are kept. The PIQ said that training is in health and safety and infection control is part of the home training plan or the next three months Accidents and incidents that may affect the wellbeing of residents are reported to the CSCI as required by Regulation 37. There is a Varity of policies and procedures available to staff. The PIQ stated that policies and procedures are in place and there have been no changes since 2005. The manager said if there are changes in legislation all necessary changes will be made by head office and the revised information sent to the home and made available to staff which is discussed at staff meeting or training. . . Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 24 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 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 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 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Statement of purpose must be updated to reflect the care that is being provided in the home. This refers to the absence of information regarding rehabilitation care provided by the home. (12/9/06 timescale was not met) The registered manager must make sure that there is detailed assessment information covering all the needs of the prospective resident. The registered manager must ensure resident’s plans contain sufficient information relating to the individual specific care needs. (From previous report) 30/06/06 Any cultural and religious needs must be recognised and responded to. (Timescale from previous report 30/06/06) Timescale for action 20/11/06 2 OP3 15 20/11/06 3. OP7 15 20/11/06 4. OP8 15 20/11/06 Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 26 5. OP10 12(2) 12(4)(b) 20/11/06 The registered person shall make suitable arrangements to ensure that the home is conducted with due regard to the, religious persuasion, racial origin, and cultural and linguistic of residents. (Previous timescale 30/06/06). The resident’s wishes concerning terminal care and arrangements after their death are discussed and carried out. The service user 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. (Previous timescale 30/07/06). Resident’s Social care assessments must be completed. (Previous timescale 30/06/06). Religious or cultural dietary needs are catered for as agreed at admission and recorded in the care plan and food for special occasions is available. (Pervious timescale 30/06/06). The nurse administering medication must make sure that the administering of medication is in line with the NMC and the RPS guidelines for safe handling of medication. Residents must have their social needs assessed and met Recreational activities plan must be in place for all residents’, which takes into account their background and their interests past or present. 6. OP11 12 & 15 30/11/06 7. 8. OP12 OP15 14 & 15 12(4) 20/11/06 30/11/06 9. OP9 13 31/12/06 10. OP12 16 20/11/06 11. OP27 18 The manager must continually 31/12/06 assess the staffing level of the home to meet the dependency level of the resident in the home, to makes sure that there is enough staff available to meet. DS0000044506.V310934.R01.S.doc Version 5.2 Page 27 Harrogate Lodge Care Home 12. 13. OP28 18 19 OP29 Their needs. People living in the home must have access to staff that is trained to meet their speclist care i.e. Dementia and people recovering from illness. The manager must make sure that 50 of care staff have an NVQ qualification. The registered organisation must make sure that staff have CRB check before take up employment. 31/12/06 14/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 Refer to Standard OP33 OP30 OP1 Good Practice Recommendations The quality management and supervision systems can be further used to drive improvement and use outcomes to drive improvement during supervision with staff. It is recommended that staff at all levels receive training in recognising and responding to the diverse cultural and religious needs apparent. Staff should make residents aware of the service user guide in their room, so that they are fully inform of the service as a resident in the home. The manager must make sure that staff providing the care to residents have access to care plans, which would provided them with about the care needs of residents and what action to be take to meet all their care needs. Residents should be given the opportunity to self medicate The home should carry out a risk assessment for residents who wish to administer their medication. Support should be given to residents who have no contact with family or friends to have bedrooms that are personalised. More thought should be given to provide residents with DS0000044506.V310934.R01.S.doc Version 5.2 Page 28 5 OP7 6 7 OP9 OP19 8 OP19 Harrogate Lodge Care Home 9. 10. 11. 12 OP14 OP35 OP7 OP36 access to the garden to the rear of the building. Some consideration should be given to look at how the sound level of the nurse control system can be lowered. The registered manager should give some consideration to have resident sign any monies given from monies kept on their behalf. The home should have person centred care plan for all residents taking in account the person and not only their identified illnesses. The registered manager must ensure that all staff have one to one supervision. Harrogate Lodge Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Aire House Town Street Rodley Leeds 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 Care Home DS0000044506.V310934.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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