Inspection on 28/03/06 for Harrogate Lodge Care Home

This inspection was carried out on 28th March 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 21/09/06

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 28th February 2006 10:30 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.V283808.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 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 (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.V283808.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th July 2005 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 build 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 C 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. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced. Two inspectors visited the home on 28.02.06 between 10:30 and 16:50. In line with CSCI policy a number of standards were assessed including any items outstanding from previous inspections. Reports and information on this and other, registered care services is available on the CSCI Website at www.csci.org.uk. The following methods were used. Twelve residents were able to make comment about the care and services at the home. One inspector joined the residents for lunch in one communal dining room. Residents and staff were observed in their interactions to help make a judgement about the way care is provided. Specific questions were asked in respect of the individuals’ judgement of the standard of diet, activities and meeting cultural and religious needs. Seven members of the staff team were observed in undertaking some of their duties and in their interactions with residents. Five made comment about the level of supervision and training they had received. Three personnel files, training and supervision records were assessed. Case tracking was undertaken in respect of the care and services provided to six individuals. Two were concerned with short stay residents others were of the long-term nursing and residential categories. The arrangements for the management of resident’s money were inspected. Particular attention was given to outstanding issues. The home provides a number of ‘step down’ beds that are contracted and paid for by the local Social Services Department. The care provided includes personal care but no other therapies are provided. This means that intermediate care is not provided and the term ‘step down’ means short stay/respite care. Individuals in this category are able to stay at the home and be supported with their personal and daily living tasks until discharge. The length of stay varies in line with the individuals’ needs. Several requirements and recommendations have been in this report. It is acknowledged that the registered manager over the last eighteen months has worked hard to improve standards at Harrogate Lodge. There have been many improvements in the services provided and the way in which care is delivered to the people living in the home, for example the staff now receive regular moving and handling training. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 6 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 7 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 8 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 9 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 10 What the service does well: What has improved since the last inspection? What they could do better: Half of the case records inspected had not been transferred to the new record. Hence many of the shortfalls previously observed continue. There is for Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 11 example a lack of evidence that service users and their representative and family are not involved in this process. None of the service users spoken to had seen their assessment or care plan. This also results in some areas being poorly recorded and this included examples of individual’s cultural and religious background as well as skill level. Training specific to the diverse cultural needs is recommended. The poor recording should be an area that is part of the quality assurance and supervision of staff in order to achieve timely improvements. The registered provider should give some consideration to provide the deputy manager with some supernumerary time, so that she could carry out the management areas of her job and to assist the registered manager to manage the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 12 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.V283808.R01.S.doc Version 5.1 Page 13 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, 2 & 6 The statement of purpose needs further amendment to provide the information required ensuring that individuals have the right information about the service. Terms and conditions (contract) are available. EVIDENCE: A revised statement of purpose/service user guide (dated 03 November 2005) has been received. The following comments were provided as feedback during the inspection. The pages are not numbered. ‘Castleton’, a sister home, has been named within and this needs to be changed. In respect of staff training the document states “certificates can be obtained”. This section should make clear what training is required (compulsory and provided in each case) and should distinguish what is additional. The document quotes that the theories by “Roper Tierney and Logan” underpin the philosophy of care. Further clarification is needed in this respect. The language is not as clear as it may be and some sections are repeated making the document lengthy. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 14 The described admission procedures were discussed with the manager. The document states that prospective residents are able to spend the day at the home and that they are allowed to choose to stay and be admitted that day. The manager agreed that this is not good practice and that in most cases the individual should be allowed to return home and allowed to consider any choices before making a decision. With regard to emergency admission standard 5.3 applies. The newly admitted individual has to be informed within 48 hours of the key aspects, rules and routines of the service and a full assessment must be undertaken within five working days in line with standard 2. This should be reflected within the statement of purpose. Residents spoken to said that they had not seen the statement of purpose. The statement of purpose is available in the reception. The organisations terms and conditions were provided as part of the statement of purpose and the manager and administrator confirmed that residents are issued with this contract and that copies are held. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 15 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, 10 & 11 Whilst care plans have continue not to reflect personalisation. This is individuality or choice. decision-making as they been much improved since the last inspection some all of the individual’s needs and there is a lack of in-keeping with a care model that does not reflect This results in resident not being as involved in the may be and compromises their rights. In the majority of cases seen the records did not reflect any of the residents wishes in relation to terminal care, periods of illness or after their death. Diverse cultural and religious needs are not adequately assessed and may not be adequately responded to. EVIDENCE: A needs assessment is recorded within the homes own records. This includes health care needs assessment and risk assessment in areas such as skin viability, nutrition & diet, falls, dependency rating and challenging behaviour and aggression. The practice is that any areas were a risk or need is identified this is then transferred to the care plan. The assessment information seen for residents did not provide enough information to put together a detailed care plan. A “Detailed Social Assessment” form provides the template to record the individuals social and cultural needs assessment. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 16 Six case studies were undertaken to look at how individual needs are assessed, recorded and care plans developed and how the care needs are met by practices and services provided. A number of shortfalls continue since improvements were required after the last inspection. This included the need to improve the content. Assessed areas of need were not always transferred to the care plan. Care plans were pre-printed with objectives. There was concern that the individuals’ rights to choice may be compromised. Staff record the contents of care plans and assessments and there is no evidence that there is discussion and agreement with the service users or their representatives. Whilst not all records have been reviewed there is evidence that the reassessment and transfer of records to the new system has ensured much improvement. Priority has been given to serious and complex reviews being done first. This has lead to good improvement being made to many of the assessments and care plans and risk reduced substantially. The manager has introduced a new assessment and care planning system. Some residents care plans seen were recorded on this new format. It was evident that when completed properly the improvements addressed previous shortfalls. A timescale was given during the previous report for the care plans and assessments to be reviewed and revised by 05.11.05. This timescale has not been met. There were a number of concerns specific to the case tracking undertaken during this inspection. There are several residents at the home who are not of an English culture and background. This includes Asian, mid and eastern European and Caribbean individuals. The companies ‘Detailed Social Assessment’ was only partially completed or not completed at all within the eight case studies. One case study revealed that the cultural background, first language and religion were not recorded at all. This is poor and does not reflect that the service aims at provide flexible services that are in line with the diverse cultural, religious and linguistic needs of the service user group at the home. In one case the care plan was concerned with aggressive behaviour. There was insufficient detail as to the triggers to any aggressive behaviour. The daily records and monthly evaluations showed no incidents during the past year or so. Hence this aspect should be removed. This resident said that the service was ‘ok’. He said he felt ‘less down’ and attributed this improvement in mood to ‘jolly staff try to cheer you up”. This is the type of discrepancy of practice and recording. This resident had not been involved in his care plan or seen it. Individuals spoken to could not name a member of staff specifically responsible as a key worker. A culture of involving residents as required and using the care plan as a tool for discussion with those who receive the service must be Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 17 ensured. Relatives and previous carers when appropriate must be offered the opportunity to be involved in the planning of care and decision making. When individuals are not able to give consent it is particularly important to involve family and advocates. Evaluations though duly recorded on a monthly basis do not always ensure that care plans are appropriately changed to reflect observed and changes. The two case studies undertaken in respect of short stay residents showed their needs to be better recorded and in one case there was good evidence that the residents wishes were ascertained and acted upon. Both were showing marked improvements in their general and medical well being. Dependency levels were decreasing in line with stated aims for the placements. There was a clear lack of attention to detail and personality and individual’s preferences and choices were not reflected in the majority of recordings. There was little or no evidence that residents are involved in the assessment or care planning process. This can result in resident’s rights to make decisions and choices being compromised. Adequate discussion with residents about their cultural needs and wishes must be ensured. Residents spoken to reflected in their comments that staff were mostly patient and responsive to requests. A number of residents who were not able to clearly verbalise requests were seen to have signs and signals that staff understood. Many individuals clearly enjoyed the conversation and banter with staff during the meal in one dining room. One individual specifically commented that she prefers to spend all her time quietly in her own room. The case records were evaluated in respect of instructions about the resident’s wishes in case of ill health and after their death. The two case notes seen relating to two short stay service users included no details. One long term resident’s file showed contact details and instructions for funeral arrangements. This resident said that he had informed staff about his planned arrangements and this was reflected as detailed above. None of the recordings seen showed if individuals wished to be resuscitated or not. The manager and nurses on duty were made aware of up to date standards for terminal and palliative care. All had knowledge of the ‘Liverpool pathway’ but stated that they were not following this good practice guidance. Whilst the home does not specialise in terminal care the resident’s wishes concerning terminal care and arrangements after their death must be discussed and recorded. The lack of recording in this area might result in poor outcomes for residents. Spiritual needs, rites and functions must be ensured. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 18 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 Poorly completed social assessments result in activities not being based on individual stated interests. Whilst service users are able to make some choices their input is not apparent within the assessments or care plans. The visiting arrangements are flexible and judged to be good by residents spoken to. The recording must be improved in respect of monitoring of weights. The menu plans must reflect the needs and preferences of Asian, Caribbean and Mid and Eastern European service users that are not already incorporated in the ‘alternative daily menu’. EVIDENCE: A template is available to record areas of the resident’s history, family relationships, hobbies, interests, religion and personal preferences (“Detailed Social Assessment”). The completion of this assessment offers an opportunity for discussions with the resident and would enable a staff member to get to know a resident as an individual including their interests and choices. This would also be an opportunity to discuss individual’s diverse religious, linguistic and cultural needs. In those cases seen this opportunity was lost and the documents seen were incomplete and hardly anything was recorded. One poor example was seen. This gave no details of the resident’s background, first language or religion. The ‘skills and knowledge’ section stated “none”. Whilst this resident needed much help from staff there are Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 19 many areas were this individuals’ skill and knowledge was apparent. This individual was able to discuss personal choice and preference in all areas. This example shows a lack of respect of individuals past achievements and lack of recognition of skill, knowledge and abilities. Two “Detailed Social Assessments” seen pertaining to short stay residents were also not fully completed and gave little detail. This results in the assessments being of little or no use when planning entertainment or activities for the service users. The activities programme includes various activities including crafts, outings, coffee morning, reminiscence and recall, bingo and vintage films. A part time activities co-ordinator is employed to provide some of these activities. Residents spoken to were not able to say what activities were regularly on offer. With regard to religious observance the activities plan shows a planned Christian service each Sunday. The social assessments seen did not give details about any religious needs, observances or practices followed by an individual. Due consideration must be given to the diverse needs of all the service users in the home. A number of residents took part in a Christian service during the morning. Three visitors were spoken to during the inspection two were visiting the short staff residents and the other parent lived at the home all made positive comments about the service at the home. Residents said that their friends and family are able to visit at any reasonable time. Visits can take place in private (own room) or in a communal area. Some residents said that they go out with their family. Visiting is allowed at any time. Assessments and care plans show little or no evidence that the content has been discussed or agreed with individuals or their representatives. Though there is a key worker system in place this does not lead to documentation that reflects individuality or choice. Service users cannot name their key worker and only one individual said that she had been involved in care planning. Whilst there were shortfalls in the recording and evidenced input in planning is apparent it must be noted that observations showed staff to take account of wishes and requests made by service users. Interactions were observed over a two hour period in the dining room and lounges. The assessments include a nutritional assessment that is completed by staff. It was noted that not all areas showing risk or need are transferred to the care plan. Three of the six case studies showed no ongoing weekly weight chart as required. In one case a medium risk was assessed but this area was not addressed within the care plan. Good and appropriate nutrition must be ensured and adequate monitoring undertaken especially when a risk is Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 20 apparent for example after major surgery or when infections and wounds increase the risk of malnutrition. The chair scales in place are unsuitable for the use by one service user who is at high risk in this area. Alternative systems of monitoring must be implemented in this case. Three residents care plans, which was recorded, on the new format had all the required information relating to their assessed care need. The chef takes a good level of interest and collates details in respect of each individual. This includes details of weight charts when available. The chef was fully involved in serving lunch and he takes the opportunity to discuss menu choices. He monitors waste and clearly discusses food with individuals and groups. He aims to provide a choice within the menu that meets needs whilst incorporating individual preferences. He was able to show examples of items included in the menu after requests from service users. The chef was also aware of specific needs and provided soft, liquidised, vegetarian and diabetic choices. He stated that staff have access to food outside of his working hours and are hence able to prepare snacks at any time. At breakfast there is a choice of cooked or continental breakfast. Individuals spoken to say that there is a good breakfast and all said that they had whatever they preferred. Lunch is a three-course meal. Soup, main course and pudding. At tea time there is a choice of sandwiches, home made whole soup and a variety of hot choices. Snacks are served in between meals and at supper. There is much home baking and fresh ingredients are used in the meal preparation. An alternative daily menu provides for choices that are outside of a classic English diet including rice, pasta, curry and southern fried chicken (“subject to availability of ingredients”) The lunch consisted of soup of the day, a choice of main course and pudding. Staff served individuals from the serving counter that opens into the kitchen. Individuals were able to choose the portion size and had a choice of menu. Sauces and condiments were available on the table for individuals to help themselves. When needed staff assisted individuals by helping to cut up food and assisting with feeding. There were sufficient staff available to allow service users to eat at their own pace and make the meal time a happy and social occasion. Service users said that the quality of meals varied and some meals were “better than others”. The chef has reintroduced a comment book to the dining room in order to record any comments good or bad. A more confidential comment system may lead to better outcomes. The lunch was well prepared and most enjoyed the meal. Staff and service users interacted well. There was a good deal of banter and staff involved service users well in conversation making the mealtime enjoyable and relaxed. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 21 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 22 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): 17 & 18 Staffs is trained in understanding and recognising abuse and there are clear procedures There are systems in place for service users legal rights to be protected. EVIDENCE: The residents are able to access advocacy services provided by Age concern. This ensures that individuals with no family support are able to access help and assistance with any concerns or affairs. Residents have the opportunity to vote, which is either at polling stations in the community, or postal votes. There is an adult protection policy that is linked to the Leeds multi agency procedures, and there is a whistle blowing policy. Staff spoken with confirmed that they receive training on abuse and know that there are policies and procedures to be followed. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 23 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): 20, 22 & 26 An assessment must be undertaken in respect of the provision of a stand aid. Suitable and needed equipment must be provided. Good hygiene practices are generally ensured and recordings showed ongoing monitoring and cleaning is undertaken. However, some areas in the laundry are in need of a good clean and some repairs are needed. EVIDENCE: There are sufficient shared facilities including dining rooms, lounge areas and hair dressing facilities. The entrance provides a good waiting and meeting area for visitors and this has coffee making facilities to enable visitors to help themselves. There is ample car parking. However, the usable area of the garden is limited to one patio area to the front and left of the main entrance. Residents said that during the warm weather tables and seating is available and they sit outside if they like. Staff said that there are regular Bar-Be-Que’s held during the summer. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 24 Staff confirmed that handling belts, hoists and assisted bathing equipment and showers are available and in good working order. There is currently no standing hoist provided though this would benefit several service users and make the process of care easier for staff. An assessment should be undertaken and if the inspector’s observations are confirmed must lead to this equipment being provided. The laundry was inspected. Full time staffing is ensured. The laundry provided for ‘clean’ and ‘dirty’ areas and this ensured protection from the spread of infection. Red bags are available for laundering soiled items as required. A yellow bin is available to dispose of any clinical waste. Adequate washing machines capable of cycles above 70 degrees and including sluicing cycles are provided. There are tumble dryers and ironing equipment. The area behind the washing machines was in need of repair to the plasterwork. The area was full of fluff and needs to be cleaned regularly. Two domestic staff were able to comment on the standard of cleaning infection control. Both had received training appropriate to their roles and included NVQ training, health and safety, food hygiene and COSHH example. Domestics were able to state how spillages would be sanitised this reflected good practice. and this for and There was good evidence that areas are regularly cleaned. In the kitchen daily records showed regular cleaning of all areas. Foodstuffs are labelled showing dates of opening, freezing etc. The chef ensures that good practice is followed in checking the temperature of food at various stages of preparation and during serving. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 25 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): 29 & 30 Recruitment practices and vetting undertaken in respect of staff employed ensures that residents are protected. There is a good level of induction and ongoing training ensuring that staff have the knowledge they need to undertake their duties with confidence. Training is recommended to meet the needs of staff on all levels in recognising and responding to the diverse cultural and religious needs apparent. EVIDENCE: Three recruitment/personnel files were looked at. All three files included a job application, signed and completed declaration of rehabilitation of offenders act, POVA & CRB clearance, two references, and Home Office clearance for foreign workers and appropriate Identification. Staff have to attend for interview and are subject to a probationary period of employment. Practices ensure that staff are vetted appropriately ensuring residents are not put at risk. All new employees attend induction training. This includes required areas such as health and safety, manual handling and fire safety for example. Once completed the future training is depending on the observed individual needs. These are discussed and assessed periodically during supervision and appraisal. Training needs are clearly recorded and good planning ensures that identified needs are met and planned for. There is a high level of training provided for and evidence of good commitment to support staff in their personal and professional development. Staff stated Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 26 that they get a good amount of training and at times it can be ‘too much to take in’. Staff were able to discuss areas of good practice in various areas. Training needs are identified for all levels of staff to cover diversity awareness and therewith improve practices and outcomes for service users who are not ‘English’. Individuals spoken to felt confident that the staff are skilled in undertaking their duties and assisting with mobility was an example. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 27 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): 33, 35, 36 & 38. The quality monitoring system must be developed to be effective in recognising shortfalls. This will ensure that shortfalls are addressed in a more timely manner. The supervision system is effective and could be further used in improving standards of assessment, care planning and recording that continue to show shortfalls. Records are kept of any money held or handled that belong to service users. Fire safety issues from the last and previous fire safety report from West Yorkshire Fire Service. EVIDENCE: The outcomes of quality surveys undertaken must be published. The handy person said he checks and records standards of maintenance and good working order of equipment in the home. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 28 It is clear that the quality system does not ensure that the standards of recording, assessments and care planning are regularly checked and improved when needed. The content of some files was poor and the registered person should take regular opportunity to monitor and improve the quality of recording at the home. This lack of effective quality and performance measurement is leading to timescales set for improvements not being met. When poor standards of recording are apparent the supervision and training system should be used to ensure timely improvement are made. There must be an apparent cycle of review, evaluation and improvement. The manager was advised of changes within the future inspection regime and the manager was made aware of the publication of “Inspecting For Better Lives” and anticipated legislative changes. Residents have the opportunity to keep their own money though they are discouraged to keep amount of money on their person or in their room. Many individuals hand money for safe keeping to the administrator or managers. Records are kept of any balance available or outstanding for additional services. Details of any debits or credits to the account are recorded. The staff take part in ongoing staff and team meetings and staff felt well involved in the decision making at the home. Additionally all are subject to appraisal and regular one to one supervision with the manager or deputy. Supervision sessions and appraisals are recorded and give good details of individual team members’ strengths and weaknesses. Any concerns are clearly monitored and disciplinary proceedings are ensured when needed. When training needs are apparent there is good evidence that these are addressed by training or information being provided. The staff supervision system is effective in this respect. The supervision system can be further utilised in addressing some of the shortfalls that continue with regard to care planning and assessment. Improvement can be driven and speeded up using this process that is already well established and lead to improved teamwork and continuity of practice can be evidenced from recordings seen. During discussion with the manager the fire safety report in February 2006 in which Schedule 2 recommendations needs to be done, to make sure the home fully comply with fire safety. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 29 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 2 3 3 2 3 2 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X 2 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The organisation must have a statement of purpose and service user guide that meets the requirements of the legislation. (Requirement outstanding from previous inspection) The registered manager must ensure resident’s plans contain sufficient information relating to the individual specific care needs, and all assessed care needs. (Requirement outstanding from previous report) Unless it is impracticable the registered person must carry out consultation with the residents, or a representative of his as to how the resident’s needs are met. Residents and their representatives must be consulted during any review or informed of any changes. Timescale for action 12/09/06 2 OP7 15 30/06/06 Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 31 3 OP8 15 Any risk identified risk in the Nutritional assessments must be linked to a care plan. (Requirement outstanding from previous inspection) Nutrition must be appropriately monitored following recognised monitoring tools and practice. Any cultural and religious needs must be recognised and responded to. The registered person shall so far as is practicable enable residents to make decisions with respect to the care they receive and their health and welfare. 30/06/06 4 OP10 12(2) 30/06/06 12(4)(b) 5 OP11 12 & 15 6 7 OP12 OP14 14 & 15 12 & 15 The registered person shall make suitable arrangements to ensure that the home is conducted with due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of the service users. The resident’s wishes concerning 30/07/06 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. Resident’s interests are 30/06/06 recorded. Social care assessments must be completed. The registered person conducts 30/06/06 the home so as to maximise resident’s capacity to exercise personal autonomy and choice. 8 OP15 12(4) Religious or cultural dietary needs are catered for as agreed at admission and recorded in the DS0000044506.V283808.R01.S.doc 30/06/06 Harrogate Lodge Care Home Version 5.1 Page 32 9 OP22 16 10 OP38 16 care plan and food for special occasions is available. In relation to a ‘stand aid’ assessment should be undertaken by a qualified Occupational Therapist and recommendations addressed. The matters relating to fire safety must be fully resolve. (Requirement outstanding from previous inspection) 30/07/06 01/09/06 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 *RCN 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. The registered provider should give some consideration to provide the deputy manager with some supernumerary time. Harrogate Lodge Care Home DS0000044506.V283808.R01.S.doc Version 5.1 Page 33 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.V283808.R01.S.doc Version 5.1 Page 34 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!