CARE HOMES FOR OLDER PEOPLE
Healey Lodge Nursing Home 114 Manchester Road Burnley Lancashire BB11 4HS Lead Inspector
Mrs Marie Matthews Unannounced Inspection 15th July 2008 09:30 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 Healey Lodge Nursing Home DS0000068937.V368406.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. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Healey Lodge Nursing Home Address 114 Manchester Road Burnley Lancashire BB11 4HS 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) 01782 717204 01282 453750 Silverdale Care Homes Ltd Mrs Yvonne Goodwin Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to provide nursing and personal care for a maximum of 21 service users to include:*Up to 21 service users in the category of OP (Old age not falling within any other category). 28th August 2007 Date of last inspection Brief Description of the Service: Healey Lodge is a care home offering nursing and personal care for either men or women aged 65 years and over. A considerable programme of building is planned and large areas of the home have been demolished although progress with this has been extremely slow. At the time of the inspection the home could accommodate twenty-one residents and the lounge, dining and bathroom space had been reduced. There is one lounge and a dining area on the ground floor and a smaller lounge for smokers on the first floor. There was a passenger lift to access the first floor. At the time of the visit all available rooms were being used as single rooms. Residents and their visitors could access a small patio area to the side of the home. The home is located on the outskirts of Burnley town centre and is on a main bus route. Shops, pubs, churches, the library and other amenities are within walking distances. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees range from £346.00 to £503.50 per week. made for hairdressing. Additional charges are Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
The key unannounced inspection, including a visit to the home, took place on 15th July 2008. Following previous inspection visits the Commission for Social Care Inspection had had a number of concerns about how the home was run and how this affected the people who lived there. The registered provider (the owner) had supplied an improvement plan following the last key inspection of 28th August 2007 and a random inspection had been undertaken on 12th December 2007 to check on progress with improvements. It was noted at the random inspection that improvements had been made. The date of this key unannounced inspection was brought forward as a number of concerns had been notified to the Commission. The inspection process included looking at records, a tour of the home, discussions with the nurse in charge, a temporary administrator, a registered manager from another home in the group, one care staff, two visitors and two residents. Information was also included from survey forms filled in by one visiting professional (GP) and one member of staff. The inspection also looked at things that should have been done since the last visit and a number of areas that affect people’s lives. There were twelve residents living in the home on the day of the inspection. What the service does well:
People were given sufficient information to assist them to make a decision about whether their needs would be met at Healey Lodge. One visitor said she had visited the home with her relative before making any decisions about whether Healey Lodge was the right place; she said staff had been ‘very helpful’ and answered their questions clearly. Detailed assessments of residents care needs were completed prior to admission to ensure their needs would be met. Residents had access to a range of services to respond to any changes in their health and that staff had sought appropriate advice on any health care issues.
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 6 One visiting GP (doctor) commented that resident’s health care needs were met and that staff responded to any changes in care needs. Medication records were accurate and showed that staff managed residents medication safely. It was clear that residents had choices regarding how they preferred to spend their day and a range of activities had been provided to meet their social needs and expectations. Residents were offered a varied, nutritious diet that met their dietary needs. One resident said he had ‘enjoyed’ his lunch and had dined at a time of his choosing. Another resident said the food was ‘OK’. One member of staff described the food as ‘tasty’. There was a clear complaints procedure and this was available with the information about the home and on the notice board. One visitor said she had been given the information when she looked around the home and would know who to speak to if she was unhappy. Resident’s rooms were bright, clean and odour free; some residents had brought in personal items to make it feel more homely. More than half of care staff had a recognised qualification in care and others were working towards it; this would ensure that staff had the skills and experience to look after people properly. One visitor said ‘there is a nice homely atmosphere’ and ‘staff are very nice and friendly’. What has improved since the last inspection?
The care plans generally indicated choices and preferences, had been reviewed and showed that residents and their relatives has been involved in decisions about care. The safeguarding (abuse) procedures were clear and most staff had received update training; this would ensure residents would be protected and staff would respond appropriately to any suspicion of abuse. Resident’s bedroom doors had been fitted with locks; this supported their rights to privacy. All areas of the home were clean and odour free. The way new staff were employed had improved; records showed that a safe process had been followed and this would protect residents from unsuitable staff. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 7 Most staff had been provided with training that would give them the skills and knowledge to keep them and others safe from harm. Management had responded to any concerns noted at the last key inspection and had provided a plan for improvement. There were systems in place to monitor whether staff were following care planning and medication policies and procedures and the registered provider visited the home regularly to monitor whether the home was running well. People’s views and opinions had been sought in the form of a recent survey and there had been a resident’s and relatives meeting held where people were consulted and able to discuss any concerns. What they could do better:
All residents should be issued with a copy of their contract so that they are aware of their rights and obligations and of what to expect whilst living at the home. The content of resident’s care plans varied and did not always include details about how residents care needs would be met or updated to reflect their current care needs; this could place residents at risk of not having their needs met. The medication procedures needed to be reviewed again to ensure staff had access to safe guidance. There were still concerns about the standard of the environment and improvements were not supported by a plan of maintenance and renewals. During a tour of the home a number of areas were in need of repairs or replacement and were not recorded anywhere; there should be a book that could be used to alert the handy man to any problems. Improvements needed to be made to ensure the home was safe and residents and staff protected. Areas of concern included the water temperatures had been monitored but there had been no action taken to taken to ensure the temperatures were safe and comfortable, cleaning products had been left in a bathroom and could be a risk to residents if not used or stored properly and the home had been left without any security for a period of three days. Not all bedrooms were supplied with call leads and this could prevent staff and residents calling for assistance and a number of bedrooms were again not provided with duvets or valances; this impacted on residents’ choice, privacy and dignity and the reasons for this were not recorded in the care plans. Staff had not always followed the complaints procedure; people need to be certain that their concerns would be dealt with according to the procedure.
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 8 There had been a number of concerns and comments about the staffing levels. One resident said ‘staff are very busy and you sometimes have to wait’ and ‘there have been a lot of changes in staff and nurses’. Staff commented ‘sometimes staff numbers are a problem as the residents needs a lot of care’ another said ‘staffing is not enough’. Staffing levels must be reviewed to ensure resident’s needs and aspirations were met in an individualised and person centred way. There had been no staff meetings for some months; staff should be consulted with, kept up to date and involved in decisions about the home to ensure standards of care were maintained. New staff had not always received an induction or introduction to the home which could place residents at risk of not being looked after properly. It was unclear whether staff had received training in safe working practice as there were no records of training undertaken or planned. There is no registered manager for the service. The acting manager who had been responsible for a number of improvements has resigned and without an experienced manager in post there were a number of concerns noted at this key inspection. The inspector could not access all the records needed for inspection until someone came with the keys; records must be at all times available for inspection by any person authorised to enter and inspect the care home. Staff had not properly reported two incidents that had affected the health and well being of residents; all incidents of this nature must be reported to the Commission for Social Care Inspection under Regulation 37. Some policies and procedures were in need of review in light of changing legislation and to ensure they reflected current practice; policies and procedures would provide staff with safe guidance. Quality assurance systems need to be developed to enable the registered person to monitor whether peoples needs and expectations were being met. 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
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People were given information about services offered by the home to be able to decide whether the home was suitable for them and whether their needs would be met. Detailed assessments of care needs were in place to ensure resident’s would be looked after properly. EVIDENCE: There was information about Healey Lodge in the form of a statement of purpose and service user guide. The service user guide had been made available in resident’s rooms and contained useful information about services available at Healey Lodge although was in need of review as some of the information was out of date. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 12 Not all residents had been issued with contracts. All residents should be issued with a copy of their contract so that they are aware of their rights and obligations and what to expect whilst living at the home. The records of two recent admissions were looked at in detail. The records showed that information about residents needs had been collected from various sources to ensure they could be looked after properly. Letters assuring residents that their needs would be met had been sent. Residents were allocated a named nurse or key worker to help them to settle in. One visitor said she had visited the home with her relative before making any decisions about whether Healey Lodge was the right place; she said staff had been ‘very helpful’ and answered their questions clearly. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The content of resident’s care plans was varied and did not consistently include details about how residents care needs would be met. Medicines had been managed safely although policies and procedures needed minor amendment to ensure staff were supported with safe practice. EVIDENCE: Three care plans were looked at in detail. Two of the care plans had been generated from assessment information, indicated choices and preferences and had been reviewed and updated and showed that residents and their relatives has been involved in decisions about care. One resident with complex care needs did not have a plan of care, which meant that staff did not have clear directions on how to meet her individual needs. The daily report indicated that appropriate care was being given but it
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 14 was unclear whether this was meeting all aspects of the residents needs. There were no assessments of any risks to this resident and equipment had been provided without an assessment to determine whether this was appropriate. Another care plan had not been updated following changes to the resident’s needs; this meant that the resident was at risk of not receiving the care they needed. Risks to residents had been assessed for two of the residents and there were clear instructions informing how these risks would be minimised or reduced. There was no evidence to support residents or their relatives had been involved in decisions to use bed rails and it was unclear whether protective covers had been provided for the rails to reduce any risk of injury to residents. One visiting GP (doctor) commented that resident’s health care needs were met and that staff responded to any changes in care needs. Some of the care staff were trained in health care matters and records supported that residents’ health was monitored and appropriate advice sought as needed. There was evidence that some of the care plans had been checked to ensure they were completed properly and to monitor whether the correct care was being given. The medication policies and procedures that had been reviewed and provided as part of the improvement plan could not be located. There was an old copy but the procedures for ordering, disposal and self-medication needed to be amended and procedures to support staff with the administration of ‘PRN’ or ‘as needed’ medicines, handwritten directions and medications supplied for periods away from the home need to be developed again to reflect current practice and to provide staff with safe guidance. The storage of medicines was secure although the room temperature was fairly high at times and ventilation should be provided to ensure medicines are stored at the correct temperatures. Records were accurate and clear; however prescriptions needed to be seen prior to dispensing to reduce the risk of error or mis-use. Monthly checks had been completed to ensure staff were following procedures safely. Staff responded to residents and their visitors in a friendly but polite manner. One visitor said staff were ‘very nice and friendly’. A GP commented that residents’ privacy was respected. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Social and recreational activities met resident’s needs and expectations. Residents received a healthy, varied diet that was suited to their individual preferences and dietary requirements. EVIDENCE: From observation it was clear that residents had choices regarding how they preferred to spend their day. One care staff said ‘residents are given choices about most things including meals, activities, where they sit, rising and retiring’. An activity person was employed and records showed that a range of activities had been provided although it was not clear who had participated or whether they were suitable. It was recommended that the records included the names of residents that had been involved and whether the activity had been enjoyed. One resident said he was able to get out and about to visit his friends and relatives.
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 16 Two visitors said they were happy with the care and were made to feel welcome. There was useful information for residents and their visitors regarding different organisations they could contact if they needed advice or support. There had been concerns raised about the standard and quantities of the food and this was looked at to ensure residents nutritional needs were being met. The menus offered a nutritious choice of meal and records supported that alternatives had been provided; suppers were also provided for those residents who had requested. The cook was aware of residents likes and dislikes and was observed consulting residents about choices and portion size. One resident said he had ‘enjoyed’ his lunch and had dined at a time of his choosing. Another resident said the food was ‘OK’. One member of staff described the food as ‘tasty’. There were a number of residents who needed assistance with their meals and staff gave them time and support although it was difficult to meet residents needs in an unhurried manner due to the staffing levels (see standard 27). The cook said there was enough food to cater for the numbers of residents and portion sizes were sufficient; additional items could be ordered as necessary. There had been some problems with the weekly delivery as staff had had to go to the local shops for eggs and potatoes but the cook said this had been resolved. The cook said special occasions would be celebrated with a cake and a party. Dining areas were bright and tables were set with appropriate condiments and cutlery. Environmental health had visited to recommendations were being progressed. inspect the kitchen areas and Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. People had access to a clear complaints procedure although this had not been followed consistently. Residents were protected from abuse by staff awareness and policies and procedures. EVIDENCE: There was a clear complaints procedure and this was available in the information about the home and on the notice board. One visitor said she had been given the information when she looked around the home and would know who to speak to if she was unhappy. The records showed that one complaint had been responded to appropriately but staff had not followed the procedure in respect of concerns that had been raised recently regarding a resident’s care; people needs to be certain that their concerns would be dealt with according to the procedure. The safeguarding procedures were clear and most staff had received update training in November; this would ensure residents would be protected and staff would respond appropriately to any suspicion of abuse. One care staff was aware of the different kinds of abuse and how this should be responded to.
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 18 There were safe procedures to support staff with raising concerns about bad practice and dealing appropriately with verbal and physical aggression. There was a procedure to support staff with the safe and appropriate use of bed rails although people had not been involved in the decision making process when restraint was used (see standard 8). Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The standard of the environment was improving slowly although there were no records to support plans or timescales for any ongoing improvements; further work was needed to create a safe and attractive environment for the people who lived there. EVIDENCE: There had been ongoing concerns about the standard of the environment. An area of the home had been demolished and plans that were in place to develop the site and extend the home had not yet been progressed. A tour of most areas of the home was conducted. A room-to-room audit, requested as part of the improvement plan, had not been kept up to date. It
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 20 was clear that some areas had improved although there were still areas in need of repair and attention and these were not recorded for the handyman or registered providers’ attention. It was recommended that an audit of all areas be regularly undertaken to identify areas needing attention and they should be listed for the handyman’s attention with the date of the request and date of completion clearly recorded. Areas requiring attention included décor in need of upgrade, leak in the kitchen store, light fitting not working in the kitchen store, carpet trip hazard on the stair way and damaged furniture. Also the front door lock had been broken for approximately two weeks and had not been repaired. The door had been left without any locking mechanism for four days and nights placing residents and staff at risk; this was a serious concern as nobody had taken responsibility for ensuring it was repaired. This was discussed with the administrator and a locksmith was contacted immediately. The home still did not have a planned programme of maintenance and renewals that would show how improvements would be progressed. The grounds remained untidy and unsafe in places; the driveway was in need of repair and the area to the side of the driveway remained an abandoned building site that was now overgrown with weeds. New patio furniture, fencing and potted plants had improved the front patio area for residents and records showed they had been able to sit out and enjoy the warmer weather although the view from the patio area was of the derelict and overgrown area. The building complied with the fire service and the Environmental Health Officer had recently inspected the kitchen areas; recommendations were being responded to. Communal areas were clean, bright and comfortable. The main lounge had been redecorated and seating had been re-arranged; the second lounge was used as a smoking area. Toilets and bathrooms were located close to communal and bedroom areas and had suitable locks in place to maintain residents privacy. One of the shower areas had been improved but the shower had not yet been reconnected and could not be used. Water temperatures varied from room to room; records showed that temperatures had been checked each month but no action had been taken to ensure temperatures were within the required safe levels. Aids and adaptations to assist residents with maintaining their independence and provide comfort and safety were provided around the home. There were limited storage areas and items were stored in empty rooms or bathrooms. Once again not all areas were supplied with nurse call leads and Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 21 this could prevent staff and residents calling for assistance; there were no risk assessments to support reasons for non-provision. Resident’s rooms were comfortable, bright, clean and odour free; some residents had brought in personal items to make it feel more homely. Locks had been provided on bedroom doors to enhance resident’s privacy and risk assessments were in place to support non-provision of keys. A number of bedrooms were again not provided with duvets, valances or eiderdowns and staff said this was because the rooms were too hot at night; this impacted on residents’ choice, privacy and dignity and the reasons for this were not recorded in the care plans. Some bedroom furniture was in need of replacement or repair; a member of staff described the furniture as ‘falling apart’. A number of residents had been provided with specialised beds that would help to maintain their comfort and some new furniture had been supplied. All bedrooms were supplied with lockable storage and non-provision of keys to this facility was recorded on the care plan. A concern had been raised that the home ‘smelled’. On the day of the key inspection the home was odour free and cleaning staff were on duty. Sufficient cleaning products were available although some of these products were stored inappropriately in a bathroom and could put residents at risk (see standard 38). The laundry was clean and organised and the laundry staff said there were enough bed linen and towels. Gloves, aprons and hand washing facilities were provided to maintain control of infection. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Recruitment practices ensured residents were protected from being cared for by unsuitable people. Staff were not always provided in sufficient numbers but have the skills and competencies to meet residents needs. EVIDENCE: Staffing rotas were available although it was not an accurate reflection of staff on duty on the day of the inspection; rotas should be accurate to ensure the safety and protection of residents and staff. There had been concerns raised regarding a reduction in staff numbers and that there were insufficient staff to ensure resident’s needs were met. On the day of the key inspection there were two care staff and one nurse for twelve residents; records showed that most of the residents needed assistance from two staff and their dependency levels were high. It was noted that the nurse was called away for long periods to meet with visitors, answer the telephone, complete administrative tasks and complete nursing care tasks often leaving a carer on their own with residents. One resident said ‘staff are very busy and you sometimes have to wait’ and ‘there have been a lot of changes in staff and nurses’. Staff commented ‘sometimes staff numbers are a problem as the
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 23 residents needs a lot of care’ another said ‘staffing is not enough’. Staffing levels need to be kept under review to ensure resident’s needs and aspirations were met in an individualised and person centred way. There was a clear recruitment procedure in place. The files of two recently appointed staff were looked at in detail. The records showed that a safe procedure had been followed that would protect residents from unsuitable staff. It was again recommended there should be a record of the interview to demonstrate a fair and equal process had been followed. Existing staff or staff from one of the other homes covered any vacancies or sickness; this would help to ensure some continuity of care. More than half of care staff had a recognised qualification in care and others were working towards it; this would ensure that staff had the skills and experience to look after residents properly. Records and comments from staff survey showed that not all new staff received an induction or introduction to the home; this could place residents at risk of not being looked after properly. One new care staff had not commenced recognised induction training linked to ‘Skills for Care’; induction training would provide inexperienced staff with the skills they need to perform their role of carer. A training plan had been developed as part of the improvement plan although this could not be found and it was unclear what training had taken place or what further training was planned or booked. Staff meetings that had commenced following the last key inspection had not been held since February 2008. Staff should be consulted with, kept up to date and involved in decisions about the home to ensure standards of care were maintained. One staff commented on the high level of commitment from staff despite a cut in wages, reduction in hours and demanding work-load. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home needs to be properly managed to ensure people’s health, safety and welfare was promoted and protected. EVIDENCE: There is no registered manager for the service. The acting manager who had been responsible for a number of improvements has resigned and without an experienced manager in post there were a number of concerns. The registered provider states he has been trying to recruit a manager since May and will shortly be interviewing applicants.
Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 25 The day-to-day management of the home had been left to the nurse in charge who could contact a registered manager from another home in the group for support and advice. On the day of the key inspection the nurse in charge was not extra to numbers, did not have management experience, had been employed only a few weeks and had not had an induction to the homes safe procedures. Concerns regarding the current management situation were discussed with the administrator; arrangements were made for a temporary experienced manager to visit the home three days each week to ensure people were supported. There was no immediate access to some of the records needed for inspection as the office was locked and the administrator and provider had been on leave. Records must be at all times available for inspection by any person authorised to enter and inspect the care home. From a review of records and discussion with staff it was clear that two incidents affecting the health and well-being of residents had not been reported to the Commission for Social Care Inspection under Regulation 37. The incidents included the lack of security to the front door and an injury sustained by a resident. People’s views and opinions had been sought in the form of a recent survey; the responses had not yet been collated but would be made available to people. There had been a resident’s and relatives meeting held in May where people were able to discuss any concerns but it was unclear whether this was to be a regular meeting. Quality assurance systems need to be developed to monitor whether peoples needs and expectations were being met. The AQAA, that provides information about the home, had been returned to the commission as requested. The information gave a reasonable picture of the current situation in the home but could have been more detailed. The registered provider had visited the home and provided a report of his findings; this showed he was monitoring the day-to-day running of the home. Some policies and procedures were in need of review in light of changing legislation and to ensure they reflected current practice; policies and procedures would provide staff with safe guidance. The home did not manage resident’s personal monies. There were clear records and receipts of fees paid and these could be accessed on the computer. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 26 It was unclear whether staff had received training in safe working practice, as there were no records of training undertaken or planned. Records identified that two new staff had not yet had Moving & Handling training and this could put people at risk. From staff files it was assumed that most staff had received Moving & Handling training and fire training but it was unclear whether all staff had had first aid, Protection of Vulnerable Adults and food hygiene training. Records showed that equipment and systems were safe and had been serviced regularly. As noted earlier in the report (standard 25) the water temperatures were monitored monthly; it was noted that the temperatures varied from cool to hot and no action had been taken to ensure the temperatures were safe and comfortable. Cleaning products had been left in a bathroom and could be a risk to residents if not used or stored properly. The accident forms need to be replaced with an accident record that meets the data protection act. Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 2 X 2 2 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X 2 2 Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement All residents must have a written plan that shows how their needs will be met and must be updated to reflect any change in circumstances. Any risks to residents’ heath must be assessed and preventative measures to reduce or eliminate the risk introduced. Residents or their relatives must be involved in the decision making process when bed rails (restraint measures) are used. Staff must ensure bed rail covers are used if the risk assessment determines this. The registered provider must ensure that any complaints or concerns raised are investigated according to procedure. Action must be taken to respond to any fluctuations in water temperatures to ensure the temperatures are within safe and comfortable limits. There must be sufficient numbers of staff to meet the needs of the residents.
DS0000068937.V368406.R01.S.doc Timescale for action 01/09/08 2. OP8 13 01/09/08 3. OP8 13 01/09/08 4. OP16 22 01/09/08 5. OP25 13 01/09/08 6. OP27 18 01/09/08 Healey Lodge Nursing Home Version 5.2 Page 29 7. 8. OP30 OP37 18 17 9. OP37 37 10. OP38 13 There must be an induction and training programme that meets the Skills for Care requirements. Records must be at all times available for inspection by any person authorised to enter and inspect the care home. The Commission for Social Care Inspection must be notified of any incident affecting the health and well-being of residents under Regulation 37. Cleaning products must be stored safely and in accordance with the COSHH Regulations to reduce any risks to residents. 01/09/08 01/09/08 01/09/08 01/09/08 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 OP1 OP2 OP9 Good Practice Recommendations The service user guide needs to be updated to reflect the current situation. All residents should be issued with a copy of their contract so that they are aware of their rights and obligations and what to expect whilst living at the home. The medication procedures regarding ordering, disposal and self-medication should be reviewed to reflect current and safe practice. Procedures to support staff with ‘PRN’ or ‘as needed’ medicines, handwritten directions and medicines for leave or periods away from the home need to be developed. Measures to control the temperature of medication storage areas should be considered. 4. OP12 Staff should check prescriptions prior to dispensing. Records of activity should include the names of residents who have participated and whether the activity was enjoyed.
DS0000068937.V368406.R01.S.doc Version 5.2 Page 30 Healey Lodge Nursing Home 5. OP19 An audit of all areas of the home should be regularly undertaken to identify any areas requiring repair or replacement. Any areas identified as needing repair or replacement should be recorded (including dates of request and completion) for the handyman’s attention. There should be a planned programme of maintenance and renewals to show how internal and external improvements will be progressed. All residents should be provided with accessible nurse call leads unless a risk assessment suggests otherwise. All residents’ bedrooms should be supplied with duvets and covers and valances unless the residents has specifically requested otherwise. The staffing rotas should clearly show who is on duty and in what role. Records of the interview and selection process should be maintained. A training matrix should be available to indicate what training has taken place and what training is planned. All new staff should have a recorded induction or introduction to the policies and procedures and routines of the home. Regular staff meetings should be arranged to ensure staff are consulted and kept up to date. There should be a competent and experienced person in day-to-day control of the home. An application to register a manager with the Commission for Social Care Inspection should be completed. Quality assurance systems need to be developed to monitor whether peoples needs and expectations were being met. Policies and procedures should be kept under review to provide safe and current guidance for staff. An up to date accident book should be in use in accordance with the Data Protection Act. Any gaps in safety training for new and existing staff should be covered. 6. 7. 8. 9. 10. OP22 OP24 OP27 OP29 OP30 11. OP31 12. OP33 13. OP38 Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 Healey Lodge Nursing Home DS0000068937.V368406.R01.S.doc Version 5.2 Page 32 - 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!
