CARE HOMES FOR OLDER PEOPLE
Healey Lodge Nursing Home 114 Manchester Road Burnley Lancashire BB11 4HS Lead Inspector
Marie Matthews Key Unannounced Inspection 26th February 2007 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.V332020.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.V332020.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 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.V332020.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). 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. The home is due to undergo a considerable programme of building and large areas of the home have been demolished. At the time of the inspection the home could only accommodate twenty-one residents and the dining and bathroom space had been reduced. 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. There are two lounges and a dining area on the ground floor and a smaller lounge on the first floor. Residents and their visitors could access a small patio area to the rear 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 £299.00 to £483.50 per week. Additional charges are made for hairdressing. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection of Healey Lodge was conducted on 26th February 2007. There had been some concerns identified at previous inspections and the Commission for Social Care Inspection had conducted extra visits to the home to monitor the registered providers progress to address areas of concern. The inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. The inspection involved looking at records, talking to the registered manager, two staff, three visitors and four residents, a tour of the home and generally looking at what was happening in the home. Information was also obtained from survey forms received from seven visitors. There were twenty-one residents living in the home on the day of the inspection. What the service does well:
Every resident had a care plan; the plans had been reviewed and updated and showed that relatives and residents had been involved in decisions about changes to care. Residents had access to a range of services to respond to changes in their health and staff had taken appropriate action on health care issues. Medication records were accurate and showed that staff managed residents medication safely. There had been a recent complaint about unsafe medication practices although it was noted that medication was stored safely at all times to prevent any risk to residents. Residents were happy with the way that most staff delivered their care and respected their dignity. Residents were offered a varied, nutritious diet that met their dietary needs Comments included ‘the food is always good’, ‘we always get enough to eat’ and ‘its delicious’. The complaints procedure had been made available to residents and relatives; they knew who to talk to if they were unhappy and felt their concerns would be taken seriously. The adult protection procedure included clear guidance to help staff protect residents but needed slight amendment to bring it up to date. Staff were aware of action to take to protect residents if they suspected abuse. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 6 The home had various aids and specialised equipment available to meet residents assessed needs and to keep them safe from harm. All areas were accessible to wheelchair users. Residents were happy with their rooms, they had brought in personal items and generally the rooms were warm, bright and clean. The laundry was clean and organised and residents said their clothes were always returned in a good condition. The rotas were clear and showed there were sufficient staff on duty to meet resident’s needs. Residents said they were ‘looked after’ and the staff were ‘smashing’. Six relatives thought there were enough staff on duty and two thought there were insufficient staff. What has improved since the last inspection? What they could do better:
The care plans should have included assessments to determine the level of risk to each resident but these were not always in place and action to be taken to reduce or remove the risks were not always recorded in the plan. The medication procedures still did not provide the correct guidance for staff in all aspects including PRN medication, verbal changes, covert administration, ordering and disposal. The home did not provide residents with a range of suitable activities and entertainments that would meet their needs and expectations. Three residents said they would not be interested in the activities provided, as they were not appropriate for them and were happy to sit in their rooms and watch TV or go out with their friends and relatives. One visitor said ‘there is never much going on’.
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 7 The menus showed a choice of meal however other records indicated that only one choice of meal was provided at lunchtime. Three residents confirmed they were not given a choice at lunchtime but were given options for the evening meal. The adult protection procedure needed slight amendment to bring it up to date although most staff had not had any training to support them in this area. The standard of the environment both internally and externally was poor and did not always meet people’s needs and expectations nor create a safe and attractive environment for those living there. There were no storage areas in the home which had resulted in wheelchairs and equipment being stored in bathrooms, lounges and corridors this could be a safety risk to residents, staff and visitors to the home. Not all bedrooms were supplied with call leads and this could prevent staff and residents calling for assistance. Some areas of the home had an unpleasant odour despite staff working hard to ensure carpets were cleaned regularly. There were problems with the washing machine due to reduced water pressure; the machine had to be filled by hand during the rinse cycle and this was time consuming for staff. It was noted that the registered manager had still not followed a safe recruitment procedure and had employed new staff without making sure appropriate employment checks were in place and this could put residents at risk. The home needed to provide staff with appropriate training and supervision to help them to meet people’s diverse needs. Staff had not had training updates for moving and handling, fire safety, food hygiene or first aid training; this training was required to give staff the skills and knowledge to keep them and others safe from harm. The home did not have sufficient staff to provide emergency first aid on every shift. There were no systems in place to monitor whether staff were following policies and procedures and meeting the aims and objectives of 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. The summary of this inspection report can be made available in other formats on request. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents and their families were given sufficient information about the home to assist them to make a decision about whether the home could meet their needs. The home ensured they were able to meet resident’s needs by completing detailed assessments prior to admission and confirming this in writing. The home needed to provide staff with appropriate training to help them to meet people’s diverse needs. EVIDENCE: There was a service user guide that contained useful information about the services that the home offered. The records of two recently admitted residents were looked at. The records showed that the home had collected detailed information about new residents and had confirmed they were able to meet their needs prior to admission. Three staff training files were looked at and two staff were spoken to regarding training offered by the home. It was clear that the home needed to improve the provision of appropriate training to ensure staff had the skills and knowledge to meet the needs of residents in their care (see standard 30).
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 10 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 care plans were generally detailed but needed to include all aspects of action to be taken by staff to keep residents safe and to meet their needs. Residents and relatives had been involved in decisions about care. The medication policies and procedures needed minor improvement to provide safe guidance for staff and to maintain residents safety. EVIDENCE: Three residents care plans were looked at. The plans had been generated from the information obtained about residents prior to admission and generally included detail about action staff needed to take to ensure needs were met. The care plans had been reviewed and updated and two showed evidence to support that relatives and residents had been involved in decisions about changes to care. The care plans included a number of assessments of risks to residents but the assessments for moving and handling, nutrition, falls and bed rails were not always in place and interventions to reduce or remove identified risks were not always detailed in the plan. At the last inspection the registered
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 11 manager had been advised to obtain information to assist with the development of bed rail assessments. Residents had access to a range of services to respond to changes in their health and staff had sought appropriate action on health care issues. The home had two different medication procedures and this could be confusing for staff. The procedures still did not provide the correct guidance for staff in all aspects including PRN medication, verbal changes, covert administration, ordering and disposal. Records were accurate and showed that staff managed residents medication safely. There had been a recent complaint about unsafe medication practices and storage was reviewed at this inspection; it was noted that medication was stored safely at all times to prevent any risk to residents. Three residents confirmed that their privacy was respected; they said they could spend time in their rooms and staff knocked at doors prior to entering. There were no locks on bedroom doors although some had keys to safe storage areas in their rooms (see standard 24). Staff respected resident’s privacy by delivering unopened mail to them or by storing it safely for relatives. Two residents confirmed consultation with their doctor had taken place in the privacy of their rooms. Residents were happy with the way that most staff delivered their care and respected their dignity. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to the service. The home did not provide residents with a range of suitable activities and entertainments that would meet their needs and expectations. The home supported residents to have some control over their lives and to maintain contact with friends and family. Residents were offered a varied, nutritious diet that met their dietary needs but were not consistently offered a choice of meal. EVIDENCE: The registered manager said they had not progressed with the provision of suitable and varied activities. Staff said they didn’t have time for activities and would try to do hand massage or play bingo/dominoes if they could. Three residents said they would not be interested in the activities provided, as they were not appropriate for them and were happy to sit in their rooms and watch TV or go out with their friends and relatives. One visitor said ‘there is never much going on’. Care plans generally contained information about hobbies and interests although this was rarely followed up or acted upon. Residents said staff tried to be flexible and to meet their needs by offering them choices.
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 13 Those who were able to were assisted to maintain contact with friends and family. Visitors said they were welcomed into the home and would be invited to special events. Residents said their visitors could visit at any time and in any area of the home. The menus showed a choice of meal however other records showed that only one choice of meal was provided at lunchtime. Three residents confirmed they were not given a choice at lunchtime but were given options for the evening meal. Records showed that residents were generally given a choice at the evening meal but this had not always been recorded and there was no detail recorded for those who had taken a soft diet. The chef and registered manager said meals were blended separately and attractively served although this was not seen. The registered manager confirmed that a large number of residents needed assistance at meal times and routines were changed to ensure they received appropriate assistance from staff; staff and confirmed that suppers were always given prior to bed time but this had not been recorded accurately. Residents were complimentary about the food. Comments included ‘the food is always good’, ‘we always get enough to eat’ and ‘its delicious’. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 14 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. The home had a clear and accessible complaints procedure with evidence that people are aware of whom to complain to. Adult abuse procedures provided staff with clear guidance about how to protect residents from abuse however staff needed training to ensure they fully understand the risks to residents. EVIDENCE: The complaints procedure had been made available to residents and relatives and was displayed in the entrance hall. The procedure in the file was out of date and inaccurate; the manager was advised this needed to be removed to ensure people had the correct information at all times. Residents and relatives knew who to talk to if they were unhappy and felt their concerns would be taken seriously. The Commission for Social Care Inspection had been involved with two complaints; documentation regarding these complaints should be stored on the complaints file. The adult abuse procedure included clear guidance to help staff protect residents but needed slight amendment to bring it up to date. Staff were aware of action to take if they suspected abuse although most had not had any training to support them in this area. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 15 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, 22, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The standard of the environment both internally and externally was poor and did not always meet people’s needs and expectations nor create a safe and attractive environment for those living there. EVIDENCE: The Commission for Social Care Inspection had raised a number of concerns about the lack of progress to improve the home. However there had been a recent change of ownership and the new owners had made assurances that the home would be improved to provide residents with a safe and comfortable place to live. Some areas of concern had been discussed with the registered provider following the key inspection.
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 16 A tour of the home was completed. The home still did not have a planned programme of maintenance and renewals that would show how improvements to the home would be progressed. There was a list of minor repairs needing the handyman’s attention although some areas requiring repair were not included on this record. Following the last inspection the registered manager stated she had introduced recorded monthly audits of the home to identify areas in need of repair or replacement; the records had not been kept to evidence that this had been done although the domestic said she checked all areas each month and discussed areas for attention with the handyman. One resident’s room had suffered water damage and had damp areas in a corner of the room including the area around the electrical sockets. The resident said it had been like that for some weeks. The registered manager said the tanks had been isolated and they were waiting for it to dry to enable the plaster to be removed and re plastered. The roof in the linen roof had suffered serious damage due to a leak and this was also awaiting repair. The light fitting could not be used due to damage by water. A number of light switches were damaged and had not been replaced. Some rooms had been redecorated and were bright and pleasant and others were in need of redecoration. The Environmental Health department had inspected the kitchen in January 2007 and had identified a number of areas in need of attention; these had not been progressed as yet. There had been concerns from residents and relatives about the reduction in space, particularly in the dining and lounge areas, since one area of the home had been demolished. This could only be resolved once the planned development of the home was completed. Communal areas were furnished with comfortable seating although a number of matching armchair cushions were missing. The home had aids and specialised equipment available to meet residents assessed needs and to keep them safe from harm. All areas were accessible to wheelchair users. There were no storage areas in the home which had resulted in wheelchairs and equipment being stored in bathrooms, lounges and corridors this could be a safety risk to residents, staff and visitors to the home. Not all bedrooms were supplied with call leads and this could prevent staff and residents calling for assistance; there were no risk assessments to support reasons for non-provision. Residents were happy with their rooms, they had brought in personal items and generally the rooms were bright and clean. Not all rooms had minimum furnishings or locks to doors and the reasons for this had not been explained in the care plan. Following a requirement made at the last inspection the registered manager introduced records to support that residents were consulted about keys, furnishings and storage but this was not being used on the care plans looked at during the inspection. All rooms had lockable storage Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 17 for resident’s personal items but the lack of locks on bedroom doors impacted on choice and privacy. Bedrooms were warm and bright. There had been a complaint about a radiator not working in a resident’s room but this had been repaired. The temperatures of water outlets were tested at random and found to be safe. The outside of the home was generally tidy and the patio area to the front of the home was accessible to residents although seating had not been provided. The laundry was clean and organised and residents said their clothes were always returned in a good condition. There were problems with the washing machine due to reduced water pressure; the machine had to be filled by hand during the rinse cycle and this was time consuming for staff. The registered manager said this could only be sorted when the laundry was re sited in the proposed new building and staff had accepted this had to be done as a temporary measure. Some areas of the home had an unpleasant odour despite staff working hard to ensure carpets were cleaned regularly. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 18 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 poor. This judgement has been made using available evidence including a visit to the service. Recruitment practices had not improved and continued to put residents at risk and staff had not received appropriate training that would help them to keep people safe and meet residents needs. EVIDENCE: The rotas were clear and showed there were sufficient staff on duty to meet resident’s needs. Residents said they were ‘looked after’ and that the staff were ‘smashing’. Six relatives thought there were enough staff on duty and two thought there were insufficient staff. One relative was concerned that staff only had time to speak to residents about ‘meals, drinks and personal care’ and another said staff were not always within calling distance. Comments from visitors included ‘staff are always pleasant and caring’ and staff ‘are all fantastic’. The lack of suitable employment checks had raised serious concerns at previous inspections although on the last inspection the registered manager had demonstrated that a safe procedure had been followed for a new recruit. Three recruitment files were looked at; two of these were recently appointed staff. It was noted that the registered manager had still not followed a safe
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 19 procedure and had employed staff without appropriate employment checks being in place and this could put residents at risk. The recruitment procedure needed minor review to reflect current practice regarding Protection of Vulnerable Adults. Passport photographs were being used as a means of identification and these were sometimes unclear. Residents said they were not involved in the interview and selection of new staff and this should be considered. Records of the interview and selection process should be maintained to demonstrate an equal opportunities procedure was used. There had been concerns during previous inspections that the home did not provide staff with suitable skills and knowledge to help them to meet resident’s needs. At the last inspection there was evidence that the registered manager had begun to address this and said the home had purchased a training pack. Training was discussed with staff and records were looked at. New staff said they had received a basic introduction to the home and thought some of it had been documented although there were no records to support this. One of the new staff had received moving and handling training and the other had not, neither had received any other training to keep them and others safe. Training was very limited and staff were not provided with sufficient training to help them to meet residents needs. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 20 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, 36 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 had begun to seek people’s views and opinions although residents and relatives needed to be consulted on a regular basis. Staff were supported but had not consistently received regular formal supervision, which would help to identify areas needed to improve their skills and knowledge to meet residents needs. The home was able to demonstrate that systems were maintained however the lack of basic health and safety training for staff could put people’s health, safety and welfare at risk. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 21 EVIDENCE: The registered manager or person in charge of the home is Mrs Goodwin; she is a qualified nurse and has many years experience in care and management. Mrs Goodwin does not have a relevant management qualification and has no plans to achieve one as she plans to retire soon. Records show that Mrs Goodwin had maintained her skills and knowledge by attending relevant training. The Commission for Social Care Inspection had had a number of concerns regarding unsafe management practices that could be risks to residents, visitors and staff and also recognised that Mrs Goodwin had been unable to fully discharge her responsibilities as registered person as she was not involved in the planning and did not have access to budgets. There were no systems in place to monitor staff compliance with policies and procedures. The last survey to obtain the views and opinions of relatives and residents was completed in April 2006; the results were collated and made available in the service user guide. Comments had included the need for more entertainment, improvements to gardens, driveway and communal areas. Comments regarding staff were positive and included the care is ‘excellent’ and the staff ‘are caring’. The registered manager held regular meetings with staff where they were able to air their views but still none with relatives and residents. The home had achieved the Investors In People award, which is a recognised professional quality award that monitors a number of systems in the home. The registered manager said the home did not normally deal with resident’s finances although there were records and receipts to support that the home managed some aspects of finances for residents and relatives. Staff had not received regular one to one supervision that would help identify areas of improvement needed to meet resident’s needs. Staff said senior staff were ‘helpful’ and supported them in all aspects of their work. Training, supervision and development of staff was inconsistent. The Commission for Social Care Inspection had not received regular reports to show that the registered provider had monitored the running of the home. However it was recognised that the home had recently been sold and this area will be monitored. The records to support that people’s health, safety and welfare were protected were stored on file and accessible for inspection. A number of service and maintenance certificates were due to expire and the registered manager was aware of due dates. The records to support staff attended regular fire drills were missing and the fire risk assessments had not been reviewed. Following
Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 22 the last inspection the registered manager had purchased a fire-training package that would provide staff with the knowledge and skills to maintain people’s safety but this had not been introduced. Staff had not had training updates for moving and handling, fire safety, food hygiene or first aid training; this training was required to give staff the skills and knowledge to keep them and others safe from harm. The home did not have sufficient staff to provide emergency first aid on every shift. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 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 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X 2 X 2 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 24 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. 2. Standard OP7 OP7 Regulation 15 13 Requirement Care plans must detail how residents health, personal and social needs will be met. The use of bed rails must be risk assessed and agreed with the resident and/or their representative. Timescale of 25/10/05 not met. The care plans must include assessments of risks and record action to be taken to reduce or eliminate those risks. The medication procedures must be reviewed to include current safe practice for ordering and disposal of medicines. Suitable activities, both inside and outside the home, must be provided following consultation with residents. Timescale of 05/06/06 not met. Residents must be offered a choice at every mealtime and accurate records must be available to support this. The registered person must ensure a programme of routine
DS0000068937.V332020.R01.S.doc Timescale for action 23/04/07 23/04/07 3. OP8 13 23/04/07 4. OP9 13 23/04/07 5. OP12 16 23/04/07 6. OP15 16 23/04/07 7. OP19 23 23/04/07 Healey Lodge Nursing Home Version 5.2 Page 25 8. OP19 23 9. OP22 13 10. OP29 19 11. OP29 19 12. OP30 19 13. OP38 13 14. 15. 16. OP38 OP38 OP38 13 13 13 maintenance and renewal of the fabric and decoration of the home is produced and implemented with records kept. Timescale of 4/07/05 not met. Repairs to the areas damaged by water in the bedrooms and linen rooms must be commenced and the Commission for Social Care Inspection notified on completion. All rooms must be fitted with an accessible alarm facility. Reasons for non-provision must be risk assessed and documented in the care plan. The recruitment procedure must be reviewed to reflect current practice regarding Protection of Vulnerable Adults checks. The registered person must ensure all required employment checks and assessments of any risks are in place prior to employment of staff. The registered provider must ensure there is a nationally recognised training programme in place that fulfils the aims and objectives of the home and meets the changing needs of the residents. All staff must receive regular fire safety, moving and handling, food hygiene and health and safety training. The fire risk assessments must be reviewed A record of all staff that attended fire drills must be maintained. There must be a qualified first aider on duty at all times. 26/03/07 26/03/07 23/04/07 26/03/07 23/04/07 23/04/07 23/04/07 23/04/07 23/04/07 Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard OP9 OP9 OP15 OP16 OP16 OP18 OP19 OP19 Good Practice Recommendations The medication procedure should be reviewed to include current safe practice for ordering, disposal, PRN medication, verbal changes and covert administration. The procedure file should contain only the current medication policies and procedures. Liquidised meals should be presented in separate portions The procedure file should contain only the current complaints procedure The complaints file should contain records of all complaints made and the outcome of the investigation. The adult abuse procedure should be updated to reflect the correct contact names of local agencies. Consideration should be given to the provision of suitable garden furniture. A regular audit of all areas of the home should be undertaken to ascertain which items need repair and replacement in order to begin a planned programme of repair and refurbishment. Action should be taken in response to the areas identified in the report from Environmental Health. Consideration should be given to alternative, safer storage of wheelchairs. Accommodation should be audited against NMS 24 and where the resident requires it the furnishings and fittings be updated and a record should be kept when residents do not wish to have items of furniture in their room. Residents should be provided with keys to lockable storage unless a risk assessment states otherwise. It should be determined whether there are alternatives available to prevent the need for the washing machine to be hand filled during the rinse cycle. Staff files should include a recent photograph as a means of clear identification. Consideration should be given to involving residents in the interview and selection of staff. Records of the interview and selection process should be maintained. There should be 50 care staff with a minimum NVQ level 2, or equivalent, qualification.
DS0000068937.V332020.R01.S.doc Version 5.2 Page 27 9. 10. 11. OP19 OP22 OP24 12. 13. 14. 15. 16. 17. OP24 OP26 OP27 OP27 OP27 OP28 Healey Lodge Nursing Home 18. 19. 20. 21. 22. OP30 OP31 OP33 OP33 OP36 A record of basic induction and any further training should be maintained and stored on staff files. The registered manager should obtain a recognised management qualification to support her skills and knowledge. There should be systems in place to monitor staff compliance with policies and procedures. Meetings with residents and their relatives should be held regularly Staff should receive formal one to one supervision at least six times a year. Healey Lodge Nursing Home DS0000068937.V332020.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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