CARE HOMES FOR OLDER PEOPLE
Healey Lodge Nursing Home 114 Manchester Road Burnley Lancashire BB11 4HS Lead Inspector
Mrs Marie Matthews Key Unannounced Inspection 28th August 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.V342601.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.V342601.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.V342601.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). 26th February 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. At the time of the inspection the home could only accommodate twenty-one residents and the lounge, dining and bathroom space had been reduced. There are two lounges 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 £332.00 to £483.00 per week. Additional charges are made for hairdressing, newspapers and dry cleaning. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection, including a visit to the home, took place on 28th September 2007. The inspection process included looking at records, a tour of the home, and discussion with the operations manager, two care staff, one visitor and four residents. Information was also included from survey forms filled in by one visiting professional (GP) and two visitors. 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 nineteen residents living in the home on the day of the inspection. Following previous inspection visits there had been a number of concerns regarding unsafe management practice that could put people at risk. The Commission for Social Care Inspection had monitored the registered persons response to any issues. 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. 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. A General Practitioner (GP) commented that staff always managed peoples’ health needs, sought advice and responded appropriately if residents’ health changed. One relative commented that staff provided ‘good nursing care’. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Medication records were accurate and showed that staff managed residents medication safely. Residents were happy with the way they were looked after; they said staff respected their privacy and dignity. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 6 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. Residents were happy with their rooms which were bright and clean and generally odour free; some residents had brought in personal items to enhance the homely feel. The laundry was clean and organised and residents said their clothes were always returned in a good condition. Residents said there were sufficient staff to meet their needs, one resident said ‘there are enough staff around’ another said ‘staff are great, really friendly’. The records to support regular servicing and maintenance of equipment were available for inspection and showed that people’s health safety and welfare were protected. What has improved since the last inspection?
An activities co-ordinator had been employed since the last key inspection and records showed that a range of suitable activities had been provided to endeavour to meet residents’ diverse social needs. Some residents said they preferred not to join in the group activities and this had been respected. The menus had been reviewed to offer a varied and nutritious choice. There were records to show that a thorough room-to-room audit had been completed; any areas in need of repair and attention had been included as part of the audit with assurances this would be kept under review. 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. An Operations Manager had recently been employed to provide support and advice to the registered manager. A number of concerns that had been raised in previous inspection visits were being responded to; new systems were being introduced that would improve safety for staff and residents. More than half of care staff had achieved an appropriate (NVQ) qualification in care and others were working toward one; this would develop staff skills and experience to help them to meet residents’ needs. Formal one-to-one staff
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 7 supervision had recently commenced; supervision would help identify any training or support needed for staff to meet residents’ needs. A number of staff had received fire safety training to help them to respond appropriately in the event of a fire. People had been asked their views and opinions about whether their needs and expectations were being met. Staff meetings were held regularly and staff said they were able to raise any concerns and were kept up to date. What they could do better:
There were major concerns regarding residents’ care plans. The documentation had recently been changed but did not record individualised care and could place residents at risk of not having their needs met. The plans had not always been reviewed and updated to reflect current care needs. The adult protection procedure again needed slight amendment to bring it up to date although most staff had not had any training to support them in this area. The records of food served showed only one choice was offered at each mealtime; however from discussion with residents it was clear that choices and alternatives had been offered and the records needed to be improved to reflect this. 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 been delayed following a change of ownership. 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, inaccessible and unsafe in places. One visitor commented ‘the outside grounds are a real mess’ another suggested to improve the home ‘the owner could build the back of the building which the previous owner demolished’. There were no storage areas in the home which resulted in wheelchairs and medical supplies and equipment being stored in bathrooms and residents’ bedrooms; 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. Not all rooms had minimum furnishings, only one bedroom was provided with a lockable door and a number of bedrooms were not provided with duvets, valances or eiderdowns and the existing bedding was not colour co-ordinated; this impacted on residents’ choice, privacy and dignity and the reasons for this were not recorded in the care plans.
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 8 Some areas of the home had an unpleasant odour despite staff working hard to ensure carpets were cleaned regularly. 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 of being cared for by unsuitable people. Staff must undertake appropriate training and be formally supervised to help them to meet people’s diverse needs. Staff had not had training updates for moving and handling, 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. Action to address requirements and recommendations had not been taken within agreed timescales and it had taken some time to obtain information to support improvements were being progressed. There were no systems in place to monitor whether staff were following policies and procedures and no records to support that the registered provider had monitored all aspects of management of the home. One recommendation regarding the dishwasher flooring needs to be addressed following the Environmental Health visit; this would ensure the kitchen was safe. It was noted that work to chlorinate the water supply was overdue; the operations manager stated this had been referred to the engineer and certificates would be forwarded to the Commission on completion. 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.V342601.R01.S.doc Version 5.2 Page 9 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.V342601.R01.S.doc Version 5.2 Page 10 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. Standard 6 not applicable. 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 to assist them to make a decision about whether their needs would be met at Healey Lodge. Detailed assessments of residents care needs were completed prior to admission to ensure their needs would be met. Staff did not have the appropriate skills and knowledge to keep residents safe. EVIDENCE: Information about the services the home provided had improved so that people could make informed decisions about whether the home was suitable for them. The service user guides were available in residents’ rooms and on display in the entrance; two relatives said they had been given enough information about the home. Detailed information was collected about residents, before they were admitted, to determine whether they could be looked after properly; it was then confirmed in writing that people’s needs would be met. The assessment
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 11 document needed minor review to ensure all aspects of their needs were considered including the risk of falls and family contacts and involvement; it also should be dated to determine the date of assessment. Copies of the care management assessments, completed by the local authority, should be included on the care file for staff to reference. Staff had a mix of skills and qualifications to help them to meet residents assessed needs although records did not support that staff had the necessary training to maintain the safety of residents in the home (see standard 30). Despite assurances in the improvement plan there had been little progress since the last key inspection; however there was a training plan to commence in September and October to ensure staff had received mandatory training. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 12 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 do not clearly detail action to be taken by staff to meet residents’ needs and do not demonstrate that people are involved in decisions about care. The medication policies and procedures provide safe guidance for staff and maintain residents safety. Residents’ privacy and dignity were respected. EVIDENCE: Three care plans were looked at in detail. The documentation had been changed but the format did not record individualised care to help staff to meet residents’ diverse needs. Care plans had been reviewed generally each month although there were some gaps and the format did not clearly record assessment information, risks, reviews and changes to care. Some people had been involved in decisions about care. The care plans showed that 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. A General Practitioner (GP) commented that
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 13 staff always managed peoples’ health needs, sought advice and responded appropriately if residents’ health changed. One relative commented that staff provided ‘good nursing care’. Residents were provided with a range of specialised aids and adaptations to maintain their comfort and safety and to help them to maintain their independence wherever possible. Two of the care plans contained assessments to identify that residents were at risk of developing pressure sores; interventions to reduce or eliminate risks were not recorded in detail. One resident had developed pressure sores and there was a wound care plan to clearly direct staff with appropriate care. Moving & Handling assessments were included in two of the care plan although the information in one of these was out of date. Assessments of residents’ nutritional needs were included in only two of the care plans although residents’ weights had been monitored and any changes responded to. All three care plans included a risk assessment regarding falls although the record of interventions was not up to date in two of the care plans and use of a cocoon (restraint) was not discussed with the residents’ relatives. The information in care plans was not currently monitored although documentation was provided to assist with this process. The medication policies and procedures had been supplied as part of the improvement plan and provided safe guidance for staff in all aspects of management of medicines. Records were accurate and showed that medicines had been managed safely. Instructions or protocols needed to be introduced to guide staff with their decisions to administer ‘PRN’ or ‘as needed’ medicines or not; a form was provided to assist development of clear protocols. Medication storage areas were secure and clean. One GP commented that staff managed medication safely. The management of medicines was not currently audited; audits would determine whether staff were following safe procedures. Documentation was again provided to assist management with this process. Two residents confirmed that staff respected their privacy and dignity. They said they were able to spend time in their rooms if they wished and were visited by their GP in the privacy of their rooms. One GP commented that residents’ privacy and dignity were always respected. There were still no locks on bedroom doors (see standard 24) and this impacted on residents’ privacy although one resident had requested a lock and this had been arranged. Some residents were unable to manage keys to their lockable storage and risk assessments were in place to support non-provision of keys. Staff were seen responding to residents and visitors in a friendly but respectful manner. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. A range of suitable activities and entertainments were provided that would meet residents’ needs and expectations. Residents’ were able to make choices and to maintain contact with friends and family. Residents were offered a varied, nutritious diet that met their dietary needs. EVIDENCE: Residents said the daily routines were flexible and they were able to make choices in relation to a number of areas and two staff confirmed this. An activities co-ordinator had been employed since the last key inspection and records showed that a range of suitable activities had been provided to endeavour to meet residents’ diverse social needs. Some residents said they preferred not to join in the group activities and this had been respected. Three residents said they were able to maintain social contacts outside of the home with assistance from friends and relatives. The assessment information in care plans contained some reference to choices and preferences and hobbies and interests and it was suggested that the activity person involved some of the
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 15 relatives in providing more detailed social information about residents as staff would find this useful to make appropriate decisions for them. Two visitors said they were able to visit at any time in the privacy of the bedroom or in the communal areas and two others said they were kept up to date with any changes affecting their relative. One visitor commented that it was cramped in the lounge when visitors were in; the lounge areas had been recently re-organised to provide comfort and safety. Information about outside agencies such as advocacy, relatives and care associations and citizens advice bureau were on display on the notice board; this would ensure people could contact the appropriate people for help and advice. The menus had been reviewed to offer a varied and nutritious choice. Residents made positive comments about the meals including ‘we always get plenty’, ‘we have a choice’ and ‘the food is good’. There were records of food served that showed only one choice was offered; however from discussion with residents it was clear that choices and alternatives had been offered and the records needed to be improved to reflect this. Mealtimes were at different sittings to ensure all residents received appropriate assistance from staff. Fresh fruit had been introduced in the afternoons as part of a ‘healthy eating campaign; residents said they enjoyed this. Dining areas were bright and tables were attractively set. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 complaints procedure was clear and accessible. Adult protection procedures did not provide staff with clear guidance about how to protect residents from abuse. EVIDENCE: The complaints procedure had been made available to residents and their visitors and was displayed in the entrance hall on the notice board. The records showed that complaints were responded to appropriately and two visitors were sure their concerns would be responded to appropriately. Three residents said they knew whom to complain to and that staff would resolve their concerns. The adult protection procedure had been reviewed as part of the improvement plan; however the procedure made available for inspection did not include the contact information for local agencies and did not provide clear guidance for staff to help them to respond to any suspicion of abuse. Staff had not received adult protection training; the operations manager said all staff would receive adult protection training following completion of mandatory health and safety training. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 17 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 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 both internally and externally requires attention as it does not always meet people’s needs and expectations nor does it create a safe and attractive environment for those living 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 been delayed following a change of ownership. A tour of all areas of the home was conducted. A room-to-room audit, that had been required as part of the improvement plan following concerns raised at the previous two inspection visits, had not been kept up to date. However the newly appointed operations manager had recently completed a thorough
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 18 room-to-room audit with assurances this would be reviewed and addressed each month. Areas in need of repair and attention, noted during the tour, had been included as part of the audit and some had been recorded in the handy mans daily list; these included broken dimmer switches, décor in need of upgrade, damage to plasterwork by bed heads, carpet trip hazard, broken TV and damage to treatment room ceiling. Damage to the walls, ceiling areas and plasterwork that had been identified at the last inspection had been repaired. 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, inaccessible and unsafe in places. The rear patio area was derelict and overgrown and the area to the side of the driveway remained an abandoned building site. 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. One visitor commented ‘the outside grounds are a real mess’ another suggested to improve the home ‘the owner could build the back of the building which the previous owner demolished’. The building complied with the fire service; risk assessments were in place and action was being taken to complete the recommendations. The Environmental Health Officer had inspected the kitchen areas and all but one recommendation had been addressed to ensure the kitchen was free from hazards. Aids and adaptations to assist residents with maintaining their independence and provide comfort and safety were provided around the home. There were no storage areas; wheelchairs were being stored in a locked bathroom and medical supplies were stored in residents’ rooms. Once again not all areas were supplied with nurse call leads and this could prevent staff and residents calling for assistance; there were no risk assessment to support reasons for non-provision. Residents were happy with their rooms which were bright and clean and generally odour free; some residents had brought in personal items to enhance the homely feel. Not all rooms had minimum furnishings, only one bedroom was provided with a lockable door and a number of bedrooms were not provided with duvets, valances or eiderdowns and the existing bedding was not colour co-ordinated; this impacted on residents’ choice, privacy and dignity and the reasons for this were not recorded in the care plans. All bedrooms were supplied with lockable storage and non-provision of keys to this facility was recorded on the care plan. The laundry was clean and organised and residents said their clothing was returned in a good condition. There had been problems with a washing machine at the last inspection and this had been resolved. Generally the home was odour free with the exception of three rooms, which were brought to the operations managers’ attention. Gloves, aprons and hand washing facilities were provided to maintain control of infection. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 19 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 continued to put residents at risk of being cared for by unsuitable people. Staff had not received the appropriate training that would help keep people safe and meet residents needs. EVIDENCE: Staffing rotas showed there were sufficient numbers of staff to meet the needs of the residents. Residents said there were sufficient staff to meet their needs, one resident said ‘there are enough staff around’ another said ‘staff are great, really friendly’. There had been ongoing concerns regarding the registered managers failure to follow a safe recruitment procedure and how this could put residents at risk. Three staff files were looked at in detail; it was clear that unsafe practices involving the lack of suitable references continued to put residents at risk. An audit of all staff files, to ensure appropriate checks were in place, had been requested following the last inspection visit; it was disappointing that this had only recently been commenced. Residents were not yet involved in the recruitment and selection of new staff although the operations manager said this would be considered. Records of the interview and selection process had not been maintained and failed to show that an equal opportunities procedure had been followed.
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 20 More than half of care staff had achieved an appropriate (NVQ) qualification in care and others were working toward one; this would develop staff skills and experience to help them to meet residents’ needs. However there had been serious concerns regarding the lack of appropriate induction and health and safety training available for new and existing staff. There was still no evidence that all new staff had been provided with a basic induction or that existing staff had received regular safety training to help keep them and others safe. Records showed that a number of staff had received fire safety training following the last inspection and the operations manager had developed a plan to support that mandatory safety training was due to commence in September and October. An induction programme that was linked to the skills for training induction standards was to be introduced to support staff in their work. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 21 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, 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 was safe although not well managed. The quality assurance systems that monitored whether the home met people’s needs and expectations had been improved. EVIDENCE: The registered manager or person in charge of the home is a qualified nurse and has many years experience in care and management. She does not have a recognised management qualification to support her with her role. An operations manager has been appointed recently and will provide support for the registered manager and monitor the day-to-day running of the home. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 22 Following this and previous visits to the home the Commission for Social Care Inspection has had a number of concerns regarding unsafe management practices that could put people at risk particularly care planning, medication, recruitment, training and supervision. The registered manager had not had access to budgets or been involved in business planning so it had been accepted that some environmental concerns were out of her control, however following the change of ownership earlier this year the new registered provider had made sufficient resources available to address a number of areas of concern although little progress had been made. People had been asked their views and opinions about whether the home was meeting their needs and expectations. Staff meetings were held regularly and staff said they were able to raise any concerns and were kept up to date. The home had achieved the Investors In people award; this is a recognised quality award that monitors a number of systems within the home. Action to address requirements and recommendations had not been within agreed timescales and it had taken some time to obtain information to support the improvement plan. There were no systems in place to monitor whether staff were following policies and procedures although the operations manager was given information and advice to assist with developing internal audits. There were no records to support that the registered provider had completed his responsibilities in accordance with Regulation 26. This was discussed with the operations manager who stated this would be her responsibility. The recruitment records were unavailable initially as the registered manager had the keys; she was contacted at home to provide the keys. Records, as listed in schedule 3 & 4, must be at all times available for inspection by the Commission for Social Care Inspection. Information in the service user guide stated that the home did not deal with residents’ finances and that alternative arrangements should be made. There were records and receipts to record management of fees. Formal one-to-one staff supervision had recently commenced; supervision would help identify any training or support needed for staff to meet residents’ needs and should be conducted on a regular basis. The records to support regular servicing and maintenance of equipment were available for inspection and showed that people’s health safety and welfare were protected. The fire risk assessment had been completed and action was being taken to respond to recommendations. The Environmental Health officer visited and one recommendation regarding the dishwasher flooring needs to be addressed as detailed earlier in the report. It was noted that work to chlorinate the water supply was overdue; the operations manager stated this
Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 23 had been referred to the engineer and certificates would be forwarded to the Commission on completion. The provision of mandatory training had not been progressed and could put staff, residents and visitors at risk from unsafe practices. However the operations manager had a training plan to support moving & handling, first aid, food hygiene and dementia were booked to take place this year. The majority of staff had received fire safety training in May 2007 following concerns raised at the last key inspection. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 1. OP7 15 Care plans must detail how 08/10/07 residents individual health, personal and social needs will be met. Timescale of 23/04/07 not met. 2. OP7 15 The care plans must be reviewed 08/10/07 at least monthly and updated when care needs change. 3. OP8 13 The use of bed rails and other 08/10/07 restraint measures must be risk assessed and agreed with the resident and/or their representative. Timescale of 25/10/05 not met. 4. OP8 13 The care plans must include 08/10/07 assessments of any risks to residents and clearly detail action to be taken to reduce or remove those risks. Timescale of 23/04/07 not met. 5. OP18 13 The adult abuse procedure 08/10/07 should be updated to reflect the correct contact names of local agencies. 6. OP19 23 Plans to re-build and develop 01/11/07 areas of the home must be progressed to ensure residents have an attractive, safe and comfortable place to live. 7. OP19 23 A programme of routine
DS0000068937.V342601.R01.S.doc 08/10/07
Version 5.2 Page 26 Healey Lodge Nursing Home 8. OP22 13 9. OP29 19 10. OP30 19 11. OP33 24 maintenance and renewal of the fabric and decoration of the home must be produced and implemented with records kept. Timescale of 4/07/05 not met. All rooms must be fitted with an accessible alarm facility. Reasons for non-provision must be risk assessed and documented in the care plan. Timescale of 26/03/07 not met. The registered person must ensure all required employment checks, including suitable references, are in place prior to employment of staff. Timescale of 26/03/07 not met. All staff must undergo a training and development programme that fulfils the aims and objectives of the home and meets the changing needs of the residents. Timescale of 23/04/07 not met. Action must be taken, within agreed timescales, to respond to requirements identified in the inspection report. 08/10/07 08/10/07 08/10/07 08/10/07 12. OP37 26 There must be a record to 08/10/07 support regular monitoring of the management of the home. Records specified in schedules 3 & 4 must be kept up to date and available for inspection by any person authorised by the Commission for Social Care Inspection. 08/10/07 13. OP37 17 14. OP38 13 Certificates to support servicing 08/10/07 and chlorination of the water system must be forwarded to the Commission for Social Care Inspection. All staff must receive moving and handling, food hygiene and
DS0000068937.V342601.R01.S.doc 15. OP38 13 08/10/07
Page 27 Healey Lodge Nursing Home Version 5.2 health and safety training regularly to maintain and update their skills. Timescale of 23/04/07 not met. 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. Refer to Standard OP3 Good Practice Recommendations The pre-admission assessment should include all aspects as listed in standard 3. The pre-admission assessment should be dated at the time of the assessment. The local authority needs assessment should be included with the care plan. ‘PRN’ or ‘as needed’ medications should be supported with clear directions or protocols as per procedure. Records should clearly detail that residents have been offered a choice of meal at each sitting and that alternatives to the menu have been provided. Staff should receive regular adult protection training Action should be taken to respond to recommendations identified in the report from Environmental Health. 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. Suitable bed linen should be provided for all residents. All areas should be free from offensive odours. Consideration should be given to involving residents in the interview and selection of staff. Records of the interview and selection process should be maintained. 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. Staff should receive formal supervision at least six times a year.
DS0000068937.V342601.R01.S.doc Version 5.2 Page 28 2. 3. 4. 5. 6. OP9 OP15 OP18 OP19 OP24 7. 8. OP26 OP27 9. 10. 11. 12. OP30 OP31 OP33 OP36 Healey Lodge Nursing Home 13. OP38 Risk assessments should demonstrate that suitably qualified and competent first aiders are available twentyfour hours a day. Healey Lodge Nursing Home DS0000068937.V342601.R01.S.doc Version 5.2 Page 29 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.V342601.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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!
