Inspection on 23/10/08 for Lodge The Residential Care Home

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lodge The Residential Care Home 02/11/07

Lodge The Residential Care Home 03/11/06

Lodge The Residential Care Home 24/05/06

Lodge The Residential Care Home 07/02/06

Lodge The Residential Care Home 17/08/05

Lodge The Residential Care Home 17/03/05

Lodge The Residential Care Home 24/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lodge The Residential Care Home Lodge The Residential Care Home Heslington York YO10 5DX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sean Cassidy     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Lodge The Residential Care Home Lodge The Residential Care Home Heslington York YO10 5DX 01904430781 01904870430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Geraldine Ann Timbs Type of registration: Number of places registered: Colourscape Investments Limited T/A The Lodge Residential Home care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Lodge is a care home registered by Colourscape Investment Limited to provide accommodation and personal care to up to twenty four older people who may have dementia. The company has recently been sold and new directors have been appointed. The home consists of a large, detached, pre Victorian house with a newer purpose built extension. It is situated in the village of Heslington and is within walking distance of local facilities and amenities including shops, cafes and pubs. The amenities of York city centre are also accessible by transport. Twenty of the rooms for single accommodation, two for shared. None of these rooms has en suite facilities; there are however sufficient bathroom and WC facilities for the residents that are located close to bedrooms as well as ground floor shared rooms including the dining room, lounge Care Homes for Older People Page 4 of 30 Over 65 24 24 0 0 Brief description of the care home and quiet room. Bedrooms are situated on the ground and first floors, the latter being accessed by one of two staircases. The home does not have a passenger lift but one of the staircases has a stair lift. There is ramped access to the home. The home has a large well maintained garden and there is an area of hard standing for parking to one side of the building. At the last inspection current fees for the home range from 410 to 425 pounds per week. The fees do not include the use of services such as hairdressing and chiropody. The inspection report is made available upon enquiry. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The accumulated evidence in this report has included: A review of the information held on the homes file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. Information received from the Annual Quality Assurance Assessment document provided by the manager. One inspector conducted an unannounced visit to the home, which lasted one day. The Care Homes for Older People Page 6 of 30 majority of this time was spent looking at documentation, speaking to residents, management, staff and relatives. A number of documents were looked at during the visit and parts of the environment used by the people living there were also looked at. A proportion of time was spent speaking to the manager, the deputy manager, staff and visitors. The information required from the service in the form of the Annual Quality Assurance Assessment was obtained before this report was written. The manager was provided with feedback at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 30 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures all people who choose to be admitted are assessed prior to admission to ensure their needs can be met. Evidence: The home has a Statement of Purpose and a Service User Guide. These documents were looked at and the provider agreed that they were in need of review so that they included all the information needed to ensure people are well informed about the services offered. Seven people who returned the surveys said they did not receive enough up to date information before they moved in and three surveys said they did. The people spoken to said they they all had an opportunity to come and look around. They also said that this was encouraged by the manager. The care files seen showed people were assessed by the manager before they arrived at the home. This is good practice as it helps the home ensure that the prospective admissions needs can be Care Homes for Older People Page 11 of 30 Evidence: met. Intermediate care is not offered at this service. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not provided with appropriate care planning and risk assessments to ensure their care needs will be met. People are provided with their care package from a staff group that is respectful and helpful. There are some areas where dignity can be improved. Evidence: Each person is provided with a care file that includes information about: care plans; risk assessments; daily records; assessments and Professional visits. The care files for three people were closely looked at. In all cases there was evidence that the assessment of each individual had not been completed as there were gaps left that should have been filled in. Evidence was also seen to show assessments were not reviewed regularly or hen they were in need of review. Some care files showed a good person centered care approach and provided staff with a good insight into the likes and dislikes of each individual. This is good practice. Care Homes for Older People Page 13 of 30 Evidence: The Annual Quality Assurance Assessment supplied by the manager stated that care plans are reviewed on a regular basis and that they all included risk assessments. This was found not to be accurate. Care plans and risk assessments did not have evidence to show they were reviewed monthly and involved the person or their representative. Not everyone had risk assessments carried out in areas such as nutrition, falls and moving and handling. One person was being weighed regularly but when there was an identified weight loss there was no evidence that action had been taken to deal with this problem. The staff were observed providing the care over the course of the day. This were seen as being respectful to people and kind. They treated people courteously and there was positive interactions seen over the course of the day. People spoken to gave positive comments about the care staff. they said, The staff treat me really well. The carers are kind to people and their families. The staff are good communicators. They tell me everything about my husband and how his health is. Staff were observed knocking on peoples doors before they entered. People were dressed appropriately and they appeared well groomed. Some issues with regards to dignity were raised with the deputy manager and provider during the inspection. Staff were observed going round the home with a box of continence aids asking people to go to the toilet or their rooms to get changed. This was highlighted at the last inspection and is undignified practice and should stop. The provider agreed that this would be looked at as a matter of urgency. One person said that the staff put him in the bath whether he likes it or not. He said, I want to go to the bath when i want and not to be told! Evidence was seen that the care home operates a bath rota system. This is not good practice and should stop. People should be encouraged to have a bath or a shower when they want and not when it is convenient for the staff. The medication storage and administration in the home was reviewed. The person in charge of the shift that day was observed administering medication. The medications were administered correctly and the correct recording was made. There was a fridge in the managers office used to store medication. The temperature of the fridge was monitored regularly. This is good practice. The medication charts were looked at. The records showed that staff were not prescribing medication consistently. One person had not had a sleeping tablet for thirteen days. Tablets were being omitted without consulting the general practitioner. This is not good practice. Care Homes for Older People Page 14 of 30 Evidence: Records need to be in place that show the medications stored in the home are audited using an appropriate auditing tool. This will help protect people living in the home. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people are provided with some leisure outlets in the home, a more structured approach is needed to ensure the specialist dementia needs of people are being properly provided for. Evidence: People spoken with said they were happy with the visiting times that were available. It was clear that open visiting was provided and people said they always felt welcome when they arrived. I was told that there was a chocolate fondue party put on the week before the inspection. Relatives and people who live in the home said they accessed the gardens in the good weather. A singer also comes to the home monthly to entertain people. A Halloween party was being planned by staff. There was music played in the lounge area during the inspection which seemed calming and enjoyed by those that were listening. Some people were doing jigsaws and one was playing dominoes. There was little evidence available about how the staff provide structured activities that are specifically aimed at people with dementia. There are many specialist activities available in this specialist area that help stimulate people with dementia but Care Homes for Older People Page 16 of 30 Evidence: this was not seen on the day. No evidence was seen displayed around the home that informed people as to what activities were being provided for the week. The surveys that were returned by service users highlighted a problem with the provision of activities. People said they had very few opportunities to access facilities outside the home. The deputy manager on duty at the time of the inspection confirmed that there were few opportunities provided to access leisure activities outside. Evidence was found to show some peoples spiritual needs are provided for in the way of a monthly service being provided by the Church of England. However, there are people from the Roman Catholic community in the home that have not had their spiritual needs properly assessed and provided for. One person was identified as being a devout Catholic who played an active part in the church. However, since arriving at the home no provision has been made for him to prove for this spiritual need. He and his relative said they would very much appreciate an opportunity to attend mass. This was passed on to the provider during feedback for action. Papers are provided for people to read during the week and at weekends. The end of the breakfast meal and the lunchtime meal was observed. people were seen to enjoy this social occasion and were provided with assistance when needed. This was carried out in a respectful and dignified manner. People were asked what they wanted and a choice was offered. Good practice in dementia care recommends that people are shown two dishes so that they may understand what is being asked more easily. The cook was spoken to and she explained how they cooked meals for people in the home. She confirmed that all people who are involved with food handling have been properly trained. The cook said that finger buffets are not offered to people as part of the dementia care package. It was recommended that the cook attends a course in food provision for people with specialist dementia needs. This will help those people living in the home to ensure meals provided are appropriate for people with specialist dementia needs. There was an extra lounge with a television for those that did not want to be in the large lounge room. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a complaints process should they need to complain. Although people said they felt safe living in the home, the staff are not all trained in safeguarding. Their understanding of their role in safeguarding was unclear. This does not thoroughly protect people who live there. Evidence: The deputy manager said that there had been no complaints recorded since the last inspection. The home has a complaints procedure in place that contains all the required information needed to assist people with making a complain. People spoken to were said they were well informed and knew how to complain if they wished to. it was recommended that the complaint procedure displayed in the home could be written with bigger lettering to help those with bad eyesight. Dementia signage should also be used to assist people with making a complaint. Not all staff have received training in safeguarding vulnerable people. This was evidenced through speaking with carers during the inspection. Two carers were spoken to about safeguarding issues and how they would protect people if they identified abuse had taken place. They were unclear of what constitutes abuse and the homes policy/procedure for dealing with this if it was identified. Care Homes for Older People Page 18 of 30 Evidence: People spoken to said they felt safe living in the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with an environment that is good. Evidence: The home has recently undergone some refurbishment work. The front entrance was nearing the end of building work needed to repair water damage. The corridors of the home have had the carpets replaced with non slip wood flooring which looks well. The garden at the front of the house has been revamped. It has been fenced as well s that people are able to wander safely out of the home. This is good practice. There are two other gardens that have been updated to be more accessible to people. On is a sensory garden which the provider said was well used. The bedroom doors have had name plates put on them to help people identify there rooms. Other ways should be looked at to help people do this. people with dementia often loose the ability to understand the written word. The home employs domestic staff to carry out cleaning and laundering duties. People said they were happy with the standard of cleanliness in the home. There were some infection control issues identified at the inspection. The use of communal toiletries and linen towels was identified as a potential infection risk. The toiletries were also highlighted as compromising peoples dignity. The small bathroom on the ground floor Care Homes for Older People Page 20 of 30 Evidence: was in a very poor state. This was pointed out to the provider who immediately took action to rectify this. The person involved with cleaning the toilets during the inspection had little awareness of infection control as she had not received training in this area. There were concerns identified with her cleaning practices as they posed potential cross infection risks. People were seen to wander freely around the area of the home if they wished to do so. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the recruitment procedures adopted by the home. Improved training in all areas will help ensure people living in the home receive the care they need from a staff group that are trained in the areas relevant to their care needs. Evidence: There is a staff rota in place which allocates staff to each shift during the week. Although the deputy manager said they were short staffed the care staff were filling all the outstanding shifts that were needed. people said they felt there was enough staff on duty to help meet the needs of the people who lived there. Three people said assistance was usually good when the call bell was used. Staff recruitment files showed that all the required evidence needed before a person could be employed was obtained before they started working in the home. The training files for three people were reviewed and there were long gaps identified with health and safety training. Not all have received training in safeguarding adults. Some people have been trained in dementia but the good practice taught in the training is not apparent around the home itself. The deputy manager said staff are not trained in areas such as epilepsy and continence care. These are all conditions that people in the home have but no training has been provided. This could Care Homes for Older People Page 22 of 30 Evidence: place people at risk if staff are not aware of the symptoms and problems that arise through these conditions. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems and processes used in the home do not ensure good quality care is provided to people who live there. Evidence: The manager has worked in this role for a long period of time. She has been trained to NVQ Level 4 and has attained the registered manager award certificate. feedback from staff and others provided evidence that showed that showed the manager is approachable and deals with matters effectively. One member of staff raised a concern about the communication between management and staff. That person said, Sometimes things come as a surprise and important information isnt always passed over, like residents that have been taken to hospital or who have died. Sometimes only certain members of staff are told about information leaving those at the bottom of the communication line clueless. Care Homes for Older People Page 24 of 30 Evidence: The information contained in the Annual Quality Assurance Assessment document was minimal. It did not provide the CSCI with enough information to assure us that quality assurrance is understood and monitored within the home. The evidenec available with regards to quality assurance was minimal. There was no evidence of auditing care or records within the home. This means that areas where care could improve for people who live there are not monitored closely. The home looks after small amounts of monies for some of the people who live there. These records were seen and were all in order with appropriate receipts in place. Evidence was seen that showed electrical wiring, gas appliances and water system had been assessed. The home has health and safety policies in place to assist staff with protecting people who live there. The home does have an accident book to record accidents that occur in the home. One persons file that was looked at showed that she had sustained an injury from the use of the wheelchair. the wound was being dressed by staff in th ehome. this had not been recorded as an accident and there was no risk assessments for the use of wheelchairs in the home. Theis persons file did not have any information contained within it to assist the staff with managing the wound. There was no evidence that a referral had been made to other professionals to assess the wound. This is poor practice. Staff training and knowledge with regards to infection control issues was weak. The provider confirmed that she was aware of the areas where there are concerns in relation to the standard of care provided. She has employed the services of an independent group of health care consultants to assist in improving the quality of care provided in the service. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 The assessment of needs must be reviewed at regular intervals and also when the need arises. This will ensure people will receive up to date care packages. 12/01/2009 2 8 12 All care plans and risk assessments must be developed for the areas where people have an identified need. These must contain evidence to show people or their representative have been involved with the process. This will help ensure people receive the appropriate care package. 12/12/2008 3 9 13 The systems for 30/11/2008 administering, recording and storing medication in the home must be adhered to. This will help protect people who live in the home. Care Homes for Older People Page 27 of 30 4 18 13 All staff must be trained in 31/01/2009 Safeguarding Vulnerable People. The training provided must be robust and staff must understand their role in this area. This will help protect those people living in the home. 5 30 18 The training provided to care 31/01/2009 staff must be reviewed to ensure they are properly trained in the specific areas of care need of the people who live in the home. This will ensure people who live there receive their care package from a well trained staff group 6 33 24 Robust systems must be implemented to ensure the quality of care provided is monitored and improved. This will help improve the quality of care provided to people living in the care home. 31/01/2009 7 38 12 There must be robust systems in place to ensure the health and safety of people living in the home is protected at all times. This will help protect people. 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should Page 28 of 30 Care Homes for Older People be reviewed to ensure all the required information is included and is up to date. People must be provided with this information before they move in. 2 3 12 26 The spiritual needs of people living in the home should be provided for. The practice of using communal toiletries and linen towels in bathrooms should cease as this poses potential infection controls risks to people living in the home. Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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