Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Mill Lodge Care Home Belmont Road Great Harwood Lancashire BB6 7HL 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: Graham Oldham
Date: 3 0 0 9 2 0 0 9 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. that people have said are important to them: They reflect the things 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 29 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home
Name of care home: Address: Mill Lodge Care Home Belmont Road Great Harwood Lancashire BB6 7HL 01254883216 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Karamchand Jhugroo,Mrs Pryamvada Jhugroo care home 16 Number of places (if applicable): Under 65 Over 65 16 3 6 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 0 0 0 The care home should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 16 service users to include: Up to 16 service users in the category of DE(E) (dementia over 65 years of age) requiring personal care. Up to 6 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 3 service users in the category of MD(E) (mental disorder, excluding learning disability or dementia over 65 years of age) requiring personal care. When any of the service users in the category of MD(E) leave the care home, the registered person must apply for a variation to have maximum numbers of 3 reduced accordingly. Date of last inspection Care Homes for Older People Page 4 of 29 Brief description of the care home Mill Lodge is situated within walking distance of the town centre of Great Harwood. There are 14 single bedrooms and one double bedroom situated on two floors. Access to the first floor is via a passenger lift. Communal space consists of a separate lounge and a dining room that leads to a furnished conservatory. Some internal areas are ramped. Toilets and baths are located near to communal rooms and bedrooms. Residents have access to all community health services, and activities and functions are available to everyone living at the home. A statement of purpose and service users guide is available for residents or their families to be informed of the facilities and services the home provides. The documents need updating to inform prospective residents of the change of ownership. The fees for Mill Lodge are £405.50 - £426 per week. Not included within the fees are hairdressing, newspapers or periodicals and outings. Care Homes for Older People Page 5 of 29 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection, which included a visit to the service, took place on the 30th September 2009. Much of the information gained was obtained from talking to the responsible person, people who used the service and staff. Residents were observed for cleanliness, their general demeanor and were able to answer simple questions. Two residents were case tracked. Case tracking gave the inspector an overall view of the specific care for the individual resident by checking the plans of care, other documentation, talking to people who used the service and staff about the care they gave to determine if it matched what was detailed in the plans of care. Care Homes for Older People
Page 6 of 29 Paperwork examined included plans of care, assessment documentation, policies and procedures or documents relevant to each standard. A tour of the building was conducted. The registered person returned a self assessment form which informed us of the current and planned standards at the home. The last inspection on this service was completed on the 11th July 2007. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 29 The hot water outlet which was too hot and posed a scalding possibility had been decommissioned prior to refurbishment. The registered manager added the hours she worked to the duty rota to demonstrate when she was available for management duties. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People
Page 9 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 29 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 11 of 29 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No assessment had been undertaken by staff to ensure people who used the service had their needs met at this care service. Evidence: Two plans of care were examined during the case tracking process. One plan of care contained evidence that social services had supplied information to the home to aid the admission process. A member of staff at the home had partially completed the admission checklist. There had not been an assessment completed by staff at the home for either person case tracked. People who are admitted to the home must have their needs assessed to ensure they are suitably placed. Care Homes for Older People Page 12 of 29 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. Plans of care did not contain sufficient detail to reflect the changing needs of people who used the service. Parts of the plans of care had not been reviewed to keep staff updated on the needs of people who used the service. Medication policies and procedures were generally safe for people who used the service. The private and individual care given to people who used the service helped maintain their dignity. Evidence: Two plans of care were examined during the case tracking process. Plans of care did not contain sufficient detail to ensure staff were aware of each persons needs. On examination of the plans of care the outcome was described sufficiently although sometimes two completely different set of needs were listed under one heading. This was misleading to staff who had to review the plan. The outcome for each identified need was usually the desired result each person would require to be given the correct care. However, the actions described in some parts of
Care Homes for Older People Page 13 of 29 Evidence: the plans were vague or had not been addressed at all. This could mean the information supplied to staff was not sufficient for them to meet the needs of people who used the service. A member of staff gave a good account of the care the two people case tracked received which showed she was aware of their needs. Risk assessments for tissue viability, falls and nutrition had not been undertaken for one person case tracked or reviewed on a regular basis. This could mean the health care needs of people are not sufficiently assessed to prevent them from harm. All staff who administered medication had been trained to be competent to perform the task. There were policies and procedures for the administration of medication for staff to follow good practice. The medication administration charts were examined and had been correctly completed. However, hand written entries in the medication records had not been signed by two members of staff to follow safety guidelines. Medication was stored and disposed of safely. There was a cupboard and separate register for staff to record controlled drugs safely. The registered manager said the local pharmacist was available for advice and staff knowledge was supplemented with suitable publications. The home did not have a copy of the Royal Pharmaceutical guidelines to keep abreast of current practice issues. In general the administration of medication was safe for people who used the service. There was evidence contained within the plans of care that people who used the service had access to specialists. People who used the service confirmed they had access to their G.P. and other specialists to help keep their health care needs up to date. Staff were observed carrying out their tasks in a professional and private way which ensured people who used the service were comfortable with their personal care. Care Homes for Older People Page 14 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities were provided to keep people who used the service stimulated. Visiting was encouraged for people who used the service to keep in contact with family and friends. Choice within the routines of the home was offered to help people who used the service retain some independence. Evidence: Plans of care had a section for recording peoples activities and hobbies. This part had not been completed for the two people case tracked. It is good practice to record the likes and dislikes of people who use the service to provide them with suitable activities. On the day of the inspection people were sat talking to each other, reading, watching television and some played skittles. The registered manager said dominoes, pamper sessions, film nights, exercises and bingo nights were available amongst the activities held to keep people from getting bored. The care home provided a helper from a domiciliary care service to take people out twice a week. This was a good practice and provided a talking point between people who used the service. Two people who were involved in the case tracking process said they were satisfied with their social life and
Care Homes for Older People Page 15 of 29 Evidence: said they liked to chat with each other as well as attend activities. The two people involved in the case tracking process met regularly with their visitors and said there were no restrictions. The registered manager said visiting was twenty four hours a day and people had stayed overnight to help support their family member. Visiting was unrestricted for people to socialise with family and friends. Two people case tracked were quite clear that they were given choices within the routines of the home to help them maintain some independence. Plans of care examined did not contain sufficient detail of the choices people could make for staff to assist them to maximise their contentment. The kitchen was clean and tidy on the day of the inspection. The cook completed the necessary environmental health checks to help keep people safe. The dining room was pleasantly set for people to enjoy their meals. The food served on the day of the inspection was hot, tasty and nutritious for people who used the service. The cook said there was a choice if people did not want what was on offer. People were discreetly observed taking lunch. The atmosphere was good with people talking to each other and having a rapport with staff which provided a sociable occasion. In general food met people who used the services tastes and nutritional needs. Care Homes for Older People Page 16 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service were given the opportunity to voice their concerns if they wished. The robust safeguarding procedures helped protect people from harm. Evidence: The complaints procedure was located in the hallway and was accessible for people who used the service and their families. The complaints procedure contained good timescales for response and the address of the Care Quality Commission (CQC) if people were not satisfied with the care homes response. There had not been any complaints made to the CQC since the last key inspection. Two people involved in the case tracking process were satisfied with the facilities and services and had no complaints. People who used the service were given the information to complain if they wished to ensure their wishes were taken into account. There were policies and procedures in safeguarding for staff to follow good practice. The care home followed the Lancashire County safeguarding procedures to follow a local initiative. There had been an allegation of abuse, which had been founded. The registered manager had taken the appropriate action to safeguard the people at the home. Most staff had undertaken training in the protection of adults. Staff had access to the No Secrets document and whistle blowing policy to obtain advice and help protect people. The policies, procedures and staff training helped keep the people who used the service safe from possible abuse.
Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 of 29 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. The environment met the needs of people who used the service. The care home was clean, warm and suitably furnished to provide a homely atmosphere for people who used the service. Evidence: On the day of the inspection the home was warm, clean and free from offensive odours to provide people who used the service with a comfortable setting. There was a lift to access both floors. There were grab rails and other equipment to aid people with disabilities. There was equipment for assisted bathing and a hoist to keep staff and people who used the service safe when being moved. Communal areas contained domestic type furnishings and fittings in sufficient quantity to provide a homely atmosphere for people who used the service. Bedrooms had been personalised to peoples tastes to maximise their contentment and help them settle at the home. There was an outside space with seating for people to enjoy good weather. Care Homes for Older People Page 19 of 29 Evidence: Radiators had a suitable guard fitted, windows had restricted opening and the water outlets were temperature controlled to help keep people who used the service safe. There were policies and procedure for infection control to enable staff to follow good practice. Staff had been trained in infection control to be aware of cross infection issues. The laundry was sited well away from any food preparation areas and had suitable equipment to launder clothes. Care Homes for Older People Page 20 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient numbers of trained staff to meet the needs of people who used the service. The robust recruitment procedures helped protect people who used the service from possible abuse. Evidence: There were three staff and the manager on duty on the day of the inspection to meet the needs of people who used the service. More than 80 of staff had achieved NVQ2 or better. Staff had undertaken training in infection control, moving and handling, first aid, health and safety, food hygiene and dementia awareness to have the knowledge to care for the people living at the home. Two staff files were examined during the case tracking process. Staff files contained proof of identity such as two written references, a criminal records check, past employment history and other documents to ensure staff were suitable to look after people with dementia. Two staff files showed an induction was provided at the start of employment to give staff the confidence to meet peoples needs. The induction appeared to satisfy current sector skills needs but was not in a format provided by a recognised body. The induction should be checked against the General Social Care Councils guidelines to
Care Homes for Older People Page 21 of 29 Evidence: ensure all topics are covered. Care Homes for Older People Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a suitably qualified and experienced person to manage the service which met the requirements of the Care Quality Commission. Quality assurance systems gained the views of people who used the service to help meet their needs. The good financial system helped protect people who used the service from possible financial abuse. Health and safety polices, procedures and staff training helped protect the health and welfare of staff and people who used the service. Evidence: There was a registered manager who had the necessary qualifications and experience to manage the service. The registered manager had updated her skills to keep abreast of changes and provide leadership to staff. The registered manager held formal meetings with staff, had an open door policy for visitors and conducted quality assurance surveys for people who used the service to gain their views. The results of the surveys should be produced as a summary to
Care Homes for Older People Page 23 of 29 Evidence: inform relevant parties of the results and how management have reacted to their views. The registered manager was not aware of the Mental Capacity Act or the issues surrounding the deprivation of peoples liberty. It is imperative that a member of staff is aware of the legislation and can assess people who use the service to ensure the home is not acting outside of current legislation. The pocket money for some people was handled by staff at the home. The money was stored individually in a safe. Two staff witnessed the transaction and receipts were issued to ensure the system was secure for people who used the service. There was a health and safety policy for staff to follow good practice. Staff had received good training in health and safety topics to help them provide a good service. The electrical and gas installation and equipment had been serviced to ensure it was safe to use. The registered manager was aware of current health and safety legislation to comply with current laws. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 25 13(4)(a) The registered manager 30/07/2007 must ensure all parts of the home are free from hazards to resident?s safety. Hot water outlets in baths must have a suitable device fitted to restrict the temperature to restrict the risk of scalding.. Care Homes for Older People Page 25 of 29 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 1 33 24 The registered person must ensure that she or a senior member of staff is aware of current issues surrounding the Mental Capacity Act. Current legislation requires that people with dementia are assessed for their rights to choose to live at the home. 10/12/2009 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 3 14 The registered manager must ensure a full needs assessment is obtained for each person prior to admission to the home Each person must be assessed as to their suitability to enter the care home and ensure their needs can be met prior to admission. 21/10/2009 2 7 15 The registered person must ensure that a plan of care showing how each persons needs are to be met in respect of their health and welfare. 06/11/2009 Care Homes for Older People Page 26 of 29 The plans of care examined were avgue and not sufficiently detailed to direct staff working at the home. 3 8 15 The registered person must 06/11/2009 ensure plans of care and risk assessments are reviewed on a regular basis. Plans of care should demonstrate that each persons needs have been reviewed and recorded to help meet their needs. 4 8 15 The registered person must 06/11/2009 ensure a full assessment of risk is undertaken for falls, nutrition and tissue viability. Any person who enters the care home must have the required assessments to protect their health and welfare 5 9 13 The registered person must ensure any hand written entries in the plans of care are witnessed by two members of staff. Two staff must check and record any medication that requires staff to enter into the medication records to minimise errors. 21/10/2009 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 Care Homes for Older People Page 27 of 29 1 7 The registered person should ensure all aspects of the plans of care are completed to ensure staff have the correct details to work from. The registered person should ensure they have an up to date copy of the Royal Pharmaceutical guidelines to help update the medication policies and procedures. The registered person should record the activities and hobbies of people who used the service to ensure each individuals wishes are taken into account. The registered person should ensure the personal preferences of people are recorded in the plans of care to help demonstrate choice is regarded as necessary for promoting independence. The registered person should produce a copy of the survey results as a summary to demonstrate a good quality assurance system is in place. 2 9 3 12 4 14 5 33 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) 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 29 of 29 - 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!
