Inspection on 30/09/09 for Nesfield Lodge

This inspection was carried out on 30th September 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Nesfield Lodge Nesfield Lodge 45 Nesfield Road Belle Isle Leeds LS10 3LG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sean Cassidy     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 24 Information about the care home Name of care home: Address: Nesfield Lodge Nesfield Lodge 45 Nesfield Road Belle Isle Leeds LS10 3LG 08456044977 01132771347 nesfield.lodge@orchardcarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Orchard Care Homes.com Ltd Name of registered manager (if applicable) Mrs Tina Garside Type of registration: Number of places registered: care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Service users with Dementia - Code DE, Old Age, not falling within any other category - Code OP 2. The maximum number of service users who can be accommodated is 44 Date of last inspection Brief description of the care home Nesfield lodge is a 44 bedded care home situated in the Belle Isle area of South Leeds. It is a new build and was specifically designed to provide care for people with specialist dementia needs. It has been built within a local urban area with many local amenities at its disposal. The public transport systems are very accessible and there are regular bus routes to all areas of Leeds. Care Homes for Older People Page 4 of 24 Over 65 0 44 44 0 Brief description of the care home The weekly fees charged by the service range between £510 and £560. Care Homes for Older People Page 5 of 24 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 Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects services at a frequency determined by how the service has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.cqc.org.uk This visit was unannounced and was carried out by one inspector. The majority of the inspection time was spent speaking to the main stakeholders of the service and looking at specific documentation that included care plans, risk assessments and policies and procedures. The purpose of the inspection was to make sure the service was operating and being managed for the benefit and well being of the people who use the service. Feedback was given to the manager and area manager during the site visit. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 24 consistency. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 24 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 following this report, you can contact them using the details on page 4. 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 Care Homes for Older People Page 8 of 24 order line 0870 240 7535. Care Homes for Older People Page 9 of 24 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 24 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. People are provided with a good standard of information to assist them with making a choice about moving into the home. Evidence: The management team have developed a Statement of Purpose and Service User Guide that contains all the necessary information needed to ensure people are informed about the services that are offered by the home. I spoke with two relatives of people who live in the home. They told us they received enough information to assist them with making their choice about taking a place at the home. They told us the manager and staff were very helpful when they visited. We looked at the files of three people who live at the home and we found evidence contained within each that showed each person had been appropriately assessed prior to being admitted to the service. This means the home can be assured that they can meet the needs of people before they are offered a place. Care Homes for Older People Page 11 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care of people living in the home is promoted by the staff and management that work there. Evidence: We looked at the care documentation for three people living at the home. These documents were well written and informative. They gave the reader a good insight into the care needs of each individual. We found risk assessments completed in areas such as moving and handling, nutrition and skin integrity. These documents were reviewed monthly and there was evidence that consent from relatives and representatives was gained where possible. The care records showed evidence that other health professionals are regularly involved when the need arose. Staff told us that they are involved with the care planning documentation and that they record the care they provide over the course of each shift. Care Homes for Older People Page 12 of 24 Evidence: Staff were observed providing care packages and interacting with people that use the service. Good positive interactions were observed and communication between staff and people who use the service was seen. Staff used both verbal and non verbal methods of communication which people seemed to respond well to. Three relatives of people who live at the service spoke very positively about the staff and how they communicate with people living in the home. They said: They are always smiling and interacting with my mother as well as everyone else. I was happy with the way the staff treated people at the home and that gave me confidence to leave her here. We spoke with a member of staff who was administering medication during the morning. She was very aware of her responsibilities in this area and was observed administering medication correctly. A random review of the medication administration charts showed these were completed to a good standard. Care Homes for Older People Page 13 of 24 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. There are programmes in place to help ensure peoples physical, mental and spiritual wellbeing are promoted within the home. Evidence: The manager and staff told us about activities that are arranged to promote mental and physical wellbeing. Exercise classes and reminiscence therapy is used to try and stimulate people in a positive way. The staff were observed supporting people in the home to get actively involved with domestic chores such as setting the table for dinner and washing up using the facilities in the dining area. This is good practice. The manager said that they are looking towards developing more access to activities outside of the home as there are very few opportunities provided to people at the moment. The manager gave examples of how the religious needs are promoted in the home. We found evidence in the care plans that showed peoples religious needs are assessed on admission and that action was taken to provide for these needs. The manager identified days where staff had made special efforts to entertain people such as St Georges day and Royal Ascot day. Plans are in place for a Halloween party Care Homes for Older People Page 14 of 24 Evidence: and Christmas party. It was recommended that a display board is developed with memories from these special days so that people might have the opportunity to look at theme and stimulate the mind as a result. The lunchtime meal was observed during the inspection. This was observed as a social event. The tables were well presented and staff were responsive to the needs of people when they were having their meal. Those that were provided with assistance received it in a manner that was supportive and respectful. Care Homes for Older People Page 15 of 24 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. There are robust systems in place that help protect people from harm. Evidence: We looked at the complaints procedure and found this was an informative document that included all the information needed to support indiviuals to complain if they needed to. This document is on display at the entrance of the home and is also available to people in the Service User Guide. This document is available in peoples bedrooms. There is a system for recording and investigating complaints. We spoke to relatives who informed us that they knew what to do if they had a complaint about the home. We have not received any formal complaints at the Care quality Commission since the home was registered. There is a safeguarding policy and procedure in place. Staff spoken to provided us with a good understanding of what safeguarding adults meant and what their role would be if they came across a safeguarding incident. The manager provided with recent notifications that had been sent to the laocal safeguarding team. The manager followed the correct procedures to ensure people were protected. Care Homes for Older People Page 16 of 24 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 clean, tidy and suitable for their needs. Evidence: The home has been recently built to provide care packages to people with dementia. The environment is very clean and tidy and well decorated. The decor of the home is suitable for people with dementia as it is plain and not busy. This is good practice. There is suitable signage on doors that helps people identify the bathroom and toilets. It was recommended that alternative ways are used to assist people with identifying their own rooms. This would help reduce the risk of people going into bedrooms that are not their own and promote wellbeing. It was noted that there is a practice of locking peoples bedrooms when they have been assisted to get washed and dressed and left the room. This can be viewed as restrictive in its nature and should stop. People should be allowed to wander and encouraged to enter their rooms if they so choose. This will allow them to familiarise themselves with their rooms and possessions if they so choose. Care Homes for Older People Page 17 of 24 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. People receive their care packages from a staff group who are recruited and trained to a good standard. Evidence: We looked at the recruitment files for two new employees. The files contained all the necessary information needed before a person could start working with vulnerable people. There was also evidence that a structured induction is provided to new staff. The manager has developed a training matrix which highlights all the training that will be provided within the forthcoming 12 months. This also includes dates when refresher training is needed. This is good practice. Staff are actively completing training to NV(National Vocational Qualification) Level 2 and NVQ Level 3 standard. We found evidence that people received training in areas such as dementia awareness, moving and handling, safeguarding adults and infection control. The manager told us that the home does have a high number of empty bedrooms. The reason for this was that they want to gradually increase the numbers to full complement. The staffing levels will increase as the number of people moving in increases. During the majority of the day we observed the staff performing their roles. The Care Homes for Older People Page 18 of 24 Evidence: evidence seen suggested that there were sufficient staffing levels on duty to meet the needs of the people living in the home. However,we highlighted a concern about the number of staff present in the lounge and dining room during the inspection. Only one member of staff was present in this area for about fifteen minutes, As she was in the dining area of the room no one was present in the lounge area. A verbal altercation between two people living in the home was seen but no one was present to intervene in the situation. This could have easily escalated into a more serious situation. It is important that there is a staff presence in all areas of the home where people like to congregate. This will help reduce the risk of harm occurring. Care Homes for Older People Page 19 of 24 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. The management systems and processes implemented at the home help to ensure people receive a good standard of care. Evidence: The manager has been in post since the home opened and has been registered with the Care Quality Commission. She has a good awareness of her role and was able to highlight a good knowledge of the use of their internal quality assurance systems to maintain and improve care. We did point out that the Annual Quality Assurance Assessment (AQAA) Had not been completed to a standard that we would expect from a care service. The information contained in the document was not detailed and did not reflect the good work we observed during the inspection. There were also a lot of gaps that should have contained more detail to support the work that is ongoing within the service. There are systems in place to hold small amounts of money for people living in the Care Homes for Older People Page 20 of 24 Evidence: home. Appropriate signatures are taken as well as receipts. The home is part of a larger group and has audit systems in place to allow them to review the standards of care in the home and improve them where necessary. Team meetings are held and people told us they receive regular supervision. Monthly regulation 26 visits take place and these are available to view. There are robust health nd safety policies and procedures in place and the manager has the main responsibility for ensuring these are implemented. Care Homes for Older People Page 21 of 24 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 22 of 24 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 19 12 People should not have their 30/11/2009 bedroom doors locked during the day as this could be viewed as restrictive. This will further enable choice and allow people to enter their own rooms when they wish. 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 2 19 27 It is recommended that alternative measures are used to help people to identify their own bedrooms. Staff should be available in sufficient numbers in all areas of the home where people are congregated. This will help minimise the risk of harm occurring. The manager should ensure the AQAA is thoroughly completed and reflects the work that is carried out at the home. 3 31 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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