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Inspection on 15/09/05 for Norewood Lodge

Also see our care home review for Norewood Lodge for more information

This inspection was carried out on 15th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Norewood Lodge is a purpose built home, which has pleasant, airy and spacious communal areas. It is immaculately presented, clean and well decorated. The home has an unhurried relaxed atmosphere. The recruitment procedure was robust with appropriate records held at the home. Account is taken of the residents day to day routines and accommodated by the staff at the home where possible to do so.

What has improved since the last inspection?

Care plans have improved and now tie in with the residents risk assessments offering a clear picture of how to attend to residents needs safely. The care plans contained residents finer details such as preferences and the individual`s peculiarities, as well as recording their hobbies and social needs. The middle floor of the home has been re-carpeted and redecorated with redecoration commencing on the top floor. Provision is made to ensure that this is undertaken with the minimal amount of disruption to the resident`s lives. Use of a restraint `lap strap` on a resident`s wheelchair is now undertaken only when consent has been given.

What the care home could do better:

Documenting the resident`s wishes in the event of death, although a sensitive discussion area should be addressed during the admission process. Further privacy measures to be considered during GP visits for those residents who are bed bound and in shared accommodation. Medication records should show the total quanity of medication so that at any given time the home is aware of a residents stock of medication in accordance with the Royal Pharmaceutical Society.

CARE HOMES FOR OLDER PEOPLE Norewood Lodge 72 Nore Road Portishead North Somerset BS20 8DU Lead Inspector Carrolle Wise-Scanlan Announced 15 September 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Norewood Lodge Address 72 Nore Road Portishead North Somerset BS20 8DU 01275 818660 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Belmont Care Limited Mrs Judith Maddalena Care Home 48 Category(ies) of OP - Old Age (46) registration, with number PD - Physical Disability (2) of places Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 48 persons aged 50 years and over. 2. Of the 48 persons, up to 2 Young Physically Disabled Persons may be accommodated. 3. Staffing Notice dated 15th October 2001 applies. 4. Manager must be RN on parts 1 or 12 of the NMC register. Date of last inspection 17th March 2005 Brief Description of the Service: Norewood Lodge is registered to provide nursing care for up to 48 people. The category of registration is for 46 persons over 50years of age and for 2 young physically disabled persons. The home is a purpose built property set in large attractively maintained grounds. Accommodation is provided in both single and double rooms over three floors. The home provides communal areas of a dining rooms and lounges with a spacious reception area. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over seven hours. The inspector spent time discussing various topics about the home with fourteen residents and three visitors. This was a positive inspection with the residents offering glowing reports on the staff, the cleanliness and the food. The comments received by the commission were very positive and included those of two General Practitioners and a resident. Various records, which need to be kept by the home, were sampled and reviewed during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 6 Documenting the resident’s wishes in the event of death, although a sensitive discussion area should be addressed during the admission process. Further privacy measures to be considered during GP visits for those residents who are bed bound and in shared accommodation. Medication records should show the total quanity of medication so that at any given time the home is aware of a residents stock of medication in accordance with the Royal Pharmaceutical Society. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4 & 5 Resident’s needs are appropriately assessed and residents and their families are offered opportunities to visit the home and assess the facilities. EVIDENCE: Residents recalled being visited by the matron to discus their admission to the home. The majority were seen in hospital and as such asked their families to view the home to see if it would suit their requirements. It was felt by most that this was a time when they were acutely ill and they did not recall all the information they may have been given. The visitors met had opportunities to visit the home and meet with the staff. When asked if the home met their expectations many had not formed any impressions of what life would be like living in a nursing home and still found it difficult and upsetting to have left their own homes. Several felt that Norewood Lodge and the staff had helped them come to terms with this and it had become their ‘home from home’. Records reviewed contained contracts and two contained copies of the homes terms and conditions. One resident recently admitted to the home had a contract but the file did not contain a copy of the homes terms and conditions. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 9 The matron felt the document might be awaiting signatures from the residents’ representative and would follow this up. Care records supported the fact that assessments take place prior to admission to the home. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11. Residents care plans have developed and improved, they contained finer detail regarding care provision, are reviewed every month and involve the residents where able. Residents gave examples of the ways that staff preserve their privacy and dignity when giving them support with personal care. Systems are in place for the safe administration of medication, however the homes medication procedure needs to improve with regard to the recording of residents total stock of medication. EVIDENCE: Several less frail residents described their illnesses and the care and help they received by the staff. On reviewing their care plans the care received was well documented and evaluated monthly with risk assessments linked into the care planning process. Several records demonstrated the involvement of the residents or their representative in the care planning process, which is good practice. Each care record was individualised identifying their preferences, hobbies and preferred social activity. An example of the finer detail within the care plans seen was that of communication. A care plan record suggested that Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 11 staff ensure the resident is given time to think and respond to any questions staff may ask, as speech is delayed following the residents illness. Residents gave examples of the ways that staff preserve their privacy and dignity when giving them support with personal care. Staff were observed knocking prior to entering residents rooms. One comment received from a GP was that it was sometimes difficult to see a ‘patient’ in private if the patient is bed bound and sharing a room. The matron accepted that the logistics of the shared rooms in the event of GP visits did prove difficult at times and further consideration could be made. Recording the residents wishes regarding funeral arrangements and involving, where appropriate, families in the process regarding contact in the event of death is currently under review at the home. The General Operations Manager and Matrons of the Belmont Care Group of which Norewood Lodge forms part, want to base their procedures on the NHS ‘Gold Standards framework’ for care homes which is currently still at the development stage. Not all the records sampled contain details of the resident’s wishes regarding funeral arrangements. Medicines are supplied to the home by Pharmacy Plus using a blister pack system. The medication for each resident was difficult to audit, as the remaining quantity was not added to that received from pharmacy on the Medication Administration Record (MAR sheet). Totals had been recorded onto a separate sheet but not all of the residents records randomly selected for audit tallied. It was suggested that the recording of residents medication stock was reviewed with further advice sought from their pharmacy supplier. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The home accommodates residents preferred routines and arranges activity services around individual residents preferred choices where able. Residents enjoy the food at the home and their views are considered and taken account of when menus are reviewed. EVIDENCE: Residents said that their relatives and visitors are welcomed into the home at any reasonable time. They choose whether to receive guests in their private accommodation or communal areas. The inspector spent some time chatting with fourteen residents to discover how they like to spend their day amongst other topics. In so far as they are physically able residents felt they are self determining of their day to day routines, with staff alert to who prefers to retire late or early to bed. Several residents are very frail and tire easily and suggested they preferred their own company and to stay in their rooms. Some residents said they would enjoy the company of other residents but found it difficult to establish conversations with fellow residents as several residents suffer with dementia and others have varying hearing and sight difficulties. The staff and social activities organisers make every effort to accommodate their social needs with introductions made to fellow residents. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 13 The activities organisers were both present on the day of the inspection and had arranged a ‘lunch party’ on the ground floor lounge area, which the inspector attended. Residents were chatting neighbourly several residents had come to know each other a little over time. Conversation and banter although relaxed may have been assisted with the use of a hearing ‘loop’ system which was suggested to the matron. Activities undertaken are noted in an event diary and who attended generally recorded too. It would be useful to see over a period of time that all residents received activities to meet their needs either via the activities organiser or the staff meeting these needs through care planning. Residents stated they enjoyed the food at the home several saying they thought it was ‘very good’. Resident’s views regarding the food are sought by the staff and fed back to the cook on a regular basis according to the matron. An audit regarding the menus has not recently been undertaken, however the residents said they do let the staff know if they have not liked the choice and alternatives are always offered taking account of any specific dietary need. The kitchen staff had been reorganised with a new cook and several new kitchen assistants. The catering development manager was also present. He overseas and assists the cooks in developing the catering services in the three homes within the Belmont Care Group. The staff all receive food hygiene training. The appropriate use of protective wear to ensure hygiene standards were met was also noted. The kitchen looked well ordered with food date labelled in the fridges. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents and relatives benefit from the homes complaints procedure and are confident that their complaints are listened to and acted upon. EVIDENCE: Residents demonstrated an awareness of the complaints process, most noting they had had no cause for complaint. Relatives met who had discussed various minor issues with the staff and matron found the homes responses to be acted upon immediately with any remedial action taken promptly if necessary. One resident remarked that she did not enjoy the new profiling bed, which was used to assist with her pressure area care and mobility in bed. Although she had not formalised this as a complaint it was clear that the matron was aware of the issue. Consideration was being made as to what action to take, balancing her wishes against the risk regarding her health and safety needs. The home has a complaints procedure in place and records each complaint with an action plan should this be necessary. In the three complaints recorded all were acted upon promptly. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26. Resident’s benefit from a pleasant and comfortable environment. EVIDENCE: Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 16 The home is over three floors. Each floor has a lounge area. The lowest floor houses the laundry and staff room as well as resident’s bedrooms. The ground floor has a spacious dining room, with doors leading into a smaller room, which doubles as a dining room/lounge room overlooking the rear of the property, to the side of the property on this floor is a large lounge with spectacular views over the estuary. There is a passenger lift to all floors. The home is decorated and furnished to a high standard with recent redecoration to the middle floor now complete and the upper floor just commenced. There is an unhurried relaxed ambience to the home. The home was purpose built and has some attractive features making the best of the light, surrounding garden and vistas. There are communal toilets and spacious communal bathrooms fitted with specialist equipment on each floor. The light pull cords in the bathrooms needed to be replaced or cleaned due to their general wear and tear. The bedrooms are all en suite. All bedroom doors have magnetic door releases and are connected to the homes fire alarm system. Residents had personalised their rooms with their belongings such as photographs and pictures and arranged the furniture to suit their needs. All areas of the home smelled pleasant and were cleaned to a high standard. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Resident’s benefit from appropriately trained staff in sufficient numbers to meet their current needs. EVIDENCE: A random selection staff records were reviewed during the inspection. These files verified the home has a robust recruitment procedure in place. All records seen held references, Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks undertaken amongst other documents. The registered nurses records are checked and verified regarding their registration with the Nursing and Midwifery Council (NMC). Thirty five per cent of the care assistants have successfully completed their NVQ level 2 or above so far with the majority of the remaining staff currently on an NVQ course. The staff complete an induction program and the homes in-house trainer ensures that staff undertake their mandatory training each year, producing an excel document to easily review the training undertaken. The staff met during the inspection enjoyed the training they received; one was in the process of her induction, and said that they receive regular updates regarding their mandatory training. The pre-inspection questionnaire states that 12 staff members are trained in first aid currently to meet the needs of the residents. Staff training certificates were not seen during the inspection. The matron advised that staff do receive at least the minimum of three paid days training per year including in-house training. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 18 Residents remarked that the staff offered care in an unrushed manner, and were always willing to help. The rota is arranged so that there is a balanced skill mix of staff on each shift. The care staff numbers include that of fourteen registered nurses, six senior care assistants and 26 care assistants providing appropriate staffing levels. The ancillary staff include that of the cooks, kitchen assistants, housekeeper, laundry, maintenance and domestic staff. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 36, 38 The home is well managed and the matron provides clear leadership and direction. EVIDENCE: Judith Maddelena is the Registered Manager of the home and is an experienced qualified registered nurse. She is in the process of undertaking NVQ Level 4. She is well respected amongst the staff team and residents alike. Residents were aware of the management structure of the home and readily identified staff roles by their uniforms and names. The matron has adopted an ‘open door’ approach should staff have any concerns, with supervision undertaken regularly. Staff meetings have been less frequent recently with the Matron suggesting that attendance is greater when the staff themselves initiate interest in the next meeting date. The last recorded meeting was that of June. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 20 The residents take care of their own financial interests in some cases with the assistance of a family member or representative. The home invoices residents following receipt of a service such as hairdressing, which the resident then settles, records of these transactions are held in each residents’ individual file. Fire drills checks and procedures were undertaken regularly safeguarding the staff and residents. Lift and gas servicing were randomly checked and found in order. The pre-inspection questionnaire completed by the registered manager lists the other health and safety checks under taken within the last 12 months. Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x 3 3 x 3 Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Medication records should show the total quanity of medication on the MAR sheet so that at any given time the home is aware of the residents stock of medication in accordance with the Royal Pharmaceutical Society. The residents wishes concerning terminal care and arrangements after death are discussed and carried out. Light pull cords to the communal bathrooms to be cleaned or replaced. Residents in shared room have further consideration and accomodation made regarding their privacy during a GP visit. 2. 3. 4. OP11 OP38 OP10 Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Norewood Lodge D53-D02 S20308 Norewood Lodge V243294 150905 Stage 4.doc Version 1.40 Page 24 - 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. 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