CARE HOMES FOR OLDER PEOPLE
Old Lodge, The Nursing Home Sandypits Lane Etwall Derby Derbyshire DE65 6JA Lead Inspector
Steve Smith Unannounced Inspection 15th February 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Old Lodge, The Nursing Home Address Sandypits Lane Etwall Derby Derbyshire DE65 6JA 01283 734612 01283 733067 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Folcarn Limited Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (5) of places Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 40 Places for OP 5 Places for younger PD aged 50 years and over included in the total above 28th September 2005 Date of last inspection Brief Description of the Service: The Old Lodge is a detached house, which has been adapted and extended to provide nursing care for up to 40 people, aged 65 years and over. However, up to 5 of the bedrooms can accommodate disabled people, aged 50 years and over. The Home is situated in a rural position, approximately a mile from Etwall village centre. The village has several local shops and is on a bus route for Derby. The Old Lodge has 32 single and four double bedrooms across two floors. 10 of the bedrooms have ensuite facilities. Access to the first floor is by stairs or by a passenger lift. The Home has 2 lounges, a conservatory and dining room. The Home also has a well laid out garden. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in just over 2 hours. Discussion was held with the Home’s Acting Manager. Some of the Home’s records were examined, some of the bedrooms were seen, and the public areas of the Home were looked at. What the service does well: What has improved since the last inspection?
Information provided in Residents files had greatly improved. For example, initial assessments of need were completed, as were risk assessments on each Resident, and regular reviews of care were documented within each file, etc. The recording of the administration of medication had improved. The Manager had put measures in place to support those staff with limited English.
Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 6 The recording of complaints, both written and verbal complaints, were appropriately recorded and acted upon. A number of improvements to the contents of Residents bedrooms and elsewhere in the Home had been addressed. Fire Safety training had been provided for all night staff. What they could do better: 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. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 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 the following standard(s): Standard 1 The Residents Guide could be extended to provide potential and new Residents with clear information on the provision of services in the Home. EVIDENCE: Standard 1 was not examined during this inspection of the Home. However, while reviewing the Recommendations of the last inspection report it became apparent that the Registered Provider had not provided all of the details recommended for the Residents Guide. Residents’ views of the Home had not been included in the Guide. This detail had been outstanding since the inspection of December 2004. Standard 6 does not apply to this Home. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 9 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 the following standard(s): Standards 7 & 9. The care provided to Residents was of a good quality, but the Acting Manager needed to ensure that the recommended records were maintained for all Residents. EVIDENCE: Standard 7 was not examined during this inspection of the Home. However, while reviewing the Recommendations of the last inspection it became apparent that the Acting Manager had not provided within each Resident’s file details of the keyworker who was currently working with each Resident. The Registered Provider and Acting Manager were recommended to attend to this during the inspection of September 2005. The Acting Manager was also encouraged to show that she had reviewed each Resident’s file on a monthly basis by signing each file. The Acting Manager pointed out that some of the Resident’s files she had added details to each month while working in the Home, but agreed that this was seldom all Residents’ files. This issue had been outstanding since September 2005, which was before the Acting Manager began working in the Home.
Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 10 All medication and the method of distributing it to Residents were examined, and a good record was found. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 11 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 the following standard(s): These Standards were not examined during this inspection of the Home. EVIDENCE: Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 12 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 the following standard(s): These Standards were not examined during this inspection of the Home. EVIDENCE: Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 13 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 the following standard(s): Standards 19, 24 & 26. Generally, the Home was well maintained throughout, however, slight improvements were needed to ensure all Residents lived in a well-maintained environment. EVIDENCE: Only Standard 19 was formally inspected on this visit to the Home. However, on reviewing the Requirements and Recommendations of the previous year the following items were found not to have been addressed: It is a Requirement across the whole country for all Residents bedrooms to be fitted with a door lock that can be operated from both the inside and outside by the Resident. However, the Registered Provider had not provided this and this Requirement has been outstanding since November 2003. All single bedrooms need to be provided with two double electric sockets and double bedrooms to be provided with four double electric sockets.
Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 14 This issue was raised in the inspection report of September 2005, but had not been addressed. Each Resident’s bedroom needs to be provided with a lockable space for Resident’s important private items. Again, this had not been provided, but had only been outstanding since the last inspection of September 2005. Within the inspection of November 2003 the Registered Provider was required to provide at least one sluicing disinfector, but this had not been carried out. During the current inspection of the premises a large amount of bedding and other items were found to be stored under the staircase at the far end of the Home. As these items amount to a fire risk they needed to be urgently removed. The inspection also found that in the area of the Home identified to the Acting Manager there was a very strong smell of urine that needed to be attended to urgently. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 and 29. The Registered Provider was found to be providing more than adequate staffing in the Home. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. This showed that during the four weeks beginning 9th to the 30th of January 2006 the Home was providing care staffing above the minimum requirement of the Residential Forum for 40 Residents at the High Dependency level. These figures were calculated without the Manager’s working time included, as recommended by the Residential Forum. However, it was found that between six and nine care staff each week worked double shifts, and that between 4 and 5 nursing staff worked double shifts over this four week period. As a double shift amounted to 13 hours it is considered by the Commission that this does not encourage staff to meet the needs of Residents in a kindly, understanding and patient manner. The staffing records of two staff employed since April 2002 were examined. These showed that the Acting Manager had obtained some of the requirements necessary, although a number were missing. Relevant qualifications and photographs were available. Criminal Records Bureau information was available for only one member of staff and not for the other. Two references had again been obtained for one member of staff but only one for the second.
Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 16 The potential members of staff had not been asked whether they were mentally and physical fit for the job they had applied for, and a full history of their employment record, back to when they were 16 years old (or 18 years old, if appropriate), had not been obtained. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38. The Acting Manager was appropriately qualified to manage the Home, although she needed to be formally assessed by the Commission to ensure that the requirements of the Home could be appropriately met. The Registered Provider and Acting Manager also needed to address the required Quality Assurance issues to ensure that Residents’ care was maintained at a positive standard. EVIDENCE: The Acting Manager has been in post for at least the last 6 months, but to date she has not put forward an application to the Commission to be considered as manager of the Home. However, she had already obtained an NVQ level 4 in Management. The Registered Provider continues to visit the Home on a very regular basis, approximately twice a week, and does discuss his finding with the Acting
Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 18 Manager. However, he had not as yet begun to complete the paper work required by law to formally inform his Acting Manager of the results of his unannounced ‘inspections’ of the Home. The details of the written work required can be found in Regulations 26 (4) and (5). The Acting Manager was asked about the Quality Assurance measures she had put in place within the Home. However, it transpired that as the new Acting Manager of the Home she had not as yet addressed this section of required reporting. During the inspection of September 2005 the Acting Manager was required to begin the supervision of all care staff and nursing staff in the Home. She again said that as yet this task had not resolved by her. However, she said it was her intension to do so in the coming months on the year. The training provided for staff was examined. This showed that the Registered Provider and Manager had ensured that all staff had received training in Fire Safety, including the training of night staff twice each year. However, it transpired that 11 care staff had not received training in Moving and Handling within the past 12 months. Approximately a third of all care staff were out of date with their training in First Aid, at least a half of all care staff also needed training in Food Hygiene, and all staff were in need of training in Infection Control. In addition to the above statutory training, the Acting Manager was able to say that the Home provides additional training in Continence Awareness, Palliative Care, Diabetes, and Stroke Awareness. All Residents had been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Manager said that the Home did not have information on the Workplace (Health, Safety and Welfare) Regulations of 1992 or the Workplace (Health, Safety and Welfare) Regulations of 1992, or the Provision and Use of Work Equipment Regulations of 1992. Risk assessments had been carried out for all safe working practices in the Home that related to the care staff, catering staff and domestic staff tasks. However, the Acting Manager said that she had not provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. The Manager ensured that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. She also had ensured that fire safety notices were posted in relevant places around the Home. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The old furniture stored under the staircase at the far end of the Home must be urgently removed, to ensure fire safety. All bedroom doors must be fitted with a lock that can be operated from both the inside and outside of the room by the Resident. Each Resident must be provided with a key to their bedroom. Risk assessments must be carried out and recorded in the Resident’s file when it is considered by the Acting Manager that the Resident is not able to hold the key to their bedroom. (This issue should have been addressed from the inspection report dated 27 November 2003) Two double electric sockets should be provided within each bedroom, and four double sockets in each double bedroom. However, this could be discussed with each Resident, or their Representative, and fewer electric sockets could be provided if they agreed, and if this was recorded within each
DS0000002135.V282301.R01.S.doc Timescale for action 12/04/06 2 OP24 12 12/04/06 3 OP24 16 12/04/06 Old Lodge, The Nursing Home Version 5.1 Page 21 4 OP24 23 5 OP26 13 & 23 6 OP29 19 7 OP31 8&9 8 OP31 26 Resident’s Care Plan. (This issue should have been addressed from the inspection report dated 28 September 2005) All Residents bedrooms should be provided with a lockable space for items such as medicine, money and valuables. (This issue should have been addressed from the inspection report dated 28 September 2005) The Home must be provided with at least one sluicing disinfector. (This issue should have been addressed from the inspection report dated 27 November 2003) The Acting Manager must check, and hold documentary evidence, that all staff employed in the Home, since April 2002, have satisfied the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004. The Acting Manager must apply to the Commission to be assessed as the potential manager of the Home. The Registered Provider must carry out unannounced inspections of the Home at least once a month and complete the required reports listed in Regulation 26. (This issue should have been addressed from the inspection report dated 27 November 2003) The Registered Provider and Acting Manager must address the quality assurance issues listed within Standards 33.1 to 33.7. (This issue should have been addressed from the inspection report dated 28
DS0000002135.V282301.R01.S.doc 12/04/06 12/04/06 12/04/06 12/04/06 12/04/06 9 OP33 24 12/04/06 Old Lodge, The Nursing Home Version 5.1 Page 22 10 OP36 18 11 OP38 13 & 18 12 OP38 13 & 18 13 OP38 18 14 OP38 18 September 2005) The Acting Manager must provide supervision for all care staff covering all aspects of practice; the philosophy of care in the Home, and the career development needs of care staff. (This issue should have been addressed from the inspection report dated 28 September 2005) The 11 members of staff, identified during the inspection, must receive training in Moving and Handling. The third of all care staff, identified during the inspection, must receive training in First Aid. The half of all care staff, identified during the inspection, must receive training in Food Hygiene. The Acting Manager must ensure the services provided by the Home comply with the Management of Health and Safety at Work Regulations 1999, the Workplace (Health, Safety and Welfare) Regulations 1992 and the Provision and Use of Work Equipment Regulations 1992. 12/04/06 31/08/06 31/08/06 31/08/06 12/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP1 Good Practice Recommendations The Registered Provider and Manager should provide Residents views of life in the Home as part of the Residents Guide. (This issue should have been addressed from the inspection report dated 15
DS0000002135.V282301.R01.S.doc Version 5.1 Page 23 1 Old Lodge, The Nursing Home 2 OP7 3 OP7 4 OP19 5 OP24 6 OP27 7 OP36 8 9 OP38 OP38 December 2004) Each Residents file should contain details of the keyworker who is currently working with each Resident. (This issue should have been addressed from the inspection report dated 28 September 2005) The Acting Manager should review each Resident’s file on at least a monthly basis. She could indicate that this has been done by signing the record with a red or green pen. (This issue should have been addressed from the inspection report dated 28 September 2005) The Acting Manager should make sure the strong smell of urine is removed from the area notified to her during the inspection. All care staff and domestic staff should be provided with master keys to Residents bedrooms. (This issue should have been addressed from the inspection report dated 27 November 2003) The Acting Manager should review the length of time care staff are allowed to work in the Home, and where possible limit this to no more than 40 hours each week or only 8 hours per shift each day. The Acting Manager should carry out formal supervision with all care staff and nursing staff at least 6 times a year covering the issues listed in Standard 36.3. (This issue should have been addressed from the inspection report dated 28 September 2005) All nursing staff and care staff should receive training in Infection Control, during the next eight months of the year, i.e. by 31 October 2006. The Acting Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. Old Lodge, The Nursing Home DS0000002135.V282301.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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