CARE HOMES FOR OLDER PEOPLE
Old Lodge, The Nursing Home Sandypits Lane Etwall Derby Derbyshire DE65 6JA Lead Inspector
Vanessa Davies Unannounced Inspection 24th April 2006 10:00 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.V291098.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.V291098.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.V291098.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 15th February 2006 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 en-suite 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.V291098.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was unannounced, the inspector met with the Acting Manager and the proprietor. Information for this report was gathered by reading records and speaking with staff, management and residents. What the service does well: What has improved since the last inspection?
The manager has commenced supervision with the staff. All residents are given the opportunity as to whether they would like a lock fitting to their bedroom door. The manager and provider have addressed issues raised at previous inspections. Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 6 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.V291098.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.V291098.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): 3,6 Quality in this outcome area is good. Detailed assessments of nursing needs ensures that staff are able to meet the needs, however lack of information relating to social needs potentially prevents staff from meeting the holistic needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Each of the care files examined had a completed assessment of need. The assessments were very detailed when addressing nursing needs, however there was little or no information regarding social needs. One file had no date of admission. There were details of the use of bed rails, however this was not detailed in the assessment of need. Although there was signed agreement from the resident or a relative about the use of bed rails, the manager did state that there were agreements sought from relatives and that this was an on going process.
Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 9 There was evidence of information sharing between relatives and the staff, in the files seen. Care plans developed from the assessments of need address all of the nursing needs of the residents. Care plans are regularly reviewed. The manager stated that assessments would be reviewed with a view to addressing the lack of social information within the files. The home does not offer intermediate care. Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 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 the following standard(s): 7,8,10 Quality in this outcome area is good. Completed assessments of need ensure that staff are able to meet the health needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: As stated in the previous section the health needs of the residents are clearly met. There are detailed care plans, reviewed regularly, in place to address health needs. There was evidence of input from other professionals, the manager stated that referrals to other professionals were made as necessary. Residents spoken with stated that all of the staff treat them with respect, they knock on doors before entering, they ensure that doors are closed when doing personal care. Old Lodge, The Nursing Home DS0000002135.V291098.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): 12,13,14,15 Quality in this outcome area is good. Good, positive relationships between staff and residents assists residents to lead a meaningful life in care with appropriate support. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: As stated previously the manager intends to address the lack of social information for each of the residents. It was evident on the day of inspection that the staff have very good positive relationships with the residents. Relatives are made to feel welcome at the home and their input with the residents care is encouraged. The manager is in the process of asking residents whether or not they would like a lock fitted to their bedroom door, many have indicated no. This choice is offered to all new residents. The home offers a varied and healthy choice of diet. Each day the residents are asked what they would like to eat the following day. The cooks keep a record
Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 12 of menus and any changes to the menu. Any foods needing to be liquidised are done so appropriately. Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 13 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): 16,18 Quality in this outcome area is good. Policies and procedures and staff awareness ensures that residents and relatives concerns and complaints are taken seriously and that the residents feel safe. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The manager and provider stated that there had been no complaints made since the previous inspection. There is a policy in place to address any complaints within a timescale. The home keeps a record of complaints made, along with responses. The home has a policy regarding adult protection. The manager stated that all staff are made aware of adult abuse and how to address this. She stated that all staff have a completed CRB, however as these are applied for under an ‘umbrella’ organisation, she was not able to evidence this. Ways to overcome this were discussed during the visit. Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 14 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): 19,20,25,26 Quality in this outcome area is good. A well maintained and clean home ensures that residents live in a comfortable environment. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The home is in a good state of repair, the provider is currently refurbishing the first floor lounge, presenting a bright clean and homely environment. The home provides a safe and comfortable environment both internally and externally, this was confirmed when speaking with residents and a relative. The home appeared very clean on the day of the visit. All issues raised at previous inspections have since been addressed.
Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 15 Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 16 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): 28,29,30 Quality in this outcome area is good. Well trained staff and a satisfactory recruitment procedure ensures that residents are kept safe, however lack of CRB evidence for the staff could potentially put residents at risk. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The manager offers a range of training for staff and the home has policies and procedures in place to ensure residents are cared for by competent staff. The manager stated that well over the required 50 of staff now have NVQ2 care. All staff recruited have 2 written references, 2 forms of identity and a completed Criminal Records Bureau check. The manager was not able to evidence the CRB checks and this was discussed on the day of inspection. Old Lodge, The Nursing Home DS0000002135.V291098.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): 31,33,38 Quality in this outcome area is good. The appointment of a qualified competent manager ensures that the home progresses with the changing needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The manager has worked hard to address requirements made at previous inspections. Although she has not applied to the CSCI for registration yet, she does intend to following this inspection, 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 findings with the Manager.
Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 18 The Manager was asked again about the Quality Assurance measures she had put in place within the Home. She has obtained details to assist in the development of a quality monitoring tool. The manager stated that although not all staff had received supervision she was in the process of arranging this. Training offered included manual handling, food hygiene, fire safety and recognising abuse, in addition to the above statutory training, the manager stated 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 ensures that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant bodies. She also ensures that fire safety notices were posted in relevant places around the home. Old Lodge, The Nursing Home DS0000002135.V291098.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X 3 3 STAFFING Standard No Score 27 X 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Old Lodge, The Nursing Home DS0000002135.V291098.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 OP33 Regulation 24 Requirement The Registered Provider and Acting Manager must address the quality assurance issues listed within Standards 33.1 to 33.7. Timescale for action 30/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP36 Good Practice Recommendations 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. The Acting manager should ensure that all assessments of need are reviewed to include social needs and history of residents. The manager should ensure that she has documentary evidence of all CRB checks for staff. 2 3 OP3 OP29 Old Lodge, The Nursing Home DS0000002135.V291098.R01.S.doc Version 5.1 Page 21 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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