Inspection on 10/04/06 for Raunds Lodge Nursing Home

This inspection was carried out on 10th April 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Raunds Lodge Nursing Home 11/02/09

Raunds Lodge Nursing Home 10/04/07

Raunds Lodge Nursing Home 05/01/06

Raunds Lodge Nursing Home 18/05/05

Raunds Lodge Nursing Home 23/09/04

Raunds Lodge Nursing Home 26/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Raunds Lodge Nursing Home 63 Marshalls Road Raunds Wellingborough Northants NN9 6EY Lead Inspector Mrs Linda Preen Unannounced Inspection 10th 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 Raunds Lodge Nursing Home DS0000012636.V288550.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. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Raunds Lodge Nursing Home Address 63 Marshalls Road Raunds Wellingborough Northants NN9 6EY 01933 625404 01933 625404 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) Raunds Lodge Nursing Home Limited Vacant Care Home 19 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (19) of places Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A total of 19 residents may be accommodated in the home at any one time. A total of 19 residents may be accommodated in the category of OP. A total of 16 residents may be accommodated in the category of DE (E). No more residents in the category of DE (E) may be accommodated in the home when there are already 16 residents in this category accommodated. No more residents may be admitted to the home when 19 residents are already accommodated. 5th January 2006 Date of last inspection Brief Description of the Service: Raunds Lodge is a facility providing personal and nursing care for elderly frail service users, and those suffering from Dementia. The number of residents in the category of DE (E)(dementia) has been increased since the last inspection as a response to the increased need for this type of service, and the majority of the residents in the home at present fit into this category. Accommodation is provided in both single and double rooms, over three floors, in a homely environment, as the facility is a converted house. The facility is located in Raunds, a small town halfway between Rushden and Thrapston. There is a bus service within the town, and also from towns and villages in the surrounding area. The main A14 and A6 roads are close by. Fees range from £331.60 to £555.00 per week. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One day was spent prior to the site visit reviewing previous requirements and recommendations, and collating information provided by the service. The site visit took place over a period of 5 1/2 hours as part of the statutory inspection programme. Four residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them (where possible owing to their diagnosis of dementia) and their relatives and also to the staff concerning the care received. In addition to this staff records and medication records were seen. Two monitoring visits have been undertaken since the last published inspection, in order to monitor compliance with the large number of requirements made at this time. Considerable progress has been made during this period. What the service does well: What has improved since the last inspection? All staff have now completed a four-day dementia care course and have begun to put their newfound knowledge into place for the benefit of the residents. Staff supervision and induction programmes have been implemented to ensure their training needs can be met. New activity programmes are being developed, suitable for the assessed needs and preferences of the residents. Physical care plans and assessments are being reviewed to ensure that care plans are up to date and guide staff on meeting the current physical needs of the residents. Two bedrooms and one of the bathrooms have been redecorated to improve the environment and simple signs provided to assist residents in navigating the home. Four new recliner chairs have been purchased, along Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 6 with additional pressure relieving mattresses and cushions and moving and handling slings. Health and Safety issues have been addressed and all fire doors were found to be closed on inspection, unless fitted with automatic closers. Chemicals have been stored away and the laundry is kept locked to protect residents from risks in this area. 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. Raunds Lodge Nursing Home DS0000012636.V288550.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 Raunds Lodge Nursing Home DS0000012636.V288550.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 and 4 Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Thorough assessments and Terms and Conditions ensure that residents are confident that their needs may be met in the home. EVIDENCE: A new Statement of Purpose and Service User Guide were developed as part of a recent variation in the conditions of registration, which increased the permitted number of residents in the category of DE (E) (dementia) to be accommodated in the home. A resident who had been recently admitted was case tracked and this demonstrated that a comprehensive assessment had been made to ensure his needs could be met in the home. This included information from professionals at his previous hospital admission. Equipment such as pressure relieving devises and a new recliner chair had been provided to ensure a good level of care could be offered. Existing residents case tracked had evidence that their assessments were being reviewed and updated. Raunds Lodge Nursing Home DS0000012636.V288550.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): 7, 8, 9 and 10 Quality in this outcome group is adequate. This judgement has been made using available evidence, including a visit to the service. Staff do not always have the information required to ensure that all resident needs are met. Residents are treated with dignity and respect. Medication systems in the home are satisfactory with the exception of the administration of covert medication, which could be in breach of residents Human Rights. EVIDENCE: Four residents were chosen to case track. Physical care plans and assessments are being reviewed to ensure that care plans are up to date and guide staff on meeting the current physical needs of the residents. Some work has been done to provide care plans for those residents with a diagnosis of dementia, but these need to be expanded further to give more detailed guidance concerning coping strategies for differing behaviours and to give more emphasis on what the resident is still able to do rather than concentrating on the negatives. Guidance was given to staff in this respect to enable them to meet this requirement. This was a requirement following the last inspection and remains unmet. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 10 Residents were observed to be well groomed and well cared for, and staff treated them with dignity and respect. Staff were obviously aware of residents particular strengths and weaknesses and responded to a potentially volatile situation between two residents in a speedy and appropriate manner, diffusing the situation without impinging on the dignity of either resident. Medication systems were monitored and good systems are in place to ensure that the ordering, receipt, administration and disposal of medication are handled in an appropriate manner. A recent pharmacy inspection recorded advice on the recording of medication, and this advice was noted to have been put in place. The procedures for the administration of covert medication were still not in line with the Nursing and Midwifery Council Guidance, but advice had been taken from the pharmacist concerning the provision of more liquid medications and a meeting had been arranged on the 12th April to discuss this area with the General Practitioner. Consent forms in the notes seen were still only signed by the family and the home, with no review dates set and no particular drugs specified. This was a requirement at the last inspection and remains outstanding. Raunds Lodge Nursing Home DS0000012636.V288550.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 and 15 Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Social Activities and meals are both well managed, creative and provide daily interest and variation for people living in the home. EVIDENCE: Residents were observed to be enjoying 1-1 attention in the form of aromatherapy hand massages during the inspection. The gentleman providing this had a very good rapport with the residents, who were enjoying his chat and singing old time songs with him during treatment. One resident was enjoying knitting, others were looking at the paper or magazines and others were watching television. Records demonstrated that the hobbies and interests of individuals had been identified and that staff were attempting to engage residents in activities suited to these interests. Two rummage boxes have been provided to stimulate memories in those residents with a diagnosis of dementia and a specialist apron with zips, buttons etc has been ordered to help those residents who fiddle with their clothing. Although verbal communication with this group was difficult, they all appeared to be happy and settled when spoken to, smiling and laughing in response. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 12 Visitors are welcome at any time, and two families visited during the inspection. Both of these families expressed their satisfaction at the care and attention provided and both stated that it could not be better. Staff greeted them in a friendly manner and offered a cup of tea or coffee. Case files seen, demonstrated that residents choices in relation to clothing, food and activities had been recorded. In discussion, staff were aware of these choices and were observed to be acting on them. In discussion with the cook, it was apparent that she was aware of the individual preferences of residents in regards to their food. The use of food moulds has been reintroduced to improve the appearance of pureed food. Menus seen were varied and nutritious, with alternative choices offered. Lunch was observed and looked and smelled appetising. Residents confirmed that it was very nice. Staff gave 1-1 attention to those residents who required feeding and offered help to others in an unobtrusive way. The meal was relaxed and unhurried. Staff confirmed that snacks were offered to those residents who chose not to eat their meals. Two residents case tracked were having their food and fluid input monitored owing to an identified need in this area. Discussions were held with the Provider concerning the latest report and guidance issued by the Commission for Social Care Inspection in respect of nutrition. He stated that there is no set budget concerning food and that he purchases it according to need. Raunds Lodge Nursing Home DS0000012636.V288550.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 and 18 Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. The company takes all complaints seriously and acts upon them. Residents are protected from abuse. EVIDENCE: No complaints, concerns or allegations have been received by the Commission for Social Care Inspection since the last inspection. Records in the home demonstrated that one complaint had been received concerning a specified member of staff. The provider had dealt this with in an appropriate manner, and records of the investigation and outcome were available for inspection. A copy of the home’s complaints procedure was on display in the home. Staff records demonstrated that they had received training in the prevention and reporting of abuse. A copy of the Interagency Procedures for the Protection of Vulnerable Adults was available for staff reference. Staff spoken to were aware of the types of abuse and of their responsibility in reporting any incidences. Raunds Lodge Nursing Home DS0000012636.V288550.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): 19,20,22, 23, 24, 25 and 26 Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Residents live in homely surroundings, which are well maintained and clean. EVIDENCE: A tour of the environment was undertaken. This demonstrated that the home was clean and tidy. All areas were fresh and airy. Two bedrooms and a bathroom had been redecorated since the last inspection. An extension to the home is in the process of being built and the provider stated that there were plans to refurbish the existing home when the new rooms are available for the current residents. All areas of the home were comfortably warm. Resident’s rooms showed evidence of personalisation with small items of furniture, ornaments and pictures in evidence. One lady had several religious icons on display, the staff having ascertained that she had been very religious prior to her dementia and she appeared to be comforted by them. Raunds Lodge Nursing Home DS0000012636.V288550.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): 27, 28, 29 and 30 Quality in this outcome group is good. This judgement has been made using available evidence, including a visit to the service. Procedures for the recruitment of staff provide safeguards necessary to offer protection to the people living in the home. Staff are provided with training and are in sufficient numbers to meet the needs of the residents. EVIDENCE: One Registered Nurse and four carers staff the home in the morning, one Registered Nurse and three carers in the afternoon and one Registered Nurse and one carer at night, which the staff confirm is sufficient to meet the needs of the current resident group. Of the eleven carers employed, three hold a National Vocational Qualification level 2 in care, four are qualified nurses from overseas who have yet to obtain registration in this country and two are adaptation nurses who have now been registered in this country but who have yet to obtain positions as qualified nurses elsewhere. An induction programme is in place for new staff. Two staff files were monitored. These demonstrated that the necessary references, Criminal Records Bureau checks and work permits were in place to protect residents from potential abuse. All staff have now completed a four-day dementia care course and have begun to put their newfound knowledge into place for the benefit of the residents. Staff supervision and induction programmes have been implemented to ensure their training needs can be met. All qualified staff are scheduled to attend first aid training on the 12th April. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 16 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, 36 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence, including a visit to the service. Management of the home is unstable and does not give continuity to resident’s care or guidance to staff. There is no evidence of Quality Assurance in the home. EVIDENCE: There is currently no Registered Manager in the home. The previous acting manager has left and recruitment is ongoing for a replacement. In the interim, the care services manager is overseeing the home on a part time basis assisted by the deputy manager. While this is satisfactory in the short term, efforts must be made to appoint a permanent manager as soon as possible. This was made a requirement at previous inspections and remains outstanding. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 17 Improvements to the care of residents have been made since the last inspection, but there is still no evidence of quality assurance being undertaken in the home. Health and Safety issues identified at the last inspection have now been addressed. Fire doors were closed unless they were fitted with automatic closers. Chemicals were stored in a secure manner and the laundry was locked to protect the vulnerable residents from danger. Records of the testing of fire alarms and emergency lighting were seen and found to be satisfactory. Staff had all had an update in Fire training on the 29th March. Moving and handling practices in the home were observed to be appropriate, and staff records demonstrated that moving and handling training had been provided. Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 18 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X 3 X 3 Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 19 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 OP38 Regulation 8(1) Requirement An application to register a manager for the home must be forwarded to the CSCI (Previous timescales of 31.10.04, 01/08/05 and 01/02/06 not met) Timescale for action 01/06/06 2. OP38 13(4) A qualified first aider must be on 10/05/06 duty at all times. (Previous timescale of 01/08/05, 01/02/06 and 01/04/06 not met) 3. OP7 15 Residents with a diagnosis of dementia must have care plans in place to guide staff in how to care for their mental health needs. (Previous timescale of 01/02/06 not met.) 10/05/06 4. OP9 13(2) Covert medication must be reviewed to ensure that systems comply with the Nursing and Midwifery Council guidelines. DS0000012636.V288550.R01.S.doc 01/06/06 Raunds Lodge Nursing Home Version 5.1 Page 20 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 Good Practice Recommendations Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Raunds Lodge Nursing Home DS0000012636.V288550.R01.S.doc Version 5.1 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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