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Inspection on 18/05/05 for Raunds Lodge Nursing Home

Also see our care home review for Raunds Lodge Nursing Home for more information

This inspection was carried out on 18th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

The home is bright, airy and well maintained. A resident spoken to stated that she was very well looked after and that the staff were very caring. All of the comment cards received from residents and ten of the eleven comment cards from relatives indicated satisfaction with the care received. All of the residents appeared well groomed and well cared for.

What has improved since the last inspection?

The activities programme in the home has been expanded and records of residents preferences and involvement in these activities are available. Accident records are now completed by the staff member on duty at the time of the occurrence to ensure that accurate records are made to monitor resident risks in the home.

What the care home could do better:

More work needs to be done to ensure that resident`s plans include all of their assessed needs and are not contradictory. Pureed diets were presented in a very unappetising manner, which did not encourage residents to take an adequate diet. Staff were observed to be using unsafe moving and handling lifts, putting both the residents and themselves at risk of injury. There is no qualified First Aider on duty in the home at all times in order to provide the correct care to residents in case of accident. The key to the front door is not easily accessible in case of fire, leaving residents and staff at risk. There is still no Registered Manager in the home, to direct staff and the care provided. The provider has been required to address these issues. Staff were found to be working without the necessary Criminal Records Bureau checks having been made, to protect residents from potential harm. An immediate requirement was made to address this issue.

CARE HOMES FOR OLDER PEOPLE Raunds Lodge Nursing Home 63 Marshalls Road Raunds Wellingborough Northants NN9 6EX Lead Inspector Linda Preen Unannounced Wednesday, 18th May 2005 at 10.00am 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. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Raunds Lodge Nursing Home Address 63 Marshalls Road Raunds Wellingborough Northants NN9 6EX 01933 625404 01604 646394 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) Raunds Lodge Nursing Home Ltd Vacant CRH 19 Category(ies) of DE(E) 9 Dementia - over 65 year registration, with number OP Old Age of places Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Up to a maximum of 3 personal care beds Date of last inspection 23rd September 2004 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. 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. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of four and a half hours as part of the statutory inspection programme. Two residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this medication records, Fire records, Complaints and accident records were seen. 3 comment cards had been received from residents, 11 from relatives and information was available from a questionnaire completed by the providers of the service. A limited tour of the premises was also undertaken. What the service does well: What has improved since the last inspection? The activities programme in the home has been expanded and records of residents preferences and involvement in these activities are available. Accident records are now completed by the staff member on duty at the time of the occurrence to ensure that accurate records are made to monitor resident risks in the home. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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) 3 The home is not registered to provide intermediate care. Prospective residents are assured that their needs will be assessed prior to admission to the home. EVIDENCE: Resident’s files seen, demonstrated that assessments are completed prior to admission and relatives had signed to confirm the contents of these and care plans formulated. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 standard(s) 7, 8, 9 and 10. The care plans in place do not provide clear and consistent information to enable staff to satisfactorily meet the resident’s needs. Comprehensive medication systems ensure resident safety. Resident’s dignity is not always respected. EVIDENCE: Resident plans were sometimes contradictory, leading to potential confusion by staff. For example, one lady had three different references to continence, one of which stated that she wore pads, one of which stated that she did not and the third that she was incontinent of faeces. Care plans did not reflect all areas of need. For example, A resident who had recently undergone surgery, had no reference to this or the post operative care required in her care plan. A second resident with a diagnosis of dementia, had been transferred from a residential care home owing to behaviour problems, but there were no plans in place to guide staff on these issues. Requirements have been made in this respect. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 10 Staff were observed to be transferring a resident with an underarm lift, which is dangerous for both the resident and staff members involved. This was made the subject of a requirement. A gentleman recently admitted to the home, had hearing problems identified on his initial assessment. He was observed to be hearing his visitor and staff members unaided and his daughter stated that he had never had a hearing problem as far as she was aware. This same resident was reported as needing spectacles but he had none available, his daughter stating that he had lost them at his previous home. Staff had taken no action to correct this shortfall. The communication plan states his method of communicating his needs to go to the toilet but this information does not appear in his continence care plan. This was the subject of a requirement at the last inspection and remains outstanding. Medication systems are robust with good records kept. Staff were observed to be administering medication in the required manner. The home and next of kin had completed covert medication consent, but there was no evidence that the General Practitioner or Pharmacist had been consulted about this, or of a system for review of this protocol. Interaction between residents and staff was observed to be sensitive and respectful, but residents were seen to be wearing bibs at times other than meal times, which does not respect their dignity. There was no evidence that residents had been offered locks to their personal rooms, or reasons why this was inappropriate if residents could not manage this choice. This was the subject of a requirement at the last inspection and remains outstanding. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 standard(s) 12, 13 and 15. Efforts have been made to provide social interaction for residents. Improvements are needed in the presentation of food, to make it more attractive to residents. EVIDENCE: A record of activities provided was available and included such things as reading aloud, music, television, sing songs and armchair exercises. Each resident has a daily diary in which social interaction is recorded. The acting manager has requested that relatives provide information concerning resident’s lifestyle and previous interests so that this may be incorporated in their programme where possible. Visitors are welcome in the home and a lady visiting her father at the time of the inspection was welcomed by staff and offered a cup of coffee. Lunch was observed and looked appetising for those able to eat a normal diet. The resident able to converse with the inspector stated that the food was very good and that an alternative was provided for her if she did not like the meal on offer. The meal for those who required a pureed diet looked very unappetising and consisted of a helping of brown “mush”. The cook had recently attended training on the presentation and content of these meals and Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 12 a delivery of food moulds arrived during the inspection. This will allow meals to be presented in shapes recognisable as food and will encourage residents to improve their nutritional intake. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 standard(s) 16 Complaints are dealt with in a manner that recognises their importance. EVIDENCE: Complaints records seen demonstrated that every effort had been made to address the complaints of a relative concerning her mothers care, with meetings being arranged with advocates and solicitors in an effort to resolve the matters raised. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 standard(s) 19, 20, 23, 24, 25 and 26 The home is maintained to a good standard in order that residents may live in clean, homely and pleasant surroundings. EVIDENCE: The home was bright and airy with well furnished and comfortable communal areas. Resident’s rooms seen showed evidence of personalisation, with small items of individual furniture, pictures and ornaments on display. One resident, who spends all of her time in her room, said that she enjoyed watching her television and showed her collection of singing soft toys to the inspector. Domestic staff are employed in addition to care staff in order to maintain cleanliness throughout the home. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 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 and 30 The home has a commitment to staff training in order to meet resident’s needs, but recruitment practices are unsafe and place residents at risk from harm. EVIDENCE: Duty rotas seen, demonstrated that there are four staff in the morning, four in the evening and two staff at night for 18 residents. The registered nurse spoken to confirmed that this meets the requirements of the current resident group. The pre-inspection questionnaire demonstrated that eight out of the ten care staff employed hold a National Vocational Qualification and a further member of staff is working towards this at present. The acting manager has developed training records in order to monitor the provision of statutory and other training in the home. The staff member spoken to confirmed that she had undertaken moving and handling, fire, health and safety and food hygiene training since she commenced in the home ten months ago. In addition to this, she had completed Protection of Vulnerable Adults and dementia training. Training updates planned were on display on the staff notice board. Only one member of staff currently holds a first aid certificate and the requirement that a member of staff is on duty at all times with this qualification is therefore outstanding. It was identified that staff are being employed without Criminal Records Bureau checks or POVA 1st having been received in the home. All of these Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 16 checks had been applied for but had not been returned in five cases. An immediate requirement was left that no staff be employed who do not have these checks returned. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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 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, 36 and 38 Frequent changes of management in the home, leads to a lack of direction and continuity of care for staff and residents. The residents are not always protected by health and safety issues in the home. EVIDENCE: There has been no Registered Manager in the home for some time and a requirement has been made that an application to register a manager is forwarded to the Commission for Social Care Inspection without further delay. The acting manager stated that she had commenced staff supervision sessions, but staff files were not available to demonstrate this. Records of the testing of fire alarms and emergency lighting were seen to be satisfactory, as were maintenance checks for equipment in the home. Staff confirmed that they had received Moving and Handling training but carers were observed to be using an underarm lift when transferring a resident from the Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 18 wheelchair to his armchair. This is dangerous for both the resident and staff concerned. This has been made the subject of a requirement. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 3 3 x x 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 x 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 1 x x x x 2 x 2 Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 20 yes 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 7 Regulation 15 Requirement Resident plans must be reviewed to ensure that all residents assessed needs are addressed and that information is clear and not contradictory. The presentation of pureed diets must be improved to make them more appetising to residents. A system of formal staff supervision must be implemented six times a year (Previous timescale of 30.11.04 not met ). Criminal Records Bureau and POVA 1st clearance must be received in the home prior to the commencement of employment. An application to register a manager for the home must be forwarded to the CSCI (Previous timescale of 31.10.04 not met) Staff must be reminded of the correct moving and handling manouvres in order to protect both residents and themselves from harm. The key to the front door must be immediately available to all people in the home in case of Version 1.10 Timescale for action 1/7/05 2. 3. 4. 15 30 16(2)1 18(1)a 1/6/05 1/8/05 5. 29 19(4)b Schedule 2 8(1) 19/5/05 6. 38 1/8/05 7. 38 13(5) 1/6/05 8. 38 12(4)c 1/6/05 Raunds Lodge Nursing Home Raunds Lodge Page 21 9. 38 13(4) fire. The practice of keeping this on the person in charge must cease (Previous timescale of 7/10/04 not met) A qualified first aider must be on duty at all times. 1/8/05 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. 2. Refer to Standard 10 10 Good Practice Recommendations Residents should wear protective bibs at mealtimes only and not be left wearing them at all times, in order to protect their dignity. Evidence should be available that residents have been offered keys to their rooms or the reasons for this choice not being given recorded. Raunds Lodge Nursing Home Raunds Lodge Version 1.10 Page 22 Commission for Social Care Inspection 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 Raunds Lodge Version 1.10 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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