Inspection on 05/01/06 for Raunds Lodge Nursing Home

This inspection was carried out on 5th January 2006.

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

Other inspections for this house

Raunds Lodge Nursing Home 11/02/09

Raunds Lodge Nursing Home 10/04/07

Raunds Lodge Nursing Home 10/04/06

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 5th January 2006 09.45 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.V276242.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.V276242.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 01604 646394 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 Care Home 19 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (19) of places Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 3 Personal Care beds. Date of last inspection 18th May 2005 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 DS0000012636.V276242.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One hour was spent prior to the inspection reviewing previous requirements and recommendations, and collating information provided by the service. The inspection took place over a period of four 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 staff rotas and records were seen. A tour of the environment was undertaken. What the service does well: What has improved since the last inspection? Some improvements have been made to the care plans but these are still inadequate to meet all of the residents needs. Where residents require their food to be liquidised, this is now done in a manner that leaves individual components recognisable, which makes it more appetising. Moulds to form the liquidised food into recognisable food substances were introduced following the last inspection but the use of these has been discontinued owing to a reduction in catering staff hours. A key for the fire exit at the front of the house has now been provided in an accessible place. Staff recruitment procedures have been improved in order to protect residents from possible abuse. Raunds Lodge Nursing Home DS0000012636.V276242.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. Raunds Lodge Nursing Home DS0000012636.V276242.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.V276242.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 Assessment of residents is inadequate to ensure that their needs may be met in the home. EVIDENCE: A format is available to record the assessed needs of residents but the information on these forms was incomplete, not dated or signed, and there was no evidence that residents or their advocate had been involved in the assessment. Requirements have been made in this respect. Raunds Lodge Nursing Home DS0000012636.V276242.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 and 8 Care plans are incomplete and do not give staff sufficient guidance on meeting the residents’ needs. EVIDENCE: Work has been done to provide up to date and accurate care plans to guide staff in the care of the residents, but these care plans remain incomplete and contain unclear information. For example, one resident was recorded as being diabetic on admission but there was no care plan for diabetes. Another resident was recorded as having an indwelling urinary catheter in one area of his plan but the daily statement for 25/10/05 states that this catheter was found to be out. There is no record of whether it was replaced, or of a toileting regime if it was decided not to replace it. Abbreviations have been used in these records without any explanation as to what these abbreviations represent, leaving the reader unable to understand the record. Residents with a diagnosis of dementia do not have care plans to guide staff in the care of their mental health needs. For example one resident had a care plan for aggression but this only described the behaviour and did not give staff any guidance on how to deal with this behaviour. Residents seen appeared well groomed and comfortable. Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 10 Records were available of visits by the General Practitioner, chiropodist and optician and also attendance at the local hospital. Staff advised that insufficient protective gloves are available and that they were expected to use one pair of gloves to care for all residents at toileting rounds. This practice poses a risk of cross infection and proper provision of gloves must be made. A requirement has been made in this respect. The only resident able to express an opinion stated that she was happy with the care and attention provided, but that she was unable to get up as she had been waiting for two years for the provision of a suitable chair in which to sit. A requirement has been made in this respect. In addition to this, it was reported that a specialist chair required by one resident had been broken since 30/02/04, and an entry in the maintenance book confirmed this. Since that time, the chair has been propped up against the wall to prevent its collapse when the resident used it. A new chair had been provided for another resident who was assessed as needing the same type in December, and this is now being used by the first resident until his chair is repaired or replaced. This means that the second resident can still not get out of bed. A requirement has been made in this respect. There was no evidence that residents had been offered choice concerning their daily life, times of rising and retiring, activities, food preferences or where they spent their day. Care is provided in an institutional manner with staff referring to toileting rounds etc rather than individual routines. Requirements have been made in this respect. The home is registered to provide accommodation for up to 9 residents with dementia. Despite this, it was reported that 15 of the current residents were in this category. This is a breach of the Conditions of Registration and requirements have been made in this respect. There is no specialist provision for those residents with a diagnosis of dementia. All residents are nursed in the same area with only one lounge being provided. No environmental adaptations or specialist activities are provided for this group. Apart from feeding lunch, no one to one time was observed to provide stimulation, occupation or activity for these residents. Requirements have been made in this respect. Raunds Lodge Nursing Home DS0000012636.V276242.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 and 15 Little consideration is given to meeting residents’ social, cultural or religious needs. Visitors are welcome to the home at any time. Meals are served in adequate portions in a pleasant environment. EVIDENCE: There are no records of residents social or life history to guide staff in the provision of suitable activities and stimulation. As 15 of the 18 residents currently accommodated suffer with various levels of dementia and two of the three non-demented residents have communication problems, it is impossible to ascertain from them on a daily basis what their preference would be. Staff stated that an outside entertainer provides music approximately every six weeks. A record is kept of activities provided by care staff and resident participation. Records such as “toys played with” have been made. These “toys” were seen, and found to be suitable for small children in some cases and not for adults. Requirements have been made in this respect. The only resident able to hold a conversation, spends all of her time in her room and has her own television. Visitors are welcome in the home at any time and were reported to have attended the Christmas party. Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 12 Lunch was observed to be served in adequate portions. Residents who require assistance with eating were helped in a sensitive manner and those who require food liquidised had this done so that individual components were recognisable. The use of moulds for liquidised meals has been discontinued owing to a reduction in catering staff hours. Raunds Lodge Nursing Home DS0000012636.V276242.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): These standards were not assessed on this occasion. EVIDENCE: Raunds Lodge Nursing Home DS0000012636.V276242.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): 19,21, 22, 24, 25 and 26 Lack of attention to maintenance leaves residents and staff at risk. Bathrooms are not available to meet the required standard. Specialist equipment is poorly maintained and not always provided to meet assessed needs. Attention is needed to the décor in some areas of the home. The environment is clean and hygienic. EVIDENCE: A tour of the environment was undertaken. The platform lift on the first floor was found to have the emergency stop button missing. In addition, the control panel above this lift was out of order so that if a resident or staff member became trapped, there was no way to stop the lift within reach. It would involve another member of staff coming to operate the other control panel away from the unit. Records in the home showed that the safety knob had been missing since 10/01/04 and staff reported that the control panel had been out of order for approximately six Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 15 months. An immediate requirement was made that this lift should not be used until it has been repaired. Notices were observed on one bathroom door and one toilet door to state that they were out of order and not to be used. On investigation it was discovered that neither were actually out of order but that notices had been placed on them for other reasons. In the case of the bathroom, it was stated that this was to stop incontinence pads being put down the toilet and in the case of the toilet this notice had been left on following a previous problem now resolved. Requirements were made in this respect. Resident rooms seen were clean and tidy, but two rooms had torn wallpaper borders which need replacing. One resident’s room had a strong odour of urine. Requirements were made concerning these items in order to make the rooms more pleasant places in which to live. There was no evidence that residents had been offered the facility of locking their rooms or personal possessions, in order to protect their privacy. This was a recommendation at the last inspection and remains outstanding. Raunds Lodge Nursing Home DS0000012636.V276242.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): 27, 29 and 30 The numbers and skill mix of the staff appear adequate to meet the physical needs of the current resident group. Recruitment practices protect residents from potential abuse. Staff training is provided to meet statutory requirements except for first aid. EVIDENCE: Duty rotas seen demonstrated that the home is staffed by one Registered nurse and four carers in the morning, one Registered Nurse and three carers in the afternoon and one Registered Nurse and one carer at night, which the staff nurse spoken to confirmed is adequate to meet the physical needs of the current resident group. No activities co-ordinator is employed but catering and cleaning staff are provided. A selection of staff files were seen. These demonstrated that systems are in place to ensure that the necessary checks are made in order to protect residents from possible abuse. Staff training records demonstrated that statutory training in moving and handling, fire, food hygiene are provided. This was the subject of a previous requirement and remains outstanding. 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. Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 17 Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 18 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 EVIDENCE: There has been no Registered Manager in the home for at least two years. An acting manager has been employed since May 2005 but has yet to be proposed to the Commission for Social Care Inspection for Registration. This has been a requirement at the last two inspections and remains outstanding. There was no evidence that the home is run in the best interests of the residents. As previously stated there is no record of their preferences concerning activities, choices concerning food, times of rising and retiring or how they wish to spend their day. They are treated “en-masse” and do not have individual attention. Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 19 There was no evidence in the staff files seen of any formal supervision having been carried out as required. This was a requirement at previous inspections and remains outstanding. Fire doors throughout the home were found to be propped open with items of furniture or wooden wedges. This presents a risk in case of fire. A requirement was made concerning this. The key to the fire exit at the front of the house is now situated in a key box affixed to the door. This was the subject of a previous requirement and is now met. “Steradent” tablets were found in resident rooms. This has been notified as a hazard in homes providing care for those residents with dementia owing to the risk of ingestion. A Requirement was made in relation to this. A large container of fabric conditioner was found in an unlocked toilet. A member of the management team removed this at the time of the inspection so no requirement will be made concerning this. The laundry is left open and unattended, which could also put residents at risk with access to the cleaning chemicals. A requirement is made in this respect. An introduction to first aid is given by the only member of staff to hold a first aid certificate, but there is no qualified First Aider on duty on all shifts as required. His was a requirement at the last two inspections and remains outstanding. Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 20 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 1 X 2 1 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X 2 X 1 Raunds Lodge Nursing Home DS0000012636.V276242.R01.S.doc Version 5.1 Page 21 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 OP1 Regulation 12 1)14© Requirement Residents must be assessed on all aspects of their daily life including physical, spiritual, mental and emotional needs before admission in order to ensure that their needs may be met in the home. Evidence of the resident or their advocate having input into this assessment must be available. Resident plans must be reviewed to ensure that all residents assessed needs are addressed and that information is clear and not contradictory. Previous timescale of 01/01/05 not met) Residents with a diagnosis of dementia must have care plans in place to guide staff in how to care for their mental health needs. Sufficient quantities of disposable gloves must be provided to ensure that a new pair is worn for each resident every time they receive personal care. A suitable chair must be DS0000012636.V276242.R01.S.doc Timescale for action 01/02/06 2. OP7 15 01/02/06 3 OP7 15 01/02/06 4 OP8 13 (3) 01/02/06 5 OP4 16(2)c 01/02/06 Page 22 Raunds Lodge Nursing Home Version 5.1 6 OP4 16(2)c 7 OP14 12(3) 8 OP1 CSA 2000 9 OP12 16(m)(n) 10 OP12 16(m)(n) 11 OP38 23(2)c 12 13 OP21 OP19 23(2)j 23(2)d 14 OP19 23(2)b provided in order that the resident who has been waiting for this facility for two years may get up when she chooses. The specialist Kirton chair must be repaired or replaced in order that both residents assessed as needing this facility may get up. Evidence must be available of residents’ choice concerning times of rising and retiring, food preferences, hobbies and interests and daily life. Evidence must also be available to demonstrate that these choices are facilitated in the home where possible. No more residents in the category of dementia may be admitted to the home unless there are less than nine residents in this category already accommodated. Evidence must be available that suitable activities are provided for the specialist needs of those residents with a diagnosis of dementia. Residents must be consulted concerning the provision of activities and the practice of using children’s toys for activities must cease. The use of the platform lift on the first floor must cease until repairs have been carried out. (An immediate requirement was issued in this respect) All registered bathroom and toilet facilities must be available for residents’ use. Attention must be paid to eradicate the odour of urine in the room identified at the time of the inspection. The torn borders in the two identified rooms must be replaced or repaired. DS0000012636.V276242.R01.S.doc 01/02/06 01/03/06 14/01/06 01/02/06 01/02/06 05/01/06 01/02/06 14/01/06 01/02/06 Raunds Lodge Nursing Home Version 5.1 Page 23 15. OP36 18(1)a 16. OP38 8(1) 17. OP38 13(4) 18 OP38 12(1) a 19 OP38 23(4) c 20 OP38 12(1) a A system of formal staff supervision must be implemented six times a year (Previous timescales of 30.11.04 and 01/08/05 not met). An application to register a manager for the home must be forwarded to the CSCI (Previous timescales of 31.10.04 and 01/08/05 not met) A qualified first aider must be on duty at all times. (Previous timescale of 01/08/05 not met) “Steradent” tablets must be kept in a locked facility in order to protect residents with a diagnosis of dementia from the risk of ingestion. Fire doors must not be propped open, in order to prevent the spread of fire throughout the home. The laundry must be kept locked when unoccupied in order to protect residents from the chemicals and machinery found within. 01/03/06 01/02/06 01/02/06 14/01/06 14/01/06 14/01/06 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 OP10 Good Practice Recommendations 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 DS0000012636.V276242.R01.S.doc Version 5.1 Page 24 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. 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