Inspection on 31/10/05 for Risedale At Aldingham St Cuthberts Nursing Home

This inspection was carried out on 31st October 2005.

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

Risedale At Aldingham St... 29/05/07

Risedale At Aldingham St... 06/02/06

Risedale At Aldingham St... 07/01/05

Risedale At Aldingham St... 29/07/04

Similar services:

Chirnside House

Rosehill Residential Home

Ruskin Lodge

Langrigg House

Parkside

The Good Companions

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

CARE HOMES FOR OLDER PEOPLE Risedale At Aldingham St Cuthberts Nursing Home Aldingham Ulverston Cumbria LA12 9RT Lead Inspector Jenny Donnelly Unannounced Inspection 31st October 2005 09:15 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 Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 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. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Risedale At Aldingham St Cuthberts Nursing Home Aldingham Ulverston Cumbria LA12 9RT Address 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) 01229 869203 01229 869152 Risedale Estates Limited Mrs Julie Alexander Care Home 43 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (41) of places Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 43 service users to include: up to 43 service users in the category of DE (E) (Dementia over 65 years of age) 2 named service users in the category of DE (Dementia under 65 years of age) may be accommodated within the overall number of registered places. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 7th January 2005 2. Date of last inspection Brief Description of the Service: Risedale at Aldingham St Cuthberts is a single storey, purpose built home for 43 older people suffering from dementia, and requiring nursing care. Risedale Estates Ltd operates the home and the registered manager is Mrs Julie Alexander. The home is built around a central square, which encompasses a secure garden to which residents have free access. There are 37 single and 3 double bedrooms, some of which have en-suite facilities. There are two large lounge diners and two other smaller sitting rooms. There are five fully adapted bathrooms with specialist equipment. The home is located in the small hamlet of Aldingham, just of the coast road between Ulverston and Barrow-in-Furness, overlooking the Morecambe estuary. The sister home, Risedale at Aldingham, is adjoined to St Cuthberts and although the homes are managed separately they do share the kitchens and laundry. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out during the morning and over lunchtime. The registered manager was present. The inspector spoke to residents, visitors and staff. Care and staffing records were inspected. A tour of the building was carried out. Due to the residents’ advanced dementia, they were not able to contribute much to the inspection process. The inspector judged the standard of care through direct observation and reading residents’ records. Morning coffee, activities, lunch and general interaction between staff and residents was observed. What the service does well: What has improved since the last inspection? What they could do better: The manager strives to continually monitor the quality of the service provided and makes changes as necessary to update systems and practices. On the day of inspection, the two main lounge carpets did smell. The manager was aware of the problem and said a contractor professionally cleaned these Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 6 carpets once a month. This cleaning was due to take place. The manager said she was reviewing the frequency of cleaning and putting in ozone machines to de-neutralise any smell. Risedale were also considering replacing these two carpets. In light of these actions, no recommendation or requirement is made at this time. The inspector will check for improvement at the next inspection. 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. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 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 Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 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, 4 and 6 Residents’ care needs had been fully assessed before a place in this home was offered. Residents and their relatives therefore knew the home would be able to meet their needs before they moved in. EVIDENCE: There were detailed pre-admission assessments in residents’ files. These demonstrated that residents, relatives and staff were well aware of the persons’ care needs before they moved into the home. The manager was very sensitive in supporting relatives whose loved one was suffering from severe dementia. Often the manager had met with relatives many times and had detailed discussions about what the home could offer, as part of the pre-admission process. A copy of the assessment and a letter confirming the home could meet the persons’ needs was sent to the resident/family. The first few weeks of a residents’ stay was considered a trial period for all parties to review the suitability of the home for that person. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 9 The home had previously operated a number of dedicated intermediate care beds. This had now stopped and the rooms returned to normal use. The intermediate care team in the area had not made sufficient referrals, and local social workers wanted places for people in need of long-term care. Risedale as a company are very good at responding to the needs of local people and adjusting their services accordingly. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 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 and 10 Health, personal and social care needs were carefully planned and residents received a very high standard of all round care. The staff team made great efforts to treat residents with the up most dignity and respect, which added to peoples’ sense of wellbeing. EVIDENCE: Care records in St Cuthberts had always been of a good standard. Since the last inspection staff had put more work into these and created an excellent model. Records clearly showed residents nursing and care needs including general safety, skin/wound care, behaviour, medicines, bathing and nutritional needs. All care interventions were clearly recorded, up to date, re-assessed and rewritten as the need arose. This gave staff very good guidance to follow. In addition to this were lovely “pen portraits” showing a brief history of residents’ lives, loves and interests. These helped staff enormously see past the dementia to the person inside. The care plans also contained the details that mattered to each resident; liking music, having lemonade at bedtime, liking to hold hands, or not liking to be touched. Care plans told a story about each person and were much than a list of things to be done for them. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 11 There were very good arrangements for providing general and specific health care. All residents had easy access to their GP, consultant psycho-geriatrician and community psychiatric nurse, who all visited the home regularly. Staff or families made other general health care appointments for residents, such as dentist, physiotherapist, chiropodist and optician. Risedale employ specialist nurses in wound care, dementia, continence, diabetes and terminal care, who can be called on for advice at anytime. Privacy and dignity featured highly in staff training. Extra emphasis was placed on problems encountered in dementia care, such as loss of inhibition and undressing in public. Staff were very sensitive in dealing with these behaviours, and spent time supporting families trying to come to terms with this. Staff were seen to speak kindly and respectfully to residents and guide people gently to appropriate private places to undress or use the toilet. There was a philosophy of offering, not forcing, care to people and accepting a residents wish not be shaved or bathed. Staff would go away and try again later rather aggravate the person by insisting. In this way there were less aggressive outbursts by residents. Care was very much led by the resident; what they wanted or would allow at a time suitable to them. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 12 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 Close contact with family and friends was very much encouraged. Residents were able to spend their day as they liked and could opt in or out of the various activities on offer. Meals were very much enjoyed and well tailored to the residents’ needs. EVIDENCE: St Cuthberts employed a full time activities person who organised one to one and group activities. In previous years the manager had received comments from visitors about a lack of activity. The manager felt that people didn’t know what had taken place, as they were not there to see it. Photograph boards around the home now show what residents have done, and where they have been. Various events had taken place; visiting bands, singers, picnic in the park, flower planting and painting. On the day of inspection it was Halloween. A small group of residents were icing cakes for a party later in the day. The home had been decorated, staff had dressed up, and some residents were wearing witches hats. Those people who did not wish to take part, did not. The home had two large lounge/diners plus two small quiet rooms, so residents could stay away from events without having to go to their bedrooms. Visitors were welcomed at a time, although the manager said not many came during the daytime, more in the evenings and weekends. The inspector only Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 13 saw two visitors who praised the home and the staff, for their care and attention. Lunchtime was calm with all staff present in the dining rooms, serving and assisting people. There was a choice of two main dishes on display, although the inspector saw four different meals served, in response to residents’ preferences or need. Many residents needed help with their meals and staff offered this in a calm friendly way. Many residents managed themselves, either with cutlery or fingers, and some were offered aprons to protect their clothes. The menu was varied and regularly included some type of finger food for residents who liked to eat by themselves but could not manage cutlery. There was special cutlery and plate guards available, as well as a variety of drinking cups. Hot and cold drinks and snacks were served throughout the day, and staff offered refills. Very few residents had good communication skills, but the inspector could see that people enjoyed their food and, recognised and responded well to the staff. Although lunchtime was set, people who did not want to eat at that time were offered something later. Breakfast was much more informal and was served from early to late morning. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 14 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 There were sound systems in place for people to raise any concerns or complaints, and be listened to and answered properly. EVIDENCE: The home had a complaint procedure on display. A copy was also given to each resident/family. The manager said she had not received any complaints since the last inspection. No complaints had been made to CSCI about the home. Staff were aware of the complaints procedure and the need to refer any issues to the manager or senior nurse. The visitors spoken to say they knew they could ask the manager, or one of the nurses, about anything that worried them. Most residents were not really able to understand or use the complaint procedure, due to the advanced stage of their dementia. For this reason the manager and staff were particularly careful to gain residents’ consent to care, through the residents’ co-operation. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 15 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, 21, 22, and 26 St Cuthberts provides a high standard of accommodation, which is furnished, decorated and maintained to a high standard. On the day there was a smell from the dining/lounge carpets, which were due to be professionally cleaned. EVIDENCE: The home is purpose built and set in a square around a central enclosed courtyard garden. Many bedrooms and the main dining/lounges had patio doors allowing free access into the courtyard. The external doors to the car park had keypad security controls. The square layout allowed residents to walk right round the building without coming to any dead ends, which can be frustrating to people with dementia. There was a programme of regular maintenance and servicing, as well running repairs. Since the last inspection work had been undertaken to increase the number of single, and reduce the number of double bedrooms. There are now 37 single and 3 double rooms, 19 of the rooms have full en-suite facilities; the others had a wash hand basin. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 16 Bedroom door locks were fitted, but on the most part they were not used. Most residents had no desire to lock their door, and staff felt locked doors caused distress to the residents who tried to open them. The home had five bathrooms, three with assisted baths and two with wheel in shower cubicles. Since the last inspection two baths have been replaced with newer models. There were plenty of toilets all well signposted with picture notices. The home has two small sitting rooms, one of which was decorated and fitted as a reminiscence room. There are two large dining/lounges and a light and sound stimulation room (known as a Qualia). There was good quality furniture and furnishings, with new armchairs and sofas in the main lounges. However, a urine smell was noted from the carpets in the lounge/diners. The manager was aware of this and was looking into the frequency of cleaning (currently monthly by contract cleaners at night, and due now), the use of ozone machines to de-neutralise any smell, and consideration was also being given to replacing the carpets. The inspector is not making any recommendation at this time, as the manager is already addressing the problem. St Cuthberts was well supplied with specialist equipment, such as hoists; grab rails, assisted baths, pressure care mattresses and specialist beds. With the exception of the carpets mentioned above, the home was fresh smelling. All areas were clean and kept tidy from clutter, enabling residents to walk freely around the corridors. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 17 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 and 30 The home employed good numbers of staff, who had received excellent training, enabling them to meet residents’ complex needs well. EVIDENCE: There had been no major changes in staffing since the last inspection. Two health care assistants had left to commence their nurse training. Risedale has a history of preparing and encouraging care staff to take up nurse training. These vacancies had been filled, and there were 10 staff on duty as expected, (4 nurses and 6 health care assistants). An additional carer was being provided during the evening for one resident, who had been assessed as requiring this input. There was a strong staff structure with the registered manager being well supported by two senior nurses. Both seniors had different skills and particular areas of expertise, as did the other nurses. Several registered nurses held additional qualifications in mental health, dementia care and challenging behaviour. Some were currently doing additional training in management, NVQ assessment and upgrading their basic qualifications by distance learning courses. The health care assistants received compulsory training in all aspects of care, including the additional needs of people with dementia and general health and safety. There were annual updates for fire, moving and handling, abuse and infection control. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 18 Approximately 70 of the care assistants had completed an NVQ in care, which is an excellent achievement. St Cuthberts also employed sufficient housekeeping, administrative and maintenance staff to ensure the smooth running of the home. These staff groups had also received the necessary training to do their jobs well. Risedale places great emphasis on training and runs its’ own in-house accredited training programmes. This has enabled the staff group as a whole to have a broad range of general and specialist skills. The residents have benefited from the time and effort spent on training, through the high standard of care provided in the home. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 19 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, 35 and 38 The management of this home is very stable, and has a positive effect on residents’ quality of life. Quality checks and health and safety audits ensure residents receive good care in pleasant and safe surroundings. EVIDENCE: The registered manager is well qualified and competent to run the home. She is a first level registered nurse with additional management qualifications. There were clear lines of responsibility both within the home and within the company structure. There was a quality assurance system in place and quality surveys had been sent to residents’ families in September. Due to their advanced dementia, most residents were not able to contribute to such a survey, although the manager had other methods of noting their wishes. The inspector saw the survey responses. There were 23 in total, of which 22 were positive with one giving more negative feedback. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 20 These responses were yet to be formally audited, at which point the manager would produce an action plan to address any issues raised. Where asked to, the home held residents’ spending money, or petty cash for safekeeping. The records and actual monies were inspected and were accurate. The money was securely stored with limited access. There were clear records of all transactions and receipts were maintained for expenditures. Some residents had solicitors who managed their main finances and arranged for monies to be handed to the home to cover daily living costs such as hairdressing and clothing. Staff had received training on all aspects of health and safety at work, in relation to protecting themselves and residents from harm. Regular building inspections were carried out by one of the management team to ensure that maintenance and health and safety issues were satisfactory. There was a maintenance programme covering all required servicing and safety checks on the homes’ systems and equipment. The annual room safety audit was about to be updated, following changes to some of the bedrooms and bathrooms. This is a well run home. Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 21 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 4 8 4 9 X 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 3 3 3 X X X 3 STAFFING Standard No Score 27 3 28 4 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action 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 Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Risedale At Aldingham St Cuthberts Nursing Home DS0000006150.V253525.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!