Inspection on 15/02/06 for Risedale At Lonsdale Nursing Home

This inspection was carried out on 15th February 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 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 Lonsdale Nursing Home 23/05/07

Risedale At Lonsdale Nursing Home 02/11/05

Risedale At Lonsdale Nursing Home 14/10/04

Risedale At Lonsdale Nursing Home 05/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Risedale At Lonsdale Nursing Home Albert Street Barrow In Furness Cumbria LA14 2JB Lead Inspector Jenny Donnelly Unannounced Inspection 15th February 2006 10:30 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 Lonsdale Nursing Home DS0000006151.V282903.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. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Risedale At Lonsdale Nursing Home Address Albert Street Barrow In Furness Cumbria LA14 2JB 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 870050 01229 822955 Risedale Estates Limited Mrs Alison Knagg Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Independent wheelchair users must only be accommodated in the following single bedrooms: 12; 14; 15; 27; 28; 30; 32; 33; 34; 35; 36; 37; 38 and 39 The home is registered for a maximum of 45 service users to include: up to 45 service users in the category of OP (Older people over 65 years of age) The home may at any time accommodate up to 3 people under the age of 65, within the overall number of registered places. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2nd November 2005 2. 3. Date of last inspection Brief Description of the Service: Risedale Estates Limited operates Risedale at Lonsdale Nursing Home. The registered manager is Mrs Alison Knagg. This is a 45 bed nursing home which shares the site with its sister home, St Georges. Both homes are registered and managed separately, but share the main kitchen and laundry. It is situated in the town of Barrow in Furness, a short distance from the main shops and amenities. Lonsdale is purpose built over two floors and has a passenger lift. There is a mixture of single and double bedrooms, each with en-suite toilet and wash hand basin. There is a large dining/lounge on each floor, a conservatory and a small sitting room. There are five bathrooms with specialist bathing facilities. There is garden area with seating and a water feature. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The registered manager was present. The home was running at full occupancy and was fully staffed. The inspection comprised of a tour of the building and review of care, medication, training and quality audit records. Residents, visitors and staff were spoken with on both floors of the home, in the communal areas and in private. The morning routine, lunch and the afternoon activities were observed. Any key standards not inspected at this visit, were checked and found satisfactory at the last inspection of November 2005. What the service does well: What has improved since the last inspection? What they could do better: No requirements or recommendations are made following this inspection. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 6 This is a well-managed care home. The manager and Risedale Estates continually work to meet the National Minimum Standards. The home has a learning and quality checking culture, which has a positive effect on the residents’ experience. 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 Lonsdale Nursing Home DS0000006151.V282903.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 Risedale At Lonsdale Nursing Home DS0000006151.V282903.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): EVIDENCE: No standards in this section were assessed. Risedale At Lonsdale Nursing Home DS0000006151.V282903.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): 8, 9 and 11 Resident’s benefit from having highly trained specialist nurses, who are proactive and alert to meeting health care needs. There is some excellent improvement work taking place in conjunction with the NHS, around the care of dying people. There is safe and knowledgeable management of medicines in the home. EVIDENCE: Residents were wearing clean clothes, had tidy hair, and looked comfortable with knee blankets and their feet and legs covered. Residents had good access to healthcare services and specialist advice as necessary. Care records showed that the doctor, dentist, optician, social worker and so on had seen residents as needed. There was clear evidence of liaison with external specialists such as the wound care specialist, dietician and mental health experts. The home provided short-term respite care, and there was evidence of good liaison with their home care providers, such as family, care agency and community nurse. Senior staff were proactive in recognising and dealing with health issues at an early stage. There were clear treatment plans in place for any health issues, and these were up to date had been evaluated regularly. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 10 The recent introduction of the new clinical nurse manager role has been very successful for residents and staff. This clinical nurse manager oversees the care of residents with the most complex needs in all Risedale homes. She advises on problematic wound care and undertakes any liaison with NHS staff, leaving the homes’ nurses to concentrate on hands on care delivery. Inspection of the medicines management systems found medicines to be well managed. There were clear and accurate records of medicines received into the home, those administered and any returned/destroyed. Medicine administration charts had been accurately completed by staff, and clearly showed the necessary details of each resident including a photograph and record of any allergies. A sample stock check showed the right amount tablets had been used by this date, and there was sufficient stock for the remainder of the month. In some instances the home had accrued excess stock for certain residents, so the senior nurse had cancelled the next order of these items. This was good because overstocking can lead to errors in medicine administration. The nurses were knowledgeable about the medicines in use and understood what any “as required” medicines were for, and when to use them. The senior nurse had noted a contra-indication (two medicines which should not be taken together) in one resident’s medicines, and put a note on the chart to alert other staff and contacted the doctor about it. Risedale Estates had a “charter of rights” for dying people, setting out how people should be cared for, including physical and emotional needs. All staff had received training on death and dying, as part of their induction and ongoing training. The company employed nurses with specialist qualifications in palliative care, who could be called on for advice. Lonsdale was also involved with an NHS Gold Standard Framework project on care of the dying. This wad leading to a review of current practice around the provision of resuscitation, basic life support and residents preferred place of death. Once completed, this work will be shared across the Risedale group. It is excellent for residents that this company are involved with national NHS projects, as well as developing their own staff to take on extended specialist roles. Risedale At Lonsdale Nursing Home DS0000006151.V282903.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): 14 Residents were being asked their views and given choices about their daily lives. EVIDENCE: Residents confirmed that they could exercise choice and control over their lives at Lonsdale. Some residents chose to spend much of their time in their bedroom with their books, videos, radio or television. Other residents liked to spend the day in the communal lounges and join in with group activities. Some residents managed their own money, whilst others asked the home to take care of their petty cash for safekeeping. Residents were seen exercising choice in whether to stay in their bedrooms or go into the lounge, and in what they wanted to eat. Staff were heard asking residents their views and wishes, and acting accordingly. One resident had chosen to sleep in a recliner chair, rather than a bed, and was able to do so. Care plans recorded peoples’ preferences in relation to care and food. During the inspection a sing a long took place in the upstairs lunge. Residents from the ground floor, and the sister home Risedale St Georges, were invited to take part. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 12 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): 18 Staff were protecting residents, and promoting their wellbeing. EVIDENCE: Staff were knowledgeable on the protection of vulnerable adults, and received regular update training on the subject. The home had procedures to follow in the case of any abuse being suspected or alleged. These procedures were in line with local multi-agency guidance, and senior staff had a good understanding of this system. Residents stated they would report any ill treatment to the manager or other senior staff, but did not think this would ever be necessary. The care staff showed a good understanding of Lonsdale being the residents’ home, and said that residents should be treated with respect and dignity. Staff said if they did observe any poor practice, they would be confident in reporting this, as they felt the standard of care in the home should be high. There was a good level of monitoring by senior staff, so any poor practice should be quickly picked up and dealt with. The home did not operate institutionalised practices, and residents were being encouraged to make choices and voice their views and opinions. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 13 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): 26 Residents lived in a clean and fresh smelling home, where the staff adhered to good infection control practices, to reduce risks of cross infection. EVIDENCE: The home was clean and tidy in all areas. There were sufficient domestic staff on duty each day to keep the home hygienic. Domestics had received sufficient training to their job well and understood the safety information for the products they used. There was a cleaning schedule, detailing which were daily, weekly or monthly tasks. The domestic staff took pride in their work, and quickly attended to any spills or emergency cleaning needs. Nursing and care staff were well informed on infection control procedures, and had access to the necessary equipment to safe guard themselves and residents from cross infection. Staff received compulsory annual updates on hand washing and infection control procedures. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 14 There was a large well-equipped and properly staffed laundry. Dirty linen was handled safely and kept separate from clean items. Residents said that staff did wash their hands regularly. Risedale At Lonsdale Nursing Home DS0000006151.V282903.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 The staffing levels and skill mix was very good, with an excellent provision of staff training. Residents benefited from having a well-trained and highly motivated staff team caring for them. Recruitment procedures were thorough in protecting residents from unsuitable people working in the home. EVIDENCE: The home was staffed in excess of the minimum expected, so as to adequately meet the needs of some very dependant residents. There were 3 nurses and 10 care staff on duty for 45 residents. In addition were the registered manager, domestic, catering, maintenance, activity and administrative staff. The staff worked in two teams, one on each floor of the home, each led by a senior nurse. Residents said the staff were “lovely”, “marvellous” and “so helpful”. The home placed a great importance on providing good training for staff. National Vocational Qualifications in care were ongoing for care assistants, with 55 of them holding, or working towards an NVQ in care. This is a very good achievement for a large staff team. There was also an in-house training programme for all staff to complete, as well as regular update sessions. There had been recent training on basic life support, fire safety, infection control, safe moving and handling and the prevention of abuse. Nurses were able access to training appropriate to their needs, and most of the nurses had specialised in a particular area of care such as diabetes, Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 16 continence, wound care and so on. Residents directly benefited from having a well trained and knowledgeable staff group. The manager was completing a masters degree in human resource management, which would be of benefit to the company in updating their policies and procedures in this area. Risedale Estates operates thorough recruitment procedures. Inspection of new staff files showed that Lonsdale had adhered to these procedures. All new staff had completed an application form, attended for interview, and worked a voluntary assessment shift. Written references had been taken up and a criminal records bureau check had been completed, before the person was offered the job. There was evidence that new staff worked induction shifts, where they were extra to the usual staff numbers, and worked alongside experienced staff. Recruitment procedures were sound, and served to protect residents from having unsuitable persons working in the home. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 The home had a quality assurance system, which included the views of residents, so they could comment on the home, and ask for improvements if necessary. Residents’ money, where handled by the home, was safely managed. The company had sound systems in place to promote and protect the safety and welfare of residents and staff. EVIDENCE: The home operated a quality assurance system that comprised of satisfaction surveys to residents and internal audits by the manager. The last satisfaction survey was carried out in May 2005, and included residents who had been in the home less than 12 months, as it focussed on admissions procedures. The results of that survey were mostly “good” to “excellent”. The manager said the next survey would have a different focus. Apart from this annual survey, residents and visitors felt they had daily opportunity to comment on the quality of service provided at Lonsdale. As part of ensuring the expected standards were being maintained in the home, the manager undertook regular audits. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 18 These included checking care plans, a kitchen inspection, and review of accident reports and staff absenteeism. These audits helped the manager to check if staff were doing their jobs properly and whether any changes were needed to improve the service for residents. The manager held spending money for safe keeping on behalf of some residents. The money was held securely in individual named cases, and there was an individual record sheet showing all income and spending for that person. Residents confirmed that the manager had shown them how this system worked, and said they were able to get their money when they wanted. The money and records of four residents were checked, and correct. The record sheets were audited periodically to check that no maths errors had been made. Residents who wished to keep their own money in their bedroom were able to do so, but were asked to keep it locked away for safety. Where a resident seemed forgetful with their money, the manager asked their family to help, or offered to store it in the safe as described above. The home had comprehensive health and safety procedures in place, and staff had received appropriate training in fire safety, safe moving and handling and safe use of chemical substances. Risedale Estates employed a qualified health and safety manager, who provided training and advice to all Risedale homes. There was evidence in care plans of how staff maintained each residents safety and there were protocols in place for the use of safety measures such as bed rails and bathroom guard bars. Residents were individually assessed for the suitability of any equipment used such as hoists and slings. An external contractor had undertaken a fire risk assessment in December and given advice to the home, which mainly stated to continue with their current good practice. No health and safety hazards were seen during the inspection. Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 4 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Risedale At Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? N/A 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 Lonsdale Nursing Home DS0000006151.V282903.R01.S.doc Version 5.1 Page 21 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. 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