Inspection on 21/07/09 for Shire Lodge Nursing Home

This inspection was carried out on 21st July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shire Lodge Nursing Home 27/04/09

Shire Lodge Nursing Home 02/05/07

Shire Lodge Nursing Home 01/11/05

Shire Lodge Nursing Home 16/06/05

Shire Lodge Nursing Home 25/11/04

Shire Lodge Nursing Home 22/06/04

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Bramble Lodge

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Hunter`s Lodge

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Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: Shire Lodge Nursing Home 281 Rockingham Road Corby Northants NN17 2AE one star adequate service 27/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathy Jones Date: 2 1 0 7 2 0 0 9 Information about the care home Name of care home: Address: Shire Lodge Nursing Home 281 Rockingham Road Corby Northants NN17 2AE 01536200348 01536447873 birchesterplc@yahoo.co.uk helenrussellrgn@AOL.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Birchester Medicare Ltd care home 50 Number of places (if applicable): Under 65 Over 65 10 50 40 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 Four named service users who are below the age of 65 years. In the category Personal Care only 3 named residents may be accommodated in the category Physical Disability PD under the age of 65 years. Of the 50 residents, up to 20 may be in the category of Personal Care only in the categories OP, DE(E) and PD(E). To accommodate one named service user who is under the age of 65 years within the category of DE (E) Date of last inspection 2 7 0 4 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Shire Lodge Nursing Home is a fifty bedded care home located on the outskirts of the town of Corby. Birchester Medicare own the home. Shire Lodge is registered to provide care for older people requiring personal care, nursing care and dementia care. The care home is a converted and extended farmhouse and is within walking distance of community resources, which include churches, shops, and pubs. Accommodation is provided across two floors, the home is divided into several areas each area consisting of bedrooms and lounge/dining facilities. The home has a rear garden, which is accessible to residents and car parking to the front. Fees range from a weekly charge of 500 to 600 pounds plus any nursing contribution. Care Homes for Older People Page 3 of 12 What we found: This random inspection was carried out unannounced by two inspectors. The purpose of the inspection was to check compliance with requirements that had been made following the key inspection on the 27th April 2009. The requirements made, were all based on helping to ensure that systems were in place to support, and help ensure that people get the care they need. Some of these requirements had been outstanding from the previous inspection, and we had considered taking enforcement action as a result of continuing non compliance with the regulations. However we decided to give the registered provider and registered manager a further opportunity to make improvements, and asked for an improvement plan to tell us how this was going to be achieved. The information submitted by the Registered Manager provided us with confirmation that action had been taken to address the requirements. This inspection involved looking at a sample of peoples care records to see how the care was being supported, talking to staff about the care being provided, and talking to the manager. We visited people in their rooms to look at their level of comfort and the equipment in place. The people whose care we looked at on this inspection, were unable to tell us about their experiences of the care they receive due to having dementia or not being well enough. Requirements have been made following the last two inspections, about care planning and the need for care plans to be specific about the actions required of staff to meet peoples needs and preferences. This is important in helping to guide staff in providing people with consistent care. The improvement plan told us that staff were being allocated more time for care planning. We could see that work had been carried out on improving the care plans, and that basic information about peoples needs and the care required, was in the main within the care files. One person who had been identified as being at risk of constipation had a specific care plan detailing how staff should monitor and support her to maintain a healthy bowel pattern. A clear communication plan was in place for another person. Staff spoken with were clear about peoples needs and the care to be provided. We did find that information was not always easy to find and follow in the care records. Information was there, but in some cases it was necessary to read all of the documentation to establish what peoples current needs are, rather than being able to quickly identify someones needs in relation to a particular aspect of their care. This is particularly important when different staff are providing care, or if staff have been away and someones needs have changed. We discussed the fact that the current care planning format which is pre-printed, leaves little room for comments and additional information to help ensure that the plans are person centred and fully capture individual needs and expectations. Advice was given to review assessment and care planning documentation and consider revising this to make it easier for staff to use these as working tools. One of the previous requirements related to the need for care plans, for people who were identified as being at risk of, or have pressure ulcers. We looked at care plans for Care Homes for Older People Page 4 of 12 someone with a pressure ulcer and found that there was a recently completed care plan in place. We advised that the plans would benefit from more detail. For example, one plan viewed stated that a pressure mattress was in place, though it did not include information about the type of mattress that the person was assessed as needing or the setting which is dependent on the weight of the person. The records for this person relating to the ongoing assessment of pressure ulcers were fragmented, which made it difficult to establish the condition of the ulcer at any one time and track improvement or deterioration of pressure ulcers. This is important in reviewing the effectiveness of treatment and identifying when specialist advice may be required. We looked at the pressure relieving equipment in place for this person, and asked the Registered Manager to check the mattress as it could not be confirmed that the mattress was on the correct setting for the persons weight. There was also a query as to whether this air mattress was working effectively. While looking at the pressure mattress we noted that the person was nursed on a divan type bed which had bed rails fitted. There was a large gap between the bed rails and the mattress creating a risk of the person becoming trapped. The manager arranged for the mattress to be changed and the bed rails altered during the inspection. The above findings highlighted the need for systems to be implemented, with frequent checks to ensure that equipment is safe, and working correctly, and that the settings are based on peoples weight and according to manufacturers guidance. The Registered Manager has confirmed following the inspection, that systems are now in place and bed rails and pressure mattresses throughout the home have been checked. We advised that a more thorough risk assessment, for the use of bed rails must be used, as the one in place did not take into account the suitability of the rails for the type of bed. We discussed with the Registered Manager, the need to review the suitability of furniture and equipment in relation to the high level of needs of people for whom care is now provided. Discussion with the nurse on duty at the time of the inspection identified that she had received training in the care of pressure ulcers, however this was approximately two years ago. We advised the registered Manager to review staff training in this area, to ensure that staff are kept up to date with current practice. While the specific requirement relating to care plans for people at risk of or with pressure ulcers has been met, requirements relating to ongoing assessment and review of pressure ulcers and pressure relieving equipment have been made in this report. A requirement had been made at the last inspection about the need for people admitted to the home for palliative care to have a care plan that details how their needs should be met in the last stages of their life. The registered manager informed us that at the time of inspection they did not have anyone who had been admitted for palliative care. We did however discuss the need to develop plans for people within the service, who were approaching the end of their life, as it is important that there needs and wishes are known. This would help to ensure that care and support is provided in the way that they would wish. We looked at the care plans for someone who was nearing the end of their life. Their care plans had been updated in some places to show how their needs had changed but more detail about their preferences would have enabled staff to offer care that was more Care Homes for Older People Page 5 of 12 individual. The person did not have a specific end of life care plan and there was little detail about how the person wished to be cared for in the last stages of life, for example any spiritual or religious preferences. We also noted that a note on one persons file stated that they did not wish to be resuscitated. There was no detail recorded about how this decision had been made or who had been involved in making it. This is important in helping to ensure that people are safeguarded. We found that records of meals that people have taken are kept, however the information is fairly general and there was a lack of clarity about when more detailed food and fluid charts would be implemented. We advised that this needs to be more closely linked with nutritional assessments and other health information which identifies the need for a particular diet. For example a high protein diet to aid wound healing for people with pressure ulcers. Charts are in place to monitor the care of people. In some cases, these records contain information for more than one person on the same sheet, which would make it difficult for someone to see their records, if they wished to do so without compromising the confidentiality of other people. We had made a requirement that where any restrictions are placed on an individual a thorough assessment must first be conducted to show that it is in the persons best interests. This requirement related to the use of reclining chairs. We found that where people use reclining chairs, there was evidence that they had been assessed to ensure that this did not stop them from being able to get up from the chair if they wished. Assessments seen did not however evidence that the chair had been assessed to make sure that it was the appropriate type of chair for the person or that other risks such as choking whilst in the chair had been assessed. Advice was given to include these issues in the assessment. An activity co-coordinator is employed on a part-time basis. A notice board in the dining room outlines the activities on offer each day. Records show that people participate in an activity approximately once a week. Activities included having their hair cut, having their nails done and going for a walk to the shops. Advice was given to review the range of activities on offer and to make the planning of activities more person centred. The timescale for compliance with a requirement relating to quality assurance had not been reached at the time of this inspection. This requirement required that the quality assurance measures, must assess all aspects of service delivery including care planning and progress of compliance with Care Quality Commission requirements. This is to help ensure that there is a proactive approach to assessing and improving the quality of care provided. We advised that the focus needs to be on the outcomes for people using the service. Our general observations during the inspection were that the Registered Manager and staff were responsive to peoples needs and keen to address issues discussed and act on advice given. Observations and discussion with a member of staff on the dementia unit, identified that they interacted well with people who use the service and had a good understanding of people with dementia. Our focus was on the care being provided and we only saw parts of the premises during the inspection, however we noted that some areas were looking a bit shabby and were very cluttered. The Registered Manager confirmed that she would discuss the findings with the Registered Provider and work with him on Care Homes for Older People Page 6 of 12 developing an action plan. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24 Quality assurance measures must assess all aspects of service delivery including care planning and progress of compliance with Care Quality Commission requirements. To ensure that the service meets the required standards and provides quality outcomes for people living in the home. 01/08/2009 Care Homes for Older People Page 8 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Assessment and care planning systems must be reviewed and revised to ensure that important information about peoples current needs can be easily located and changing needs monitored. This is to help ensure that staff can use these documents as working tools to provide consistent care which meets peoples needs. 30/10/2009 2 8 13 A more thorough bed rail risk 14/10/2009 assessment must be implemented which includes ensuring that the rails are suitable for the type of bed they are fitted to and suitable for the individual. To help reduce the risk of injury. 3 8 13 Assessments for the use of reclining or specialist chairs must take into account the suitability of the equipment for the individual needs and 30/10/2009 Care Homes for Older People Page 9 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action take into account risks relating to that individual. To ensure the equipment is safe for, and meets the needs of the individual. 4 8 12 Where there is an assessed 14/10/2009 need to monitor an aspect of someones care, such as food and fluid intake, bowel care, their must be regular review and oversight of the information. This is to ensure that appropriate action can be taken to maintain peoples health. 5 8 13 Pressure relieving mattresses 14/10/2009 must be correctly calibrated according to the persons weight and manufacturers instructions. This is to help ensure that people receive the care that they need and are not placed at increased risk of pressure ulcers. 6 8 12 Care planning and assessment documentation relating to pressure ulcers must be more detailed and thorough in relation to prevention and the current condition of pressure ulcers. To help ensure that staff can quickly identify and act on any deterioration. 14/10/2009 Care Homes for Older People Page 10 of 12 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 14 13 Where information is held on 30/10/2009 file to say someone does not wish to be resuscitated, there must be evidence to confirm that this is the persons wishes. To help ensure that people are safeguarded. 8 22 23 A full review of equipment 14/10/2009 which includes beds and bed rails should be carried out to ensure that they are suitable for meeting the needs of people. Where applicable a programme of replacement with timescales should be developed. To help ensure that appropriate care can be provided safely. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 As care plans are developed with people, and they approach the last stages of their lives, the plans should take into account their needs and wishes. This is to help ensure they receive the care and support that they want and need. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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