Inspection on 27/04/09 for Shire Lodge Nursing Home

This inspection was carried out on 27th April 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 21/07/09

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

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 14/03/2010.

Key inspection report Care homes for older people Name: Address: Shire Lodge Nursing Home 281 Rockingham Road Corby Northants NN17 2AE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Catherine Perrins     Date: 2 7 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 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 Birchester Medicare Ltd care home 50 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 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 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, Care Homes for Older People Page 4 of 27 0 0 0 Over 65 10 50 40 Brief description of the care home 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 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection which means that we focussed on the key national standards. The key standards are those considered by the Commission to have the most impact on outcomes for residents. As part of the preparation for this inspection a period of three hours was spent reviewing previous inspection reports and other information that The Care Quality Commission has received about this service. The inspection visit lasted seven and a half hours hours during the morning and afternoon of a weekday. Care Homes for Older People Page 6 of 27 During the inspection three people were case tracked. This involves looking in detail at all aspects of their care and experiences at the home, including looking as their individual plans of care and other records, talking to them and talking to their care staff. Because people with dementia are not always able to tell us about their experiences we also used observations of peoples state of well being and how they interacted with staff members and others. A sample of staff files were also viewed as part of the inspection. The registered Manager was present for the majority of the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: A full and detailed assessment of a persons needs should be undertaken and documented before they move into the home. Care plans must contain specific information about the individuals full range of needs and detail how their needs should be met and their preferences respected. Where people have pressure care areas, or have been identified as being at risk of developing pressure care areas, a detailed care plan should be put in place to detail how the risk of pressure sores should be reduced. Where people are admitted to the home for palliative care they should have a care plan that details how their needs should be met in the last stages of their life. Where someone has been identified as being at risk of constipation steps should be taken to monitor their bowels so that appropriate action can be taken to stop them becoming constipated. The home must comply with the requirements of the Freedom of Information Act 2000 and ensure that records pertaining to one person can be made available without compramising the confidentiality of others. A range of meaningful and stimulating activities must be made available to people to take part in if they wish. Where it has been identified as being required, food and fluid intake charts are kept for people. These are checked to ensure that people are receiving adequate food and fluid. Care Homes for Older People Page 8 of 27 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. All instances of possible abuse should be considered for referral to the Local Authority under the Safeguarding Adults policy and procedures. If the home decides not to refer an incident this should be clearly documented with the reasons for this decision. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home manages aspects of the admissions process well but people would benefit from a more detailed initial assessment to ensure that the home is able to meet peoples full range of needs. Evidence: The home has a combined statement of purpose and service user guide which gives good information about the home to people who may want to move there. A relative told us that he was happy with the information that he received about the home before his mother moved in. Records show that peoples needs are assessed before they move into Shire Lodge, however a more detailed record of the individuals needs would ensure that staff had all of the information to support and care for people in the right way. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care do not consistently detail how staff should care for people to ensure that their needs are met and their preferences respected. Evidence: Each person who lives at Shire Lodge has an individual plan of care. Individual plans of care are important as they provide staff with the information that they require to care for people in the right way to make sure that their needs are met in a way that respects their preferences. At the last key inspection on 2nd May, 2007 we made a requirement of the home that care plans must be specific about the actions required of staff to meet peoples needs. Care plans seen during this inspection did not consistently contain the information required to meet peoples needs. As this constituted a breach of regulations 12 and 15 of The Care Home Regulations 2001 a code B notice was issued. This notice is issued in accordance with the Police and Criminal Evidence Act 1984 and explains our powers and rights. Records were copied and seized during the inspection and this evidence will be reviewed and considered in relation to possible enforcement action. Care Homes for Older People Page 12 of 27 Evidence: People who have, or are at risk of developing pressure sores, have specific needs in relation to their care. Records seen did not detail how staff should care for people with pressure sores. There was some evidence people being helped to change position, but records did not state how often this should happen and in some cases records showed people were left for many hours without a position change. Records of peoples food and fluid intake was not available. The registered manager explained that these had been accidentally disposed of on the morning of the inspection. There was some evidence of peoples preferences being included in their care plans such as their food likes and dislikes, their preferred morning and night time routines and how they like their personal care to be done, this was, however, not consistent. Staff spoken to described the improvements that one person had made since moving to the home. Records show good progress for this person in relation to their mobility, eating and general health. One person spoken to told us that he was happy with the home saying I have everything I want. A relative told us that he is happy with the standard of care. The administration of medication appears to be well managed. All entries on the medication administration record had been signed and a spot check showed medication to be correctly accounted for. Medication was stored securely. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities available but people would benefit from a greater range and availability of stimulating activities to chose from. Evidence: Individual plans of care seen contained some details of peoples life histories, hobbies and interests, this was however not consistent. The home employs an activity co-ordinator who works in the mornings during the week. An activity rota showed that on the day of inspection a range of different games were taking place however no games were observed. Activity sheets for each person detail the activities that they have taken part in. Some people appeared to have enjoyed a range of activities both within the home and going out into the local community while other people had very limited and infrequent activities. The menus for the home are done on a four weekly rota. Menus seen included fresh fruit and vegetables. Lunch on the day of inspection was pork with potatoes and fresh vegetables followed by rice pudding. People told us that the food is good. People told us that they were able to have visitors whenever they wanted. One Care Homes for Older People Page 14 of 27 Evidence: relative told us that he visits everyday and has a good relationship with the staff. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures for dealing with concerns and complaints however the homes practices do not consistenly ensure that peoples rights are safeguarded. Evidence: The registered manager explained that the home has received one complaint since the last inspection which she is in the process of investigating. The home has a complaints procedures which outlines how people should raise concerns and how their complaint will be responded to. The home has made one referral to the Local Authority under the safeguarding adults procedure. A further incident was identified within the daily notes which should have been considered for a referral to the safeguarding team. Some people were observed sitting in reclining chairs in the lounge that they were unable to get out of. The registered manager stated that no assessments had taken place to show that using these chairs was in the persons best interests. Staff spoken to were aware of how to raise concerns however the majority of staff had not received any training on safeguarding adults. The registered manager explained that some staff had a place on a course in the near future. Care Homes for Older People Page 16 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in a spacious and homely environment. Evidence: The home comprises of an old farm house which has been extended to provide spacious accommodation for the people who live there. There are four lounge areas, two of which have adjoining dining areas. The reception area also has comfortable seating and is used by some people as an area to relax in. Communal areas had been made homely with pictures and ornaments. There are a number of bedrooms on the ground floor which some others on the first floor which is accessible by stairs or a lift. There is a separate area on the first floor for people with more advanced dementia. A recommendation was made at the last inspection that the home considered making the bedrooms of people with dementia more easily recognisable to enable people to access their rooms during the day if they wished to. This had not been done. The home was generally clean and no unpleasant odours were noted. Bedrooms seen had been made personal with ornaments, pictures and personal effects. Care Homes for Older People Page 17 of 27 Evidence: The majority of radiators had covers on them to prevent people from being burnt. Some however did not. The registered manager explained that a risk assessment had been completed to ensure that any risks to people had been minimised. Care Homes for Older People Page 18 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot consistently rely on staff being sensitive to their needs despite some staff being considerate and caring. Evidence: The recruitment process appears to be well managed and pre-recruitment checks had generally been carried out to ensure that staff were suitable to work with older people. One person had a character reference as their second reference. The registered manager explained that this was due to specific circumstances and not usual practice. Records show that staff receive training such as moving and handling, fire safety, infection control, first aid and dementia. The homes deputy manager over sees staff training and development. Some staff were observed showing kindness and sensitivity to people and spending time talking and interacting with them. Over lunch time staff were seen helping people who required assistance to eat their meal, unfortunately there was very little conversation during this time with no explanation being given to people of what the food was. Staff spoken to indicated that at times the home had been short of staff which made it hard to fully meet peoples needs. Care Homes for Older People Page 19 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of the people who live their. Evidence: The registered manager has worked at the home for eighteen years. She is a registered nurse and has an NVQ 4 in management. The home also employs a deputy manager and there is a qualified nurse who leads each shift. The registered manager explained that the home conducts an annual quality care review where the views of people who use the home and of staff are sought. The review carried out in October 2008 showed that 94 of people living at the home who participated in the survey gave positive comments about the home and did not feel any changes needed. 89 of staff who responded gave positive feedback. An action plan is devised from the quality review to address any areas of concern. Quality audits did not appear to identify or address the shortcomings in care planning and progress of compliance with Care Quality Commission requirements as mentioned Care Homes for Older People Page 20 of 27 Evidence: in this report. Fire safety checks appeared to be up to date and a spot check of moving and handling equipment showed that items had been serviced as per manufacturers recommendations. Care Homes for Older People Page 21 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12 (1) (a, b), Care plans must be specific 30/07/2007 15 about the actions required of staff to meet residents? needs to ensure they are fully met. Care Homes for Older People Page 22 of 27 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, Care Homes 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 15 Care plans must contain specific information about the individuals full range of needs and detail how their needs should be met and their preferences respected. To ensure that staff have all of the information that the need to care for people in the right way. 01/07/2009 2 8 15 Where people have pressure 30/06/2009 care areas, or have been identified as being at risk of developing pressure care areas, a detailed care plan should be put in place to detail how the risk of pressure sores should be reduced. To ensure that staff have the information that they need to care for people to reduce the risk of pressure sores. Care Homes for Older People Page 23 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 3 8 15 Where someone has been identified as being at risk of constipation their care plan must detail the steps to be taken to monitor their bowels. To ensure that appropriate action can be taken to stop people becoming constipated. 01/07/2009 4 8 17 Records of peoples food and 30/06/2009 fluid intake must be maintained where their needs require and these records available for inspection. To ensure that people receive adequate nutrition and hydration. 5 11 15 Where people are admitted 30/06/2009 to the home for palliative care they should have a care plan that details how their needs should be met in the last stages of their life. To ensure that staff have the information that they need to care for people in the right way. 6 12 16 A range of meaningful and 01/07/2009 stimulating activities must be made available to people. Care Homes for Older People Page 24 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 To provide people with interest and stimulation. 7 18 13 Where any restrictions are 30/06/2009 placed on an individual a thorough assessment must first be conducted to show that it is in the persons best interests. To ensure that restrictions are appropriate and lawful. 8 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. 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 01/08/2009 1 3 A full and detailed assessment of a persons needs should be undertaken and documented before they move into the home. All instances of possible abuse should be considered for referral to the Local Authority under the Safeguarding Adults policy and procedures. If the home decides not to 2 18 Care Homes for Older People Page 25 of 27 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 refer an incident this should be clearly documented with the reasons for this decision. 3 4 19 30 Consideration should be given as to how to help people with dementia orientate themselves around the home. Staff should receive training and guidance to ensure that they are aware of the needs of older people with dementia and understand how to communicate with them. Care Homes for Older People Page 26 of 27 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!