Random inspection report
Care homes for older people
Name: Address: St Andrews Lodge Care Home Riber Crescent Basford Nottingham NG5 1LP two star good service 04/11/2008 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: Angela Starr Date: 2 9 0 3 2 0 1 0 Information about the care home
Name of care home: Address: St Andrews Lodge Care Home Riber Crescent Basford Nottingham NG5 1LP 01159245467 01159245485 slodge@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Karsten Klups Type of registration: Number of places registered: Conditions of registration: Category(ies) : Trinity Care Limited care home 80 Number of places (if applicable): Under 65 Over 65 80 80 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 0 0 No person falling under category MD(E) Mental Disorder older people over 65 years (excluding Learning Disability or Dementia) or DE(E) Dementia shall be admitted to St Andrews Lodge when there are already 80 persons of these categories/combined categories accommodated in the home The maximum number of persons to be accommodated within St Andrews Lodge is 80 To admit into St Andrews Lodge 10 service users aged between 50 - 65 years under category DE To admit into St Andrews Lodge one named service user aged 40 years under category DE To admit into St Andrews Lodge one named service user aged 45 years under category
Care Homes for Older People Page 2 of 11 DE Date of last inspection Brief description of the care home St. Andrews Lodge provides nursing care for 72 older people with Mental Illness and for those with Dementia. The registration allows for up to 10 people between the ages of 50- 65yrs to be accommodated. The purpose built home is split into two separate nursing units, Garden and Assisi, and a residential care unit, Robin. There are lounge and dining areas in each of the units which are comfortable and suitably furnished to cater for the people living there. There is a hairdressing salon in the home and the hairdresser visits twice a week. Sited in an established residential area the home has sufficient car parking and a well maintained garden. All areas of the home were accessible to service users. The fee range is from £356.00 to £807.00 per week including the nurse determination fee. One to one support can be provided where there is an assessed need but this does incur further costs and is currently £1.071.27 per week. The Registration Certificate is prominently displayed in the entrance area of the home, together with copies of the Service User Guide, Statement of Purpose, the complaints procedure and daily menus. A copy of the last Key Inspection that took place on the 4th November 2008, can also be found in the entrance of the home and on the web site for the Care Quality Commission. 0 4 1 1 2 0 0 8 Care Homes for Older People Page 3 of 11 What we found:
The inspection process focuses on outcomes for people and their views on the service that is provided. We consider the providers capacity to meet regulatory requirements and minimum standards of practice and focus on aspects of service provision that need further development. We completed the last key inspection of St Andrews Lodge on the 4th November 2008 and a rating of Good was achieved. A copy of this last report is available on the Care Quality Commission web site on the internet. Since the last inspection visit took place there have been a number of changes in the management of the service and we have received several concerns and complaints from different sources. We carried out this random inspection visit following information received about various concerns that alerted us to the possibility that there may have been a breach of the Care Homes regulations 2001. We were particularly concerned about how people are being treated with regard to Dignity and Respect and the management systems in place to keep people safe. We did not give anyone notice of this visit. We reviewed all of the information we have received about the home since the last key inspection to consider what has changed. This included an improvement plan provided by the service, information from people who have relatives living at the service and information from professionals involved in supporting some of the people and safeguarding vulnerable adults. We also considered information contained in a recent annual quality assurance assessment (AQAA) that was sent to us by the service when we completed the last Annual Service Review. There are current safeguarding issues being investigated by the local authority. These involve a number of people who live at the service. Some staff have already undergone disciplinary action as a result of these concerns and some recent investigations have been concluded. Staff told us they have received training in Safeguarding Adults and in the Mental Capacity Act. (Safeguarding Adults is a process of identifying and reporting suspected or potential abuse of vulnerable people and provides a framework of consistency to protect those individuals at risk.) A current training matrix was seen to show when training has taken place and future training dates. Training issues are addressed in the action plan produced by the service and the acting manager has been tasked with ensuring that a full training needs analysis is completed to ensure the professional and personal development of all staff. St. Andrews has several staff who have undertaken training to be Dignity Champions and they are reveiwing this at present. The Dignity Challenge is a clear statement of what people can expect from a service that respects dignity. It is backed up by a series of dignity tests that can be used by providers, commissioners and people who use services to see how their local services are performing. The Southern Cross Dignity Manager is spending a week at St Andrews to look at practice, liase with staff and co-ordinate necessary training to improve the Dignity and
Care Homes for Older People Page 4 of 11 Respect for people living at the service. The focus of this inspection visit was to observe practice and to talk with staff, people living at the service and relatives who were visiting on the day. We also looked at care plans for seven people who we then observed receiving support from staff. In addition to looking at the standards around Health and Personal Care, we also looked at the Management and Administration of the service. These areas had deteriorated since the last Key Inspection and there have been a number of changes in manager. However, Southern Cross have now provided the necessary management support to enable the necessary improvements. There is an acting manager at St. Andrews who will remain in post until a permanent manager has been recruited and inducted into the post. This process can take several weeks, but on the day of this inspection visit, some candidates were being interviewed. Since the inspection visit took place we have been informed that a manager has been appointed and subject to all the necessary checks, he will be in post within the next few weeks. The acting manager was present at the service throughout the inspection and further representatives from Southern Cross attended later in the day. These were the Area Manager and a Senior Quality Adviser, both who remain actively involved in ensuring that the standards at St. Andrews improve and all areas of concern are addressed. The action plan states that the monitoring and reviewing of progress will take place on a weekly basis until further notice. A meeting with relatives and residents has taken place and further meetings are planned. A number of questionnaires have been completed by relatives and these were looked at as part of this inspection. Some people had made very positive comments and reflected that improvements are taking place. There were also a number of negative comments which people have made and the Southern Cross Area Manager assured us that these will be addressed. Some of the care plans we looked at were lacking in detail about how the person should be supported and some risk assessments were missing. People had not been assessed for Best Interests and Capacity. These issues have been raised by other professionals who have visited the service and we were told that a four week period has been identified during which these issues will be addressed. We saw some care plans that have been thoroughly reviewed and these were detailed and contained all relevant and necessary information, including risk assessments to address each area that had been identified as a risk. Examples were; Tissue viability, Falls, Nutrition and Challenging behaviour. The manager has told us that all the care plans will have undergone a review by the end of April 2010. We observed staff using equipment to move a person from an armchair to a wheelchair. We saw that they spoke with the person throughout this manouvre and offered reassurance and support in a respectful manner. A concern that had been raised was regarding the fact that staff were not communicating with people when supporting them. We saw evidence that this has improved, although we did observe one member of staff who did not speak with the person they were supporting. This was discussed with the acting manager at the time, and she told us that this will be raised with the staff member in question and any necessary action will be taken.
Care Homes for Older People Page 5 of 11 One of the concerns that had been raised was with regard to the suitability of equipment being used for the Moving and Handling of people. The manager has told us that all the necessary equipment has been ordered and a report has been completed by the companys Back Care advisor. We saw evidence to support the fact that staff have recently attended training in Moving and Handling and staff we spoke with did appear to be knowledgable about this area. We also observed staff providing support on a one to one basis. This was done sensitively and the staff member providing the support engaged with the person in a number of suitable activities, including reading a newspaper. Staffing levels have been increased since concerns were raised about the management of some peoples challenging behaviour. The manager has told us that this will continue to be assessed and staffing levels will be decided according to the identified needs of the people living at St. Andrews Lodge. We did not look at the Administration of Medicines at this visit but have since received two further regulation 37 notices informing us of errors that have been made in this area. We spoke with the acting manager and she assured us that the staff who were responsible for these errors have been spoken with and necessary steps have been taken. Following the errors, the correct procedures were followed and peoples Doctors and familys were informed. Neither of the people involved have suffered any ill effects from this. What the care home does well: What they could do better:
A number of areas require further improvement. These include; The appointment and registration of a permanent manager. Clinical support for Qualified Nurses. Improved supervsion for staff to ensure their professional and personal development. Staff training
Care Homes for Older People Page 6 of 11 that is relevant to the needs of the people living at the service. Effective quality monitoring systems to ensure that people are satisfied with the service. Provision of suitable and well maintained equipment to assist people. Thorough care planning, risk assessment and assessment of peoples capacity to make decisions. People and their relatives must be involved in the care planning process and any Best Interest decisions. 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 11 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 8 of 11 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 13 Ensure that all care plans are 30/04/2010 reviewed and are comprehensive to include all needs and risk assessments. This will ensure that people receive care and support in their preffered manner. 2 8 12 Ensure that records made of peoples well being are accurate and up to date. This will ensure that peoples well being is monitored accurately. 30/04/2010 3 10 13 Ensure that arrangements for 14/04/2010 health and personal care consider peoples dignity and respect at all times. This will ensure that people feel that they are treated with respect and their right to privacy is upheld. 4 18 12 Ensure that care plans show that the Mental Capacity Act has been considered. 30/04/2010 Care Homes for Older People Page 9 of 11 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 To ensure that people have their rights and choices protected. 5 31 18 There must be a registered manager in post to manage the home. This will ensure the home is run by someone who has demonstrated they will look after peoples best interests. 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 30/06/2010 Care Homes for Older People Page 10 of 11 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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!
