Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Stallingborough Lodge Care Home Station Road Stallingborough Grimsby North East Lincs DN41 8AF The quality rating for this care home is:
one star adequate service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Theresa Bryson
Date: 2 1 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home
Name of care home: Address: Stallingborough Lodge Care Home Station Road Stallingborough Grimsby North East Lincs DN41 8AF 01472280210 F/P01472280210 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) : Shire Care (Nursing and Residential Homes) Ltd care home 44 Number of places (if applicable): Under 65 Over 65 44 20 old age, not falling within any other category physical disability Additional conditions: 0 20 The maximum number of service users who can be accommodated is: 44 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admssion to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD and PD(E) Date of last inspection Brief description of the care home Stallingborough Lodge Care Home is a purpose built establishment that is registered for 44 service users with problems of old age, physical disability over 65 years of age and under and also has a nursing registration for service users. The accommodation is set on the outskirts of a small village, near the larger town of Grimsby. It has some local amenities for service users to visit and the home is near a regular bus route into the town. The home is set in enclosed gardens, which are all accessible to wheelchair users. The home is part of a small group of homes, Shire Care Ltd, and is supported by Care Homes for Older People
Page 4 of 26 Brief description of the care home a head office team and a visiting Director of Operations. It has the benefit of also having service users visiting from other local homes. The home has several groups of staff employed including; - professionally trained nurses, care assistants, domestic and laundry staff, kitchen staff, administrator, handyman and activities organiser. The weekly fees are reviewed annaully .Extra charges are made for hairdressing and chiropody depending on treatments. This is also reviewed annually. The provider makes available to all prospective service users and current service users, the service user guide, which is also available and on display in the main entrance hall. Care Homes for Older People Page 5 of 26 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: This inspection took place over one day in April 2009. Prior to this visit we looked at the surveys which had been returned to us from people using the service and staff. We also looked at the events notified to us by the home and other information sent to us since the last inspection. The service sent us their Annual Quality Assurance Assessment in good time which gave us a lot of statistical date about the home and how they were planning there service in the future. The Acting Manager and Operations Director were present throughout the inspection and the Owner came for the feedback session. Care Homes for Older People
Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The assessment process for admissions has been reviewed and although still closed to admissions at this site visit the staff are now more prepared to admit individuals when the time comes. The range of activities in house has improved and there has been better recording of when events have taken place and the level which people have participated in. This will ensure peoples social,cultural and religious needs are being met. The training of staff has improved and the new training matrix should ensure that individual staff needs can be met as well as mandatory training taking place. This will ensure they can look after people safely. The Company also decide to adopt the recommendations, set out in the last report by CSCI. These covered better documentation for care planning and ensures peoples progress can be mapped and their current needs can be met. The administration of medication has been tightened up and staff more closely supervised to ensure people are receiving all medication as prescribed. Staff have now been trained to recognize abusive situations and how to pass this information to the relevant bodies, should the need arise. A full maintenance program is now in place to ensure the home is a safe and Care Homes for Older People Page 8 of 26 comfortable place in which to live. When recruiting staff the management team ensure they have sufficient command of the English language to enable them to work with people safely. 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 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 26 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 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be assessed in a holistic manner to ensure the home can meet their needs. Evidence: At this site visit the home was still closed to admissions by the Local Authority, but the company had reviewed its policy on this topic. This will ensure that once admissions are opened staff are prepared and people wanting to use the service can be confident that staff will look at their needs in an holistic way. The home does not provide for people with needing intermediate care and there fore Standard 6 is not applicable. Care Homes for Older People Page 11 of 26 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. Evaluations should be completed regularly to ensure peoples current needs are being met and evidence produced to ensure they or their advocates contribute to the care planning process. Evidence: 6 people using the service returned surveys to us prior to the site visit and we were able to speak to a further 5 people during the visit, who are resident in the home and 1 relative. A couple of people had stated that staff took a long time to answer call bells,but the majority of people said that there was sufficient staff to meet their daily needs. 3 care plans were tracked in depth and there had been a marked improvement. New in depth assessments had been completed and risk assessments put in place where appropriate. There was also better recording when other health care professionals had been asked to respond to need. For example if a person had an open leg wound it was recorded what the homes own staff did to wards the healing process and what had
Care Homes for Older People Page 12 of 26 Evidence: been advised by the tissue viability nurse from the local Primary Care Trust. Accidents were now recorded when they happen and are in each persons diary sheet, plus on an accident record.Senior staff then monitor these weekly and record the follow up required. 1 persons had not been so accurately recorded or details sent to CQC and these details were given to the manager at the feedback session. The recording by staff was clearer and more legible, but the evaluations had only just commenced so it was difficult for us to ascertain whether this format will continue. Regular evaluations of care are essential to ensure peoples current needs are being met. More evidence needs to be in the report sheets on each individual to ensure if they can not make informed decision that their advocates have been approached to contribute to the care planning process. The local Community Matrons are still visiting the home on a regular basis, but have said over the last six months there has been an improvement in the communication between the home and Primary Care Trust staff. This was also reiterated by local Social Services staff who have been supporting the home. People using the service made such comments as staff speak to me nicely and well satisfied with my care. There was a general very happy atmosphere in the home and lots of people resident having conversations with each other in the dining and sitting rooms. A senior member of staff showed us around the drug storage room, which was tidy and clean. A drug round was observed and staff appeared to be using safe practices guidance. Staff were able to discuss certain drug therapies for some people resident and these were checked as being accurate on the care plans and administration sheets. Staff would benefit from regular drug audits being completed to ensure safe practice and that peoples needs are currently being addressed. Care Homes for Older People Page 13 of 26 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. Peoples social,religious and cultural needs must be met both inside and outside in the community to ensure people do not feel isolated. Evidence: The recording of activities had improved and people living in the home were able to tell us what events had taken place over the last year. The records also showed more variety of in house events taking place. In the care plans people were being encouraged to complete life histories, so staff could have a better picture of what they had enjoyed doing prior to coming to the home and a little about them selves. This was not compulsory and staff need to ensure people are aware of this as some people said they were anxious about telling people about their past life. Some,however said they had enjoyed starting to reminisce. To ensure peoples social, cultural and religious needs are being met the senior management staff must ensure that during the absence of the permanent facilitator for activities that staff are allocated this role on a daily basis. Care Homes for Older People Page 14 of 26 Evidence: People resident during the site visit were seen to be enjoying the visit of a mobile clothes shop and were being helped by staff to choose new clothes. Others were enjoying the sunshine in the garden and some were doing some gardening. For example 2 people were cleaning the bird bath, whilst another was starting to plan the work around completing some hanging baskets, in the potting shed. Another resident was dead heading some plants and told us Im in my wheelchair,but this one part of gardening I can do on a regular basis. Another person described how she got wool to able to do her knitting and was showing us some blankets she was making. There had been insufficient time since the last inspection for staff to be able to access resources in the community to fully satisfy peoples cultural needs, but this was being worked upon by staff. A brief tour of the kitchen took place as there had been a recent visit by the Environmental Health Officer who had given the home a 3-4 star rating. At the time of the site visit food was being prepared in a safe and clean environment. No issues had been raised by people living in the home about their meals and positive comments had been received such as have a choice of meals and very good food. Staff were observed over a lunch time meal assisting people with dignity and respect for their wishes and what and how they wanted to eat. Care Homes for Older People Page 15 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can go to the management team knowing their concerns will be addressed promptly and in confidence and they can live in the home and be free from harm. Evidence: Since the last inspection a further safe guarding issue had been raised concerning care practices in the home. Although this investigation by the local safe guarding adults team was drawing to a close, no final decision had been received in writing at the site visit by the home or CQC. All other previous issues had now been completed and feedback given to each person involved. The complaints log showed no other concerns had been raised internally. People spoken to stated they would definitely go to the manager if the need arose and people spoke of how they felt issues would be dealt with in confidence. Since the last visit all staff have now received training in how to recognize abusive situations and how to refer these matters to the right authorities. This will ensure people are free from harm and risk. Care Homes for Older People Page 16 of 26 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 can live in a safe and secure environment suited to their needs and tastes. Evidence: We were able during the site visit to tour the building both unescorted and with the management team. Several more areas had been refurbished including one of the main corridors, the dining room and some bathroom areas. Some peoples rooms had been repainted and looked fresher and lighter. Care has also been taken to improve the signage on the doors. For example, if so wished people can have their names on bedroom doors - for example with a name and favorite flower. The bathrooms with toilets and individual toilets now have different colored doors for ease of identification. All areas were clean and tidy with many homely touches. There was ample evidence in individual rooms that people had been able to personalize them to suit their taste and needs. Some people said how his had initially helped them to settle into the home. The garden area was tidy and free from hazards and was very colorful. Thought had been given to help people living there to contribute to the work in the garden,which they told us, passes the day and makes us feel wanted.
Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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. Robust recruitment practices are in place to ensure staff are safe to work with people prior to commencement of employment and are then trained to do their jobs. Evidence: Of the surveys returned to us by people who use the service only a couple stated they would like their call bells answered quicker. We were able to see the staffing matrix and how the staffing levels had been determined. This ensures, alongside the dependency levels completed monthly that sufficient staff are on duty at all times to meet peoples needs. 6 staff personal files were tracked in depth and there was sufficient evidence seen that all safety checks had been completed prior to their employment commencing. At the time of the site visit there were no foreign nationals working in the home who required a work permit and all PIN numbers of the professionally trained nurses had been checked, according to the documents seen, with the Nursing and Midwifery Council. A new training matrix had also been completed on all staff employed. This has determined what training staff have completed and where updates are required and a new topics which need to be covered.This will ensure staff have the most up to date information to do their jobs. More staff have completed their NVQ training and these
Care Homes for Older People Page 19 of 26 Evidence: certificates were now seen to be in their files. Staff spoken to said how much they had appreciated the training being put in place and how this was helping them look at their job roles in a different way. Some work still needs to be completed for service specific training to ensure current peoples needs can be met, but the management team were able to show us evidence of sessions booked with an outside provider. 8 staff returned surveys to us ad 10 more were spoken to during the site visit. They made many positive comments about working at the home and feel recent changes were for the better. Others commented on how team moral had improved and a different way of looking at work load could mean they spent more time with the people living there. Care Homes for Older People Page 20 of 26 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. Peoples views must be sought to ensure the home is meeting their needs and it is a safe and secure place for people to live free from harm. Evidence: Since the last inspection the management structure in the home had changed, but staff made positive comments about the staff promotions and new structure. Managers meetings within the Company as a whole have been restructured and each home now works closer within its own team but shares ideas in the Company as a whole. Staff supervision records were tracked and there was much improvement in this area. Each session had been detailed in a written format, with tasks to do identified and this brought forward to the next session. Staff spoken to stated these sessions were more structured and they could work better with the way action points had been detailed. Time must also be taken to ensure there is a balance between observational supervision and discussion to ensure staff are monitored to do their jobs safely.
Care Homes for Older People Page 21 of 26 Evidence: At the time of the site visit we were informed there were no bad debts and the office staff work with sufficient petty cash money to support emergency buys in the home. The residents fund records were well recorded and there was no inappropriate use of funds. The arrangements for managing the residents fund needed to be tightened up to ensure this can be accessed when required and not when only certain signatories were available. The quality assurance program was now being looked at in depth again as a member of staff had returned to work on a more permanent basis. A topic was looked at monthly and throughly investigated. There was some evidence to support that actions were being checked and carried forward if not completed. This will ensure that all aspects of running the building are audited regularly to ensure it is being run for the benefit of the people living there. More evidence needs to be in place to ensure the views of people living there, other visitors and stakeholders have been recorded. This will ensure their views will be taken into consideration when planning their personal needs and outcomes for running the business. All safety certificates were seen to be in place to prove the building was a safe place to live and work in. There is still no registered manager in place but we were assured by the candidate this application is in the process of being completed. Care Homes for Older People Page 22 of 26 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 13 16 Peoples must be allowed to have contact with the local community and maintain contact with family and friends. A failure to meet peoples expectations will result in them becoming isolated and unfulfilled. 05/11/2009 Care Homes for Older People Page 23 of 26 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 33 24 The Responsible individual must ensure that the views of people living in the home are recorded as part of the quality assurance auditing process. This will ensure their individual needs are being met and the business is being run for their benefit. 05/11/2009 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 Evaluations of care plans should continue to ensure peoples current needs are being met and evidence is on record to show they or their advocate has been a part of the care planning process. Regular auditing of medication should take place to ensure safe practices are in place and people are receiving what has been prescribed in the correct manner. Senior management staff should ensure that social activities can still take place on a daily basis whilst the permanent facilitator is not available.
Page 24 of 26 2 9 3 12 Care Homes for Older People 4 33 Work should continue on the quality assurance system to ensure peoples views are sought in the running of the building and it is a safe place in which to live and work and meets peoples needs. The residents fund bank account should be available to be accessed at all times and not when only certain people are available. 5 35 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!
