CARE HOMES FOR OLDER PEOPLE
Stanley Lodge Residential Home School Lane Bay Horse Lancaster Lancashire LA2 0HE Lead Inspector
Mrs Jennifer Dunkeld Unannounced Inspection 09:30 31st July 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Stanley Lodge Residential Home Address School Lane Bay Horse Lancaster Lancashire LA2 0HE 01524 791904 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Unlimitedcare Limited Post Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service is registered for a maximum of 23 service users in the category of OP (Older People) Date of last inspection Brief Description of the Service: Stanley Lodge is registered with the Commission for Social Care Inspection to accommodate and personal care to 23 residents of either sex aged 65 years and above. The home is situated in a rural area of Forton near Lancaster. Stanley Lodge is a detached property set in landscaped gardens and has uninterrupted views of the surrounding countryside. The majority of the residents have been admitted from the surrounding area. There are strong community links, which the management and staff endeavour to maintain. Residents are encouraged to continue to pursue outside interests and to invite visitors into the home as they wish. A range of activities are arranged and trips are organised. The accommodation comprises of 23 single rooms, twelve of which have ensuite facilities. There are two conservatories, a lounge, and a dining room; these communal areas provide residents with a choice of where to sit and who to sit with. All the personal needs of the residents are catered for by staff that receive training in all aspects of care of the older person. The resident’s General Practitioners and district nursing staff manage any medical needs. Chiropodist, dental and optical treatment is arranged for residents. At the time of the visit on 31/7/07 the information given to the Commission showed that the fees for care at the home are from £360 to £415 per week, with added expenses for hairdressing, private chiropody and newspapers. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This home has been inspected against the National Minimum Standards for older people introduced in April 2002. A selection of residents, their relatives and visiting health professionals were invited to take part in a written survey. A total of 12 questionnaires were received, 7 from the people receiving care, 3 from relatives and 2 from health professionals. The surveys returned were generally praiseworthy about aspects of care at Stanley Lodge. Comments included: “I feel they provide comfortable, personal care, in a pleasant, friendly atmosphere” “ A good standard of care exists here” “meals are good” “ The care staff are very caring and I am looked after well, although the staff are always very busy” “Staff are always available to discuss any concerns and re-assure.” The first day of the inspection was unannounced in that the homeowners, staff and people living in the home did not know it was going to take place. This inspection was over 2 days commencing on 31/07/07. The total time spent in the home was 5-hours and various aspects of care were looked at. In the report there are references to the “tracking process”, this is a method whereby the inspector focuses on a small group of residents. All records relating to these individuals are examined, along with the rooms they occupy in the home. Residents are invited to discuss their experiences of the home with the inspector; this is not to the exclusion of the other residents who contributed in many ways. This inspection included discussion with residents, staff, the manager and the service provider. This was in addition to viewing the home’s required written information such as the administration of medication records. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 6 The residents written plans of care were also viewed for 3 people. The plan of care is a document outlining the needs of the individual resident and how these are to be met. The plans of care cover all aspects of the individual’s life including health, personal care and social activities. Thereby ensuring people are content in the care they receive. The residents the inspectors spoke with were generally happy with life at Stanley lodge. The staff stated they enjoyed their work at Stanley lodge and spoke to the inspector in a professional manner about the residents. They were also full of praise for Bernadette the homes manager. Bernadette is applying to be registered with the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? What they could do better: Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 7 The residents spoken with were generally happy with the care they receive but a number did raise concerns about the shortage of staff in the afternoons. 6 out of 7 resident’s surveys also reflected concern at the shortage of staff in the afternoon. This was discussed with the provider who immediately put into effect an increase in staffing for 2 afternoons per week to enable the residents to have walks out in the garden and countryside. Some of the residents in their returned surveys said they do not have a contract with the current provider. When this was discussed with the provider she is arranging for people to have the option of transferring to a new contract or keeping their current contractual arrangements, which she will honour. It was identified that people do not have a copy of the homes complaints procedure including the addresses and phone numbers of the local social services and the Commission for Social Care Inspection. The provider has agreed to rectify this immediately. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Standard 6 not assessed, as this home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not move to live at Stanley Lodge without their needs being assessed and assured that they will be met. EVIDENCE: The Home’s Statement of Purpose and Service User Guide contains all the relevant information needed for prospective residents to make an informed choice when they are considering Stanley Lodge as their home. These have been given to all residents. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 10 Comment cards received showed that many residents had also obtained information from friends who were already residents in the home. Residents spoken with, said they had heard good reports about the home, from others in the locality. Residents in their returned surveys stated they do not have a contract with the current provider. This was discussed with Francesca service provider who said she will offer each resident the opportunity to transfer to her terms and conditions/contract or stay with their current contract, which she will honour. People new to Stanley Lodge and their relatives are provided with opportunities to visit the home and allow them to make an informed decision. There is an intention to make sure people’s individual needs are clearly assessed and risks identified. From the initial assessments, care plans are developed reflecting how the person’s needs are to be met. The assessments were seen for 3 people who were part of the “tracking process” The completed questionnaires received from the people who live at Stanley Lodge reflect that they were able to choose this home indeed people commented during the inspection that they feel they were lucky to live in this lovely home. One resident said, “We are so well looked after, the staff are very kind and patient.” Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from living in a home where their needs and aspirations are generally met EVIDENCE: Case tracking showed that good care plans are in place for each resident, these include individual’s likes and dislikes and are reviewed regularly. Daily notes are maintained to record the persons care needs on a daily basis or as necessary. Residents spoken with confirmed these were completed with their help and that they were agreed with them.
Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 12 The 2 surveys received from residents GP’s confirmed that they are happy with the support given to their patients and that their medication was properly managed. The comments included: ‘ A good standard of care seems to exist here’ and ‘I feel they provide comfortable, personal care in a pleasant, friendly environment.’ Visits by G.P, district nurses, dentists, opticians and chiropodists, are recorded and specialist advice from geriatricians, continence advisors and community psychiatric nurses, is sought when necessary, to meet the needs of the residents. Residents said they felt their privacy is respected and their care is provided in a dignified manner. Staff were noted to knock on bedroom doors and seek permission before entering. Residents said they are always asked how they wish to be addressed, although most use Christian names as the norm. Surveys received from 2 relatives and conversations with a further two, revealed that they are content in the care their relatives receive at the home and are kept informed of their health care needs and appointments. Comments included: ‘My relative is very well cared for and is in much better health since he became a resident in the home.’ Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are generally content in the care and support they receive. EVIDENCE: During this inspection it was noted that the dining tables were well laid with tablecloths, place mats, napkins, condiments and appropriate cutlery and dishes. The dining room had a stylish homely appearance. Staff offered support in a dignified manner. Observation at lunchtime showed that meals looked appetising and were well presented. The residents spoke contentedly about the meals they receive but were a little apprehensive, as the cook had recently left. Until a new cook is appointed the manager and assistant manager are doing the catering. They have made note of peoples likes and dislikes in order to ensure their dietary needs and wishes are met. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 14 The main meal of the day is a set meal but peoples individual preferences are catered for with an alternative meal offered when required. All residents spoken with said they were very happy with their lifestyle whilst living at Stanley Lodge. Activities are on offer most days of the week. However a number of residents had commented that due to there being a reduction in the staffing in the afternoon they had not had ‘that special time’ nor been able to ‘go for a walk in the garden or countryside’. When this was pointed out to the provider she agreed to increase the staffing 2 days per week and monitor the benefits of this. The residents said that activities include dominoes, bingo, quizzes and sing-alongs. On the second day of this inspection there was a keyboard player singing some of the well-known songs of the past, which the residents were enjoying. Comments from relatives, both present at the time of the visit and by completed surveys, all confirmed they are welcomed at the home at any time and always offered refreshments. They also added they are encouraged to spend as much time as possible with their relative / friend and encouraged to join in celebrations such as birthdays and festive activities. Some relatives help with the activities. However not all relatives appear to be aware of social functions as one person commented in the survey; ‘When events take place I am often unaware that they are happening and miss the chance to attend.’ During this inspection, it was clear that residents are asked to make choices in what to eat, when to rise and retire, how to spend their time, how to furnish their room, who they wish to keep company with and who they nominate to manage their affairs (if they do not want to manage them themselves). Following a risk assessment residents are given a choice of locking their bedroom doors. The residents spoken with said they chose what to do with their time, although they were encouraged to join in activities in a communal setting, their choice to remain in their own rooms or go out into the community, was acknowledged. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from living in a safe environment where they are protected and their opinion matters. EVIDENCE: Whilst the majority of the residents who completed surveys indicated they knew how to make a complaint should they wish to do so, some stated they did not know how. Also relatives who completed surveys said they knew how to complain within the home but not to any external agencies. This was discussed with the provider who has agreed to ensure all residents and their relatives are given information on how to complain to Social services or the Commission for Social Care Inspection. The staff spoken with stated that they knew what to do should they suspect abuse had occurred. The residents spoken with had no complaints other than the concern about not enough staff in the afternoons. This is being addressed by the provider, initially by an additional member of staff on two days each week and to monitor the benefits.
Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 16 The residents felt that if they had any complaints they would tell Bernadette and she would resolve it for them. The complaints that have been received by the Commission for Social Care Inspection during the last 12 months have been swiftly investigated and appropriate action taken when necessary. The provider has a healthy attitude to complaints and recognises the importance for people to feel they can complain and have their concerns resolved. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a clean, hygienic and pleasant environment EVIDENCE: In the last 18 months all rooms have been redecorated with new carpets being fitted throughout the home. New dining tables and chairs have been purchased, new lounge furniture has been purchased, and new bedding and soft furnishings are in place. The interior of the home has also been altered to eliminate internal steps, making it easier for wheelchairs and walking frames access. The exterior garden areas have been improved and the car park is now completely resurfaced. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 18 Case tracking showed that on an individual basis, aids and adaptations had been received to meet residents’ needs. A range of other aids and adaptations were seen in communal areas, such as grab rails, raised toilet seats and specialist baths for assisted bathing. There are two stair lifts, affording residents freedom of movement throughout the home. Both from surveys received and by speaking to residents and relatives, it was clear that all are pleased with their accommodation. Comments included: ‘Friendly and welcoming environment, clean and pleasant surroundings’ ‘It’s a lovely clean home’ ‘We are lucky to live in such a beautiful home in this wonderful countryside’ It was noted that all radiators have had protective guards installed; however one in the dining room needs re fixing to the wall. During a tour of the building it was noted that the home was light, clean well presented and free from odour. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a home where they are cared for by staff that are competent to do so. EVIDENCE: Residents spoken with were complimentary about the staff team. Comments included: ‘The staff are all very good’ ‘The staff are very caring’ ‘The staff are so kind, they are all so good’ ‘The staff are good but they are short staffed in the afternoon’ ‘We could do with more staff in the afternoon for that special time, like walks in the garden’ A relative stated, ‘The home needs more staff in the afternoon’
Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 20 These comments were discussed with the service provider who has agreed to increase the afternoon staffing for 2 days per week and will monitor the benefits of this. A good relationship was noted between staff and residents and there was a relaxed atmosphere throughout the home in both days of this inspection. 3 staff files were viewed, these reflected that appropriate checks have been taken including Criminal Record Bureau clearances to ensure the right type of people are employed to meet the needs of the people living at Stanley Lodge. Staff training is seen as important by the management of Stanley Lodge. Indeed of the current 16 staff 14 have achieved the National Vocational Qualification in care at level 2 or above. This is above the National requirement of 50 by April 2008. Other training courses attended were First Aid, Moving and Handling and Food Hygiene. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from living in a home that is generally well managed and where their financial interests are safeguarded EVIDENCE: The residents stated ‘the home is being managed on a daily basis by Bernadette’ but Francesca (service provider) does visit regularly. They added ‘Bernadette is very caring’. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 22 Bernadette is relatively new to the home and is applying to be registered with the Commission for Social Care Inspection as the Manager of the home. She has a number of years experience in the management of a care home. The people spoken with included the residents, their relatives and the staff; spoke highly of Bernadette’s caring manner. Comments included: ‘She’s a lovely person, nothing is too much trouble’ ‘She’s easy to talk to’ ‘Bernadette is very caring’ ‘She is so patient and kind’ At the current time Bernadette is working alongside the carers and acting as cook in addition to her managerial role. Consequently some of the management tasks such as formal staff supervision have been neglected. Bernadette is aware of the need for supervision to take place and hopes to commence this in the near future. The atmosphere in Stanley lodge was welcoming, tranquil, friendly and supportive. Relationships between the residents and staff were good. People are encouraged and supported to look after their own money, so enabling them to maintain their independence. However there are some people who require the support of the home. Where this is the case a record of all money held and any transactions are maintained. Advice was offered to ensure two signatures are obtained for each transaction, rather that the current practice of initials. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP36 OP31 Regulation 18(2) 8(1)(b)(iii Requirement The service provider must ensure that all staff receive formal supervision. The service provider must apply to register a manager with the Commission for Social Care Inspection, to be in day-to-day control of the home. The service provider must ensure there is adequate staffing at all times to meet the resident’s leisure and social activities. Including activities external of the home. The service provider must ensure that each resident and any person acting on their behalf has a copy of the homes complaints procedure The service provider must ensure the homes complaints procedure includes the address and telephone number of the local social services and the Commission for Social Care Inspection Timescale for action 30/09/07 30/09/07 3 OP12 16(2)(m) 31/08/07 4 OP16 22(5) 31/08/07 5 OP16 22(7) 31/08/07 Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP2 Good Practice Recommendations The service provider should ensure all residents have an agreed contract covering the terms and conditions of their residency. Stanley Lodge Residential Home DS0000067072.V342144.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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