Inspection on 14/11/05 for Stanton Lodge Nursing & Residential Home

This inspection was carried out on 14th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stanton Lodge Nursing &... 21/04/10

Stanton Lodge Nursing &... 26/01/10

Stanton Lodge Nursing &... 10/06/09

Stanton Lodge Nursing &... 06/08/08

Stanton Lodge Nursing &... 04/06/07

Stanton Lodge Nursing &... 13/06/06

Stanton Lodge Nursing &... 02/06/05

Stanton Lodge Nursing &... 07/12/04

Stanton Lodge Nursing &... 26/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Stanton Lodge Nursing & Residential Home Millfield Avenue Shiremoor Tyne & Wear NE27 0LE Lead Inspector Mrs Irene Bowater Unannounced Inspection 14th November 2005 09:30 X10029.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 Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 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 and Care Homes for Adults 18 – 65*. 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. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Stanton Lodge Nursing & Residential Home Address Millfield Avenue Shiremoor Tyne & Wear NE27 0LE 0191 2522919 0191 2535017 stanton.lodge@fshc.co.uk 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) Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (51), Physical disability (21) of places Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three named service users are under pensionable age. No further admissions of under pensionable age service users must take place without prior agreement of the Commission for Social Care Inspection 2nd June 2005 Date of last inspection Brief Description of the Service: Stanton Lodge is a purpose built 72-bedded care home. The home is situated in a residential area, close to public transport and other local amenities. All the accommodation is on ground floor level and all of the bedrooms have en-suite facilities. There are three units within the home each offering a different category of care. There is a unit providing personal and social care, one providing care with nursing and one unit provides care with nursing for young physically disabled people. Qualified nurses and carers are employed in the two nursing units and senior care and care staff provides care in the third unit. Each unit has lounges, dining rooms and there is a separate smoking lounge. There are specialist baths, showers and toilets on each unit close to all communal areas. There are enclosed patio and garden areas, which is wheelchair accessible. There are ample car parking facilities. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two separate days and was the second statutory unannounced inspection of the home. On the first visit the registered manager was on holiday and a further visit was arranged to examine and inspect various records and management issues that the clinical and administrative staff did not have access to. Two additional visits have been made to the home since the last unannounced inspection. Letters sent to the registered person following those visits can be obtained from the Commission for Social Care Inspection on request. On the first day two inspectors looked around the building, spoke to staff and residents and inspected a number of records. The second visit was carried out to inspect records and discuss the progress about meeting outstanding requirements from previous reports. Fourteen staff, fifteen residents, three visitors were spoken to throughout the first day. What the service does well: What has improved since the last inspection? Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 6 There is now a registered manager of the home and she is endeavouring to put right the many outstanding issues that have been problematic over a considerable time. The contracts for residents for residents are now available and are being introduced. The problems with the care plans have been resolved and advice is now sought from other professionals to ensure residents assessed needs are met. The treatment room is cleaner and more organised. The successful recruitment of an activities organiser has begun to improve the leisure and social life of the residents. Some progress has been made to recruit qualified nurses and care staff to reduce the use of agency. Given the current numbers of residents the home is adequately staffed. There has been limited progress made with the redecoration of bedrooms. There is now a temporary chef in post who has many years experience and some small improvements regarding the food provision are taking place. New windows providing natural ventilation have been fitted to the rooms near the Metro Line. What they could do better: The qualified nursing staff must ensure that the recordings of medications are clear and the controlled drug cupboard light needs to be repaired for safety reasons. Further improvements about the recreation and leisure events need to continue so that all residents have their preferences and choices taken into account. The menus and content of the meals needs to be reviewed to ensure all residents nutritional needs are met. The kitchenette areas must be cleaned and food hygiene procedures followed to prevent any outbreak of infection and to provide a pleasant environment for residents. The stained crockery tea trolley’s and domestic electrical equipment needs to be replaced. The home needs to progress with training to meet residents’ needs and to ensure staff are skilled and competent. Policies and procedures for the control of infection must be clear and be followed by the staff. Whist minimum redecoration and improvements have taken place further work must be done to make sure the home is safe and comfortable to live in. The outstanding requirements regarding the repairs, refurbishment and redecoration of the home must be implemented without further delay. An official letter was sent following the inspection to inform the home that the outstanding requirements must now be met. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 7 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. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5 OP 2, 4, 5 YA The Statement of Terms and Conditions (or Contract) sets out the rights and obligations of the resident and provider. The assessment procedures are fully completed before and after admission to ensure residents’ needs are met. All residents’ are given the opportunity to visit for a trial period to ensure the home is suitable for them. EVIDENCE: Since the last inspection the company have finalised the terms and conditions for residents who live in the home. Residents who are funded by a Local Authority have a contract with the home, which in turn, contracts with the Authority. All of the residents have detailed preadmission and admission assessments, which are completed by care managers and the home’s senior staff. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 10 The residents are encouraged to visit the home before deciding to move in for a trial period. After six weeks a full review takes place with the resident, their representative, care manager and a member of the home staff to discuss any concerns and it is at this point a decision to stay on a permanent basis is made. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 OP 6,9,16,18,19,20 YA The care planning system is clear and provides staff with the detailed information they need to meet residents’ assessed needs. The health needs of residents’ are met, with good multi agency working taking place on a regular basis. All staff are not following medication policies that could place residents at risk. Personal support is offered in a way that promotes residents rights to privacy dignity and independence. EVIDENCE: Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 12 Random samples of the care plans from the three units were inspected. There has been an improvement in the care planning and record keeping since the last inspection. Up to date records about individuals’ health, personal and social care needs was informative and would allow staff to give suitable care. There was evidence of risk assessments for moving and handling, falls, nutrition, continence and pressure sore care. There are risk assessments in place to enable residents take responsible risks about their personal safety. Where possible residents and their representatives are involved in the care plans. Although the care plans were of a satisfactory standard the care plans are not in suitable formats that residents can easily understand. The staff try to offer choices and independence to all residents. This can be difficult given the support and nursing needs of some of the residents. Staff were observed to knock on doors and wait before entering and staff used residents preferred names. All residents have access to all NHS facilities. Specialist nurses, physiotherapists, occupational therapists and consultants are sourced for advice as necessary. The district nursing services support the residents who live on the personal care unit. The home has detailed procedures to ensure safe administration of medicines. The cleanliness and organisation of the treatment room had improved since the last inspection. The Controlled Drug cupboard warning light still has not been repaired. An audit of the Controlled Drugs was found to be correct. The Medicine Administration Records (MAR charts) showed that not all hand written entries had been double signed and several of the handwritten transcriptions had been abbreviated. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, OP 12,13,15,17 YA Social activities continue to improve to provide stimulation and interest for residents living in the home. The links with the local community are satisfactory and support residents’ social and cultural needs. Residents are supported to maintain their independence and choose their lifestyles within their capabilities. Progress is being made to improve the provision of a varied menu, which meets residents’ tastes and preferences. EVIDENCE: The residents on the younger persons unit do not have the facilities to develop their independent living skill, or find employment as the placements are Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 14 normally long term and the residents’ health care needs would exempt them from employment. The recruitment of a full time activities organiser has vastly improved the leisure and social life of the residents. Notices are displayed throughout the home and residents are encouraged to “sign up” to events both within and outside the home. A recent visit to Beamish was greatly enjoyed. Several of the residents spent their time watching television, smoking or enjoying their own company. One resident enjoys handicrafts and three residents were enjoying playing dominoes. It is difficult to meet all of the residents’ diverse needs. The activities are open to all residents and not a specific group, which still causes some problems between the older and younger residents. The residents said that their relatives and other visitors are always made welcome and can visit at any time. Some of the residents attend day centres, other residents said their family took them out, others said that their relatives were always made welcome in the home. There have been ongoing concerns and complaints about the menu’s, choices and variety. Four residents complained about the meals being “cold” when they were delivered to bedrooms, “mince was dipped in gravy” and the “carrots and cabbage was hard.” Residents also said that “today’s meal was the nicest they had in ages”,“it was the first time ever they had had lids over the meals,” and “the food is fine I get plenty to eat.” The lunchtime meal was steak pudding, mashed potato and vegetables or fish cake, waffles and beans followed by sponge and evaporated milk or jelly and evaporated milk. The standard of the dining rooms varied. The tables on the nursing and Younger persons units did not have table clothes appropriate condiments or napkins. On the third unit the tables were set with tablecloths, appropriate condiments and the menu was available on the tables. Residents on this unit were given juice and hot drinks with their meal. Residents who need assistance to eat are served their meal separately in the dining room. The pureed meal consisted of minced meat mashed potatoes and pureed cabbage. It was difficult to assess if there were any vegetables given the appearance and consistency of the cabbage and residents were unaware that they had vegetables. The residents’ were not offered a choice of dessert as the sponge pudding was not ready and they had to settle for jelly and evaporated milk. The tables were not set and the condiments available consisted of one pot of pepper. In all the dining rooms all of the condiment pots, sauces sugar basins were dirty and stained with food debris. All of the teapots and tea trolleys were ingrained with tea stains. A loaf of mouldy bread was found in the kitchenette cupboard and there were numerous fortified prescribed drinks, which were out of date. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 15 The tea trolley’s were grimy and were ingrained with tea stains. Teapots and jugs were also grimy and tea stained. The temporary chef is trying to resolve the ongoing problems and has devised a temporary menu, fruit and vegetables are being ordered daily and residents now have full fat milk. The chef is also looking at new ways of increasing the calorie content of meals for those residents who have a low weight or poor appetite. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 OP 22,23,YA The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. The procedures and staffs’ understanding of Adult Protection issues protects residents as far as possible from harm. EVIDENCE: The home has policies and procedures in place for dealing with complaints. The records show that all complaints are investigated with actions and outcomes recorded. The residents spoken to said they knew how to complain and use the procedure when they are unhappy. The complaints revolve around the food, lack of staff and attitude of some of the staff. The home and the Commission using the agreed procedures have dealt with the complaints. The Protection of Vulnerable Adults policy is in place which links into the Local Authority Procedural framework. All allegations and incidents of abuse are immediately dealt with in line with procedures and the home maintains suitable records. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 17 The manager who in turn has attended a two-day training course with the Local Authority has completed the training of staff. Currently there are two allegations of abuse being investigated following the Local Authority guidance. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25,26 OP 24,25,26,27,28,30 YA The overall quality of the furnishings and fittings is poor and has the potential of placing residents at risk. The standard of the environment does not provide a comfortable, clean, odour free living place for residents. EVIDENCE: Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 19 The home is a single storey, purpose build care home situated in a residential area. There are local shops, pubs and healthcare services and there are transport links close to the home. The home has three separate units but there is little to distinguish between the younger and older persons unit as the layout decoration furniture and fittings are generally the same. The younger persons unit is not arranged in groups of ten and there are no separate facilities for residents who need a short period of respite care. Each unit has access to a central enclosed garden area. These areas have not been well maintained and are untidy, with damaged pots, tipped up flowers, dishes of spent cigarette ends and evidence of chewed up plastic containers. There are lounges and dining rooms on each unit. All of the communal rooms have damage to the walls and paintwork from the wheelchairs. There is food spillage on the walls of the dining rooms and food debris on the flooring. Many of the lounge chairs were grubby, stained and worn. The tables and chairs in the dining rooms were sticky with spilt food and drink. The carpet in the smoking lounge is full of cigarette burns, the furniture and walls stained with nicotine. There is an overpowering smell of stale cigarette smoke, which pervades up the corridor and into bedrooms. All of the bedrooms are single en suite. Many of the bedrooms were showing signs of wear and tear in regard to worn damaged bedroom furniture, fittings and decoration. Some of the bed bases and carpets are stained with body fluids and a number have odour problems. Not all wardrobes have been fixed to the walls there are broken handrails and tiles in room 10. Since the last inspection the windows that had no natural ventilation have been replaced and these windows can now be opened and an internal redecoration of bedrooms has started. Residents have been encouraged top bring personal items with them making their own rooms very individual and reflective of their previous lifestyles. A number of the bathrooms are not used as they have domestic style baths, which the residents are unable to use even with assistance. Two bathrooms have been refitted and have adaptations necessary to meet the residents’ needs. There are ongoing problems with pooling of water in the shower rooms, dirty tiles, mouldy shower curtains, missing lampshades and emergency call bell. In bathroom two, tiles are missing by the floor and the tiles on the wall are bevelling out. The water pipes are disconnected and the room generally grimy. The staff were working hard to keep the home clean, however there was a constant odour of stale urine and stale cigarette smoke throughout the home. The laundry remains untidy, disorganised and dirty. The staff have tried to resolve some of the problems by repainting the walls and having the machines repaired. The flooring remains stained and is lifting making cleaning difficult and allowing water to seep underneath the vinyl. The hand wash sink remains practically inaccessible due to storage of dirty washing. The staff are unable to wash their hands effectively after dealing with dirty, contaminated or soiled linen. There is also a vast amount of unclaimed clothing in the laundry area. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 20 The hairdressing room remains untidy and had not been cleaned since the last visit by the hairdresser. Hair cutting were left on the floor, there were used medicine pots and plastic beakers left on the wooden shelving. The shelving was split and damaged. Water from the sink can seep under the split vinyl. The sluices were kept locked and there was liquid soap and paper towels available. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 OP 32,34,35,YA The home has made limited progress with staff recruitment. Currently the home is adequately staffed. The provision of staff training and supervision is not satisfactory to ensure all the residents’ needs are met. The recruitment and selection procedures are followed which ensures residents are protected from harm. EVIDENCE: During the past year the home has experienced difficulties with recruitment of staff and short notice staffing has been particularly problematic. The manager has endeavoured to resolve the many staffing problems, however there are still issues about retaining experienced, skilled and competent staff. On the day of inspection one nurse was having an induction and the qualified nurses have been in post for some time. The recruitment of a deputy manager has also been positive. Each unit is staffed separately Younger Persons Unit: Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 22 1 qualified nurse 8am to 8pm, 4 carers to 2pm and 3 carers 2pm to 8pm. Nursing Unit: 1 qualified nurse 8am to 8pm, 4 carers 8am to 2pm, and 3 carers 2pm to 8pm. Residential Unit 1 senior carer and 1 carer 8am to 8pm Overnight: 2 qualified nurses and 5 care staff for the whole home. The above staffing levels are changed by the home according to occupancy levels. Many of the staff are recruited from overseas and their first language is not English. The residents said that they had difficulty in making some of the staff understand what they are saying. There is evidence that the home is aware of these issues and the staff are attending further courses. There are adequate domestic, laundry, maintenance and administrative staff employed. The home does not have a chef and is currently using the company’s bank staff. The home now has an activities organiser who works full time. On inspection of staff files there appeared to be discrepancies about length of time spent in the country and obtaining two references for two of the care staff. On further discussion and investigation these concerns were resolved. Criminal Record Bureau checks are carried out, proof of identity and medical checks are available. The Personal Identification numbers (PIN) of qualified nurses are checked to ensure they are registered with the Nursing and Midwifery Council to practice. There has been little progress with NVQ level 2 training and this is still on hold. Although statutory training takes place there is little evidence to support that staff follow food hygiene procedures. The staff have not received sufficient training in dealing with aggression physical restraint or dealing with challenging behaviours. Training in Dementia Care and Infection Control is to commence in the near future. Regular staff meetings take place with minutes recorded and action taken where necessary. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 OP 23,36,37,39,42 YA The manager has knowledge of the service and demonstrates leadership qualities. Residents’ views are sought but they do not see them as having much effect in changing how the home is run. Only limited progress has been made regarding staff training and supervision, which results in inconsistent care delivery. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 24 There continues to be outstanding issues in the maintenance of the home and some care practices, which pose risks to residents’ health, safety and welfare. EVIDENCE: The registered manager has been in post since October 2004.She has successfully completed the process to become registered with the Commission. She is a first level registered nurse with many years experience. She continues to prioritise the many issues in the home that need improvement. The quality assurance and quality monitoring systems are not fully established in the home. The results of resident surveys are not published or available. There are several outstanding requirements from previous inspection reports, which have not been actioned within timescales. Appropriate action has been taken by the home within timescales following the additional inspection visits undertaken in September and October 2005. The home maintains a central non-interest bearing account for residents’ personal allowances. There are individual records and receipts available and the account is regularly reconciled and audited. Residents currently do not receive interest on their money. The arrangements for staff supervision are available, however it is still behind schedule. There is a full range of Health and Safety policies available in the home. The standard of hygiene in the kitchenettes was poor .The microwaves has solidified food splashed on the insides, the toasters were full of breadcrumbs, cereals were stored uncovered and all of the surfaces were generally sticky with drink or food spillages. The domestic fridges were grimy with spillages of food and liquids. The multi use of extension leads for the microwave, toaster, and kettle has not been risk assessed. The recommendations from the recent Environmental Health Officer are currently being addressed. Staff have little knowledge regarding infection control and effective hand washing. It was confirmed that this training is to be implemented in the near future. Accident recording was found to be satisfactory and the maintenance records were clear up to date and signed. Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 25 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 X 2 3 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 1 20 1 21 1 22 2 23 X 24 2 25 2 26 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 2 36 2 37 X 38 1 Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? YES 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 Standard OP9YA20 Regulation 13(2) 17 Requirement All handwritten directions on the MAR sheets must have a witness signature and abbreviations must not be used. The CD cupboard external light must be repaired. OUTSTANDING SINCE 31.06.04 The menus must be reviewed to ensure they are suited to individual assessed and recorded need. All meals and snacks must be varied, appealing and nutritious. The menus must be in formats that are easily read and understood. OUTSTANDING SINCE 31.08.04 The tea trolley must be replaced. OUTSTANDING SINCE 2.06.05 Food including pureed meals must be presented in an attractive manner in order to maintain appetite and nutrition. Choices of meals must be made available for all residents at flexible times. The crockery and condiments DS0000029001.V258023.R01.S.doc Timescale for action 31/01/06 2 OP15YA17 12(2) 16(2) 31/01/06 3 4 OP15YA17 YA17OP15 12 16(2)(4) 12 31/01/06 31/01/06 Stanton Lodge Nursing & Residential Home Version 5.0 Page 27 must be kept clean and serviceable. Those that are ingrained with stains must be replaced. 5 OP19YA24 13(4a&c) 23 (1a&b) The home must be kept in a 31/01/06 safe well-maintained condition that meets residents’ individual and collective needs in a comfortable and homely way. A programme of renewal of the fabric and decoration of the premises must be produced and implemented with records kept. The carpets in the communal areas must be deep cleaned to eliminate any odours. The carpet in the smoking room requires replacing. The lounge chairs, which are worn, stained and shabby, require replacing. Doors and paintwork that are wheelchair damaged must be repainted. The hair dressing room must be cleaned after use. OUTSTANDING 2.12.04 The home must ensure that repairs are carried out to ensuite areas. Ensure there is no pooling of water in shower rooms. OUTSTANDING 2.06.05 The home must repair and refurbish bathrooms and shower rooms to ensure there are sufficient bathing facilities to meet their assessed needs. The home must ensure all wardrobes are fixed to the wall to prevent toppling accidents. Bedroom furniture, which is worn and shabby, must be replaced as part of a refurbishment programme. OUTSTANDING 2.12.04 DS0000029001.V258023.R01.S.doc 6 YA28OP20 23 31/01/06 7 YA27OP21 23 31/01/06 8 OP21YA27 23 31/03/06 9 YA26OP24 13(4) 1623 31/01/06 Stanton Lodge Nursing & Residential Home Version 5.0 Page 28 10 YA30OP26 11 12 YA32OP28 YA35OP30 13 YA39OP33 14 YA23OP35 15 YA36OP36 16 YA42OP38 17 YA42OP38 12,13,16,23 The home must ensure that all carpets are deep cleaned. The home must review the cleaning schedule to ensure all areas are cleaned daily. Replace the carpets that are stained with body fluids. The flooring in the laundry requires replacing. There must be free access to the hand washbasin to allow effective hand washing. Soiled continence pads must be appropriately disposed of. OUTSTANDING 2.06.05 18 The home must ensure that care staff receive NVQ level 2 training. 12(1) 13(4) The home must ensure that 18 specialist training is provided for all staff to ensure they can meet the residents’ needs. OUTSTANDING 2.06.05 12,24 The home must implement a quality monitoring system based on the views of residents and all other stakeholders and publish the results. 12,20 The home must ensure that where they hold personal allowances for individual residents any interest accrued is paid into their account. 18 The home must ensure that all staff receives formal supervision at least 6 times a year. 13,23 The home must ensure that the procedures for all safe working practices are understood and followed at all times. OUTSTANDING 2.06.05 13,16,23 The home must ensure that that all foods are correctly stored, prepared to avoid food poisoning. All food stored must be labelled and dated and used within manufacturers use by DS0000029001.V258023.R01.S.doc 31/01/06 31/03/06 31/01/06 30/06/06 31/01/06 31/03/06 31/01/06 31/01/06 Stanton Lodge Nursing & Residential Home Version 5.0 Page 29 dates. All kitchen equipment and surfaces must be kept in a clean condition at all times. All lights must have suitable shades. The home must take precautions to prevent the smell of cigarette smoke pervading the rest of the home. 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 2 Refer to Standard YA8 YA14 Good Practice Recommendations The residents should be given the opportunity to become more actively involved in the day-to-day running of the home. Holidays should be considered for the younger residents as part of the contract price. Consideration should be given to providing a designated activities organiser for the younger persons unit. Consideration should be given to providing the complaints procedure and care plans in alternative formats. Consideration should be given regarding organising the premises into no more than ten people sharing a staff group, dining area and other common facilities by 01/04/07. 3 4 YA22 YA24 Stanton Lodge Nursing & Residential Home DS0000029001.V258023.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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. 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