Inspection on 12/12/05 for The Lodge Nursing Home

This inspection was carried out on 12th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Lodge Nursing Home 16/07/08

The Lodge Nursing Home 18/07/07

The Lodge Nursing Home 06/04/06

The Lodge Nursing Home 08/08/05

The Lodge Nursing Home 12/02/05

The Lodge Nursing Home 07/07/04

The Lodge Nursing Home 01/03/04

The Lodge Nursing Home 13/11/02

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Lodge, The Nursing Home Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH Lead Inspector Jill Wells Unannounced Inspection 10:00 12 and 19 December 2005 th th 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 Lodge, The Nursing Home DS0000002087.V272842.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. 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. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lodge, The Nursing Home Address Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH 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) 01298 814032 Union Healthcare Midlands Mrs Caroline Helen Hudson Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2005 Brief Description of the Service: The Lodge Nursing Home is located on the outskirts of Chapel en le Frith. The Victorian building has been extended and sits in its own grounds and can accommodate 36 older persons on three floors. A large dining room and conservatory plus a separate lounge are provided on the ground floor. A further smaller lounge is also provided on the first floor. Lodge, The Nursing Home DS0000002087.V272842.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 days. A complaint received by CSCI was also investigated during the inspection visit. Staff and residents were spoken with during the inspection and time was spent with the manager. Records were inspected including residents and staff files. A tour of the building was also undertaken. Staff were observed assisting residents. There are a number of requirements and recommendations as a result of the inspection visits. CSCI will monitor that appropriate action is taken by the service providers to ensure that the requirements are met. What the service does well: Staff were observed to have good relationships with residents and it was evident that most staff knew residents and their individual needs. The manager had worked at the home for some time as a nurse before being appointed as the manager, and was clearly committed and dedicated to the job. The administrator was organised, methodical and an excellent support for the home. Residents spoke positively about the service provided at the home. A new resident spoken with had quickly settled. Residents looked well-dressed and clean. Comments about the food were very positive. One resident said that, food not only looks good but it tastes good too. Care records were up to date and had been reviewed when any changes had occurred. The environment was pleasant, there were no unpleasant odours and bedrooms were personalised. There was a good staff team working at the home that generally worked well together. Visitors were welcome to the home and staff tried to meet any specific needs. For example one resident wished to hold a Christmas party for their friends, and this was arranged, with food provided. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Although the staffing levels met the minimum requirements, there was evidence that this level of staffing was not at times meeting residents needs. Examples were residents needing to wait an unacceptable amount of time for assistance to the toilet and vulnerable residents left alone in the dining room area for a significant amount of time. The dependency level of residents living at the home was very high with 33 residents requiring a hoist and two staff for assistance with moving. This made particular times for example dinnertime and mornings very busy. Immediate requirements were issued on day one of the inspection concerning radiators that were a high risk to residents being left uncovered and staff not using footrests on wheelchairs, which was unsafe practice. Immediate requirements were also left regarding confidential information concerning residents being left in a communal lounge area and stored in this area in an unlocked filing cabinet. The manager was also required to investigate gaps in medication administration records where nurses had not signed whether they had administered some medication. These immediate requirements were resolved by the second visit from the inspector. There were insufficient audits of the care and records being undertaken. The service is not being proactive in meeting the National minimum requirements. Instead they are waiting for an inspector to highlight issues that need to be resolved. At the time of the inspection visit there was not a registered manager in place. The new manager had been in post for 7 months but had not applied to CSCI to become registered with them. Lodge, The Nursing Home DS0000002087.V272842.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. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5. Some but not all required information was provided for prospective service users as well as residents living at the home. Not all new residents had their needs assessed before being admitted into the home. EVIDENCE: There was a statement of purpose and a service users guide available at the home. The statement of purpose was usually kept in the hallway but had been misplaced. A copy was returned to the hallway when this was pointed out. Although the information within the service user guide was clear, it did not include all of the information required. The statement of purpose needs to be revised as it states that Enid Pearce is the inspector from CSCI, however this Inspector retired this year. The statement of purpose included the complaints procedure as well as the address and telephone number of the Commission for Social Care Inspection. The service user guide did not include this. A new resident was spoken with during the inspection visit and her file was inspected. Although this person had been at the home for 6 days there was not a completed needs assessment in place. It was explained to the manager that Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 10 the needs assessment should be undertaken before a resident is admitted in order to assess whether the home could meet the persons needs. Prospective service users and their family/friends are given the opportunity to visit the home in order to assess the suitability of the home. A months trial was recommended within the statement of purpose. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Residents’ needs were clearly set out in individual care plans. Residents healthcare needs were generally well met. Improvements were required concerning residents privacy and dignity. EVIDENCE: Three care plans were seen as part of the case tracking methods used. Care plans were of a good standard, detailed and accurate. They were reviewed as changes occurred. Each file had a profile of the resident and an assessment of their dependency levels. There were also assessments in place concerning risks of skin breakdown, moving and handling risks, constipation, risks around bed rails and infection. The care plan included social needs as well as healthcare needs and how they were to be met. There were daily records in place for each resident. There was not however a photograph in place either in the residents’ files or in their medication records. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 12 It was evident from checking records and talking with staff and residents that specialist health care services were contacted when required. There were records of GP visits and chiropody visits. One resident said that staff would contact the doctor if ever they requested a visit. Medication administration records were inspected. They were found to be generally in good order however there were some gaps in the medication administration record sheets where nurses had not signed that they had administered medication or used a relevant code if medication had been omitted. Medication was safely stored. There were several issues of concern around privacy and dignity. Shared bedrooms did not have privacy curtains. Mobile privacy screens were available, however it was evident from talking to staff and observations that these screens were not always used. There were no privacy locks on toilets and bathrooms. Although very few residents went into these areas alone, it was explained that staff should still be locking the doors when they are assisting residents with intimate personal care. There were no locks on individual bedroom doors, however residents or their relatives if appropriate, are consulted before admission as to whether they wished to have a lock on their door. It was stated by the manager that no residents at the time wished to have a lock. Two residents spoken with confirmed this. Residents are relatives also complete a consultation document concerning their wish to have lockable storage space. A consultation record seen of one resident show that they had requested lockable storage but this had not been provided. Residents could see their visitors in private if they wished to do so. Staff were generally observed knocking before entering bedrooms. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15. Some activities were arranged for residents. Religious observance was supported and encouraged. Families and friends were welcomed and encouraged. Quality of food was good, however the atmosphere and staffing levels around mealtimes need to be improved. EVIDENCE: Residents’ interests were recorded. Information about activities was posted on a notice board, however during the inspection visit on the 12th December a notice board stated the activities in November but there was no information for December. There was an activities co-ordinator working at the home for 9 hours per week. The co-ordinator recorded activities undertaken which included dominoes, quiz, reading magazines, Christmas hat making, poetry reading, sponge ball and chatting with residents. The activities co-ordinator also occasionally brought in their dog, which was appreciated by residents. It was explained that this person was able to be very flexible in order to take into account the mood of residents, being prepared to change planned activities if necessary. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 14 Visitors were encouraged at the home at any reasonable time. Residents could see visitors in private if they wished to do so. There were several visitors seen at the home during the inspection visits. The statement of purpose informs relatives that their continued involvement will be encouraged. It also states that residents have the right to refuse to see visitors and that the home will respect this wish. One visitor spoken to at the time of the inspection was provided with sandwiches for lunch, which was much appreciated. One resident was planning a Christmas party on the afternoon of the inspection. There were 8 visitors including family and church friends. The home had arranged a private lounge area and food for the guests. This support for residents’ family and friends should be commended. There was a varied and nutritious diet provided for residents. There was a choice at every meal time. Residents were asked their preference in advance. Hot and cold drinks were available and offered regularly. The menu stated that fruit was offered in the afternoon, however this was no longer the case, and fruit was now only made available if a resident asked for this. The cook explained that residents were not interested in the fruit provided. It was advised that the food was offered in a sliced form, which may be more appealing. There was a menu displayed in the dining room. The information covered a five-week a menu. This did not assist either a resident or a visitor wishing to view what the meal was that day. The cook explained that the planned menu was occasionally changed. The alternative choice had been changed on the day of the inspection. The cook was not recording the reasons why changes had been made. The inspector observed lunch being served. Staff were observed offering assistance with eating where necessary, however staff told the inspector that they regularly had to feed two residents at once due to staff shortages over mealtimes, which was poor practice. It was of concern that staff were observed shouting requests at each other from the kitchen to the end of the dining room and conservatory area whilst serving residents. This was not conducive to pleasant surroundings whilst eating a meal. Two residents spoken to were unconcerned by this, one resident saying that, you get used to the noise. The dining area was very busy and there were insufficient space to allow all residents that wish to sit at a dining table to do so. Several residents take their meal in a lounge chair on an over table. Mealtimes seemed unnecessarily rushed, and staff spoken to confirmed this. Staff felt that breakfast time was similarly rushed. Residents praised the quality of the food. One resident said that, food is very good and, there is a choice and I enjoy most meals. Another resident said that, the food has a lot of taste to it, it is excellent. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Complaints were taken seriously. Staff were aware of adult protection and the importance of reporting any allegations of abuse. EVIDENCE: The complaints procedure was not displayed at the home, however the manager explained that it was usually available and had been taken down. The complaints procedure was redisplayed before the inspector left the premises. There was a clear complaints procedure within the statement of purpose which included the address and telephone number of the Commission for Social Care Inspection. Although there was a complaints record, improvements could be made in the way that the records were written to ensure that it is clear how a complaint has been investigated, and the outcome including whether the complaint has been upheld or not. The Commission for Social Care Inspection had received a complaint and investigated this complaint during the inspection visit. The complaint was that a resident was not receiving all of their required medication, was not being provided with adequate nail care, staff had shaved the residents head when a family requested a hair cut, and that they had been told that the home would ask the resident to leave if a member of the family made a formal complaint. These complaints have been partly upheld. The incomplete medication administration records did not give clear evidence as to whether medication had been administered or omitted. The resident’s nails were in need of cutting. It was acknowledged by the manager that the home was considering serving notice, however it was denied that the reason for this was concerning the complaint made. The inspector advised that the notice must not be given Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 16 because of a complaint made to the CSCI. Requirements and recommendations as a result of the complaint are included with the other requirements made from this inspection visit. The training records showed that most staff had attended or were due to attend adult protection training. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24,25. The environment was clean and generally well decorated and maintained. EVIDENCE: A tour of the building was undertaken with the manager. The home was clean and generally well decorated. There was a large dining room with a pleasant conservatory offset this room. There was a toilet next to the lounge area. Although there was a lock on the toilet it did not work. There was one lounge on the ground floor. There was a small TV in place, however a new TV had been ordered for Christmas that had a large screen. Some corridor areas were in need of decoration. It was stated that this was planned. Several areas had been newly decorated. The bathroom was also used as a storage area for sheets and towels and was quite untidy. The service was planning to make one bathroom that was presently unused into a storage area to increase muchneeded storage space. This had been agreed by CSCI providing there were no Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 18 changes to the homes registration. There were presently four bathrooms in use at the home. One bathroom had been changed into a shower room that was fully accessible. This had been improved to a good standard and was appreciated by residents. The water temperatures coming from taps was very varied. Some water came out scalding hot, whilst others was lukewarm (see Standard 38). There were grab rails and raised toilet seats available to assist residents. The home was fully accessible with the provision of ramps, passenger lifts and handrails, although handrails were not provided in all hallways and corridors. There was an unused electric heater in a hallway. The manager was not aware why this was here. Several bedrooms were inspected. There were five en suite bedrooms at the home and four double rooms. There was a bedroom paid for by the local GPs service that was used as a respite room. It was stated that this was well used. Bedroom number 10 had a carpet that had been badly laid and was raised up which could potentially be dangerous. No bedrooms had privacy locks in place, however there were records that residents had been consulted about whether they would want a lock on their door. There were two sluice rooms, one on each floor. There was a sluice room that the manager believed there to be a sluicing disinfector within the room, however she was unaware whether it was operational and the room was very full, being used as a store room for carpets, mattresses etc. There was no lock on this room. There was a passenger lift to all three floors. There was a small lounge on the third floor. In this lounge was a filing cabinet and desk. There was confidential information concerning service users in the filing cabinet that was not locked and placed on the desk. This had been rectified by day two of the inspection. The key had been found and records were secured. There were several doors that had notices in place stating ‘fire door keep locked’. These doors were not locked. One door was opened and bleach and domestos were found within these storage areas. The home had a high number of residents with high dependency nursing needs. There were few adjustable beds available for residents that required nursing care. Several beds that were seen were very old. A resident was observed waiting some considerable time in order for a hoist to be made available in order for them to be assisted to the toilet. Several residents were using a hoist when they could have used a rotunda, which was less intrusive and would free up hoists for other residents that required them. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30. Staffing levels did not always meet the needs of residents at busy times. Training was provided for staff, although some training was still required to ensure that staff were fully trained to do their jobs. EVIDENCE: The staff rota was inspected. Staff worked 12 hour shifts from 7 a.m.-7 p.m. This record showed that there were eight staff in the morning which included two nurses, and one nurse, six staff in the afternoon. There were four staff on duty on the night shift, which was also a 12 hour shift. The manager stated that she was able to call in agency staff if shifts could not be covered. Although this met the previously agreed minimum requirements, there was a very high level of dependency residents living at the home. There were 33 residents requiring two staff and use of a hoist for moving. It was of particular concern that the inspector observed residents sat in the dining room after a meal calling for assistance and not been heard for over 15 minutes. The inspector eventually had to intervene and call for assistance on behalf of the resident. The resident then had to wait a further five minutes for the toilet as she was told by a member of staff that there were no hoists available. The resident became very distressed. The inspector also observed a resident trying to get out of their wheelchair when the break was not in place. The resident was clearly unsafe to stand unaided. There were no staff around to assist, as they were busy assisting residents to the toilet or to their rooms. These observations evidenced that staff numbers need to be reviewed given the high needs of residents. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 20 Three staff files were inspected. Each had a job description and copies of staff passport/birth certificates. There were copies of criminal record bureau applications and it was confirmed that these have been received. Each worker had completed a medical questionnaire. There were not two written references in place for each member of staff, and some verbal references had been accepted. There was also not a photograph for each member of staff. Training records showed that most staff had undertaken moving and handling training and fire training, although there were several staff that had not received fire training since 2003. This included a care assistant working nights where they should have received six monthly training. Additional fire training was planned in January, and it was confirmed that all the staff requiring this were booked on this course. Most staff had undertaken food hygiene training if they were working in the kitchen. Some staff still needed to undertake first aid training and infection control. There were eight care staff that had undertaken NVQ training out of a possible 17. Therefore the home had almost Met their 50 target. There was a high percentage of residents that had dementia, however staff had not receive dementia training. There were a small percentage of residents that displayed verbal aggression due to their illness. Staff may benefit from training around dealing with aggression. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36, 37,38. The manager was experienced and competent. A formal system of supervision for staff had not been provided. There were several health and safety issues identified that required attention. EVIDENCE: The manager was appointed in April 2005. She was a qualified nurse and had previously worked at the home. The manager had not applied to the Commission for Social Care Inspection for registration, and this was now urgent. The area manager visited the home and supported the manager on a regular basis. There was a business plan and financial plan for the home, an annual rolling programme and a company business plan. The rolling programme for home improvements had been met for the year. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 22 Although supervision took place, often on an informal basis, and the manager described an open door policy, there was not always planned supervision at least six times a year for care staff as required. As stated previously some but not all mandatory training had been provided. The manager explained that additional training was planned. Hazardous substances were not always stored securely. Bleach and Domestos were found in unlocked cupboards. The maintenance person was responsible for general maintenance and checking of systems. Water was being stored at 50°C and distributed at the same temperature. These temperatures would not prevent the risks from legionella. The maintenance person was not aware of the regulations and guidelines concerning this. Water temperature from taps was being controlled from the water tanks, which was not safe. Water from one sink was checked and was found to be very hot and potentially unsafe for service users and could cause difficulties for staff and washing procedures. The temperature of the water from one bath that was checked and found to be 36°C that was possibly not warm enough for residents. The manager explained that water temperatures varied greatly. Staff were not recording the temperature of bath water. It was of significant concern that staff were using wheelchairs to transport residents without using foot rests. One member of staff was observed pushing a wheelchair on the back to wheels only in order to stop the residents feet catching on the floor. This was very unsafe practice. The manager had spoken with all staff by the second day of the inspection and footrests were now being used. Wedges were being used on doors around the home which was unsafe practice. Although written risk assessments had been undertaken concerning radiators, no action had been taken to minimise the risk of burns to residents on the high risk radiators. An immediate requirement was issued on day one of the inspection visit. By the second inspection visit, high risk radiators had been covered and the programme to cover the remaining radiators was underway. The manager was described by several staff as approachable and always prepared to listen. Manager meetings, nurse meetings and staff meetings were occasionally arranged. The manager gained benefit from meeting other managers within the company in order to share ideas. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 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 2 X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 2 3 2 X 2 2 X STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 2 2 Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 (2) Requirement Timescale for action 28/02/06 2 OP24 18 3 OP25 13(4)a(b) c 4 5 OP1 OP3 5 14 Schedule 3 The home must have its medication system checked by a pharmacist. Previous requirement. The original timescale 30/11/05 The programme to replace 30/03/06 bedroom furniture and fittings to meet minimum standards required must continue. Previous requirement. Original timescale 30/03/06 The temperature of water must be 28/02/06 controlled to around 43° in order to prevent risks to residents and staff of scalding, as well as risk of inadequate hand washing due to the temperature of the water coming from taps. (Original timescale 10/2/05, 30.09/05). The service user guide must be 28/02/06 revised to ensure that it includes all of the information within Standard 1.2 New service users must only be 30/01/06 admitted after a full assessment has been undertaken involving the prospective service user and relatives/advocates as appropriate. There must be a photograph kept in the home of each service user. DS0000002087.V272842.R01.S.doc 6 OP18 17(1)(a) 28/02/06 Lodge, The Nursing Home Version 5.0 Page 25 7 OP9 13(2) 8 OP10 12(4) (a) 9 10 OP10 OP15 12(4) (a) 12(4)(a) There must be no gaps in medication administration records. Nurses must either initial that they have administered medication or use an appropriate code where medication has not been administered. (Immediate requirements issued and met by the second inspection visit) Where service users share a room screening must be used to ensure that their privacy is not compromised when personal care is being given or at any other time. The service should consider providing curtain screening across the room rather than mobile screening, which may not always be available. Privacy locks must be placed on the communal bathrooms and toilets. The practice of staff assisting two residents at a time with feeding must not continue. Dining facilities must be reviewed to ensure that there is space for all residents to sit at a dining table if they wish to do so. The manager should review staff practices concerning shouting food orders across the dining area in order to ensure a more conducive atmosphere for residents whilst eating, and rushing mealtimes. Each resident must be provided with a copy of the homes complaints procedure. This should be made available in the service user guide (see requirement 1). The record of complaints received must include the detail of the complaint, a full record of the investigation undertaken, any action taken as a result, and whether the complaint was upheld, not upheld or unsubstantiated. The home must be kept tidy with unnecessary clutter removed. This includes the bathroom areas and hallways. DS0000002087.V272842.R01.S.doc 12/12/05 28/02/06 30/03/06 30/12/05 11 OP20 12(4)(a) 28/02/06 12 OP16 22 28/02/06 13 OP16 22 28/02/06 14 OP38 23 30/01/06 Lodge, The Nursing Home Version 5.0 Page 26 15 OP24 16(1)(2) 16 17 OP22 OP24 16(1)(2) 16(1)(2) Adjustable beds must be provided for service users receiving nursing care in accordance with assessed needs. A rolling programme of purchased beds must be completed by the timescale given. Grab rails must be provided in all corridors subject to assessed needs of residents. A carpet in bedroom 10 must be re laid to ensure that it is safe. The manager must check all other areas to ensure that there are no other badly fitting carpets that may pose a risk to residents and staff. 30/09/06 30/03/06 15/01/06 18 OP38 13(3)(4) 19 OP38 13(4) 20 OP37 17 21 OP22 16 22 OP27 18 19/12/05 Hazardous substances must be safely stored at all times. Immediate requirement. Informed at the time of the inspection. Storage areas that are fire doors must 19/12/05 be kept locked. Guidance should be sought from the Fire Officer if necessary. Immediate requirement. Informed at the time of the inspection. Confidential information must be 12/12/05 stored securely at all times. Immediate requirement. Resolved at the second inspection visit. There must be adequate moving and 28/02/06 handling equipment to meet the assessed needs of all residents living at the home. Residents must not have to wait an unnecessary length of time for a hoist to become available. Consideration to be given to either an additional hoist or a rotunda in order to meet residents needs. Staffing levels need to be reviewed 30/01/06 taking into account the dependency levels of the residents. Consideration must be given to providing additional staff at busy times in order to ensure that all residents needs can be met. There must be two written references obtained before appointing a member of staff, and any gaps in employment records must be explored and recorded. DS0000002087.V272842.R01.S.doc 23 OP29 19 30/12/05 Lodge, The Nursing Home Version 5.0 Page 27 24 25 OP29 OP38 Schedule 2 23(4) There must be a recent photograph in place of each member of staff. All staff must receive fire training on an annual basis. Night staff must undertake fire training on a six monthly basis. The manager must ensure that all staff have undertaken all mandatory training including refresher training. Staff must undertake training in working with people with dementia. The manager must apply to CSCI to be registered. Formal supervision for care staff must take place at least six times a year. Supervision should be recorded. Water must be stored at a temperature of at least 60°C and distributed at 50°C minimum to prevent risks from legionella. Staff must use foot rests on wheelchairs at all times. (An immediate requirement was issued and met by the second inspection visit) Fire doors must not be wedged open. Immediate. Informed at the time of the inspection visit. 28/02/06 30/01/06 26 OP38 18(1) 30/03/06 27 28 OP30 OP31 18(1) 8 30/05/06 28/02/06 29 OP36 18 (2) 30/03/06 30 OP25 13(3) 30/01/06 31 OP38 13 12/12/05 32 OP38 13 19/12/05 33 OP8 12 34 OP38 13(4) All service users nail care must be 19/12/05 attended to as required. Nail care provided for individuals should be recorded, and any care, including nail care offered and refused should be recorded. The rolling programme in 28/02/05 response to the risk assessments concerning radiators being covered must continue. Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 28 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 OP24 Good Practice Recommendations Any residents that have stated within the consultation document that they wish to have lockable storage space should be provided with this. It should be checked with residents and relatives during resident reviews whether they still wish to have no lock on their bedroom door and no lockable storage space. Information concerning activities should be made available and up to date. Fruit should be offered as stated on the menu. Staff should consider providing fruit that is sliced in order to encourage residents to eat fruit. Any changes to the planned menu should be recorded including reasons for change. The planned menu for the day should be displayed rather than the full five week menu The service should provide a sluicing disinfector. The bathroom areas where towels and linen are stored on shelves should be kept tidy. Consideration should be given to a more suitable cupboard storage area within these bathrooms. Staff should undertake training in dealing with aggressive behavior. Staff should record the water temperature of bath water to ensure that the temperature is around 43°C. These records should be monitored to ensure that bath water does not go significantly below this temperature. It is recommended that the service undertake a self-audit against the National Minimum Standards in order to assess whether additional improvements to the service need to take place. 2 3 4 5 6 7 8 9 OP12 OP15 OP15 OP15 OP26 OP22 OP30 OP38 10 OP33 Lodge, The Nursing Home DS0000002087.V272842.R01.S.doc Version 5.0 Page 29 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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