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Inspection on 16/07/08 for The Lodge Nursing Home

Also see our care home review for The Lodge Nursing Home for more information

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are usually well supported in their admission to the home and are provided with key service information to assist them in the decision making process. Overall, people live in a safe, clean, homely and generally well-maintained home, which suits their needs. People told us: `There is a good team of cleaning staff, `the laundry service is very good` and `my room is cleaned well every day.` People`s healthcare needs are well met. People told us: `There are no problems, staff are caring and helpful.` `They are always responsive to the need for doctor and hospital appointments.` The service strives to promote person centred care and agrees daily living plans with people, which they keep in their own rooms. People are provided with regular opportunities to engage in social and recreational activities at the home, including regular exercise routines and a nutritious diet served in people`s choice of location in the home. One person told us: `The food is usually good and well cooked.` People`s rights to complain and to be protected from harm and abuse are upheld and taken seriously by the home. People`s needs are well met by competent staff that is suitably recruited, inducted, trained and deployed. The home is well managed and in people`s best interests.

What has improved since the last inspection?

Nine out of the ten requirements we made at our last key inspection are complied with at this inspection. These include: Clear information of fees charged and what they cover is provided for people within the homes brochure/service user guide. Arrangements for the ordering, storage and administration of people`s, medicines are now safer and mostly accord with recognised guidance concerned with medicines practises. (Six of the seven requirements we made about medicines practises are complied with at this inspection). The arrangements for staff cover and skill mix and deployment are more consistently planned in people`s better interests.

CARE HOMES FOR OLDER PEOPLE The Lodge Nursing Home Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH Lead Inspector Susan Richards Unannounced Inspection 16th July 2008 09:30 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 The Lodge Nursing Home DS0000002087.V368873.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. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge 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 thelodge100@btconnect.com Union Healthcare Midlands Dawn Winfield Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: The Lodge Nursing Home provides nursing and personal care and support for up to thirty-six older persons, both male and female. It is located on the outskirts of Chapel en le Frith, a small town in the High Peak area to the north of Buxton. The home is a large Victorian building of substantial character, which has been extended and provides accommodation over three floors accessible via a shaft lift and stairs. The environment is suitably adapted and there is a range of adaptations and equipment provided to assist those who may have mobility problems. There is a choice of lounge space with a large dining room and conservatory also provided to the ground floor. There is level access to well kept gardens, which provide seating and a car parking area. All rooms have a sink provided, with some having en suite toilet and washing facilities. There is a range of communal bathing and toilet facilities provided, which are suitably located. The home is staffed with a team of nursing, care and hotel services staff, including an activities co-ordinator and full-time administrator that are led by the registered manager, Dawn Winfield appointed since our previous key inspection to this service. External management support is also provided. A copy of the most recent inspection report is openly displayed along with a variety of information about the home in the main reception area. Fees charged are as follows: £460.30 - £680.00 per week. Actual fees charged are determined in accordance with individual’s assessed needs. For those who may be eligible, these may include contributions from either local authority (funding for personal care and accommodation) or primary care trusts (free nursing care element of the fee). Where people are not eligible to assistance with their funding, fees are agreed by way of private contract between the home and individual. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience adequate quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 18 July 2007 and our annual quality assurance assessment questionnaire (AQAA), which we asked the home to complete in order to provide us with key information about the service. At this inspection there were thirty-five people accommodated, all who receive nursing care. We used case tracking as part of our methodology, where we looked more closely at the care and services that three of those people receive. We did this by talking with people, direct observation of staff interactions with them, looking at their written care plans and associated health and personal care records and by looking at their private and communal accommodation. We received completed survey returns from eight people who use the service and three staff employed there. Comments received from people included: ‘The nursing staff and very supportive and there is a good team of cleaning staff.’ ‘Staff are always on hand and are good, caring and helpful.’ ‘The building gardens and views are a real bonus and there is a good laundry service.’ ‘The meals are good during the week, although not always so at the weekend.’ At our visit we spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the registered manager and administrator about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Nine out of the ten requirements we made at our last key inspection are complied with at this inspection. These include: Clear information of fees charged and what they cover is provided for people within the homes brochure/service user guide. Arrangements for the ordering, storage and administration of people’s, medicines are now safer and mostly accord with recognised guidance The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 7 concerned with medicines practises. (Six of the seven requirements we made about medicines practises are complied with at this inspection). The arrangements for staff cover and skill mix and deployment are more consistently planned in people’s better interests. What they could do better: 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. The Lodge Nursing Home DS0000002087.V368873.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 The Lodge Nursing Home DS0000002087.V368873.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): NMS 1 & 3. (NMS 6 was not assessed, as the home does not provide for intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission and needs assessment process accord with good practise, in people’s best interests. EVIDENCE: At our last key inspection of the service we judged that overall people are provided with the service information they need to assist them in their admission, although lack of clear information about fees did not best inform them. We also said that people’s preferred daily living routines, choices and lifestyle preferences were not best accounted for and with them on their admission. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 10 We made a requirement that clear information about the range of fees charged should be provided within the home’s service guide. This is achieved at this inspection. We also made two recommendations. That consideration be given to providing service information in alternative formats, including audio tape to assist those who may have sight deficits and to introduce daily living plans for people to better account for their chosen lifestyle preferences and choices. In our annual quality assurance questionnaire completed by the home they say that they have a comprehensive admission and needs assessment process in place. They also tell us that they have improved their admission assessment process to ensure that they do not admit people whose needs they cannot meet, although feel that their assessment pack needs some fine tuning to avoid repetition of information. They tell us that they intend to improve over the coming months by addressing this in conjunction with external management procedures. At this inspection the service guide is available in large print format. The administrator advised that they are seeking to develop these further. People have daily living plans kept in their own rooms and as agreed with them, which were observed during our tour of the building and also via case tracking. For those people we case tracked, each had comprehensive needs assessment records based on a recognised model for nursing assessment, including evidence based risk assessment tools. They are also person centred in the style of recording. With the exception of one person, people told us that they received a contract and all said they were provided with sufficient information about the home before they moved there. Comments received include: ‘Staff were very friendly and helpful and gave us a tour of the premises providing all the information we required.’ ‘Helpful and friendly advice received.’ The Lodge Nursing Home DS0000002087.V368873.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): NMS 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall people’s healthcare needs are well met, although medicines administration records do not best underpin accountability for practise. EVIDENCE: At our last key inspection of the service we judged that people’s health care needs were generally well met by staff that treat them with courtesy and respect. We also judged that some observed medicines practises might have placed people at risk. However, the immediate action taken by the home should ensure that these would be managed safely and in people’s best interests. We made seven requirements relating to the specific areas of medicines practises to ensure their safe management and administration. The service The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 12 provided us with an immediate written action plan, telling us what they were going to do to comply with these, which was satisfactory in principle. At this inspection six of these are fully complied with. In our annual quality assurance questionnaire completed by the home, they say that they ensure each person has up to date person centred care plans, that their health care needs are well accounted for, risk assessed and met and that their rights to privacy and dignity and to be treated with respect are always promoted. They tell us that they have improved in promoting safe and correct medicines practises and have taken action in accordance with the requirements we made at our last key inspection concerning these. At this inspection most people told us that they always or usually received the care and support they need, including medical care and that staff always or usually listen and act on what they say. Supporting comments include: ‘There are no problems, staff are caring and helpful’ ‘They are always responsive to the need for doctor and hospital appointments.’ ‘Nursing staff is very supportive.’ One person felt they would like to see their own doctor more. However, discussions with that person and also the manager at our visit, together with examination of their care records indicated a focused, ongoing and comprehensive approach to the multi-disciplinary review of their care. Written care plans that we looked at via case tracking are well recorded and formulated in accordance with individual’s risk assessed needs. They are person centred and reflective of recognised practise concerned with the care of older people. However, one person did not have a care plan in place with regard to their variable dose instructions for one of their prescribed medicines. Examination of their medicines records, medical review records and discussions with staff responsible for administering that person’s medicines, identified that there was confusion amongst staff as to the dosage and administration requirements. The home advised us what they intended to do to address this and forwarded us written details. When we re-visited the home the following week to complete our inspection, this was satisfactorily addressed. In all other respects, with the exception of record keeping, arrangements for the management and administration of people’s medicines are satisfactory. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 13 In terms of record keeping for the administration of people’s medicines, significant gaps/omissions in recording were evident where staff had not either signed or entered the appropriate coded reason for not administering a medicine onto people’s individual medicine administration record sheets. At our last key inspection of this service in July 2007 we made a requirement for the home to correctly record the details regarding the administration of medicines on the Medication Administration Record. As this is not complied with at this inspection we issued a written notice during our visit to advise them of our statutory powers and their failure in this respect. The registered manager has advised us in writing of the action she intends to take to monitor this and to ensure for the consistent and accurate recording of medicines administration. This is satisfactory in principle and we will monitor compliance with this by way of a further random inspection visit. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 14 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): NMS 12, 13, 14 & 14 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are mostly satisfied with their lifestyles and the food provided and their inclusion and rights to make decisions about their lives are better promoted. Although, a more proactive approach to providing information and individual consultation about food menus, may further benefit people. EVIDENCE: At our last key inspection of this service we judged that the introduction of daily living plans, should better promote people’s own choices with regard to their daily living arrangements and lifestyle preferences. We also judged that food provided was to a good standard and met with people’s choices and risk assessed needs. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 15 We made a recommendation at that inspection that consideration is given to the implications of the Mental Capacity Act 2005 in respect of promoting individuals choices about their lives through its record keeping practises. In our annual quality assurance questionnaire completed by the home, they say that they provide dedicated staff hours for the provision of activities and regular entertainments. Provide people with information about these and also how to access advocacy services and that they promote people’s daily living preferences and their social and religious needs. They also say that people are provided with wholesome meals, with the support they need in a relaxed setting. They say they have improved their dining facilities for people since our last key inspection and identify that they could improve and develop activities arrangements further. They aim to try to achieve this over the coming twelve months. At this inspection, daily living plans are fully introduced and people have copies of these in their own rooms. The care planning records for two people we case tracked detailed key information in respect of their stated wishes and choices about their lives. These also detailed care interventions, support and assistance to be provided with regularly recorded and planned reviews with each person together with significant others and via a multi-disciplinary process. The manager had recently obtained a copy of the Mental Capacity Act 2005/guidance for care homes and was seeking to access training for staff for this. Two people told us that activities are always arranged by the home that they could take part in. Two said they usually are and four said sometimes. Information about activities, which are regularly organised are displayed in the home. These include quizzes, flower arranging, dominoes, food/cheese tasting, baking, painting, gentle exercise/soft ball games/skittles, board-games music and video sessions. Efforts had recently been made to engage outside entertainers who visit the home periodically. Photographs of residents engaged in various activities are also displayed in the home. One person who does not like to join in with group activities told us that the activities co-ordinator brings individual activities to them, which they appreciate. Four people told us that they usually like the meals at the home. Three said they always do and one said they sometimes do. A range of comments were received including: The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 16 ‘The food is good and well cooked.’ ‘Especially good on weekdays.’ ‘Reasonable variety of meals.’ ‘Food at weekends is poor.’ We observed lunches served at our inspection visit. This was well organised and meals were suitably prepared and presented. Staff assisted those who required in a sensitive manner and took meals to individual’s own rooms for those who did not wish to eat in the dining room. Menus are provided on a four-week rota and are displayed in large print. They detail a balanced nutritious diet, with the main meal of the day at lunchtime, which is a set menu with no written detail as to alternatives that may be available. Teatime is a lighter meal providing a choice of sandwiches and soups and some buffet snacks, with a warm alternative. All four weeks menus are displayed together with no clear indication as to which menu applies for that particular week. People spoken with said they did not know what was for lunch. Some people said that if they do not like what is on the menu the cook provides an alternative if they ask and we were advise that where anyone makes such a request, the cook keeps a record of any alternative food provided. However, a significant number of people said there was no choice. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 17 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): NMS 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s rights to complain and to be protected from harm and abuse are upheld and taken seriously. EVIDENCE: At our last key inspection of this service we judged that complaints, concerns and allegations are taken seriously and are acted on by the home in accordance with recognised guidance, which protects people from abuse. In our annual quality assurance questionnaire completed by the home, they say that they provide people with clear information about how to complain, that they take all complaints and concerns seriously and take action as necessary. They say that over the last twelve months they have improved their record keeping for complaints received and intend to continue dealing effectively with any complaints they may receive over the coming months. They also gave us statistical information that we asked for about complaints they have received over the last twelve months. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 18 At this inspection four people told us that they always know who to speak with if they are unhappy and know how to make a complaint. Two people told us that they usually do and two said they do not. A copy of the home’s complaints procedure is displayed in the home in large print format. It details clear information, including contact details of outside relevant agencies. The home’s complaints records are well maintained and provide clear details as to the nature of the complaint, investigation, outcomes and action taken where necessary. The home had received five complaints over the last twelve months. One of which was referred to the provider via the Commission. Following investigation of these by the provider, four of the five are upheld and records detail that satisfactory action is taken in respect of these. Complaints made, that are upheld include - poor attitude of a named carer and failure to promote individual choice for a service user, insufficient staffing levels, missing personal laundry and lack of timely assistance with personal care for one service user, alleged inappropriate behaviour from named care staff. The fifth complaint alleged the home’s failure to ensure prompt medical attention for a service user following a fall and which was not upheld. Staff spoken with demonstrated a clear understanding of their role and responsibilities in relation to dealing with complaints and the home’s internal policy and procedures concerned with protecting people from harm and abuse. However, some care staff is not conversant with external procedures and including the role and contact details of social services as the lead agency for safeguarding people. Policy and procedural guidance is in place with regard to recognising abuse and safeguarding adults and staff confirmed that they receive training and instruction in this area. Although, senior staff were not clear as to when to notify social services of any allegation of abuse. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 19 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): NMS 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall people live in a safe, clean, homely and generally well-maintained home, which suits their needs. EVIDENCE: At our last key inspection of this service we judged that people benefit from living in a safe, clean and comfortable environment, which is well maintained and reasonably well equipped. Although the routine provision of a number of previously identified facilities and equipment for people may better serve to promote their autonomy, privacy, choice and best practise. We made a recommendation that suitable locks should be routinely fitted to people’s bedroom doors (which can be easily accessed by staff in an The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 20 emergency) and lockable storage routinely provided in each bedroom in order to proactively provide people with their own choice as to whether to use them or not. These have are not addressed at this inspection. We also recommended that the home provide a mechanical sluicing disinfector. This is in place, although does not operate and is not accessible as the small room it is located in is used for storage of large equipment items. There is a hand sluice in a dedicated location. In our annual quality assurance questionnaire they say that they provide people with a beautiful grade II listed home set in attractive grounds, and which is well maintained, clean and comfortable. They have identified key improvements made over the last twelve months as the employment of a new Housekeeper who ensures high standards throughout and that the requirements of the Fire Officer’s (Local Fire Authority) report are met to their satisfaction. The Commission is provided with a copy of the Fire Officer’s report from their visit of 29 November 20077, which confirms compliance with previous recommendations made. They say they could improve by ensuring they keep up with redecoration required and intend to review their redecoration programme for the coming twelve months. They also provided us with satisfactory information about the maintenance of some systems and equipment that we asked them about. At this inspection the home was observed to be clean and odour free. However, a communal toilet with sink located on the first floor is used for storage of dirty linen. At our visit there were two full linen skips causing an odour and restricting space for people. This does not promote good infection control practise. One person who uses this facility expressed dissatisfaction about this. The floor covering to a ground floor toilet off the dining room was split, old and worn and lifting around the edges, which does not promote good infection control practise. The dining room carpet was also worn and ready for replacement. The manager advised that there are plans to replace these in the near future. However, with regard to general cleanliness in the home, all people told us that the home is always or usually fresh and clean. Comments received include: ‘ There is a good team of cleaning staff.’ ‘Housekeeping is good and my room is cleaned well every day.’ The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 21 ‘The laundry service is very good.’ One person we case tracked had requested to move to another room and also to be provided with a lockable storage facility. The manager advised their requests would be met. Otherwise, people we case tracked were provided with facilities and equipment in accordance with their assessed needs. People are also encouraged to personalise their own rooms. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 22 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): NMS 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are well met by competent staff that is suitably recruited, inducted, trained and deployed. EVIDENCE: At our last key inspection of this service we judged that people’s needs are usually met from a staff team who are recruited, inducted and trained effectively. We also judged that then recent improvements to staffing levels should be in the better interests of people who live and work at the home, although a further review of staff (nursing) skill mix may further benefit. We made two requirements, that staffing levels must continue to be consistently planned and sufficiently ensured. And that, The registered person must ensure suitable provision for staff skill mix, which is planned to ensure that people’s needs are consistently met and that the arrangements for staff deployment are based on good evidence and are in the best interests of people who live and work at the home. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 23 In our annual quality assurance questionnaire completed by the home, they say that they always strive to ensure the right staffing arrangements and that staff is effectively recruited, inducted, trained and deployed. They tell us that for up to thirty-five service users they currently they provide two Registered Nurses during the morning with x1 care manager and one Registered Nurse during the late afternoon/evening and with six care support staff throughout the day. That at night there is one Registered Nurse and three care staff. They say they keep accurate records/staff rotas and provide an additional fifty-six hours at peak times with good domestic service support. They also told use that over the last twelve months they have developed their staff-training programme, although feel that this could be improved further. At this inspection there were thirty-five people accommodated, all who receive nursing care. Individual assessments of each person’s dependency level are recorded and regularly reviewed, using a recognised dependency assessment tool. Staff spoken with and surveyed described satisfactory arrangements for their recruitment, induction, training and deployment and records that we examined in relation to these areas were reflective of this. Additional care/support staff hours are used at key times, such as mealtimes. Fifty of care staff has achieved at least NVQ level 2 with a further 33 working towards. The majority of people we spoke to or surveyed told us that staff is usually available when they need them, although two told us, they always are and one that they sometimes are. Comments include: ‘Staff are always to hand.’ ‘Even when there are unforeseen shortages, staff is always helpful and caring.’ The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 24 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): NMS 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the home is well managed and run, in people’s best interests. Although more focused management monitoring in identified staff practises may further promote people’s safety and welfare. EVIDENCE: At our last key inspection of this service we judged that the home was reasonably well managed to promote and protect people’s health, safety and welfare. However, manpower/staff deployment planning was not always consistent to people’s best interests. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 25 We made two recommendations about publishing the outcomes of satisfaction surveys with people who use the service and in formally seeking the views of outside stakeholders/professionals about the service, although these have been acted upon. In our annual quality assurance questionnaire completed by the home, they say that they the home is well managed and run in people’s best interests and their health, safety and welfare promoted and protected. They say that this includes that relating to individual’s financial interests and in ensuring safe working practises from staff. They also tell us that over the last twelve months they have improved their administration filing systems and feel they could do better by publishing the results of their satisfaction surveys, although say they need advice as to how to do so. Since our last key inspection we have approved Dawn Winfield as the registered manager for the home. At this inspection we found there are satisfactory systems in place for the management and administration of the home, including quality assurance and monitoring and the safekeeping and handling of residents monies. Although there was no progress with our recommendation made at our last key inspection about sharing/publishing the results of satisfaction surveys and undertaking such surveys with key stakeholders. We are advised at this inspection that this is something, which the home, aim to develop and to achieve. Also, focused management monitoring in respect of record keeping for medicines administration is needed – see Healthcare section of this report for details. Staff told us about satisfactory arrangements for ensuring safe working practises, including the provision of equipment and training. However, staff practises in relation to the storage of dirty laundry, do not always accord with best practise. These are specifically referred to under the Environment section of this report. The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 27 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 Details of the administration of medication on Medicines Administration Records must be correctly recorded. Gaps must not be left and staff must either sign to indicate where a medicine is administered as prescribed or where this is not given, the recognised coded reason must be recorded as necessary. Original timescale 18/08/07 extended timescale agreed. Staff must be conversant with 31/10/08 the role of Social services as lead authority in respect of safeguarding vulnerable adults procedures and the point at which they would report to that authority in accordance with the home’s internal procedures. Dirty linen must not be openly 31/10/08 and routinely stored in toilets accessed by resident. Separate suitable and dedicated storage area must be provided in order to promote good infection control. DS0000002087.V368873.R01.S.doc Version 5.2 Page 28 Timescale for action 16/09/08 2. OP18 13(6) 3. OP38 13(3) & 23(2) The Lodge Nursing 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. Refer to Standard OP15 Good Practice Recommendations The menu should offer a written choice of meal at lunchtime and displayed in such a manner that the menu for the day is clear and accessible to all people, who should be individually consulted as to their choice before being presented with their meal. The home’s safeguarding procedures should be reviewed to ensure that they give clear instructions to staff for the timely reporting of any allegation of abuse to social services, including relevant contact details and all staff should be familiar with these. The mechanical sluicing disinfector should be kept in a good state of maintenance and repair. The results of satisfaction surveys should be published/shared with people, including any action that may be taken to develop the service as a result of these. 2. OP18 3. 4. OP26 OP33 The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 © 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 The Lodge Nursing Home DS0000002087.V368873.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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