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Inspection on 18/07/07 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 18th July 2007.

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.

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 live in a safe, clean and comfortable environment, which is well maintained and reasonably well equipped. The majority of people are suitably informed, assisted and supported throughout the admissions process and their needs are reasonably well determined with them. People`s health care needs are generally well met by a staff team who treat them with courtesy and respect. Food provided is to a good standard and meets with people`s choices and risk assessed needs. Complaints, concerns and allegations are taken seriously and are acted on by the home in accordance with people`s best interests and recognised guidance concerned with safeguarding of older persons. Staff employed are effectively recruited, inducted and trained, which usually determined that people`s needs are met. The home is reasonably well managed and people`s health, safety and welfare well promoted and protected.Lodge, The Nursing HomeDS0000002087.V341365.R01.S.docVersion 5.2

What has improved since the last inspection?

There has been some improvement in the arrangements for staff deployment, although this has been during the week (Monday to Friday). A formal system of individual staff supervision has been introduced. A review of the hot and cold water systems in the home has been undertaken, with suitable measures in place to promote safe storage and distribution of water to all outlets. A review of storage arrangements has been undertaken with additional separate storage space provided and substances, which may be potentially hazardous to people`s health, are safely stored.

What the care home could do better:

Ensure that the home`s service guide provides people with clear and detailed information about fees in accordance with that specified in the Care Homes Regulations 2001 (amended 2006). Develop the format(s) of key information provided for people about the home to include audio-tape for those who may have considerable sight deficits or who may be registered blind. Develop practise and methodology, integral to the home`s care philosophy, which best promotes individual rights to choice with regard to their preferred daily living routines and lifestyle preferences. Ensure that medicines practises are always in the best interests of people living at the home and consistently in accordance with safe and recognised practises. Develop staff knowledge with regard to the Mental Capacity Act 2005 and its implications for practise in care homes with a view to implementing best practise. Ensure the routine provision of identified facilities and equipment for people (staff and residents), so as to better promote people`s autonomy, privacy, choice and best and safest practise.Lodge, The Nursing HomeDS0000002087.V341365.R01.S.docVersion 5.2Ensure better planning that staff levels, skill mix and the arrangements for staff deployment are always consistently and effectively determined. Publish the results of service user surveys conducted by the home and make these available to people. Develop existing methodology for consultation with people about the home and its services, to include outside stakeholders in order to seek as to how the home is achieving its goals for people accommodated.

CARE HOMES FOR OLDER PEOPLE Lodge, The Nursing Home Hayfield Road Chapel-en-le-frith Derbyshire SK23 0QH Lead Inspector Sue Richards Unannounced Inspection 18th July 2007 09:30 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.V341365.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. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 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 sachi.hardy@btconnect.com Union Healthcare Midlands Carole Anne Dennehy 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.V341365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th April 2006 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, which is a small town which lies 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, with interim temporary management arrangements due to the absence of the registered manager at the time of this inspection. 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: Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on all the information we hold about the service over the last 12 months. This includes the previous key inspection report of 06 April 2006, information provided by the home by way of a completed annual quality assurance questionnaire, and the unannounced site visit for the purposes of this inspection. A total of ten surveys were randomly sent out to people who live at the home, for which we received no returns. Case tracking was used as part of the methodology. This involved the random sampling of three people whose care and service provision was examined more closely. Discussions were held with those service users (in accordance with their given capacities) and where possible their representatives and also the staff involved in their care. Individual’s care and associated records were examined and their private and communal accommodation inspected. At the time of this site/inspection visit, there were thirty-five people accommodated all in receipt of nursing care, accommodation and support. What the service does well: People live in a safe, clean and comfortable environment, which is well maintained and reasonably well equipped. The majority of people are suitably informed, assisted and supported throughout the admissions process and their needs are reasonably well determined with them. People’s health care needs are generally well met by a staff team who treat them with courtesy and respect. Food provided is to a good standard and meets with people’s choices and risk assessed needs. Complaints, concerns and allegations are taken seriously and are acted on by the home in accordance with people’s best interests and recognised guidance concerned with safeguarding of older persons. Staff employed are effectively recruited, inducted and trained, which usually determined that people’s needs are met. The home is reasonably well managed and people’s health, safety and welfare well promoted and protected. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ensure that the home’s service guide provides people with clear and detailed information about fees in accordance with that specified in the Care Homes Regulations 2001 (amended 2006). Develop the format(s) of key information provided for people about the home to include audio-tape for those who may have considerable sight deficits or who may be registered blind. Develop practise and methodology, integral to the home’s care philosophy, which best promotes individual rights to choice with regard to their preferred daily living routines and lifestyle preferences. Ensure that medicines practises are always in the best interests of people living at the home and consistently in accordance with safe and recognised practises. Develop staff knowledge with regard to the Mental Capacity Act 2005 and its implications for practise in care homes with a view to implementing best practise. Ensure the routine provision of identified facilities and equipment for people (staff and residents), so as to better promote people’s autonomy, privacy, choice and best and safest practise. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 7 Ensure better planning that staff levels, skill mix and the arrangements for staff deployment are always consistently and effectively determined. Publish the results of service user surveys conducted by the home and make these available to people. Develop existing methodology for consultation with people about the home and its services, to include outside stakeholders in order to seek as to how the home is achieving its goals for people accommodated. 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. Lodge, The Nursing Home DS0000002087.V341365.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 Lodge, The Nursing Home DS0000002087.V341365.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 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people are provided with information about the home and its services, information about fees is insufficient and does not accurately inform people. People’s preferred daily living routines, choices and lifestyle preferences are not best accounted for and with them on their admission. EVIDENCE: At our previous inspection of this service in April 2007, we judged that people are provided with key information they need to help them make a decision about whether to live at the home and that individual’s needs are suitably assessed with an assurance that these can be met by the home. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 10 In our annual quality assurance assessment questionnaire completed by the home, they said they felt that their approach to people’s admission to the home is something they do well, which they feel can be evidenced by speaking with people. They did not identify any areas for improvement in respect of the identified national minimum standards in this section, but felt that they had improved their assessment approach, which better identifies aids and equipment required for those people with physical disabilities. At this inspection we were provided with copies of the home’s statement of purpose and its service user guide. Although some information was provided regarding fees in the statement of purpose, there was no information relating to fees within the service user guide and information provided was in standard print format only. This was discussed with management, who advised that this was being revised to include this and to provide information for people in larger print version, to assist people with sight difficulties. Since this inspection, we are advised that the revised version has been circulated within the home with a copy provided for the Commission. However, key information about the home is not currently available in tape format, which may better assist those people with significant visual disabilities or who are registered blind. People spoken with via case tracking said that their families had supported them during their admission to the home. They said that their needs were discussed with them, or with their representative. However, for one person, case tracked, a recorded decision made by them on their admission regarding choice of facilities/equipment was not upheld (see also Daily Life and Activities section of this report). Individual’s recorded needs assessment information was examined for those people case tracked. These were generally well recorded and comprehensive, in accordance with a recognised nursing assessment model with periodic reviews. There were written care plans in place with regard to individual’s personal and health care deficits, although there was no written daily living plan detailing individuals known preferred daily living routines and choices. This was discussed with people. Staff spoken with said that they usually found out this information as they got to know people on an individual basis, but some felt that this was an area, which could be improved for the benefit of people who live at the home. People accommodated said that staff worked hard to meet their needs. Since the inspection a copy of a draft proposal of a daily living plan format has been prepared by the home. The home does not provide for intermediate care. Lodge, The Nursing Home DS0000002087.V341365.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. People’s health care needs are generally well met by staff who treat them with courtesy and respect. Medicines practises as observed during the inspection, may have placed people at risk. However, the immediate action taken by the home should ensure that these are now managed safely and in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that residents’ healthcare needs were met, and that care was provided with respect and sensitivity. In our quality assurance questionnaire completed by the home they said that they promote people’s optimum health by ensuring people have regular and specialist access to outside health care professionals and also to their written Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 12 care plans, which are kept in their own rooms and are formulated in accordance with individual’s risk assessed needs and regularly reviewed. They said that the introduction of a key worker system and providing copies of basic care plans for people in their own rooms were good improvements since the previous inspection. At this inspection we spoke with people about their care and also with staff about the organisation and arrangements for care delivery and support for people. We also examined the written care plans and associated health care records of those people case tracked. Feedback was very positive and care staff spoken with demonstrated a caring and empathic attitude and was conversant with people’s needs. People said that staff usually treated them in a respectful and courteous manner and upheld their privacy and dignity. (Comments made under Section One, Choice of Home, also apply here with regard to individual’s daily living routines and preferences). Written care plans were formulated in accordance with individual’s risk assessed needs and had regularly recorded reviews. They were reflective of recognised practise concerned with the care of older persons. Access to outside health care professionals was well accounted for, including that relating to routine health care screening and specialist treatment and advice. The arrangements for the management and administration of medicines were examined via case tracking. Although staff responsible, was observed to administer medicines in a sensitive manner to people, there were a number of areas where poor practise was witnessed, which were not in accordance with recognised practise and guidance for the management and administration of medicines. These included areas of practise in the administration, recording and storage of medicines. These were raised with management during the inspection, who then advised of the immediate action they were taking. They have also provided us with written confirmation detailing the action being taken by them to ensure safe medicines practises in the home. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The introduction of daily living plans, should better promote people’s own choices with regard to their daily living arrangements and lifestyle preferences. Food provided is to a good standard and meets with people’s choices and risk assessed needs. EVIDENCE: At our last inspection of this service, we judged that, although some activities were arranged for residents, these could be improved, and that the quality of food at the home was good and people’s contact with their family and friends was well supported. In our annual quality assurance questionnaire completed by the home, they said they provide information about activities for people and that they always provide wholesome, good quality, fresh food with seasonal variety catering for any special dietary requirements with a choice of where to eat at breakfast and Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 14 lunch. Information provided in the questionnaire states, “our matron likes to see everybody down for lunch which is a very social affair, breakfast trays are usually served in individual’s rooms and tea is a low key affair usually served wherever our residents are most comfortable.” They said they have improved the range of activities and the recording of people’s social care needs and interests, although still feel that activities could be further improved by providing training for the activities co-ordinator. They also plan to replace their mini-bus with one that has greater capacity for wheelchairs. Discussions with people indicated that further development of activities, which account for people’s varying levels of confusion may benefit. At this inspection we spoke with people about their daily living arrangements, including meals and social activities. People said there are a reasonable variety of activities and entertainments offered on a regular basis and that they choose their involvement in these. Information regarding activities is regularly openly advertised and people are also advised on a daily basis. Examples of activities, included gentle exercise type such as skittles and quoits, picture/board games, bingo, manicures, aromatherapy, baking, arts and crafts and quizzes. Records are kept of people’s engagement in social activities and also entertainments in the home. Seasonal celebrations are also undertaken, including access to community flower festivals and via church for those who may wish to attend. We are advised that all people accommodated hold Christian based religious beliefs and examples of individual practises were provided. Information is openly provided in the home for people about how to contact advocacy services. Discussions were also held with people about how individual choice is promoted and the care records for people case tracked were examined. A recorded decision made by one person case tracked at the point of their admission was not upheld, although the reasoning behind this was not clearly recorded in terms of their rights and capacity in accordance with the Mental Capacity Act 2005, which staff were not familiar with. All people spoken with said that they enjoyed the food provided, which they felt was good quality. They also said that the cook regularly spoke with them about their satisfaction with meals. The cook provided an ongoing record kept about people’s expressed satisfaction or otherwise of meals provided. This record also included where changes were made to menus as a result of those consultations. People said they could usually have drinks and snacks at any time, although at weekends sometimes mid morning drinks were late or not provided at all. Some also said that at these times, some of their choices regarding their daily living routines could not be met as they would prefer due to staff unavailability. Staff spoken with confirmed this to be the case and said that this was due to insufficient staffing arrangements at weekends. (See staffing section of this report). Tables were attractively set at lunchtime and Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 15 staff assisted people in accordance with their needs in a sensitive and unhurried manner. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 16 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. Complaints, concerns and allegations are taken seriously and are acted on by the home in accordance with recognised guidance, which protects people from abuse. EVIDENCE: At our last key inspection of this service we judged that people have opportunity to complain if they wish to do so and that staff are aware of their responsibilities with regard to safeguarding adults from abuse. In our annual quality assurance questionnaire completed by the home, they said that people are given suitable information about how to complain, that staff are provided with the necessary information and training with regard to safeguarding adults from abuse and that each staff member undergoes proper recruitment checks during their recruitment. They said they keep good records about any complaints made, although pride themselves that few are made about their service. They also said they take safeguarding adults principles and procedures very seriously have acted Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 17 appropriately following a recent incident they reported to social services via nationally recognised safeguarding adults procedures. At this inspection we looked at how information is provided for people in terms making a complaint and also for staff in respect of safeguarding vulnerable adults. We spoke with people about the above and looked at the home’s complaints record and also reviewed the information we hold about the service with regard to concerns, complaints and allegations. Information on how to complain is openly displayed in the main entrance area of the home and also within the service user guide, which is provided in each persons’ own room on their admission. This was written in standard type format, although since our inspection we are advised that a large print format is now also provided. During the inspection we discussed the role of the Commission in terms of complaints and the home agreed to amend the information on their procedure accordingly. A revised copy, including large print format has since been received, which is satisfactory. People spoken with knew how to complain and said they were confident to do so, although felt that any concerns they had were usually dealt with without the need to make a formal complaint. Staff is conversant with their responsibilities with regard to dealing with concerns, complaints and allegations and they are provided with suitable policy and procedural guidance to assist them in these respects. Since the previous key inspection of this service, the home has notified us of one allegation of verbal abuse and also a complaint alleging staff bullying. These were both recorded by the home, including details of the action they have taken regarding these, which is satisfactory. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 18 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): 19 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a safe, 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 (staff and residents) may better serve to promote people’s autonomy, privacy, choice and best and safest practise. EVIDENCE: At our last key inspection of this service we judged that the home is well maintained and decorated with comfortable communal and bedroom areas. In our annual quality assurance questionnaire completed by the home, they said they provide a clean and well-maintained home of considerable character, Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 19 with many bedrooms above the minimum size and for which there is a rolling programme of repair and renewal. They pride themselves in their laundry facilities and arrangements, which they feel is to an immaculate standard. They said they aim to maintain environmental standards in the home over the next twelve months. At our visit we inspected the private and communal areas of those people case tracked and also the laundry facilities. We also spoke with people about regarding their satisfaction with their environment. All areas of the home seen were clean and odour free, well maintained, furnished and equipped to suit people’s assessed needs. Evidence of ongoing maintenance and review and upgrading of facilities was also seen, including the provision of additional storage facilities. People’s bedrooms are not routinely supplied with locks to their bedroom doors or lockable storage space, although there is a system for consultation with people on their admission as to whether they wish for these to be provided. Records of this consultation were seen in the care records of those people case tracked. However, lockable storage was not provided for one person who said they had requested this as detailed in their care records. (See also Social care and Activities section of this report – autonomy and choice). Suitable hand washing facilities are provided for staff and hand sluicing facilities for the cleaning of human waste receptacles. The home does not provide a mechanical sluice, which has been previously recommended by us as best and safest practise and which would include the more efficient use of staff time/resources. People said that the standards of laundry were very good. The laundry facilities are extensive and the laundry person and assistant spoken with clearly take great pride in ensuring that people’s clothing and personal items are laundered to a high standard. All large items such as bed sheets are iron by hand to a good standard, although the provision of a purpose rollator iron may better assist in terms of time and resources taken to achieve this. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 20 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): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are usually met from a staff team who are recruited, inducted and trained effectively. The 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. EVIDENCE: At our last key inspection of this service we judged that staffing levels were not always meeting residents’ needs, which could potentially put residents at risk and that training for staff had improved and safe recruiting practices were being followed. We made a requirement at that staffing levels must be revised and adjusted accordingly. In our annual quality assurance questionnaire completed by the home they said that they have improved their staff deployment arrangements and ensure that staff are effectively recruited, inducted and trained. They said that they Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 21 have also improved the monitoring of staff personal development, which includes the provision of a training matrix, which is visible to all staff. They said that they aim to continue with the above. At this inspection we spoke with staff about the arrangements for their recruitment, induction, training and deployment. We also examined records kept by the home in respect of these areas. We also spoke with people accommodated about staff availability. At the time of this inspection, there were thirty-one people accommodated, all receiving nursing care. Staff deployment arrangements were improved and satisfactory during the week – Monday to Friday. However, staffing arrangements were insufficient at weekends, which was further impacted by care staff, deployed for care duties on the rota, also covering the kitchen with no additional staff time provided. Given the number and dependencies of people accommodated and staff sickness levels, this resulted in people often not being provided with the mid morning drinks round and more rigid practises and routines, which impacted on people’s daily living choices. Staff also said that this was very tiring, given the high dependencies of people accommodated and their twelve-hour shift patterns. This was raised with management, who took immediate action to rectify this during the inspection. Increase staff cover was organised for the coming weekend and recorded on the duty rota and further duty rotas are provided, which indicate increased staffing levels at weekends consistent with those provided during the week. Twelve staff had left over the preceding 12 months, although were no records kept regarding their reasons for leaving/exit interviews. The personal records of four of the most recent staff starters were inspected. These all contained satisfactory information with regard to people’s recruitment, induction, supervision and training. Over 80 of care staff have achieved NVQ level 2 or above, with three having NVQ level 3 and one NVQ level 4. Registered nurse cover is always provided, although there are times of the day when there is only one nurse provided, usually between 4 and 7 pm, although at weekends this was from 1 to 7pm. Some staff felt that given the nursing needs and dependencies of people accommodated, that the staff skill mix would benefit from an additional nurse within the total staff numbers. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is reasonably well managed to promote and protect people’s health, safety and welfare. However, consistent manpower/staff deployment planning and further engagement with outside stakeholders by way of formal consultation about the home and its service provision may benefit people who use the service. EVIDENCE: At our last key inspection of this service we judged that the health, safety and welfare of residents and staff were generally promoted and protected, although some areas needed improvement. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 23 We made three requirements with regard to health and safety and storage in the home, which were seen to be complied with at this inspection. In our annual quality assurance questionnaire completed by the home they said that they have good management arrangements with clear lines of accountability and good arrangements for ensuring staffs’ safe working practises and ensuring environmental health and safety. They also said they have quality assurance and monitoring systems in place, which inform action plans for the annual development of the home. They identified key improvements made, which include mechanisms for obtaining feedback from people accommodated and also their representatives. They also said they had developed their policies and procedures and intended to continue this over the next twelve months. During this inspection, we spoke with management present about the current and ongoing arrangements for the management of the home in the absence of the registered manager, which are satisfactory in principle. We also spoke with staff about the arrangements for ensuring safe working practises in the home and examined associated staff training records, which are also satisfactory. We spoke with management about quality assurance systems in place and also with people accommodated about how they are formally consulted with. The home operates a comprehensive system, which include formal consultation with people accommodated or their families, about the home and its services. Feedback obtained from the most recent satisfaction survey was positive and management have collated this feedback into graphical results. There were however, no mechanisms currently in place for making public the results of those surveys. Consultation is not formally undertaken with outside stakeholders. Residents meetings have been held in the past, although not recently. Management and staff advised that this is due to current capacities conditions of people accommodated, although did advise that this is reviewed periodically. There is a communications book openly provided in the main reception area for people to write in anything they wish about the home and also a suggestions box is in place, although it was reported that uptake of the latter is rare. We also examined the home’s arrangements for the management and handling of people’s monies and also the management of accidents and untoward incidents. These were also satisfactory. A system of individual staff supervision was commenced since the previous inspection (as recommended at our last inspection of this service). Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 24 Arrangements to ensure staff safe working practises were discussed with management and staff, including staff training and the provision of equipment, which was also looked at via case tracking. These are satisfactory. No environmental hazards were noted during our inspection of the environment and details regarding the maintenance of equipment provided on the annual quality assurance questionnaire completed by the home are satisfactory. We discussed hot and cold water system storage and looked at records. These were in accordance with safe practise. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (amended 2006) Requirement Timescale for action 30/09/07 2. OP9 13 2. OP9 13 Details of the total fee payable in respect of services provided, including any additional charges to that fee and the arrangements for their payment must be provided within the service user guide, together with a statement as to whether any matters would be different in circumstances where a person’s care is funded, in whole or part by a person other than them. Medicines must always be safely 19/07/07 administered. Routine ‘potting’ of all people’s medicines at the same time and in advance to the time for their individual administration must cease as this may place people at unnecessary risk due to the increased potential for medicines errors. Medicines administration records 18/08/07 must always be properly kept. Where medicines instructions are hand written, these must always detail full medicines instruction, be signed and dated by the person completing them and countersigned and dated by a DS0000002087.V341365.R01.S.doc Version 5.2 Lodge, The Nursing Home Page 27 3. OP9 13 4. OP9 13 5. OP9 13 6. OP9 13 7. OP9 13 8. OP27 18 witnessing staff member in order to reduce the risk of potential medicine errors to service users. Medicines administration records must always be properly kept. Gaps in the recording of the administration of people’s medicines must not be left on the medicines administration record (MAR) sheet. Staff responsible must sign to indicate that these have been given or where these have not been given the appropriate coded reason must be recorded, with additional written confirmation in individual’s daily care records as necessary. Medicines prescribed for any person must be ordered and obtained for their use as soon as is reasonably possible. Staff must not administer medicines belonging to a named person (as labelled) to any other person accommodated. Homely medicines remedies must only be administered in accordance with recognised practise and the home’s policy guidance concerned with homely remedies. Medicines must be safely stored. Items other than medicines must not be stored in medicines cupboards, which are to be solely for the use of storing people’s medicines. Medicines must be safely stored. People’s inhalers must not be removed from their outer container and the pre-printed named instruction labels as provided by the supplying pharmacist must not be removed from individual’s medicines containers. Staffing levels must continue to DS0000002087.V341365.R01.S.doc 18/08/07 19/07/07 19/07/07 18/08/07 19/07/07 19/07/07 Page 28 Lodge, The Nursing Home Version 5.2 9. OP27 18 be consistently planned and ensured throughout each week as established at this inspection. The registered person must 30/07/07 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. 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 OP1 Good Practice Recommendations Consideration should be given to providing key information about the home, including the home’s service guide in an audio-tape format to assist those who may have considerable sight deficits, or who may be registered blind in choosing a home. Individual daily living plans should be introduced as agreed with each person, and which detail their known lifestyle preferences and daily living routines. Thereby promoting inclusion, consultation and choice for people. Their signed agreement to these should be recorded wherever possible. Consideration should be given to the implications of the Mental Capacity Act 2005 for care homes in that staff responsible should be conversant with its core principles in terms of promoting individuals autonomy and choice, which should be clearly demonstrated through record keeping within care plans and associated records. Suitable locks should be routinely fitted to people’s bedroom doors (which can be easily accessed by staff in an 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. The service should provide a sluicing disinfector. Results of service user surveys should be published and DS0000002087.V341365.R01.S.doc Version 5.2 Page 29 2. OP3 3. OP14 4. OP24 5. 6. OP26 OP33 Lodge, The Nursing Home 7. OP33 made available to people who live at the home and their representatives. The views of outside stakeholders (ie GPs, healthcare professionals etc) should be sought as to how the home is achieving its goals for people accommodated. Lodge, The Nursing Home DS0000002087.V341365.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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