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Inspection on 08/08/05 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 8th August 2005.

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

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

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

What has improved since the last inspection?

A number of building issues identified in the previous inspections had been addressed and there were programmes in place to ensure that the outstanding issues, such as the replacement of bedroom furnishings and carpets, would be addressed in the coming year. The home has started to address the issue of bathrooms and is having discussions with the Commission for Social Care Inspection about how to ensure they have sufficient bathing and showering facilities. The dining-room had been refurbished to a good standard.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE The Lodge Nursing Home Hayfield Road Chapel-en-le-Frith Derbyshire SK23 0QH Lead Inspector Stuart Hannay Unannounced 8 August 2005 10.00am 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 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 C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Lodge Nursing Home Address Hayfield Road Chapel-en-le-Frith Derbyshire SK23 0QH 01298 814032 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Union Healthcare Midlands CRH N - Care home with nursing 36 Category(ies) of 36 places - OP Old age registration, with number of places The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None stated Date of last inspection 10/2/05 Brief Description of the Service: The Lodge Nursing Home is located on the outskirts of Chapel en le Frith. The Victorian building has been extended and sits in its own grounds and can accommodate 36 older persons on three floors. A large dining room and conservatory plus a separate lounge are provided on the ground floor. A further smaller lounge is also provided on the first floor. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Six service users were interviewed on the day of the inspection. A check was made of the fire testing and training records and three care plans were checked. An inspection was made of the bedrooms, corridors, bathrooms and lounge areas and the previous requirements were checked with the manager. The staffing rotas were seen to check staffing levels and two sets of recruitment records were also seen. What the service does well: The service users spoke positively about the service provided at the home. They said that the staff generally had a very positive attitude and gave them all the help that they needed. They felt that there was a pleasant atmosphere at the home and one service user said that she was pleased that the staff like ‘a laugh and a joke’. Most of the service users spoken with were able to clearly communicate their feelings about the service – those who could not were well dressed and clean, the men had shaved and the women were wearing makeup. Clothes, glasses, dentures and hearing aids appeared to have been well cared for. Service users said that they could have visitors whenever they wished. Comments about the food were generally positive, both in the amounts provided and the quality. The service users felt that they had enough to do and that entertainment was provided – some of those spoken with said they preferred to spend most of their time in their rooms and were able to do this. The care records were up-to-date, they had been thoroughly monitored and reviewed and the information in the care plans reflected the help that service users said that they needed. Staffing levels were being maintained which ensure that the service users’ needs can be met, however they need to be kept under close review as the care records show that a significant number of the service users need two people to assist them. The environment was pleasant, there were no unpleasant odours and bedrooms were highly personalised. The fire training records were well-maintained and the fire systems had been regularly checked by the home and external agencies. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service users’ needs are fully assessed prior to them coming into the home to ensure the home can meet their individual needs. EVIDENCE: Three service users’ care plans were checked in detail. Each of these contained assessments made by the placing professional such as a social worker or a registered nurse. The assessments covered a wide range of service users’ needs at home or in hospital and what staff would need to do to meet these needs. The home’s initial assessments were based on these. The manager said that she visits prospective service users at home or in hospital and completes an assessment to ensure that their needs can be met by the home. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 Service users’ health and personal care needs are met by staff who treat them with respect and dignity. Social needs need to be incorporated in care plans and formal checks are required on the medication system by a pharmacist. EVIDENCE: Three service users’ care plans were checked during the inspection. They contained a detailed range of health assessments, including weight charts, risk assessments for mobility, falls and the use of bed-rails. Pressure area and skin integrity assessments were in place. These had been reviewed and updated in all the plans seen. The plans described what staff intervention was needed to meet the needs of service users. Three of the service users interviewed described their care needs and the care plans examined matched their description of what help they needed, however one service user and one relative did not feel that they had been consulted very often about the care plan. There was scant information in the care plans about service users social needs and although this was recorded elsewhere, it needs to be recorded in the care plans in a format that respects individual’s confidentiality. Service users said that the staff treat them in a friendly, polite way with respect and dignity. The records contained records of contact with GPs, hospitals, dentists and chiropodists. Some service users were not able to clearly describe their The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 10 needs due to apparent communication problems linked to dementia – however, those spoken with looked well-cared for and clean. Service users glasses, hearing aids and dentures appeared to be well looked after. Some service users said that the home kept and dispensed their tablets for them and that they were happy with this – consent forms were seen in the care plans. A new storage cupboard had been purchased for medications and was due to be installed. There were no apparent problems with the storage of medication but this had not been checked for some time by the supplying pharmacist. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 13 14 Service users felt they had control over their lives and maintain contact with family and friends. There was a range of leisure activities which matched their interests and preferences. EVIDENCE: Six people spoken with said that they could have visitors whenever they wanted and that their visitors were welcomed into the home by staff. They said that visitors could come to the home at any reasonable time. One lady interviewed was waiting to go out on a trip with a relative. Service users interviewed said that they could get up and go to bed and take baths when they wished. They said that there was a range of formal and informal activities including bingo dominoes and sing-a-longs. There were visiting entertainers and singers who came into the home. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 There is a formal complaints system at the home. Service users felt that they could make complaints, that they will be taken seriously and complaints would be acted upon. Staff are trained in the recognition of abuse. EVIDENCE: The home had a complaints procedure which had timescales for resolution. It contains the current address of the Commission for Social Care Inspection and informs the complainants that they are able to contact the Commission at any stage of the complaint if they wished to do so. Service users and relatives interviewed said that they would have no hesitation in putting any concerns to the staff or the owners and felt that they would be taken seriously. Previous reports identify that the home has procedures for the reporting and recording of abuse. Staff training in this area is now included as part of the home’s training programme. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 21 22 23 26 Service users live in a comfortable and safe environment. The home was generally well-maintained and clean. The number of bathroom/shower rooms available to service users needs to be increased. EVIDENCE: The environment appeared to be well-maintained and there were no obvious hazards noted on the day of the inspection. The lounges were well-decorated with good access for all service users to both indoor and garden areas. The home is in the process of a major revision of its bathing facilities in consultation with the Commission for Social Care Inspection, however there are currently only 3 usable bathrooms for 36 service users, which falls below the required ratio of 1 bathroom to 8 service users. The home has a high number of people who need the hoist to help them mobilise and there is a range of equipment available to facilitate this. Bedrooms were generally welldecorated and clean and tidy. They had been highly personalised and all the service users interviewed expressed satisfaction with their room. There is an ongoing programme for the replacement of worn carpets and damaged The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 14 furnishings, which has been implemented but will need to be kept under review for a further period of time. Service users had been consulted about whether they wished to have locks on their doors: at the time of the inspection, none had requested this. The dining-room had been redecorated and refurbished to a good standard. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The staffing levels currently ensure that health care and personal care needs are being met at the home. The staffing levels are being maintained. The staffing levels need to be monitored in relation to the dependency levels of service users. EVIDENCE: Three weeks rotas were checked and staff were being deployed at levels previously agreed with the Commission for Social Care Inspection. There were 8 staff on shift in the morning and seven in the afternoon. These numbers include the Registered Nurse deployed on each shift. At night, there were 4 staff on duty, including the Registered Nurse. Most service users felt that there were enough staff on duty but some said they would like staff to be able to spend more time talking to them. A high number of people at the home need two people to attend to them as they use the hoist to mobilise – the home needs to monitor staffing levels and the dependency levels of people admitted to the home. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 37 38 The home’s manager is not yet registered with the CSCI but has management and care experience. She appears to have fostered an open atmosphere at the home in the short time she has been in charge. Health and safety systems were generally well maintained. EVIDENCE: The current manager is not yet registered with the Commission for Social Care Inspection but has experience of management at a senior level. Service users and relatives spoken with said that she was approachable and they would have no hesitations in raising concerns with her. The owners need to review the number of hours she is employed as a Registered Nurse and how this is balanced with her need to undertake management tasks. The records checked were of a good standard. Fire training records were of a good standard but identified that some staff had not had formal training for over 2 years, although they had undertaken fire drills in the meantime. The records of fire drills, alarm testing and formal external checks of the fire system were of a good standard. Work had been done to try to ensure that the hot water did not The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 17 exceed 43ºc but the water checked in one bathroom and one service user’s room appeared to be hotter than this. Risk assessments need to be completed for radiators and a programme of fitting radiator guards needs to be implemented. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 2 3 x 2 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x 3 2 The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 19 Yes 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 OP7 Regulation 15 Requirement The service user plans must include information about their social needs and how they are to be met. Information about service users must be kept in an individual record which does not contain information about other people at the home. The home must have its medication system checked by a pharmacist. All bathrooms must be reviewed for usage and upgraded, decorated including the provision of appropriate aids, adaptations and provision of appropriate assisted baths. (Original timescale: 30/6/04) The programme to replace bedroom furniture and fittings to meet minimum standards required must continue. The programme to replace bedroom carpets must continue. Formal reviews of the service users care plans should involve the service user and relatives wherever possible. All staff who have not had recent fire training or instruction must Timescale for action 30/11/05 2. OP7 12 (4) 30/11/05 3. 4. OP9 OP21 13 (2) 23 (2) (f) 30/11/05 30/12/05 5. OP24 18 30/3/06 6. 7. OP24 OP7 23 (2) (f) 12 (2) 30/3/06 30/11/05 8. OP38 23 (4) (d) 30/10/05 Page 20 The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 have this updated. 9. OP38 13 (4) (a) (b) and (c) 13 (4) (a) (b) and (c) 18 (1) (a) Risk assessments need to be completed for radiators and a programme of fitting radiator guards needs to be implemented. To prevent risks from scalding water temperatures must be close to 43ºc. (Original timescale 10/2/05). The owners must review the number of supernumerary hours worked by the manager in order to ensure that they are adequate to carry out her managerial duties. 30/11/05 10. OP25 30/9/05 11. OP31 30/9/05 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 OP20 Good Practice Recommendations The home should consult service users to ascertain if they are happy with size of the television in the lounge. The Lodge Nursing Home C52-C02 S2087 The Lodge V235057 030805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road DERBY DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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