Inspection on 18/01/06 for Valley Lodge Nursing Home

This inspection was carried out on 18th January 2006.

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

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

Other inspections for this house

Valley Lodge Nursing Home 02/05/07

Valley Lodge Nursing Home 03/05/06

Valley Lodge Nursing Home 22/08/05

Valley Lodge Nursing Home 21/03/05

Valley Lodge Nursing Home 23/09/04

Valley Lodge Nursing Home 08/03/04

Valley Lodge Nursing Home 18/09/03

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Valley Lodge Nursing Home Bakewell Road Darley Dale Derbyshire DE4 3BN Lead Inspector Marie Bonynge Unannounced Inspection 18th January 2006 10:00 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 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 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. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Valley Lodge Nursing Home Address Bakewell Road Darley Dale Derbyshire DE4 3BN 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) 01629 583447 Ashmere Care Group Mr Gerald Poxton, Mrs Sandra R Poxton, Mrs Ann Theresa Poxton, Dr Michael G Poxton, Mr David A Poxton Vacancy 1 Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2005 Brief Description of the Service: Valley Lodge is a care home registered to provide accommodation and personal care with nursing for up to 33 older people. The home is located in the village of Darley Dale around a half mile from Matlock town centre off a main bus / transport route. Accommodation is provided on 2 floors with a large lounge on the ground floor and a smaller quieter lounge also. A communal dining area is also on the ground floor. Catering, laundry, domestic and maintenance services are centrally provided. The home is set in accessible and attractive well-maintained grounds with car parking space provided. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over seven and a half hours. The focus of this inspection was to follow up a complaint that had been made to the CSCI regarding concerns about inadequate staffing levels. This inspection also focused on key standards and the follow up of the requirements and recommendations from the last inspection. The Inspector spoke to 5 residents, 2 relatives, 4 members of staff and the Area Manager. Many of the residents at Valley Lodge had difficulties in expressing themselves in words and were unable to contribute directly to the inspection. They were however observed throughout this visit as to how well their needs were being met by staff. Inspection methods used included the examination of records such as care plans, staffing rotas, training records, medication systems and a sample of staff files. What the service does well: What has improved since the last inspection? A planned programme of redecoration and refurbishment has been implemented. Most of the bedrooms have now been redecorated, as have the lounge and dining rooms. A new floor has been ordered for the dining room and a number of carpets have been replaced. There are plans to upgrade the reception area and kitchen over the forthcoming year. Improvements have been made to residents care plans including obtaining thorough assessment information prior to residents being admitted to the home. A risk assessment has been introduced for the prevention of falls. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 6 Residents care plans had improved generally and daily record keeping was good. 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. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 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 the following standard(s): 2 and 3 The standard of records and record keeping in relation to residents needs assessment and care planning had significantly improved since the previous inspection and was to a good standard. EVIDENCE: A standard form of contract was seen that was comprehensive and included a statement of the terms and conditions of the home. However, the contracts had not been reviewed to take account of the free nursing care element as required by regulation. This was a requirement from the last inspection and was discussed with the Area Manager on this visit. Three residents care plans were examined as part of the case tracking process. These indicated that full assessment information had been obtained prior to these residents being admitted to the home. This included a nursing assessment and / or a community care assessment. The homes own assessment tool had been completed and provided comprehensive information about the person’s needs. The level and content of the assessment Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 9 information was generally to a good standard. A requirement made in respect of this at previous inspections has therefore been met. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8,9 and 10 Improvements have been made to residents care plans to show how individual care needs are to be met, regular reviewing and updating of these will assist to underpin the care given. Systems and policies and procedures for the administration of medication were in place although these were not consistently being adhered to. EVIDENCE: Three residents care plans were examined as part of the case tracking process. These indicated that the care plans had been updated; they were comprehensive and generally covered all aspects of residents’ health, personal and social care needs. This included a risk assessment for the prevention of falls, a nutritional assessment, moving and handling and pressure sore risk assessment. Two of the care plans had been reviewed and updated on a monthly basis with the exception of December 2005. It is noted that the general standard of the documentation had improved since the last inspection. However, in one of the care plans the pressure sore risk assessment and nutritional assessment had not been updated since April 2005 and July 2005 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 11 respectively. The daily records were detailed and indicated where changes had occurred in the identified needs and care of the resident, however this was not always reflected in the care plan. A communications book also detailed where residents care needs had changed. Two requirements have been carried forward from the last inspection and one requirement has been met. Residents and relatives considered that staff were friendly and caring in their approach. Residents who were able to express their views said that they felt their privacy and dignity was respected; relatives also shared this view. Care plans indicated that residents and relatives had been involved and consulted in the completion of care plans. Arrangements were in place for residents to access the optician, chiropodist and dentist as required. Medication Administration Charts (MAR charts) were examined for the 3 residents who were case tracked. These were generally in good order with the exception of the following: • There were some omissions of signatures on the MAR charts. • Photographs were in place for most of the residents but there were some missing. • Handwritten instructions on the MAR chart had not been signed by 2 members of staff. • A bottle of ear drops and some eye drops that had passed their expiry date were in the medicine trolley. • Eye drops that were in use were not marked with their date of opening. • A list of staff initials and signatures for those staff who administered medication was not in place. • Maximum and minimum temperatures for the medicines fridge were being recorded, however no action appeared to have been taken where the maximum and minimum ranges were exceeded. (Between 2 degrees Celsius and 8 degrees Celsius). Following recent changes in legislation relating to the disposal of medicines, the Area Manager said that the home was waiting for information from the Primary Care Trust regarding new arrangements for the disposal of medication. Returns of medication had not been made since May 2005, this had resulted in a stockpile of medications to be returned that were being kept in the treatment room. Medicines had not been recorded in the returns book since May 2005 so there was no written record of the medicines to be returned. An immediate requirement was left in respect of this and the Area Manager advised that this would be rectified as a matter of urgency. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home promotes contact with residents’ family and friends and visitors are made welcome. The home provides an appealing and well balanced variety of foods that are well presented. EVIDENCE: Individual lifestyle preferences and preferred routines, including likes and dislikes were recorded in the 3 residents care plans examined. A life history was also included where information was available. A programme of activities was in place although this was not formally recorded or documented in residents’ notes. Ashmere care group had developed a planned programme of activities that each home could participate in including days out. In house activities were also provided. It was reported that although care staff tried to accommodate residents’ individual preferences and routines, this was not always possible due to a lack of dedicated hours for activities and the numbers of staff available. (See standard 27 for further comments regarding staffing). An open visiting policy was in operation and relatives were observed to come and go throughout this visit. Relatives spoken with confirmed that they could see their relative in private and that they were made welcome by the friendly staff. Information regarding advocacy services was available and a system was in place for the administration of personal monies. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 13 Positive comments were made regarding the standard and quality of food provided. Individual likes and dislikes were catered for and special diets were provided including liquidised meals that were well presented and individually prepared. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A complaints procedure was in place, however recording of all concerns and their outcome will serve to assure residents and relatives that their concerns will be listened to and acted upon. EVIDENCE: One complaint had been made direct to the CSCI, this regarded concerns about inadequate staffing levels. This was investigated during this inspection and was found to be substantiated. The findings are reported on in standard 27. A complaints procedure was in place and the Area Manager advised that some concerns had recently been raised regarding staffing levels. A record had not been made of concerns raised or their outcome. Discussions indicated that staff were aware that they could raise issues with the manager and area manager. A procedure was in place regarding the protection of vulnerable adults and training had taken place. A ‘whistle blowing’ procedure was also in place. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 24 The implementation of a planned programme of redecoration and refurbishment has contributed to providing a clean, comfortable and homely environment. EVIDENCE: Improvements have been made to the home including the redecoration of bedrooms, replacement of carpets and the redecoration of communal living areas. A planned programme of redecoration and renewal of the premises had been implemented and further improvements were planned for the reception area and kitchen. A requirement made at the last inspection has been met in respect of this. Furniture had been replaced to include lockable storage and the Area Manager said that risk assessments had not yet been completed regarding the implementation of suitable locks on bedroom doors. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 16 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staffing numbers were not always appropriate to meet with the assessed needs of those residents accommodated. EVIDENCE: There were 24 residents accommodated on this visit. All of these residents had been assessed as needing nursing care. 10 residents were high dependency, 14 residents were medium dependency, and 0 residents were low dependency. All of the residents needed 2 members of care staff to assist with personal care and moving and handling. Many residents had some level of memory loss and confusion, with 1 resident displaying extreme behaviour. There were 3 residents who were known to shout out and need reassurance throughout the day. 9 residents needed assistance with feeding. A sample of staffing rotas was examined for the months of December 2005 and January 2006. These indicated that minimum staffing levels had not been adhered to on a number of occasions. For example there were 2 members of staff on during the night (a care assistant and an RGN) on 4 occasions. The rotas indicated that 3 staff were on duty on a number of occasions on the late shift (2 care assistants and an RGN). On this visit the rota indicated that 4 staff were on the late shift although there were only 3 on duty including the RGN. Discussions with relatives, staff and anonymous concerns received by the CSCI indicated that there were concerns about inadequate staffing levels and that Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 18 residents’ needs were not being fully met. For example the Inspector directly observed that residents had to wait for some time before being able to go to the toilet where the care assistants were already with another resident. One residents’ mouth and tongue were coated with white slough, it was reported that this resident needed frequent thickened fluids. The Inspector observed this resident being assisted to have a drink, however care staff did not have enough time to ensure that this was always the case. The Area Manager did ensure that an additional member of staff was employed to cover the night shift and the Inspector was advised that recruitment had taken place to employ 3 additional members of staff who were awaiting the appropriate employment checks. A programme had begun to be implemented regarding the achievement of level 2 NVQ. Recruitment procedures were in place and were largely followed with the exception of a Criminal Record Bureau (CRB) check for one member of staff. A staff training programme was in place and individual staff files were kept that identified what training had taken place and what training was outstanding. However, not all staff had had updates in all the mandatory training including moving and handling. An induction programme was in place and an example of an induction pack was seen, however this had not been completed for a newly recruited member of staff. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36, 37 and 38 Implementation of the homes policies, procedures and systems will ensure that it’s stated purpose, aims and objectives are achieved. EVIDENCE: A manager has been appointed who has been in post since August last year. An application to register with the CSCI is expected to be made. Residents monies were not checked on this occasion, however a system was in place for the administration of residents’ personal allowances. Regular and formal recorded supervision of staff was not taking place, although there was a form to use. Records were stored securely, however not all records were being kept in accordance with regulations as identified in the main body of the report. There were some gaps in mandatory training as identified in standard 30. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 20 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 21 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 X 2 3 X X N/A 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X X STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 2 2 2 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 a) b) Requirement Where a nursing contribution is paid in respect of nursing provided at the care home to the resident, the registered person must provide a statement specifying the date of payment and the amount of the nursing contribution to the resident. Documented risk assessments for service users must be reviewed monthly. From inspection report 08.03.04 and 22.08.05. Previous timescale 01.01.06. Care plans must be kept up to date, be reflective of each service users health, personal and social care needs and be reviewed at least at monthly intervals. From inspection report 08.03.04 and 22.08.05. Previous timescale 01.01.05. The registered person must ensure that all of the matters identified in standard 9 in the main body of the report are actioned. The registered person must ensure that medication for return DS0000002094.V278184.R01.S.doc Timescale for action 01/02/06 2. OP7 14 30/04/06 3. OP7 15 30/04/06 4. OP9 13 2) 31/03/06 5. OP9 13 2) 15/02/06 Valley Lodge Nursing Home Version 5.1 Page 23 6. OP24 16 7. OP27 18 1) a) 8. 9. OP29 OP30 13 6) 18 c) i) 10. 11. OP30 OP37 18 c) 1) 8, 17 Sch 3 12. 13. OP31 OP36 9 18 2) is recorded and a system is put in place for the disposal of medicines received into the care home. Immediate requirement left. Suitable locks must be provided to residents’ bedroom doors, which they may actively choose to use and in consultation with them and in accordance with risk assessed needs. The registered person must, having regard to the size of the care home, the statement of purpose and the number and needs of residents ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. Immediate requirement left. Criminal Record Bureau Checks must be made for all staff. The home’s induction programme must be followed and implemented for all new members of staff. Mandatory training must be completed for all staff including moving and handling. The registered person must ensure that care records are kept in accordance with Schedule 3 of the National Minimum Standards. From inspection report 08.03.04 The manager must make an application to be registered with the CSCI. Formal, recorded supervision must be implemented for all staff. 01/03/06 18/01/06 31/03/06 31/03/06 30/04/06 01/02/06 31/03/06 31/03/06 Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP16 Good Practice Recommendations The programme of activities should be further expanded and include some dedicated hours. The registered person should keep a record of all complaints and include details of investigation and any action taken. Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Valley Lodge Nursing Home DS0000002094.V278184.R01.S.doc Version 5.1 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!