CARE HOMES FOR OLDER PEOPLE
York Lodge 54-56 Crofts Bank Road Urmston Manchester M41 0UH Lead Inspector
Val Bell Key Unannounced Inspection 19th April 2006 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address York Lodge DS0000063237.V289227.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. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service York Lodge Address 54-56 Crofts Bank Road Urmston Manchester M41 0UH 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) 0161 748 2315 0161 748 2315 alan.machen4@ntlworld.com Mr Alan M Machen Mrs Ann Elizabeth Crowe Mr Alan M Machen Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home accommodates a maximum of 22 service users requiring personal care only by reason of old age. 6th January 2006 Date of last inspection Brief Description of the Service: York Lodge is a private care home providing personal care and accommodation for up to twenty-two (22) older people. The communal facilities include three lounges, a dining room and a conservatory, which was being used as a smoking area. The furnishings and fittings were domestic in nature and of good quality. The conservatory was bright and airy with a small balcony seating area immediately off. The home is owned by Mr Alan Machen and Mrs Ann Crowe and managed by Alan Machen. Since the previous inspection the owners had installed a ramp to the front entrance to facilitate disabled access to the home. The home is situated in a residential area of Urmston and is close to shops, pubs, the post office and local amenities. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during afternoon hours on 19th April 2006. During the inspection various records, including care plans, were assessed, a tour of the premises was undertaken and conversations were held with residents, staff, management and visitors to the home. The inspector also had a telephone conversation with the relative of a resident who had been recently admitted to the home. All key Standards were assessed at this inspection. What the service does well:
The service promotes equality and diversity by supporting the people who live in the home to maintain their individuality. This is achieved by encouraging people to continue to follow their chosen lifestyle, wherever possible. The daughter of a resident, recently admitted to the home, said that she had been given the appropriate information to enable her to decide that the home would be able to meet her mothers needs. She had also been consulted during the needs assessment and care planning process. She considered the staff to be kind and caring and was confident that they would keep her informed of her mother’s welfare. Comprehensive needs assessments and up to date care plans were in place. The home was commended for exceeding the standard required in care planning by the use of 24-hour monitoring records to ensure that concerns relating to residents health and welfare were detected at an early stage. Staff made good use of professional resources by consulting visiting health staff on issues of concern. This enabled prompt action to be taken to ensure that residents maintained good health. Three residents, two relatives and a visiting entertainer agreed that residents were treated with respect and dignity and that staff were kind and caring. The home employed an activities co-ordinator to ensure that residents engaged in stimulating and interesting activities. This member of staff also conducted monthly satisfaction surveys with individual residents. The manager had taken positive action to ensure that residents had regular opportunities to air their views and concerns and this information was used to make ongoing improvements to service delivery. Residents spoken to praised the quality of the catering provided and menu’s provided evidence that residents were offered a healthy and nutritious diet according to their individual needs.
York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 6 Ongoing maintenance ensured that residents lived in safe, clean and comfortable surroundings. Robust policies and procedures in recruitment, training and the supervision of staff ensured that residents were cared for by a knowledgeable and skilled team of staff. 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. York Lodge DS0000063237.V289227.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 York Lodge DS0000063237.V289227.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): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given information to enable them to make a decision on whether the home is the right place for them. However the Service User Guide must be updated to include current information on changes to the environment such as disabled access and privacy locks on bedroom doors. This will ensure that prospective residents and their representatives have up to date information on which to make an informed choice. EVIDENCE: Copies of the homes Service User Guide were available in the residents’ bedrooms. The inspector had a telephone conversation with the daughter of a resident who had recently been admitted to the home. She told the inspector that she had been given all the information she needed to make a decision if the home would be the right place for her mother. She also confirmed that a full needs assessment had been undertaken and she had been consulted on
York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 9 her mothers likes and dislikes to ensure that the right kind of care could be provided. However, the Service User Guide needed to be updated to inform prospective residents that the home now provided disabled access and that some of the bedrooms were not fitted with privacy locks as required by the local fire officer. The home did not offer an intermediate care service. York Lodge DS0000063237.V289227.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents could be confident that the home would ensure their personal and healthcare needs would be met, including the safe administration of their prescribed medication. EVIDENCE: Three residents care plans were case-tracked during the inspection. These care plans contained comprehensive information that had been reviewed on a monthly basis. Care plans contained summaries of needs and 24-hour monitoring sheets had been introduced. The manager said that this had been useful in monitoring individual’s health and personal care needs and it enabled staff to detect any concerns at an early stage. This is an area of best practice and received a commendation. The records provided evidence that residents’ health and personal care needs were being met and this was confirmed in conversation with residents and relatives who visited the home. The daughter of a resident who had recently been admitted to the home told the inspector that the home was arranging for her mother to have a pressure relieving
York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 11 mattress. This was delivered to the home on the day of inspection. Prompt referrals were made to the appropriate health professionals such as general practitioners, a psychiatrist and a skin specialist. One of the care plans recorded that the district nurse was visiting the home on a regular basis. Staff told the inspector that they had a good relationship with the district nursing service and if they had any concerns with any of the residents the district nurses were consulted for advice. This is an area of good practice as it makes good use of professional resources to ensure that residents’ health is maintained. The manager stated that he was concerned that the NHS chiropody service had become increasingly hard to access for the people living in the home and that residents were more likely to have to pay for private chiropody. Three residents, two relatives and a visiting entertainer were asked about the way people living in the home were treated. Everyone spoken to confirmed that staff treated residents with dignity and respect. One of the relatives said, ‘Staff are very kind and caring. They have developed skills in dealing appropriately with difficult behaviour and are firm but fair in their approach. My relative has lived here for about two years and can tend to neglect himself. However, the staff ensure that his personal and healthcare needs are met.’ The homes medication administration system was assessed. Medication records were accurate and up to date and medication stocks were being securely stored. A good practice recommendation was made to include a list in the medication records of signatures of those staff authorised to administer medication. York Lodge DS0000063237.V289227.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from regular contact with their family and friends and they receive stimulation by continuing to enjoy their preferred leisure activities and personal interests. Residents were provided with a choice of nutritious and well-balanced meals. EVIDENCE: One of the residents told the inspector that he used to be a professional singer. An entertainer was visiting the home that day and this resident said he would like to get up and entertain the other residents. The entertainer confirmed to the inspector that this is encouraged by the home. This is an area of good practice as it encourages individuals to maintain their chosen lifestyle and to retain the skills and interests that they enjoyed prior to admission to the home. This resident also told the inspector that he regularly goes out for a walk or to the pub with his son. A member of staff said that the resident had been riskassessed for going out to the local shops on his own, as he had enjoyed this
York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 13 activity prior to admission. The member of staff had shadowed the resident on the walk to the shop. However, it had not been possible to minimise risk and ensure the residents safety. Full consultation had been undertaken with the resident and his family. This demonstrates that the home places a high importance on maintaining peoples independence and maximising their ability to make choices that affect their lives. The homes menu’s provided evidence that residents are offered a choice and variety of nutritious and well-balanced meals and residents praised the standard of catering provided by the home. York Lodge DS0000063237.V289227.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents could be confident that their concerns would be listened to and that action would be taken to resolved the issues. Lack of staff training in the awareness of abuse potentially places residents at risk. EVIDENCE: No complaints had been received by the home in the previous twelve months. The home was taking proactive action in seeking monthly feedback on the quality of service provision. This ensured that residents could express any concerns they might have and it allowed the home to resolve any issues in a timely fashion. Residents confirmed that they would speak to a member of staff if they had any concerns. Policies and procedures for the protection of vulnerable adults were in place at the home and staff were aware of the correct procedures to follow in allegations of abuse. However, staff would benefit from training in the awareness of abuse. York Lodge DS0000063237.V289227.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 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with a clean, hygienic, comfortable and safe living environment. EVIDENCE: The homes maintenance and redecoration records show that considerable work has taken place to maintain and improve the quality of the homes environment. The outstanding requirement for the home to provide disabled access into the building had been addressed by installing a ramp at the front entrance. The recommendations of the fire officer had been actioned to provide a safe living environment for residents. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 16 On a tour of the premises the home was found to be clean and hygienic and infection control training had been undertaken by the staff team. Several residents told the inspector that they were happy and comfortable living in the home. Their bedrooms had been personalised to reflect their personalities and individual interests. York Lodge DS0000063237.V289227.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The careful selection of staff, induction and on-going training ensured that residents would be safe and receive the care that they needed. EVIDENCE: Three staff files were examined during the inspection. Records provided evidence that new staff had received induction training and ongoing training was being provided to established staff. Copies of training certificates were held on the files. Mandatory health and safety update training such as food hygiene and fire awareness were ongoing and staff had also received training in dementia. The manager confirmed that a formal staff supervision programme had been introduced. Staff spoken to confirmed that the management were approachable, supportive and responsive. Sufficient staff had been deployed on the day of inspection. The required pre-employment checks had been undertaken on all staff employed to work in the home. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 18 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents could be confident that their views were important to the home and that their suggestions for improvement would be listened to and used to continually develop the quality of the service provided. EVIDENCE: The manager’s study towards achieving NVQ 4 in care and management had been slow. However, he had freed up some time by delegating some management duties to the senior staff so that he could concentrate on his studies. The manager had introduced a quality assurance programme. The activities co-ordinator assisted residents to complete regular satisfaction surveys and
York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 19 the information provided was being used to make improvements to the quality of the service provided to residents. Additionally, the manager held monthly feedback sessions with individual residents. This enabled residents to feel confident in airing their views and contribute to the development of home. Residents spoken to said that they got on well with staff and management. One resident told the inspector that her self-confidence had increased since she moved into the home and that this was because of the support she had received. Residents confirmed that they could ask for support from staff to manage their personal finances and that safekeeping was available if needed. The home had not submitted any Regulation 37 notifications to the Commission in the previous twelve months. The manager stated that this had been an oversight. The home had been inspected on 14th February 2006 by the environmental health department in relation to the catering service. The recommendations made had been actioned by the home. Additionally, the ‘Safer Food, Better Business’ monitoring had been fully implemented and records were up to date. On a tour of the home the environment was found to be safe, clean and hygienic. Urine odour was detected in one of the bedrooms. The manager stated that this was an ongoing problem but that it was being managed within the resources available. The continence advisor had been consulted for advice and weekly cleaning of the bedroom carpet took place. The problem lay in the low absorbency of the continence products supplied by the local authority. The manager had made enquiries in relation to the purchase of more suitable continence products and he showed the inspector a sample of these. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 20 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 21 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 OP1 Regulation 5 Requirement Timescale for action 19/05/06 2. OP18 13 (6) 3. OP38 37 The homes Service User Guide must be reviewed and updated to inform prospective residents that some bedrooms are not fitted with privacy locks due to fire regulations and that the home is accessible to people with disabilities. Previous timescale of 06/02/06 not met. Staff must receive training in the 19/05/06 awareness of abuse and the procedures to be followed in allegations of abuse, in line with Trafford policy on the Protection of Vulnerable Adults. The home must inform the 19/05/06 Commission of any event that affects the welfare of residents. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 22 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 OP9 Good Practice Recommendations The registered person should include a list of staff signatures in the medication administration records. York Lodge DS0000063237.V289227.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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