Care Home: Alistre Lodge Nursing Home

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What the care home does well Appropriate systems are in place to ensure people`s needs are fully assessed prior to moving into the home. People`s health and personal care needs are assessed and appropriate support is given by the staff team. People`s daily life and social needs are catered for in a person centred manner. People`s dietary needs are met, and The systems operated by the service in relation to complaints and safeguarding promote and protect people`s best interests. People live in a clean and homely environment. People living at the home are supported a trained staff team. The home is managed is way that promotes people`s best interests, health and well-being. What has improved since the last inspection? At the last inspection a number of requirements were made which meant that greater attention needed to be paid by the management and staff to certain aspects of the the services provided at the home. These included making sure arrangements were in place to provide a safe system for the moving and handling; ensuring that care plans and risk assessments were kept under review; ensuring that proper care and treatment was offered at the home; and ensuring that the proper recruitment checks were undertaken on people before they started work. Action has been paid to these areas of service provision, care and supported and improvements have been made. What the care home could do better: Assessing and planning the care and support a person needs based on the 12 Activities of Daily Living would further enhance the work undertaken by the staff. The work of the staff at mealtimes could be further enhanced by following good practice advice such as that given in nationally produced reports. The safety of people could be further enhanced by the fitting of appropriate fire safety devices on some designated fire doors.Ensuring that people`s assessed dependency needs are fully recorded and understood will ensure that the correct staffing levels are maintained if and when an increase in the number of people living at the home takes place. Key inspection report Care homes for older people Name: Address: Alistre Lodge Nursing Home 69 St Annes Road East St Annes on Sea Lancashire FY8 1UR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tony Brindle-Wills     Date: 1 6 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Alistre Lodge Nursing Home 69 St Annes Road East St Annes on Sea Lancashire FY8 1UR 01253-726786 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): J Parker (Care) Limited Name of registered manager (if applicable) Mrs Julia Lesley Stockdale Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 43 The registered person may provide the following category of service only: Care Home with nursing - Code N To service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home Alistre Lodge Nursing Home with Care offers personal care and nursing to 43 people over and under the age of 65 years. Accommodation is arranged over three floors on one side of the home and two floors on the other. There is a passenger lift at one side of the home and a chair lift at the other. Accommodation is in a mix of single and double rooms, most of which have ensuite facilities. There are a variety of communal rooms and a garden to the front of the home. The home is situated within ten minutes Care Homes for Older People Page 4 of 23 Over 65 43 0 2 9 0 7 2 0 0 9 Brief description of the care home walk of the town centre of St Annes and is well served by public transport. Local shops and community facilities are within easy reach. Information about current fee levels can be obtained from the manager of the home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Prior to our visit, we reviewed all the information we held about this service, this included the last inspection report, any surveys we had received from people with an interest in the service, the services Annual Quality Assurance assessment (AQAA) and any other correspondence such as notifications and complaints (if any). Whilst at the home we had the opportunity to speak to the people living there, speak to the staff and deputy manager, review various documents held at the service, and discuss the progress of the service including progress since the last time it was inspected. None of the areas that we looked at raised any major concerns for us and during the course of our visit. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate systems are in place to ensure peoples needs are fully assessed prior to moving into the home. Evidence: The deputy manager explained that when someone is considering living permanently at the home they are given information to help them make a decision, including a Service Users Guide. People are also invited to visit as often as they like and stay for an evening meal and have an overnight stay if they wish so that they can get a feel of the home and meet the people who live there. She added that this gives the person the opportunity to make an informed decision and helps the home decide if they are able to meet the persons needs. There is also a settling in period, to make sure that everyone is happy that the persons needs can be met. This procedure, along with other professional assessments undertaken by the staff at the home, helps the staff to start developing a suitable plan of care and support for the individual.. Care Homes for Older People Page 9 of 23 Evidence: Information held within peoples files confirmed that appropriate assessments take place, and that as much information as possible to gathered about the person before they move in so that their support needs can be considered and planned for. The service does not provide intermediate care. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are assessed and appropriate support is given by the staff team. Assessing and planning the care and support a person needs based on the 12 Activities of Daily Living would further enhance the work undertaken by the staff. Evidence: We looked at three individual care and support plans, and information contained within them showed that people are involved as much as possible in developing and reviewing their plans. The plans were found to reflect the individuals preferences and needs of people. The staff and management team contribute to the care plans in order to make sure a full picture of the individual is obtained. The plans were found to be up to date and reflected peoples individuality. They contain sufficient detail to guide staff and help them understand each persons care and support needs. However, the order in which the plans are were presented was sometimes confusing to the reader. This was explained to the deputy manager and owner, and they agreed that they would look in Care Homes for Older People Page 11 of 23 Evidence: ways in which the files could be re-ordered. Furthermore, a suggestion was made that the care plan files could be improved by using a system based on Activities of Daily Living, and the nursing model of assessment, planning, implementation and evaluation. Our observation, and conversations with the staff, confirmed that the staff know and understand the needs of each person who lives at the home. The staff do all they can to promote peoples right to autonomy and everyone is treated as an individual. However, a look at the daily records showed that great attention could be paid to using more descriptive words to reflect and show peoples choices and preferences, and the care and support given to people through out the day. Where any activity involves a potential risk, an assessment is made and plans are agreed to minimize the risk, while still supporting peoples right to independence and choice. These assessments are reviewed regularly, along with the rest of the plan, and the plans are signed by the person (if possible) to confirm that they agree with them. All the evidence we saw clearly indicated that the homes staff support people to maintain their independence and improve or maintain the quality of their lives. We checked the systems relating to medication and how it is order, stored and given out. The systems relating to this were found to be satisfactory, with only minor points of good practice advice needing to be given. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples daily life and social needs are catered for in a person centred manner. Peoples dietary needs are met, and the work of the staff at mealtimes could be further enhanced by following good practice advice such as that given in nationally produced reports. Evidence: Information held within the care files of people at the home indicated that they are supported and encouraged to be part of the local community and that people enjoy visits to local shops and cafes. People at the home said that they do get out and visit places and enjoy this. Some people were observed to take part in a group activity, having their make up and nails done. The deputy manager explained that the staff get involved in providing activities for people and that there is a varied programme. This was confirmed by people living at the home, and evidence was seen of a list of various activities that people can get involved in. The menus show people are offered a balanced and varied diet and people were observed having a choice and selecting their own menu. People were observed enjoying their meal that was well presented. One person said the food is very good. Another said they have plenty to eat, another that they can choose their meals. Care Homes for Older People Page 13 of 23 Evidence: The cook says that all of the food is sourced locally and all meals are freshly cooked daily. They also said there are freshly baked cakes and buns provided daily. Some staff was observed assisting people with their meals. On the whole this was done in a sensitive, relaxed and unhurried manner. However, there were some instances when peoples needs could have been better met. One example was when a person who needed assistance with eating was left for some time with a bowl of food in front of them. They were told that someone would help them in a minute; however, it took five minutes for a staff member to come and assist them. No apology was given to the person waiting, and the staff member proceeded to assist the person with their meal without explaining what the food was, or how they were going to assist them. We explained that a report produced by the Commission called Highlight of the day is available for care homes, that gives guidance on how to improve meals and mealtimes, using a holistic approach so that not only peoples physical needs are met, but their social, cultural and emotional needs thereby increasing the likelihood that meals will be eaten. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems operated by the service in relation to complaints and safeguarding promote and protect peoples best interests. Evidence: The information held at the home and by the Commission shows that there is a Safeguarding Policy and Procedure for staff to follow. Staff training records show that safeguarding training is provided however, some gaps in peoples training was identified. The owner of the home explained that arrangements have been made for staff to attend training over the next few months. Evidence of this was seen. . The service history shows the CQC and the manager have received a complaint about the home over the last 12 months. Our records and those held at the home shows that this was dealt with effectively. Some people living in the home said they know how to make a complaint but have never had to do this. There is a copy of the complaints policy and procedure displayed in the home. Discussion with the care staff found they have complaint training as part of their induction. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and homely environment. The safety of people could be further enhanced by the fitting of appropriate fire safety devices on some designated fire doors. Evidence: People were observed throughout the visit relaxing in homely and comfortable surroundings. One person said they like living in the home its like home from home. Another said they have everything they need. To keep people safe the maintenance records show the fire equipment including fire alarms and emergency lighting are serviced and checked regularly. It was noted that spme designated fire doors were being propped open. The owner agreed that in order to ensure that people can move around the home freely and safely, electronic door guards should be fitted to the doors, and as these were available, they would be fitted as soon as possible. The owner has been asked to inform CQC when this is completed. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported a trained staff team. Ensuring that peoples assessed dependency needs are fully recorded and understood will ensure that the correct staffing levels are maintained if and when an increase in the number of people living at the home takes place. Evidence: To maintain the standard of care for people living in the home the owner explained that all the care staff either have or are working towards a National Vocational Qualification (NVQ) Level 2 or above in care. The staff training records confirmed this. This practice is to be commended. The manager also confirmed that the housekeeping staff also undertake NVQ qualifications and other appropriate related courses. To make sure people are cared for properly and to keep them safe the staff training records show they have First Aid, Moving and Handling, Food Hygiene, Infection Control and Health and Safety training. Some gaps in the training of some of the staff were identified, however, plans are in place to fill these gaps over the next few months. People are protected by the way staff are recruited and selected as a sample of three staff records show application forms, references, police and POVA (Protection of Vulnerable Adults List) checks are taken up before they are employed. Care Homes for Older People Page 17 of 23 Evidence: People living in the home say they like the people caring for them and positive relationships were observed being fostered between people and those caring for them. We observed the staff spending time interacting and getting to know people, and one person said this is useful as you get to know people as individuals. We saw that staff use these opportunities for interaction, engaging in reminiscence, as well as making general conversation when carrying out everyday care tasks. This is to be encouraged as it can empower both people and staff as their working environment becomes less stressful. Rather than being completely task focused, the staff were seen to relish opportunities for interaction. Again this is to be encouraged as it helps to develop closer relationships. The staff were seen to act as a team with the shared goal of providing good quality care. One staff member said that effective communication is really important at and between all levels, and again this is to be encouraged as effective communication is vital to ensuring a holistic approach to care. The records show that at the present time, the numbers of staff supporting people is sufficient to meet the needs of the people at the home. In order to ensure that the right numbers of staff are supporting the right number of people, the owner agreed to reintroduce a system of assessing peoples dependency needs, in order to ensure that the correct level of staff were on duty at all times. The records held at the home show that appropriate staff supervision takes place, and this was conformed by the staff team. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed is way that promotes peoples best interests, health and wellbeing. Evidence: People live in a home that is managed by a person that is a experienced manager, and who is supported by a deputy. Information in the maintenance records and discussions with the staff found that the health, safety and wellbeing of people and those caring for them is promoted and protected. They show regular maintenance checks including fire safety equipment and alarm testing and fire drills. The staff explained that they intend to survey people living in the home, their relatives and other people with an interest in the home, to seek their views on the quality of care and services provided. Once this is complete a a report reflecting what they said will be produced by the end of the year. Care Homes for Older People Page 19 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 23 The registered person must ensure that the fitting of appropriate fire safety devices on designated fire doors is completed. This will ensure that the safety of people is promoted and protected. 06/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Assessing and planning the care and support a person needs based on the 12 Activities of Daily Living would further enhance the work undertaken by the staff, as the model provides a systematic and logical way of delivering care and support through an holistic which encourages team participation and continuity of care. The double signing of handwritten entries on the Medication Administration Records would ensure that potential handwritten errors would be minimized. The registered person should consider how they can implement good practice advice during mealtimes, such as that produced the the report Highlight of the Day, so as Page 21 of 23 2 9 3 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations to provide a holistic approach so that not only peoples physical needs are met, but their social, cultural and emotional needs thereby increasing the likelihood that meals will be eaten. 4 27 The ratios of care staff to service users should be determined according to the assessed needs and dependency levels of people living at the home. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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