Care Home: Atherton Lodge Nursing Home

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What the care home does well Most people living at the home have single bedrooms, which they are able to personalise with their own belongings so that they are more homely. People living at Atherton Lodge told us they liked their rooms. Staff training and development is continuous and over 50 per cent of care staff had a national vocational qualification (NVQ) level 2 in care. These are nationally recognised qualifications for people working in care and show they have been assessed as competent to provide good quality care and support. Atherton Lodge has a significant number of staff who hold or are working towards this qualification to help make sure that they provide a good standard of care for the people living there. The training records we saw showed a lot of regular mandatory training covering topics including health and safety, infection control, fire training, safeguarding vulnerable adults and person centred planning. This training helps to ensure staff are aware of how to support people safely and helps them to meet their own personal development. Staff records were well maintained and showed that thorough employment checks are carried out during staff recruitment. This helps to make sure the right type of people are employed to care for people at the home. The maintenance person had detailed records of how they manage the building and equipment making sure that it is always safe with any necessary actions taken to reduce any risks. These records and practices showed good management of the environment which helped to assure people they have a comfortable and safe home to live and work in. People that we met at the home told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. We received six completed surveys from people living at the home and eight from relatives. These were mainly positive about their experience at Atherton Lodge. People told us that they were happy living at the home. Their comments included: "They look after my relative very well"; "I am very grateful the staff are very friendly" and "Staff always friendly, kind and polite....they always have a smile on their faces even when a lot of the time the duties they carry out are quite difficult". Staff told us they were very happy working at the home and felt they had a really good atmosphere. They all felt well supported and trained and were regularly offered training to help them do their job. We received 13 surveys from staff which overall were positive. Some of their comments included; "I think we look after the residents really well"; "making the home a happy home"; "Its a nice home". What has improved since the last inspection? Three empty bedrooms have been converted to provide more facilities for the benefit of everybody living at Atherton Lodge. As a result, the home now has its own hairdressing salon complete with salon equipment. There is a craft and activities room and a room where people living at the home can meet with their relatives in private. Positive feedback had been received about these changes from everyone at the home including people living there. Following our previous visit the home has introduced clear procedures for staff to follow when a new person moves into Atherton Lodge. This includes a thorough check of what people`s needs are to make sure they can be met at the home. The assessments we saw were clear and helped to show how the staff are continuing to meet the person`s needs. The care planning system has been improved so that each person living at the home has a plan of care which clearly identifies their health and personal care needs and how these should be met. These plans are reviewed monthly to ensure staff have access to up to date instructions about the care each person needs and how they would like this care to be provided. Staff had dealt sensitively with a topic which people find hard to discuss. They had developed care plans to include death and dying. This helped some people to identify their personal wishes and requests, eg regarding any future funeral arrangements to be recorded. The manager had implemented regular medication audits at the home. This helps to show good management of medications and to achieve a consistently good standard that reduces any type of risks and errors with medications. The manager and the company that runs the home had also implemented various audits that are regularly carried out including checks on use of bed rails, care plans and the complaints records. This helps to show good management to make sure that good standards are being maintained at the home. What the care home could do better: As a matter of priority the manager should apply to the commission to be registered. This is necessary to ensure the home has the stability of a manager registered with the commission who is knowledgeable and experienced in all relevant regulations. Reviews of dependency levels of people living at Atherton Lodge and calculations made about staffing levels to make sure those dependencies are met should be recorded. Information about staffing levels in the home should be easily accessible, made available for people to see and included in the revised statement of purpose. The management of people`s money kept in the home`s `comfort fund account` should be reviewed with them and their relatives to make sure that people`s individual money is clearly accounted for and kept in accounts that best suit their needs. At the time of our visit, two bedrooms smelt very unpleasant. This needed to be reviewed to make sure that the environment remained fresh and comfortable for people living in the home. The home would benefit from a maintenance and decorating plan that can be shared with everyone living there. This will help to keep everyone up to date about developments at their home and give them a say in what they would like to see improved. Key inspection report Care homes for older people Name: Address: Atherton Lodge Nursing Home 202 Pooltown Road Atherton Lodge Ellesmere Port South Wirral CH65 7ED     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: Diane Sharrock     Date: 2 3 0 4 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 31 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 31 Information about the care home Name of care home: Address: Atherton Lodge Nursing Home 202 Pooltown Road Atherton Lodge Ellesmere Port South Wirral CH65 7ED 01513554089 01513560141 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Par Nursing Homes Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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. Dementia - Code DE. The maximum number of service users who can be accommodated is: 49. Date of last inspection Brief description of the care home Atherton Lodge is a two-storey detached property that has been converted and extended by a purpose built extension into a care home for 49 older people, some of whom require nursing care. It is situated within a mile of Ellesmere Port town centre and is close to local shops. There are gardens to the rear with access for residents, and Care Homes for Older People Page 4 of 31 Over 65 0 49 49 0 Brief description of the care home parking space to the fron of the building. The main part of the building has three lounges and a dining room, all on the ground floor. A separate unit has nine places for people with dementia and has its own lounge dining room. All except one of the bedrooms are single rooms. A large percentage of the bedrooms are in the purposebuilt part of the home and these rooms all have an en-suite toilet. There are two staircases and a passenger lift for access between the floors of the home. The homes statement of purpose, service user guide and most recent inspection report are availbel to anyone and can be accessed via the manager. The fees for the home are, minimum amount per week 362.60 pounds to the maximum amount 495. pounds per week. Care Homes for Older People Page 5 of 31 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This visit was unannounced and was carried out by two inspectors on 23 April 2010. It was just one part of our inspection; other information we had received about Atherton Lodge was also looked at as part of the inspection. We looked at information that the manager had submitted prior to our unannounced visit, in the annual questionnaire all service providers who are registered with the commission are required to complete. This is called an annual quality assurance assessment and provides us with information on how the service is running, its strengths, areas for development and plans for future improvements. A selection of questionnaires were also sent out for people living at the home, their Care Homes for Older People Page 6 of 31 families and the staff. In total we have received 27 completed surveys and peoples comments about the home are included in the report. During our visit we looked at various records to check on the health and safety of the people living at Atherton Lodge. We checked the procedures for recruiting staff to make sure that they are suitable to work with the people living at the home and toured the home to check on the environment. We spoke to a number of people living at the home as well as staff on duty and they gave their views about the home. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Three empty bedrooms have been converted to provide more facilities for the benefit of everybody living at Atherton Lodge. As a result, the home now has its own hairdressing salon complete with salon equipment. There is a craft and activities room and a room where people living at the home can meet with their relatives in private. Positive feedback had been received about these changes from everyone at the home Care Homes for Older People Page 8 of 31 including people living there. Following our previous visit the home has introduced clear procedures for staff to follow when a new person moves into Atherton Lodge. This includes a thorough check of what peoples needs are to make sure they can be met at the home. The assessments we saw were clear and helped to show how the staff are continuing to meet the persons needs. The care planning system has been improved so that each person living at the home has a plan of care which clearly identifies their health and personal care needs and how these should be met. These plans are reviewed monthly to ensure staff have access to up to date instructions about the care each person needs and how they would like this care to be provided. Staff had dealt sensitively with a topic which people find hard to discuss. They had developed care plans to include death and dying. This helped some people to identify their personal wishes and requests, eg regarding any future funeral arrangements to be recorded. The manager had implemented regular medication audits at the home. This helps to show good management of medications and to achieve a consistently good standard that reduces any type of risks and errors with medications. The manager and the company that runs the home had also implemented various audits that are regularly carried out including checks on use of bed rails, care plans and the complaints records. This helps to show good management to make sure that good standards are being maintained at the home. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 31 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 10 of 31 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 11 of 31 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. Peoples needs are checked before they move into Atherton Lodge so they can receive the right care to meet their needs in the way they prefer. Evidence: The staff told us that they provide people with information about Atherton Lodge by giving them a copy of the service users guide and statement of purpose for the home. This information brochure tells people about Atherton Lodge and support they can expect when they move in. This helps everyone to decide if the home is the right place for the person to live in and if their needs and choices can be met there. The manager had developed these documents in large print and with the use of pictures to make it more visual and easier to read for some people. However, it needed to be updated in some areas such as the type of needs the home caters for. We looked at two care plans of people who had moved into the home since our last visit there. Records showed improvement to the checks that are done about peoples Care Homes for Older People Page 12 of 31 Evidence: needs before they move into the home. The staff had carried out assessments before each person moved into Atherton Lodge. The information gained was then used to form the basis of a care plan to support the individual, to make sure that their identified needs would be met. We noted one assessment had only partially been completed and was not signed for to show the person agreed with their assessment and care plan. We received thirteen completed comment cards from staff who all felt that they received enough information about the people at the home to help them support each person. Six surveys returned to us before our visit by people living at the home confirmed that they had received information about Atherton Lodge that helped them or their relative to choose to live there. Eight completed surveys from relatives were returned to us before our visit. These were all complimentary about the home and the choices offered to their relative. Their comments included: They look after my relative very well; I am very grateful the staff are very friendly and Staff always friendly, kind and polite....they always have a smile on their faces even when a lot of the time the duties they carry out are quite difficult. Care Homes for Older People Page 13 of 31 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. Each person has a plan of care so staff have clear guidance to make sure people living at Atherton Lodge have their needs met in the way they prefer. Evidence: We looked at care plans of four people living at the home to check on the care and support each was receiving. The care plans we saw were reviewed regularly, which showed that staff have up to date guidance about each persons care. The plans were well organised and covered aspects of each persons personal and health care needs by identifying those needs and how they should be met. They included information on peoples personal care, health care, medication, respiration, regular support, being weighed, special medical needs and appointments to the doctors and other medical professionals. Care plans contained information about the support the person needed and gave some information about how to provide this. They had been written in a very personalised format, always referring to the person and what they liked and didnt like. Some people had taken the opportunity of signing their care plan which showed they were Care Homes for Older People Page 14 of 31 Evidence: included with developing their plan and agreed to it. One care plan we saw had no signature of either the person whose plan it was or their representative. We noted that one plan of a new person who had moved into the home was not complete and did not identify all the persons needs or how these should be met. The manager told us that this had already been brought to her attention and agreed to review this plan as a matter of priority. The plans also contained risk assessments which showed if people were at risk of for example falling or developing pressure sores. Staff were completing records to show what action they were taking to reduce these risks. People we met during our visit told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. People told us that they were happy living at the home. We also received six completed surveys from people who live at Atherton Lodge, which were all positive about their experience at Atherton Lodge. The eight completed surveys we received from relatives were also positive and included comments such as, The staff help the residents in their own time, they often come in on their days off and All staff are pleasant and caring with patients and visitors, always make you feel welcome. We looked at a sample of the medicines and medication records to see how they were being managed at the home. The medication records were being maintained accurately and were regularly checked by the manager to make sure they were correct and that any problems were dealt with quickly. This helps to make sure that the medicines are consistently well managed so that errors do not occur and people living at the home receive their medicines as prescribed by their doctors. Care Homes for Older People Page 15 of 31 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. People living at Atherton Lodge felt they were supported so they could live their daily lives as they wanted and preferred. Evidence: The staff told us about recent developments at the home whereby three unused bedrooms had been refurbished into new facilities that could be used by everybody living in the home. One room had been made into a hairdressing salon with salon equipment. Another room had been made into a craft and activities room and a third room was now a relatives room, where residents could meet their relatives in private. There had been really good feedback about these new facilities from everyone at the home including people living there. We saw posters in the reception area with information about the activities being offered each day. The manager had developed records of what activities had been provided that helped to show that staff were regularly offering a range of activities for residents to take part in. We met people living at Atherton Lodge who were able to talk about what they had done that day and some were looking forward to their tea. Staff had put flags up to Care Homes for Older People Page 16 of 31 Evidence: help people celebrate St Georges Day and they were hoping to having a buffet with drinks for tea. Some people told us they liked to go to the hairdresser each week in the homes new salon. In the four care plans we looked at during our visit, we found there was a section called working and playing, which gave some brief information about how the peoples social preferences and needs were identified. The manager also showed us very detailed and visual plans they were hoping to start using which would include discussion with families to build up a lot of background information about each persons life, social needs and preferences. When completed, these records will help to give information how people would be supported to have an active social life both in and outside the home. We also noted that staff had dealt sensitively with a topic which people find hard to discuss. They had developed care plans to include information about death and dying. This helped some people to identify their personal wishes and requests regarding any future funeral arrangements. During our visit we found that the staff worked hard to try and do what they could but they had not been given any extra care hours or training to arrange activities. The manager agreed that the home would benefit from having its own activities organiser and would hope to eventually have one for Atherton Lodge. This would help to increase the range of group and individual activities to suit everybodys preferences. The manager had developed annual questionnaires for people living at Atherton Lodge and she showed us a sample of some of the individual responses she received for 2010. We also noted the results of the 2009 questionnaires, which the manager had published in the statement of purpose that was accessible to everyone. These questionnaires helped to show ongoing discussions and reviews with people to find out their views about their home. The dining room at Atherton Lodge was domestic in style, with attractively laid tables. The kitchen was equipped with domestic style appliances and staff helped provide meals based on the choices offered on the daily menu. We talked with the manager about the benefits of organising regular meetings to help include people who live at Atherton Lodge in developing the activities programme so they could have a say in what activities were provided. Care Homes for Older People Page 17 of 31 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. There is an effective complaints procedure and staff have received training so they know how to ensure that people living in the home are safeguarded from harm and abuse. Evidence: The six completed surveys we received from people living at Atherton Lodge and conversations we had with people during our visit showed us that people at the home know how to raise any concerns they may have about it. They were confident that the staff would listen to and act on any concerns, complaints or comments they had. The eight completed surveys that were returned from relatives also confirmed that they were aware of the homes complaints procedure and who to approach if they had any concerns on behalf of their relatives. The organisation that runs the home regularly checks the way that any concerns, complaints and comments have been dealt with to make sure that peoples concerns are listened to and acted upon. We spoke to a number of staff during our visit and found they had a good understanding of how to make sure that the people living at Atherton Lodge were safe from abuse. Training records showed that the majority of staff had received training on safeguarding adults, which helps to ensure that the people living at Atherton Lodge are supported to stay safe. We looked at a sample of records of money managed by staff on behalf of some of the Care Homes for Older People Page 18 of 31 Evidence: people living at the home. As a matter of good practice the manager does not act as appointee for anyone living at the home. We noted that some peoples money is occasionally paid into the companys comfort fund, mainly by solicitors acting on behalf of their clients. We have asked for this to be reviewed as peoples money should not be kept in a pooled company account like this. It needs to be kept in separate accounts so that it can be separately accounted for for each person. Care Homes for Older People Page 19 of 31 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 adequate 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 comfortable environment, equipped to meet their needs, but improvements are needed to make sure that people living at the home continue to have good quality facilities available to them. Evidence: Everyone living at Atherton Lodge has their own bedroom which they can personalise as they choose. We were able to see a number of bedrooms during our visit and found they were being kept to a good standard, all being clean and tidy. Various rooms had lots of personal belongings such as pictures, ornaments and some personal furniture that some people had brought in with them. This helped people to settle into their room and feel more comfortable with their personal belongings. We noted that two bedrooms smelt unpleasant and that a couple of carpets were also stained and worn. This needed to be reviewed to make sure that the environment remained fresh and comfortable for people living in the home. Some of the communal areas, including the lounges and dining room, that we saw were kept clean and tidy; they looked presentable and comfortable to live in. When we looked at the laundry room we found that there was a build up of dirt in some parts and the room needed cleaning to improve this environment. Some people Care Homes for Older People Page 20 of 31 Evidence: including relatives and people living at the home raised comments about the standards of the laundry service at the home. Some people felt their clothes became lost at times, were dirty and crumpled at other times, and not stored properly in their bedrooms. The manager confirmed that she was already aware of this feedback and was already working on solutions to try and improve the service. She had already sought different samples of how to name clothes and was hoping to start this process very soon. We also noted that some of the pillows and mattresses were lumpy and needed to be replaced. Staff told us that new pillows and linen had been purchased following the previous inspection and agreed to look at how these items were being laundered as a way of making sure that they stay of a good enough standard to enable them to continue to be used. We noted that the local fire service had visited the home and their report included various recommendations that needed to be carried out. There had been an environmental health inspection of the kitchen not long before our visit and a number of requirements had been made. The manager agreed to keep the commission informed of the action being taken to meet the requirements of environmental health and the fire service. Although the home did not have a maintenance and decorating plan to share with people, the staff advised that redecorating and repairs are carried out throughout the year. The maintenance person kept detailed records of how they managed the building and equipment making sure that it was safe, with any necessary actions taken to reduce any risks. These records showed regular checks on items such as bed rails, water temperature, and fire system checks. We noted one bed rail that had a wide gap between its rails. The manager agreed to review any risks with the bed rail on the day of our visit to ensure it was safe to continue to use it. We looked at a sample of risks assessments for the environment. These records and the risk management that was put into place showed good management of the environment which helped to assure people they have a comfortable and safe home to live and work in. Care Homes for Older People Page 21 of 31 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. The staff team is stable and well trained to enable them to provide a good standard of care and support for the people living at Atherton Lodge. Evidence: We looked at four staff files, including that of the person most recently employed before our visit, to see what checks had been carried out and what training they had undertaken with while employed at Atherton Lodge. The staff files showed us, and staff we spoke with confirmed, that a lot of staff had been provided with mandatory training. Staff were being provided with the right training and skills to help them do their job and to help them to support the people living at the home in the right way. Staff felt confident that any training they identified that they would like to do would eventually be offered as they felt their manager was fully supportive of their need to develop their skills in order to improve the quality of care they could provide for people living in the home. The staff files showed us that before anyone started work in the home a series of checks were carried out. This included obtaining a fully completed application form, references and Criminal Records Bureau disclosure (CRB). These checks help to ensure that staff are suitable and safe to work with the people living at Atherton Lodge. Care Homes for Older People Page 22 of 31 Evidence: The training records we saw showed that the mandatory training for staff includes health and safety, infection control, fire training, safeguarding vulnerable adults and person centred planning. This training helps to ensure staff are aware of how to support people safely. Over half of the staff working at the home have obtained a national vocational qualification in care at least at level 2. There a plans in place for other staff to obtain this award. These are nationally recognised qualifications for staff working in care and show they have been assessed as competent to provide good quality care for people living at the home. Having over half the staff holding this qualification is good practice as it exceeds the basic standards and showed us that the home is committed to having staff with the knowledge and skills to provide good quality care for the people living there. Staff told us they were very happy working at the home and felt there had a really good atmosphere there. They all felt well supported and fully trained and were regularly offered ongoing training to help them do their job. We received thirteen completed surveys from staff which were overall very positive. Some of their comments included: I think we look after the residents really well; making the home a happy home and Its a nice home. During our visit there was one trained nurse and 6 care staff on duty. Staff felt that the staffing levels would be increased by the manager as they had recently had a few more people move into the home. They felt confident that their views and opinions about staffing levels would be listened to. We have recommended that staffing levels should be kept under review to make sure there are sufficient staff on duty to meet the needs of the people living at Atherton Lodge, especially at times of peak demand. This should include making sure that the necessary resources are available to carry out activities and run the laundry so that it remains clean. We did not see any information about how staffing levels are calculated for the home and how they are reviewed with regards the individual needs of people living there. The manager and staff did say they would always try to provide extra staff when needed. Any calculations made about staffing levels to make sure peoples dependencies are met should be recorded. Information about staffing levels in the home should be easily accessible, made available for people to see and included in the revised statement of purpose. Care Homes for Older People Page 23 of 31 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 well managed so it is run in the best interest of the people living there to ensure they are safe and comfortable. Evidence: The manager explained that at the time of our visit she was not yet registered with the commission but would be applying as a matter of priority following our visit. This is necessary to ensure the home has the stability of a manager registered with the commission who is knowledgeable and experienced in the national minimum standards and all relevant regulations. The manager also explained that she is hoping to commence a qualification in management called (NVQ 4) which is a national qualification. This is essential to ensure good practice and development in the management of the home. We looked at a sample of certificates and records, which showed us that a series of checks are carried out on the environment and equipment at Atherton Lodge to ensure it is safe. This includes regular checks of facilities such as fire equipment, gas and Care Homes for Older People Page 24 of 31 Evidence: electricity. The manager had put a number of audits and checks in place to check the quality of the service provided. This included regular reviewing of peoples care plans, use of bed rails and management of medications. The manager had worked hard in developing regular auditing of records and practices. We looked at a sample of the reports of the monthly visits carried out by the area manager of the company that runs the home. These showed us that regular checks on the quality of the service being provided at Atherton Lodge were being carried out. These audits offer additional checks on the standards achieved at the home and help to make sure that any problems are dealt with promptly. These detailed records and practices showed good management of the home to assure people that they have a home that is well managed and achieving consistently good standards. In addition to these regular checks, surveys are carried out each year to obtain the views of the people living at Atherton Lodge and their relatives. The company arranges for the results to be published each year and we were shown the completed publication for 2009 and the surveys submitted for 2010. The overall results were very positive and complimentary about the home. The manager identified that they were aware of some peoples comments about the standard of the laundry was reviewing this area already. These checks and surveys help to ensure that the service is consistently meeting good standards and quickly identify and address any issues that arise as well as helping plan future improvements. We noted that the manager had to carry out all administration tasks at the home. We discussed the benefits in having administration support with the manager and area manager, as this would free the manager from the more mundane tasks such as organising files and training records and would help assist in the overall management of improving standards at the home with efficient systems in place. As a matter of good practice the company do not act as appointee for any person at the home. This ensures people have individual choices as to how they manage their own funds. We noted that some people were being routinely charged five pounds for toiletries each month. This was discussed in detail as to how this practice could be reviewed so that people were assisted in a more person centred way to buy their toiletries as and when they needed them. We also discussed the way in which peoples money is pooled into a company account and that action needed to resolve this so Care Homes for Older People Page 25 of 31 Evidence: that peoples finances could be individually accounted for. Care Homes for Older People Page 26 of 31 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 27 of 31 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 31 9 As a matter of priority the 30/07/2010 manager should apply to the commission to be registered. This is necessary to ensure the home has the stability of a manager registered with the commission who is knowledgeable and experienced in all relevant regulations. Money belonging to people living at the home must not be kept in any company account. Records should show how their money is managed in their best interest. This is to ensure that peoples rights about their personal money are protected and any money being kept on their behalf by the home can be individually accounted for. 30/07/2010 2 34 20 Care Homes for Older People Page 28 of 31 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 1 The statement of purpose and service user guide should be updated about the needs of people supported to live at the home. These documents should be kept under review so that everyone has enough information to make decisions about Atherton Lodge and are kept up to date with all aspects about the home. A review of the activities currently available should be undertaken with people who live in the home so they can have a say in what activities are provided. Consideration should be given to having a designated activities organiser to help increase the range of individual and group activities available for people to take part in. The work that has been started on developing information about peoples past lives and their preferences should be completed to help make sure that peoples social needs are being met. The requirements made by the fire safety officer should be met to make sure that satisfactory standards of fire protection are maintained in the home. A maintenance and decorating plan should be recorded and discussed with people living in the home so they know what improvements are planned and can have a say in how this is acheived. The standard of the pillows and mattresses that are lumpy should be reviewed to make sure that they stay fit for purpose and are comfortable for people living in the home to use. The recommendations made by the environmental health officer should be met to make sure that satisfactory standards of hygiene are maintained in the home. The cleaning schedule for the laundry should be reviewed to make sure that it is kept clean at all times. Appropriate and prompt action should be taken in bedrooms that smelled unpleasant at the time of our visit, to make sure that the environment remains fresh and comfortable for people living in the home. Staffing levels should be kept under review to make sure there are sufficient staff on duty to meet the needs of the people living at Atherton Lodge, especially at times of peak demand. This should include making sure that the necessary resources are available to carry out activities and Page 29 of 31 2 12 3 19 4 19 5 24 6 26 7 8 26 26 9 27 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 run the laundry so that it remains clean. Any calculations made about staffing levels to make sure peoples dependencies are met should be recorded. Information about staffing levels in the home should be easily accessible, made available for people to see and included in the revised statement of purpose, so people know there will be enough staff available to meet their needs. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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