Care Home: Blacklake Lodge Residential Home

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blacklake Lodge Residential Home 85 Hilderstone Road Meir Heath Stoke On Trent Staffordshire ST3 7NS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Blacklake Lodge Residential Home 85 Hilderstone Road Meir Heath Stoke On Trent Staffordshire ST3 7NS 01782388881 01782396597 blacklake-lodge@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Sylvia Dudley,Mr Eric John Dudley care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 35. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- old age not falling within any other category, OP, 35 dementia - over 65 years of age, DE(E), 11; physical disability - over 65 years of age, PD(E), 35. Date of last inspection 0 0 0 Over 65 11 35 35 Care Homes for Older People Page 4 of 28 Brief description of the care home Blacklake Lodge is an extended detached house that provides 24 hour residential care for up to 35 older people, some of whom may have a physical disability, and 11 of whom may have dementia. The home is set in 5 acres of secluded lawns and woodland and is located just off the Hilderstone Road and surrounded by open countryside. It is less than a mile from Meir Heath where there are local shops. There is easy access to the Potteries towns and public transport passes the home. The home has 35 single bedrooms all have ensuite facilties. There are 3 lounge areas and two dining areas. All parts of the home are furnished to a very high standard. There adequate assisted bathing facilities throughout the building and shaft lift access to the first floor. Care Homes for Older People Page 5 of 28 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 last key inspection of this service was carried out on 16th April 2008. The AQAA (Annual Quality Assurance Assessment) was completed by the Manager and sent to us prior to the inspection. This is a legal document and is an annual selfassessment carried out by the providers of a service to quantify the outcomes and standards of care for people using the service. Some information from the AQAA is included in this report. This inspection was carried out by one inspector on one day from 8.30 a.m. - 5.00 pm. The Registered Manager and a Deputy Manager provided valuable information and discussion about the service. Other members of staff on duty were spoken with. Most people living at the home were seen and many spoken with together and separately. Three visiting relatives were seen and spoken with and one visiting District Nurse. Care Homes for Older People Page 6 of 28 The National Minimum Standards for Older People were used as the basis for assessment during the inspection. People told us that they were satisfied with the care provided at Blacklake Lodge, that staff were excellent, treated them with respect and they will do anything for us. No reservations were expressed about the level of service. Three visitors made very positive comments about the home, environment and staff. A visiting District Nurse was able to confirm that working relationships with staff were positive and there was good cooperation in the management of health care matters. We received written feedback directly to us from relatives and people living in the home prior to the inspection. Some very positive comments were made including There are always staff available to listen to any worries we may have. They have always been caring and undertanding when mother has had a difficult day. She loves the girls who look after her. We inspected the environment including all the communal areas and a sample of bedrooms. Records relating to the inspection were seen and readily available, they included care plans, risk assessments, medication records, accident reports, staff records and other documents relevant to the inspection process. There were 32 people in residence at the time of this inspection and there were 3 vacancies. What the care home does well: What has improved since the last inspection? What they could do better: It is important that all people are weighed upon admission and regularly thereafter as a means of monitoring general health care. Care Homes for Older People Page 8 of 28 Pre admission assessments must always be carried out by the home prior to a persons admission. This will ensure that all needs are assessed and known and a system in place to inform staff how those needs can be met. We were shown a new format for pre admission assessments, which is a good comprehensive document. This is being introduced soon. The standard of recording in some records is poor and need improvement. Some records were not dated and it was therefore not possible to know if the information was still current. It is important where there are DNAR (Do not attempt to resuscitate) documents in place, that these are reviewed 3 monthly by the GP, otherwise they will not be actioned by health care professions/hospitals. Safeguarding training must be provided for all staff. Some have previously had training in the Protection of Vulnerable Adults and this needs to be updated. Two written references must be obtained prior to employment of staff and there must be a reference from the last employer. Any gaps in employment should be investigated further. It is also necessary to obtain health care declarations from staff prior to employment to ensure there are physically and mentally fit to work at the home. Where referrals are made for appointments with external health care professionals the home should ensure that people are seen and assessed swiftly. 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 set out 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 9 of 28 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 10 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the home would benefit from more detailed assessments and information prior to admission. Evidence: There is a Statement of Purpose/Service Users Guide outlining the service provided. At the time of the last inspection some updating of this information was needed and this still needs to be done. It is important to detail what service the home provides and details of the range of needs that the home is intending to meet. Fees are not included in the Statement of Purpose and this should also be added. This will ensure people have sufficient information to make a judgment about the suitability of the home for them. It was found in relation to a person recently admitted that a care need assessment had not been completed by the home prior to the admission. This must be carried out for all people prior to admission and will provide necessary information to inform the Care Homes for Older People Page 11 of 28 Evidence: care plan and ensure all needs are known and can be met. In this instance there was a Multi -disciplinary assessment that had been obtained but the homes own assessment is vital in making a judgment about meeting the persons needs. We were shown a new pre-admission assessment format and when implemented this will provide all the required information and good assessments. Care Homes for Older People Page 12 of 28 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. Some aspects of health care could be improved with better recording and monitoring of appointments with external health care professionals. Evidence: We looked a sample of care plans including people recently admitted and those in longer-term care. This enabled us to have a cross-sectional view of how care planning information was gathered, whether it was accurate and informative and how it was used to meet peoples needs. There were some good examples of general assessments and risk assessments relating to nutrition, falls, moving and handling, dependency scoring and waterlow (pre-disposition to pressure damage). There was an example of a good social history being provided. The standards of care planning information were less than those seen on the last inspection. Many records were not dated and although some were good it was not possible to define the time they were written and therefore the current relevance. Daily recording was generally brief and included statement such as slept well. It was not possible to assess from the records the levels of care provided for a Care Homes for Older People Page 13 of 28 Evidence: person on a daily basis. Some improvements are needed. The care planning format is a pre-printed former nursing model and many risk assessment are generic - for example - if this condition exists, then this action should be taken. The home should develop a more individually person-centred care planning format. Information in risk assessments was adequate but could be improved. There was some good information about pre-existing medical conditions and other relevant social information. A visiting District Nurse was spoken with privately, she or colleagues visit twice daily to administer insulin and are involved in some ongoing wound care. She said that staff were welcoming, helpful and cooperative in the treatment of their patients and there were positive working relationships with all staff. We looked at care planning information relating to a person recently admitted who had presented some management difficulties, had a history of falls and in fact had 15 falls (mostly minor with no injuries) since admission. Records showed that a referral had been made 2 months previously for a psychological assessment and a visit from the CPN was still awaited. Because of the high risk of falls a referral had been made also 2 months ago to Stone Rehabilitation Unit for a falls risk assessment. Neither of these awaited appointments had been followed up. This must be done to ensure that people have the assessment and treatment they need to ensure their health and safety. Records showed that people were generally weighed regularly, although a person admitted 4 weeks prior to the inspection had not been weighed. It is important that people are weighed upon admission and regularly to establish a base-line for monitoring their health. A DNAR (Do not attempt to resuscitate) decision had been made and recorded in the required format, but unfortunately this had not been reviewed by the GP for 5 months. Unless reviewed 3 monthly by the GP the DNAR decision will not be applied by Paramedics or the Hospital Trust. The home have a service from 2 GP practices in Stone and good relationships are reported. This was confirmed in a conversation with a GP on the last inspection visit. A GP had been called on the day of this inspection to further review the deteriorating condition of a person and constructive advice and action had been offered. We inspected the medication system in use. There were some gaps on MAR (Medication Administration Records) sheets where staff had not signed to record medication given. It was possible to establish that two tablets had been given but not Care Homes for Older People Page 14 of 28 Evidence: signed for and it was not possible to ascertain whether cream had been applied to lower legs as prescribed. It is important to ensure that all medication given is signed for by staff and appropriately recorded if not given. Care Homes for Older People Page 15 of 28 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 chosen lifestyles are known and promoted and progress is being made in the provision of activities to meet the diverse needs of people in the home. Evidence: At the time of the last inspection some people said they were satisfied with the activities provided, others said they would like more to do . A requirement was made to consult people about the programme of activities and provide a range of activities to meet individual needs. The AQAA (Annual Quality Assurance Assessment) completed by the home states Service users and relatives have requested an activities programme to include the Nintendo Wii (computer game). Changes have been made to convert the existing office and storage area into a dedicated games/activities room. The conversion is almost complete but plans for activities there not yet completed. The AQAA also states We provide a varied range of activities to all clients, placing their individual needs at the centre of everything we do. A new member of staff has taken a lead in providing some activities. Current activities include: dancing, exercise to music, singalong, reminiscence, bingo and craft type activities. The AQAA states Social visits are also arranged to local amenities such as Care Homes for Older People Page 16 of 28 Evidence: shop, public houses etc. Some progress has been made in developing activities and the creation of a dedicated games/activities room is the planned progression. There are plans to extend the service for people with dementia care needs, with themed corridors and activities room that stimulate reminiscence and planned relaxation music and themes for people. Menus seen showed varied choice at all mealtimes. People spoken with said the food is excellent and we can have anything we like. Three visitors were spoken with, one relative of a person recently admitted, another whose relative has been at Blacklake Lodge for 5 years. All were very complimentary about the home, staff and service provided comments included I am very happy with the care my mother receives The home is excellent, my mother has settled well and quickly due to the efforts of staff and I am kept informed of progress or any concerns about my relative. There are regular residents meetings relatives are invited and attend. Care Homes for Older People Page 17 of 28 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. People are confident their complaints will be taken seriously and acted upon. Further training in Safeguarding Adults would ensure people are protected from potential abuse. Evidence: There is a complaints procedure in the home that is readily available to people living there and to visitors. Following the last report a complaints book has been established to record any complaints. Only domestic-type complaints have been received by the home and dealt with swiftly and satisfactorily. No complaints have been received by us concerning this home. A recommendation of the last report to provide updated training and information relating to Safeguarding (Adult Protection) has not been arranged and a further recommendation is made in this report. A safeguarding referral was recently made by the home and we were immediately informed. This concerned a serious situation which is currently still being dealt with under Safeguarding procedures. There has been no criticism of the home but action has been taken spontaneously by the home to further safeguard people and ensure there is no repetition of the events. Care Homes for Older People Page 18 of 28 Evidence: Some training for Senior staff has been provided in relation to the operation of the Mental Capacity Act and further computerised training for other staff who read and confirm they have read and understood the implications for the people they care for. Care Homes for Older People Page 19 of 28 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 excellent 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 safe, well maintained environment that is constantly being improved to ensure the comfort of people living there. Evidence: The environmental standards are good. All bedrooms have ensuite facilities, there are 3 lounge areas and 2 dining areas. Access throughout the building is good with shaft lift access to the first floor. The home meets the National Minimum Standards for the environment. All areas are well furnished with quality decor, providing a comfortable homely place to live. The home has been in same family ownership since established 17 years ago and there has been consistent reinvestment into the fabric and facilities of the home. Maintenance is good and there is an ongoing programme of refurbishment and improvement. A sample of bedrooms seen were bright, well furnished, spacious and personalised reflecting the individuality of the person. Standards of hygiene throughout the home were observed to be very high and there were no mal-odours, a reflection of good cleaning routines and attention to detail. As stated previously the former small office and store are being converted to a Care Homes for Older People Page 20 of 28 Evidence: games/activity room. A new pleasant reception area has been created where care plans and records are being securely stored. The disadvantage is that confidentiality is restricted, it is not possible to have private conversations or make telephone calls in the reception area. This was discussed with the Manager and was also an issue raised by a visitor. The Manager felt that private meetings/conversation could be held in the dining or other area of the home. The external garden areas extend to several acres, are well maintained and provide a pleasant view of the surrounding countryside in a landscaped setting with lawns and woodland. Access to the garden are is good and there are excellent seating facilities to enjoy the summer months. Since the last inspection part of the patio area has had a low visual impact pedestrian fence added to secure an area where people can sit or wander safely. The external security lighting has been increased. Care Homes for Older People Page 21 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a committed and well trained staff group. Improvements in recruitment procedures would ensure greater protection for people. Evidence: The staffing levels at Blacklake Lodge remains constant. The numbers of staff on duty throughout the 3 shift 24 hour period is 5:4:3 There were unusually 3 vacancies at the time of this inspection, the home continually runs at virtual capacity. When full and dependency levels demand, an addition carer is provided daily from 8a.m - 1pm. In addition to the above the Manager and his wife (Providers) are on call to support the home as well as other family members who provide administrative and maintenance support. Staffing levels at the time of this inspection were adequate for the dependency levels of the people presently living there. NVQ training is provided for staff and more than the minimum 50 of staff have achieved NVQ2 or above. There has been statutory training for all staff in all areas with the exception of Safeguarding Adults training which was recommended in the last report and further repeated in this. A sample of 3 staff records were seen. Where there were some shortfalls. Only one Care Homes for Older People Page 22 of 28 Evidence: written reference, not two had been obtained for one person. Two references obtained for another but a reference from the last employer had not been obtained. This is important to ensure the suitability of the person to work in the home. In all instances Health Questionnaires had not been completed by applicants. The provider must ensure that staff are physically and mentally fit to work in the home and a health declaration is required to support this, as stated in Schedule 2 (6) of the Care Home Regulations. POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks have been obtained for new staff prior to commencing work, although in one instance the POVA check was not on file as required and a telephone call to the agency providing the checks had to be made to confirm a POVA check had been forwarded to the home prior to employment of the person. These areas of recruitment practice should be strengthened to ensure the protection of people living in the home. Staff seen and spoken with were relaxed and helpful and spoke enthusiastically and with detailed knowledge about the people they were caring for. Care Homes for Older People Page 23 of 28 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. People benefit from a well run home managed in the interests of the people living there. Evidence: Mr Dudley is owner and Registered Manager of Blacklake Lodge he is assisted by Deputy Managers. The home is run in the best interests of people living there. There are regular residents/relatives and staff meetings allowing feedback of information about the service. Mr & Mrs Dudley, the Providers, have a daily presence in the home and it was clear that people living there and visitors had a positive dialogue with them and able to approach them about any issues they may wish to discuss. The AQAA states We ensure that management is approachable and supportive to all staff whilst also providing feedback and allowing staff to contribute their own ideas. We promote team working and staff flexibility and cohesiveness. The necessary policies and procedures for running the home are in place and all were reviewed/updated in February 2009. This promotes the health, safety and welfare of Care Homes for Older People Page 24 of 28 Evidence: people living in the home. The financial viability of the home has been demonstrated in the constant reinvestment that has taken place over the years to improve the standards in the home. The AQAA states We give good quality care and support in a safe, desirable and idyllic living environment. Evidence seen during this inspection supports that statement. Quality assurance monitoring is by means of regular staff and residents meetings and additionally questionnaires are sent out to people living in the home and their carers every few months. These have provided ideas for improvement in the past that have resulted in changes and improvement to the service. Records seen were adequate although improvements in the recording of care plans and daily notes for each person are needed. Care Homes for Older People Page 25 of 28 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 26 of 28 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 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 2 3 8 Pre admission assessment must always be undertaken to ensure people needs are known and can be met. Weights should be recorded upon admission and regularly thereafter to establish a base-line for monitoring peoples health. Referrals to Health care Professionals must be pursued to ensure peoples health care needs are met. MAR sheets (Medication Administration Records) must accurately record all medication given. DNAR (Do not attempt to resuscitate) documents must be regularly reviewed by the GP to ensure they will be acted upon by healthcare professionals. Staff recruitment procedures must be strengthened to ensure the protection of people in the home. 3 4 5 8 9 11 6 29 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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