Care Home: Carlisle Lodge

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What the care home does well Carlisle Lodge offers residents a homely and comfortable place to live. Staff involved in the inspection said that they work well together, and aim to offer residents the support they need and want. Residents were equally positive saying `the staff are very caring` and `the food is very good`. What has improved since the last inspection? No requirements were made at the last inspection. What the care home could do better: The care planning systems provides staff with clear information about the nursing and care needs of the people living in the home, however details of how the residents social and psychological needs should be included with clear guidance for staff. The current procedure for administering medicines needs to be reviewed, and a safe system developed and introduced to protect residents. Moving and handling training for staff should be updated to ensure residents are protected. Key inspection report Care homes for older people Name: Address: Carlisle Lodge 103 Carlisle Road Eastbourne East Sussex BN20 7TD     The quality rating for this care home is:   three star excellent 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: Kathy Flynn     Date: 1 9 0 1 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 26 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 26 Information about the care home Name of care home: Address: Carlisle Lodge 103 Carlisle Road Eastbourne East Sussex BN20 7TD 01323-646149 01323730321 diane@carlislelodge.plus.com www.crollgroup.co.uk The Croll Group Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Diane Lawson Type of registration: Number of places registered: care home 20 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 to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Carlisle Lodge is a detached property situated in a residential area, formerly a large family home that has been extended and adapted for its present use. The home is registered at present to provide nursing care for twenty residents. The home offers eighteen single rooms, thirteen with ensuite bathrooms and one shared room. There are ample bathing facilities provided with the necessary Care Homes for Older People Page 4 of 26 Over 65 20 0 Brief description of the care home specialised equipment to meet the needs of the residents accommodated in the home. The communal areas are pleasantly decorated and consist of a conservatory, a lounge area and a dining room. The home is situated approximately 1 mile from Eastbourne town centre and the sea front. Meads village provides the nearest shops, and the bus route runs along the main Meads Road. The car park at the front of the home has been cleared and has increased the parking facility. A large well maintained garden is situated at the rear of the home. Details of the current fees can be obtained from the home. Additional charges are made for toiletries, hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Care Homes for Older People Page 5 of 26 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: three star excellent 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 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection was carried on the 19th January and included a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 17 residents at the home during the inspection. 6 residents were involved in the inspection and were happy to discuss the support provided. The manager, deputy manager, care staff, cook and maintenance staff on duty discussed the care and support they provide at the home. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home Care Homes for Older People Page 6 of 26 settings. However for the purposes of this report those living at Carlisle Lodge will be referred to as residents. The Annual Quality Assurance Assessment (AQAA) was completed by the manager within the required timescale, and was used as part of the information collected for the inspection. However there was very little information about how the home has improved over the last 12 months, how they could do better, and how they plan to improve services over the next twelve months. Advice should be sought with regard to completing this assessment appropriately. Care Homes for Older People Page 7 of 26 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 8 of 26 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 9 of 26 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. The statement of purpose provides information about the support and care offered at the home, however some of the information is not up to date and does not reflect the needs of people living in the home. Evidence: The Statement of Purpose contains information about the facilities and services offered at Carlisle Lodge, including details of the owners, staffing, training and the aims and objectives of the home. Some of the information is not up to date, the agreed staffing levels set by East Sussex Brighton and Hove Health Authority are no longer in use, and the statement that people with physical or mild mental incapacity can be admitted does not support the varied needs of people living in the home. The Statement of Purpose should be reviewed in line with Schedule 1 of the National Care Homes for Older People Page 10 of 26 Evidence: Standards for Older People, and clearly identify the needs that the home intends to meet. The manager confirmed that she assesses people to ensure that the home can meet their needs before they are offered a place, and they are encouraged to visit the home to meet other residents and staff. The pre admission assessments viewed contained information about the medical, nursing and care needs of the residents, as well as details of how they like to spend their time and their interests. Residents involved in the inspection said that they were visited and discussed what support they needed before they moved in, and were happy with their choice of home. Care Homes for Older People Page 11 of 26 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. The care planning system provides staff with information about the needs of people living in the home, although they could be developed to clearly state how the home meets their social and psychological needs. There are policies and procedures in place for medication, however current practice is not safe and may put residents at risk. Evidence: Six care plans were examined and found to contain the pre admission assessment as well as details of how the home meets the residents physical needs. They included risk assessments for moving and handling, with clear guidance for staff with regard to the hoists and slings to be used, mobility and falls assessment, dietary needs, Waterlow scores and the pressure relieving mattresses and cushions to be used. Moving and handling training is provided for staff and those involved in the inspection said they have attended, and feel confident using hoists to assist residents. However staff were noted to use an inappropriate lift when assisting a resident to sit up in his chair, and they explained that they had been advised by the trainer to use this lift. The moving and handling training should be reviewed and updated to ensure staff are Care Homes for Older People Page 12 of 26 Evidence: quite clear about how to assist residents safely. A requirement has been made under Standard 30. Some of the information recorded was not up to date, it was not clear if one resident had a catheter; an action plan had not been developed to address a residents changing needs and prevent further accidents, and it was difficult to see how the home meets the needs of some of the residents, including those with a dementia type illness, as there was no clear information regarding meeting their social and psychological needs. Details of how the residents spent their time before moving into the home are included in the pre admission assessment. However there was little evidence that the home was enabling them to continue to enjoy these interests, or if necessary develop new ones, as their needs change due to diminishing eyesight or a dementia type illness. A daily record of the support and care offered is also kept in the care plan, and it was noted that comments like all care given as planned or no change in condition, do not reflect how the needs of the residents are met. Daily records, when well written, help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review, and to record that they are following the assessment of needs. The manager advised that she has arranged training for staff to enable them to meet the needs of people with a dementia type illness, and she expects to develop the care plans to address this when the training has been completed. Therefore a requirement has not been made at this time. A keyworker system is in place which provides residents with a named person who takes particular responsibility for their care. One member of staff is a keyworker for one of the residents and was able to discuss his needs, however the residents involved in the inspection said that they did not know who their keyworker was. Residents are registered with GPs and there are links with allied health professionals including Community Psychiatric Nurses, Macmillan Nurses and chiropodists, with appointments made as required. The home has policies and procedures in place for the ordering, storage and administration of medicines and they are kept in the clinical room that is on a mezzanine landing. The manager advised that consequently they are unable to use a trolley and their current practice is to place medicines in pots on a tray and then take Care Homes for Older People Page 13 of 26 Evidence: them to the residents. The deputy manager was giving out medication during the inspection using this system, the Medicine Administration Record MAR charts were in the clinical room, and therefore the medicines were not signed for when they were given. Discussions with the manager highlighted that there has been some confusion with regard to potting up of medicines. The expectation is that if the home has to place medicines in pots then this is done for one resident at a time, and signed for at the time they are administered. The Pharmacy Inspector has discussed the homes policies with the manager, and a requirement has been made for the introduction of a safe system. Staff protected residents dignity when offering personal care, and communication between residents and staff was relaxed and friendly. Residents involved in the inspection said that the staff look after us very well. Care Homes for Older People Page 14 of 26 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. A range of activities are available for some residents to participate in if they wish, the food is good, choices are provided and specific dietary needs are met. Evidence: The home offers residents a range of activities, which include outings and celebrations that involve relatives and friends of the people living at the home. On the day of the inspection the activity programme was limited due to staff training, a short period was spent reading the daily paper with residents in the lounge, and some were provided with paper and crayons for drawing. The manager advised that the activity organiser spends time providing group and individual activities for the residents. Although there is no written evidence to support this in the care plans, and there are no clear guidelines for staff to follow to enable them to support residents to spend their time as they would wish. Residents involved in the inspection said that a number of activities are provided and they join in when they wish, although some prefer to spend their time in their own rooms. Relatives and friends are encouraged to visit the home and take part in Care Homes for Older People Page 15 of 26 Evidence: activities and outdoor trips that are arranged for residents. The meals at the home are varied, residents said that the food is good, and staff said that they are always well received. Choices are offered and residents are able to change their mind if they wish. Specific diets are catered for and staff assist residents when required. The manager explained that residents who require assistance have their lunch earlier than residents who are able to eat independently, a system that has been arranged with the support of people living in the home and their relatives. However there is no record of this in the care plans and some of the residents, due to a dementia type illness, may be unable to give their consent. There is considerable opportunity to make meals a pleasant and positive time for people living in the home, particularly those with a dementia type illness. With appropriate planning, staff training and sufficient staff numbers meals can be a valuable social experience for all residents Care Homes for Older People Page 16 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place with regard to complaints, with information available in the home to guide residents and visitors. Training in safeguarding adults is provided for staff to protect residents. Evidence: The manager confirmed that there are policies and procedures in place to enable residents and visitors to the home to raise any concerns they might have, and the aim is to deal with any issues when they first arise. Residents involved in the inspection said that they didnt have anything to complain about although if they did they would just talk to the staff and there have been no formal complaints to the home or the Commission. The home provides training to protect older people for staff, and those spoken with have attended and were able to demonstrate an understanding of abuse and what action they would take if they have any concerns. Care Homes for Older People Page 17 of 26 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. The home offers the people living there a comfortable and homely environment. Infection control training is provided for staff to protect residents. Evidence: Carlisle Lodge is a converted older building with some original features offering residents a homely environment, with comfortable rooms that they can personalise with their own pieces of furniture, pictures and ornaments. There are plans to extend the building to the side and rear, which will improve access to the lower ground floor and the large rear garden. Lifts enable people living there to access all parts of the home, and there are a range of hoists and aids to promote their independence. Training in the control of infection is provided for staff, and those involved in the inspection said they have attended and are aware of how to use gloves and aprons to protect residents. Care Homes for Older People Page 18 of 26 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. Robust recruitment procedures are in place to protect residents, and the training programmes ensure staff are aware of their responsibilities. Evidence: The manager advised that the turnover of staff at the home is low, a number have been employed there for several years and continue to provide the support and care residents need. However the staffing numbers are currently based on levels agreed prior to the Commission for Social Care Inspection and subsequently the Care Quality Commission, and these are no longer used. The expectation is that the number of staff working in the home is based on there being sufficient staff in the home, with the skills and knowledge, to meet the individual assessed needs of each of the people living there, including their social and psychological needs. Robust recruitment procedures are in place, three staff files were viewed and contained the relevant information including application forms, two references and Criminal Records Bureau and Protection of Vulnerable Adult checks. Staff spoken with said that they enjoy the work they do and feel the home is like a Care Homes for Older People Page 19 of 26 Evidence: close community with residents, relatives, friends and staff working together to provide the care the residents need. Residents involved in the inspection said that the staff are very nice, they look after us very well and are always very cheerful. The home provides an ongoing training programme that includes induction training for all new staff and there are opportunities for them to work towards National Vocations Qualifications NVQs, although the home does not meet the required 50 percent of staff with level 2 or equivalent. Staff involved in the inspection have attended mandatory training including fire training, food hygiene, safeguarding adults, infection control and moving and handling. As already identified the moving and handling training should be reviewed and updated in line with current health and safety standards. Care Homes for Older People Page 20 of 26 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 management of the home encourages the involvement of the people living there, visitors and staff in developing the services offered at the home. Systems are in place to protect the health and safety of resident and staff. Evidence: The manager of Carlisle Lodge has been responsible for managing the service for over 17 years, she is a registered nurse and holds a management qualification. Annual surveys and six monthly residents and relatives meetings are used to obtain feedback about the support and care provided at the home. The last meeting was arranged in October 2009 on a Saturday, to enable working relatives to join the residents, and the manager advised that it was well attended. Residents involved in the inspection said they are comfortable, they are well supported by the staff, the manager is very good and they can decide how we want to spend our time. Care Homes for Older People Page 21 of 26 Evidence: Staff meetings are also arranged to enable them to discuss the support and care they offer, although the manager said that informal conversations on a day to day basis are more productive. The manager confirmed that there is a quality monitoring and assurance system in place, which includes monthly visits by the provider under Regulation 26, although she advised that she knows when he is arriving. This should be reviewed as the expectation is that these visits are unannounced. The home is well maintained, with the maintenance person providing fire training as well as taking responsibility for testing the hot water system, and ensuring the lifts, hoists and other facilities are serviced by external companies. The health and safety of residents and staff is protected by the ongoing training of staff. However additional training in moving and handling and providing care for people with dementia is required. Care Homes for Older People Page 22 of 26 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 23 of 26 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 9 13 That the adminstration procedure for medicines is changed to be in line with the guidlines of the Pharmacy Society and the guildines of Building a safer NHS. To ensure a safe procedure is followed to protect the health and welfare of the residents 08/03/2010 2 30 13 That the moving and 29/03/2010 handling training is reviewed and updated. To ensure that staff follow the correct moving and handling procedures to protect residents. Care Homes for Older People Page 24 of 26 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 Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). 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