Care Home: Chapel Lodge Nursing Home

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What the care home does well Chapel Lodge was clean and fresh smelling. Staff were knowledgeable about individual people`s needs and personalities. We observed good interaction between staff and people living at the home. Staff took each opportunity to maintain people`s independence and enable them to exercise choice. People were helped to make use of local facilities. The manager encouraged staff to train and extend their knowledge and skills. People spoken with said " The staff are very good to me", They all work very hard", "Nothing is ever too much trouble for them", "I like it here". What has improved since the last inspection? Staff had received extra training in adult safeguarding adults, this was required to ensure people were provided with a good standard of care and their rights and choices protected. Record keeping and monitoring of risk had been reviewed to ensure that staff were provided with plans of care that were current and reflected the care people required. What the care home could do better: Bedroom soft furnishings were standardised, this did not reflect individual choice. The depth of information within some care records was incomplete in some areas, more detail was needed to ensure staff can provide the care and services for people. Key inspection report Care homes for older people Name: Address: Chapel Lodge Nursing Home 105 Station Road Chapeltown Sheffield South Yorkshire S35 2XF     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: Ian Hall     Date: 1 6 1 2 2 0 0 9 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 27 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: Chapel Lodge Nursing Home 105 Station Road Chapeltown Sheffield South Yorkshire S35 2XF 01142578727 01142578728 chapel@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross Healthcare (Focus) Limited care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 63. 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 admisison to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 63. Date of last inspection Brief description of the care home Chapel Lodge is a modern purpose built home that can accommodate up to 63 people. It is situated just off Station Road in Chapeltown, near Sheffield, accessed by a wide driveway shared with other properties, and is difficult to see from the main road. There is plenty of car parking at the front of the building and there are gardens to the rear adjacent to the river. The building has two floors accessed by a shaft lift and several staircases. All the Care Homes for Older People Page 4 of 27 Over 65 63 0 1 0 0 3 2 0 0 9 Brief description of the care home bedrooms are single, but of a good size with an en-suite toilet and wash- basin. Communal areas are situated in different parts of the building so that there is usually one nearby. There are ten bathrooms around the building and some toilets near to the communal areas. Although the building has operated as a home for about ten years, it was purchased by Southern Cross Health Care in 2007, requiring a new registration with CSCI. The home was then closed for six months, June to December 2007, due to refurbishment following flooding of the adjacent river. The fees range from £337 to £656 depending on a needs assessment, and do not include chiropody, hairdressing, newspapers, dental, optical, toiletries and outings. This information was provided on the 16th December 2009. The registered person makes information about the service available via the Statement of Purpose and the Service User Guide. A copy of the inspection report will be made available at the home. Care Homes for Older People Page 5 of 27 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 star. This means that people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The unannounced site visit undertaken as part of this inspection started at 13:40 on the 15th December 2009 and concluded at 13:15 on the 16th December. It was conducted by Mr I A Hall link inspector. The site visit included a tour of the building, reading records, observation of meals Care Homes for Older People Page 6 of 27 provided, discussions with staff, and people who use the service and their relatives. We also met with the manager and other members of staff. In addition the inspection took account of information received about the service since the last inspection. This included records of conversations with staff and events notified to CQC, and records of management visits to the home. Prior to the site visit the home carried out a self assessment of the service. This is called the annual quality assurance assessment (AQAA). People spoken with were happy to assist with the inspection. At the end of the site visit feedback was given to the manager. Care Homes for Older People Page 7 of 27 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 27 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 27 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 service provides people with detailed information to enable them to choose Whether the home is the one for them. Detailed assessments ensure that peoples needs could be met prior to offering them a place. Evidence: An information pack was available that provided details of the standard of care and services available at Chapel Lodge. This includes useful information about staff, their qualifications, visiting the home, choosing meals, the laundry service and how to raise concerns. We checked three case files. Each contained a detailed needs assessment; this included such things as daily living, personal care, health care, social interests and areas of risk when appropriate. Whenever the need for specialist caring equipment had been identified this had been obtained prior to the person moving into the home. Care Homes for Older People Page 10 of 27 Evidence: The assessment formed the basis of the initial care plan. People said that they had been able to discuss their wishes and the type of help they needed before they made the decision to live at the home. Whenever possible people had been encouraged to visit and spend time at the home so they could meet members of staff and other people living at the home. This was confirmed by written entries in the case files. Copies of contracts, social work referrals and assessments were available and kept in the case file. Care Homes for Older People Page 11 of 27 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 health and personal care that people received met peoples individual needs. The principles of respect, dignity and privacy were practised by all staff. Evidence: Three peoples care records were examined. Peoples care needs had been assessed. A range of recognised assessment documents had been used to measure peoples needs. These included mobility, mental ability, state of nutrition and areas of risk such as falls. These provide a baseline for staff to measure peoples progress or increasing level of need. This enables staff to plan the help and support people need. There were care plans to tell staff how to meet these needs. These had been reviewed regularly. Most people we spoke to knew about their care plan. Relatives said they had been kept informed and involved whenever possible. Care plans detailed peoples religious and cultural needs and the gender of staff they wanted to support them with their personal care. Pen portraits of the person, their lives and interests provide staff with background information to improve the care and service provided. Some pen portraits were brief statements and lacked the depth of detail and information to enable staff to Care Homes for Older People Page 12 of 27 Evidence: fully engage with people. Daily entries were made of care provided. This enabled staff to review peoples health and wellbeing and change plans of care as necessary. There were records of visits by the GP, community nurse, dentist, optician and chiropodist. One GP practice holds a surgery at the home each week; this enabled staff and people to easily access their family doctor and have their medical care regularly reviewed. There were wheelchairs, aids and equipment provided to meet peoples moving and handling needs. We saw that bathrooms and toilets had been provided with aids and adaptations so that people can maintain their independence and use them safely. Several safety aids had been removed during upgrading of the area, they were being replaced by the handyman to ensure peoples safety. We observed staff assisting people to safely take their prescribed medicines; they were helped appropriately and with empathy. Trained nursing staff were responsible for administering, ordering and storing medicines; we saw that this had been done correctly. The supplying pharmacist helped staff by auditing medicines ordered and their storage; he provided training and information as needed to maintain peoples safety. No one was responsible for their own medication. Staff said that facilities were available for people should they want to self medicate. People living at the home said Staff are very caring and helpful but they are so busy things are rushed and its not their fault and that Nothing is too much trouble for them, they are so busy but they are lovely,Sometimes I just want to sit and talk but I feel guilty asking them to. People said that staff promoted their privacy and dignity. We saw staff knocking upon bedroom doors and waiting to be invited to enter. We observed interactions between staff and people living at the home. These were warm and caring relationships with each person showing respect for the other. Care Homes for Older People Page 13 of 27 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 were supported to make choices about their lifestyle and maintain their life skills whenever possible. Evidence: Three care files and plans were checked. Theses showed that people were involved in a range of activities. We saw people reading, listening to music and watching television. No one currently left the the home unless accompanied by their family or members of staff. A dedicated member of staff was employed to organise activities that stimulate people and encourage social interaction for 5 days each week. Entertainers visited the home for peoples enjoyment. A number of people went to celebrate Christmas with a meal at a local public house. They were accompanied by staff in the homes minibus. They said the meal was very good and had made them feel very happy. We saw the cook preparing and baking cakes and buns. She said that these were freshly made each day. People said they enjoyed them with their cups of tea and there was always plenty to eat. Care Homes for Older People Page 14 of 27 Evidence: The meals provided were appealing and smelled appetising. People said they enjoyed their meals. They could choose other meals if they dont like the meal provided. People were seen and heard to make choices at breakfast time. Staff were seen to help and encourage people with their drinks and meals. Extra food portions were available as required. Peoples dietary likes and dislikes were documented and known to staff. Special diets were available as needed. Staff said they sought the dietitians advice when necessary. Drinks and snacks were available through both the day and night times. We saw that people were not constantly supervised throughout the mealtime, this presented a potential risk to frail and vulnerable people. Care Homes for Older People Page 15 of 27 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 who use the service were able to express their concerns via the complaints procedure. They were protected from abuse and had their rights protected. Evidence: The home had a complaints procedure that was available to people and their visitors. The procedure was also referred to in the information given to new people, it identified stages to follow; this included timescales to respond to complaints. The manager confirmed that any complaints received had been actioned within the timescales specified. People and their visitors said they felt confident the homes manager would act promptly to rectify any concerns they had. The manager was clear when an incident may need external input and how to make referrals to the adult safeguarding team. Staff had received in-house training about safeguarding adults and confirmed they were aware of the whistle blowing policy. External training with access to deprivation of liberty and mental capacity legislation had been planned. CQC had received one concern since the last inspection; it was being investigated by the homes owner. Relatives commented, My husband has been here for a year now and Ive never had a complaint, The one issue I had was dealt with very quickly, Im satisfied, My husbands teeth were lost almost a year ago, hes been ordered new ones, I dont think I should pay for them. The manager agreed to speak to the person concerned and Care Homes for Older People Page 16 of 27 Evidence: resolve this concern. People who had no advocate or next of kin had been provided with access to advocacy service provided by Age Concern. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean and safe environment for people who use the service. Bedrooms were clean with some reflecting personal choice. A range of colours had been used to individualise and improve the appearance of bedrooms. Evidence: We saw the home was clean and smelled fresh. Soft furnishings, pictures and ornaments had been used to provide a homely setting. However soft furnishings such as curtains and bedcovers were standardised; they didnt reflect the individual and their personal choice. A number of families had assisted with personalisation of bedrooms with favourite items and memorabilia. Bedrooms were lockable with keys available for those people who wished to exercise the choice to lock their own door. Visitors comments included, Its always clean here, the staff work hard to keep things nice, Im very happy with the standard of cleanliness. There was level access throughout each floor of the home with handrails provided to help people maintain their independence and mobility. Appropriate seating had been provided in the enclosed garden area for people wishing Care Homes for Older People Page 18 of 27 Evidence: to sit outdoors when the weather permitted. The laundry and kitchen areas were well organised and equipped. The sluice areas appeared cluttered with excess stored equipment. Care Homes for Older People Page 19 of 27 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. Staff had the skills and knowledge to fulfill their roles within the home, and there was a stable staff group. Recruitment policies were sufficiently robust to ensure the safety and protection of people that live at the home. Evidence: Staff rotas were seen. We observed people being left unsupervised during breakfast time; staff had been asked to help to care for people who were cared for in bed because of their complex needs; this potentially put vulnerable people at risk. Staff files contained written references, POVA check and CRB (criminal record bureau checks. These were required to ensure recruitment procedures were sufficiently robust to protect people who use the service. The staff training and development plan identified staff training needs, courses completed and courses being undertaken. Staff spoken with confirmed they had undertaken statutory training and updates such as moving and handling and fire prevention. Staff confirmed they had completed induction orientation and training, and national vocational qualification training. The numbers of staff trained to level 2 NVQ in care exceeded the minimum 50 required. The manager said the nurses continue to update their own knowledge by attending relevant training courses; their professional registration status was known and expiry dates monitored. This ensured Care Homes for Older People Page 20 of 27 Evidence: staff were trained to meet peoples care needs safely. We spoke to staff who said, I dont always have the time Id like to give people the time they need, The people who are nursed in bed need lots of care, I feel as though Im splitting myself in two some days and I try not to let people see how busy we are and take my time, but there are so many dependent people here and we have to meet everyones needs. Care Homes for Older People Page 21 of 27 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 were involved in making decisions about their care; they had the opportunity to control most issues that affected their lives. Evidence: The manager had been in post for one month; shes a registered nurse with a range of previous management appointments and skills. She discussed her audit of the service provided at Chapel Lodge and outlined her plans for future developments. She had undertaken a risk assessment and dependency study of people living at the home. This had been used to review how care was provided with her staff team to maintain peoples safety. She was respected and liked by relatives and people who use the service. Relatives said Shes very kind and treats people with respect and Shes very good. Staff said the manager was very approachable, very professional and they felt confident in her. Care Homes for Older People Page 22 of 27 Evidence: We saw there was always a senior member of staff on duty at the home. The manager was supernumerary to the staff on rota and was able to complete her management duties. A senior company manager visits the home to monitor care and standards at the home. A written report of their findings was available at the home. The manager was ale to demonstrate how the organisation gains the views of people who use the service. A quality survey was sent to relatives and people to complete, the results were used to influence how the service was provided. Regular meetings were held for staff and people who live at the home and their relatives. These gave people living at the home a chance to say how the home should be run. People felt their views and opinions were taken into account by the staff. Many people were unable to manage their own finances; some relatives had assumed this responsibility. The administrator told us how bank accounts were held on behalf of people who use the service. Records seen were correctly maintained, peoples monies were held in individual named accounts. Accident reports were analyzed by the manager to ensure risk assessments were developed when required, and to protect people who use the service. Maintenance and service records were up to date and current to the services provided. Staff said they were provided with protective clothing whenever it was required; this was needed to protect people from the spread of infection. Care Homes for Older People Page 23 of 27 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 24 of 27 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 27 18 Ensure that at all times 15/01/2010 suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The homes manager must carry out a risk assessment and dependency study of peoples needs. The outcome and proposed plans must be submitted to CQC Adequate numbers of staff are required to supervise people and keep them safe from risk of injury or accident. Care Homes for Older People Page 25 of 27 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 26 of 27 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). 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. 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