Care Home: Dunnington Lodge Nursing Home

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What the care home does well We spoke to the manager, and looked at the Statement of Purpose. This told us that everyone is assessed by the manager, before they have to make a decision about whether Dunnington Lodge will be a suitable place for them to move to. As part of this assessment, they and their family are invited to look round. They can spend longer periods at the home if they wish, including a trial stay, if they are having difficulty in deciding whether they want to move there. The manager told us that she tells everyone during this period about the fact that there are a number of shared rooms there. She understands that this arrangement may not be right for everyone, so she makes sure people are fully informed about the accommodation available. People we spoke with were very happy with the care they receive. Of those who returned their surveys, eight said they `always` receive the care and support they need. The ninth said this was `usually` the case. Six said that the staff were `always` available when needed, with the remaining three stating this was `usually` the case. When asked if the staff listen and act on what they say, seven people answered `always`, with the remaining two replying `usually` or `sometimes`. People said they `always` or `usually` get the medical care they need. People made comments like `Very well looked after overall`, `All care very good. Excellent staff`, `Take care of me well. Very friendly` and `Pleasant staff, good nursing care, very helpful.` There were no negative comments made about the care. We spoke to people on the day, who made similar positive comments about the care they receive. This included their response when asked how safe they felt when staff assisted them to move, and about their accommodation. We received comments like: `I`m happy with the sleeping arrangements. Staff observe privacy and dignity. If you have to be in a care home this is about the best you can get. Staff use the screens when providing care always. I pull the buzzer and someone comes. I feel safe when staff help me in and out of bed. The stair lift is quite safe - no problems`, `Staff very good. I would recommend the home to anyone`. This person said the staff use the stair climber to assist them up the final flight of stairs to their room. They said they felt quite safe when staff assisted them. Another two people said that staff made them feel safe when equipment designed to get them up and down the stairs was used. Someone who shares their sleeping accommodation said `I love my room`, whilst a visitor to someone who also shares, said that they had no concerns regarding lack of privacy or space for their relative. Another person said `I share a nice room with Mrs (x). It`s nice, and staff are nice`. We also received some positive comments from professionals who support the people who live at Dunnington Lodge. They all agreed that people`s social and healthcare needs are properly monitored, reviewed and met by the home, and that the staff seek advice and act on it to improve people`s wellbeing. The manager keeps a record of complaints made to the service, and the outcome of any complaints investigations. People who returned their surveys all agreed that there was someone they could speak to informally if they were not happy, and eight out of nine knew how to make a formal complaint. We looked at the complaints book. There were no formal complaints made about the size of the rooms, about the sharing arrangements, or about any instances of poor moving and handling.Staff have received training in safe moving and handling in the last year. This is good, because it will make them more aware of safe ways of working, whilst protecting the individuals they care for and themselves from unnecessary injury. People have, in the last year, been asked to complete a questionnaire. This was not dated, and the manager said she would amend this, so people can know better how up to date the information is. The survey results recorded no concerns about the shared rooms, or about any issues around people`s care, in relation to how they are moved, or the equipment staff have to assist them. The staff also complete a record of accidents. We looked at those recorded since September 2009. There have been no incidents reported which relate to poor moving and handling, or injuries received as a result, or of injuries as a result of the use of the stair lift. This suggests that staff work in a safe way when assisting people. What the care home could do better: When people or their family come to look round, they can look at the written information the home has put together about what the home provides, and how. This is called a Statement of Purpose and service user`s guide. The Statement of Purpose provides a lot of information about privacy and dignity, independence and choice, and how the staff will strive to maintain people`s rights to each of these. The service user`s guide is very brief, and needs to be read in conjunction with the Statement of Purpose. Neither document discusses how people`s right to privacy and dignity, independence and choice will be addressed and upheld with specific reference to the shared accommodation. It would be good practice to do so. Everyone who returned their survey said that they received enough information before they moved in to help them decide whether the home was the right place for them. However, people are sometimes unable to visit the home before they move in, because of their current circumstances. It is recommended that everyone referred to the home receives a copy of the Statement of Purpose and service user`s guide, so they can see for themselves what facilities are on offer, and how their needs will be met. This helps people make their own informed choice about whether Dunnington Lodge will be the right place for them to live, with the facilities it provides. The accommodation is provided on three floors. There is no passenger lift available. Instead, there is a stair lift, and a `stair climber`, which is a specific piece of equipment used to assist people up smaller flights of stairs. The manager said, that during the pre admission assessment, the lack of passenger lift is considered, and looked at closely, when deciding whether staff will be able to assist people safely to and from their rooms. We looked at some people`s pre admission assessments. This assessment was not formally recorded. It would be good practice to do so, so there is evidence that this has been considered. The manager said that she also thinks about the needs of the person being assessed against others with whom they will be sharing their bedroom, when deciding whether these overall needs will be met for all concerned. However, this was not formally recorded on the pre admission assessment either. Doing so would remind staff to consider these collective needs when reviewing people`s care plans, when checking thatthe arrangements are still acceptable to all those sharing their bedroom accommodation. Two of the bedrooms, located on the top floor of the building, have ceilings of irregular shape, because they are situated in the attic. We spoke to each of the occupants of these rooms, who were satisfied with their accommodation and raised no concerns. This is good. However, as above, the shape of the rooms could be considered when carrying out the pre admission assessment for people who may be moving into them, to make sure that staff will have the space and the ability to manouevre any equipment needed, in order to meet these people`s needs successfully. Although people are satisfied with the care they receive, this care is not always reflected in their care plans. Some of the information we saw about how staff were to move and handle people were not consistent, and could lead to confusion. In some cases people with equipment, such as bed rails, did not have a risk assessment completed before they were first used, and there was no record in some plans to show that this equipment had been checked regularly to make sure it was safe, and fit for use. We asked the manager to update these care plans, and referred her to the current health and safety guidelines for their use. The moving and handling techniques used for two people were discussed with the manager. We asked her to review each of the moving and handling risk assessments for these individuals, to check that they were being moved in a safe way, and to ask the doctor for a referral to the occupational therapist if this was needed. We had particular concerns regarding one person, and the moving and handling methods adopted by staff involved in the procedure, when accessing the stair lift. There was no risk assessment completed for this procedure, to show that it had been assessed as being safe for all concerned. We asked the manager to revise and update the risk assessment. We have also sought further advice from other professionals, to see how they can assist the home in making this manouevre safer, and have informed the registered provider of this discussion. The bedrooms seen contained people`s personal belongings. Staff said that they had to `plan` any moves in some rooms, and move lighter pieces of furniture around in the room shared by three people, such as a TV trolley, commodes and bedside tables, before they commenced any move. Rooms had privacy curtains. One staff commented that it was sometimes difficult to use these curtains, because of the layout of the room. Therefore they had t Random inspection report Care homes for older people Name: Address: Dunnington Lodge Nursing Home 34 Church Street Dunnington York North Yorkshire YO19 5PW two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anne Prankitt Date: 1 9 0 1 2 0 1 0 Information about the care home Name of care home: Address: Dunnington Lodge Nursing Home 34 Church Street Dunnington York North Yorkshire YO19 5PW 01904488676 01904488513 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Gill Richardson,Mr Richard Hugh Richardson care home 19 Number of places (if applicable): Under 65 Over 65 19 0 old age, not falling within any other category terminally ill Conditions of registration: 55 years plus 0 4 Service Users to include up to 19 (OP) and up to no more than 4 (TI) up to a maximum of 19 Service Users. Date of last inspection Brief description of the care home Dunnington Lodge is owned by Mr and Mrs Richardson. It is registered to provide care and accommodation for up to nineteen people with nursing needs. The premises comprises of a large period building, which is situated in the village of Dunnington, on the outskirts of York. The local village amenities are within easy reach of the home. Care Homes for Older People Page 2 of 13 Brief description of the care home People thinking of living there can see a copy of the Statement of Purpose and service users guide when they look round. A copy of the most recent report, written by our predecessor, the Commission for Social Care Inspection, is available on request. The owners should be contacted direct for information about current weekly fees, and what people pay extra for. Care Homes for Older People Page 3 of 13 What we found: The last key inspection for Dunnington Lodge Nursing Home took place on 22 July 2008. This is a report of the findings of a random unannounced inspection, which took place on 19 January 2010. The inspection included a visit to the service, to look primarily at how peoples care was managed, and how their privacy, dignity, choice and safety was maintained. We decided to do this because we had received a concern which told us that peoples rooms did not satisfactorily meet their overall needs, and that the environment layout posed problems when people were being assisted to move. The concerns made some specific reference to the one bedroom which accommodates three people. We looked at: What information people get about the accommodation, before they move to Dunnington Lodge, and how their personal needs and choices will be met alongside those they will be sharing their accommodation with. We also looked at how their needs are assessed. How people who share their bedroom with others have their care provided, and how these peoples personal choices are maintained. Whether people in shared accommodation experience good consistent outcomes. How the home ensures peoples safety when they are assisted to move by staff. We obtained evidence by: Collecting surveys from people who use the service (9 surveys returned), staff who work there (2 surveys returned), and health and social care professionals who have placed them there, and/or who support them (4 returned). Looking at some records such as the Statement of Purpose and service users guide, some care plans, some health and safety records including the fire safety risk assessment, the accident book and the complaints record. Looking around the environment, including a number of rooms, providing both single and shared accommodation. Talking to people who live at Dunnington Lodge, a relative, some staff and the registered providers, one of whom is also the manager of the home. The manager was available throughout the day, and we provided her with feedback both during and also at the end of our visit. Overall, the inspection found that people who live at Dunnington Lodge Nursing Home are happy there. They are satisfied with the care they get, with the approach of the staff, and with their accommodation. We did however raise some issues with the manager about some health and safety matters, which need attention to make sure staff understand Care Homes for Older People Page 4 of 13 current risks to people, and so they have the right information to act in a safe and consistent way to reduce these risks. What the care home does well: We spoke to the manager, and looked at the Statement of Purpose. This told us that everyone is assessed by the manager, before they have to make a decision about whether Dunnington Lodge will be a suitable place for them to move to. As part of this assessment, they and their family are invited to look round. They can spend longer periods at the home if they wish, including a trial stay, if they are having difficulty in deciding whether they want to move there. The manager told us that she tells everyone during this period about the fact that there are a number of shared rooms there. She understands that this arrangement may not be right for everyone, so she makes sure people are fully informed about the accommodation available. People we spoke with were very happy with the care they receive. Of those who returned their surveys, eight said they always receive the care and support they need. The ninth said this was usually the case. Six said that the staff were always available when needed, with the remaining three stating this was usually the case. When asked if the staff listen and act on what they say, seven people answered always, with the remaining two replying usually or sometimes. People said they always or usually get the medical care they need. People made comments like Very well looked after overall, All care very good. Excellent staff, Take care of me well. Very friendly and Pleasant staff, good nursing care, very helpful. There were no negative comments made about the care. We spoke to people on the day, who made similar positive comments about the care they receive. This included their response when asked how safe they felt when staff assisted them to move, and about their accommodation. We received comments like: Im happy with the sleeping arrangements. Staff observe privacy and dignity. If you have to be in a care home this is about the best you can get. Staff use the screens when providing care always. I pull the buzzer and someone comes. I feel safe when staff help me in and out of bed. The stair lift is quite safe - no problems, Staff very good. I would recommend the home to anyone. This person said the staff use the stair climber to assist them up the final flight of stairs to their room. They said they felt quite safe when staff assisted them. Another two people said that staff made them feel safe when equipment designed to get them up and down the stairs was used. Someone who shares their sleeping accommodation said I love my room, whilst a visitor to someone who also shares, said that they had no concerns regarding lack of privacy or space for their relative. Another person said I share a nice room with Mrs (x). Its nice, and staff are nice. We also received some positive comments from professionals who support the people who live at Dunnington Lodge. They all agreed that peoples social and healthcare needs are properly monitored, reviewed and met by the home, and that the staff seek advice and act on it to improve peoples wellbeing. The manager keeps a record of complaints made to the service, and the outcome of any complaints investigations. People who returned their surveys all agreed that there was someone they could speak to informally if they were not happy, and eight out of nine knew how to make a formal complaint. We looked at the complaints book. There were no formal complaints made about the size of the rooms, about the sharing arrangements, or about any instances of poor moving and handling. Care Homes for Older People Page 5 of 13 Staff have received training in safe moving and handling in the last year. This is good, because it will make them more aware of safe ways of working, whilst protecting the individuals they care for and themselves from unnecessary injury. People have, in the last year, been asked to complete a questionnaire. This was not dated, and the manager said she would amend this, so people can know better how up to date the information is. The survey results recorded no concerns about the shared rooms, or about any issues around peoples care, in relation to how they are moved, or the equipment staff have to assist them. The staff also complete a record of accidents. We looked at those recorded since September 2009. There have been no incidents reported which relate to poor moving and handling, or injuries received as a result, or of injuries as a result of the use of the stair lift. This suggests that staff work in a safe way when assisting people. What they could do better: When people or their family come to look round, they can look at the written information the home has put together about what the home provides, and how. This is called a Statement of Purpose and service users guide. The Statement of Purpose provides a lot of information about privacy and dignity, independence and choice, and how the staff will strive to maintain peoples rights to each of these. The service users guide is very brief, and needs to be read in conjunction with the Statement of Purpose. Neither document discusses how peoples right to privacy and dignity, independence and choice will be addressed and upheld with specific reference to the shared accommodation. It would be good practice to do so. Everyone who returned their survey said that they received enough information before they moved in to help them decide whether the home was the right place for them. However, people are sometimes unable to visit the home before they move in, because of their current circumstances. It is recommended that everyone referred to the home receives a copy of the Statement of Purpose and service users guide, so they can see for themselves what facilities are on offer, and how their needs will be met. This helps people make their own informed choice about whether Dunnington Lodge will be the right place for them to live, with the facilities it provides. The accommodation is provided on three floors. There is no passenger lift available. Instead, there is a stair lift, and a stair climber, which is a specific piece of equipment used to assist people up smaller flights of stairs. The manager said, that during the pre admission assessment, the lack of passenger lift is considered, and looked at closely, when deciding whether staff will be able to assist people safely to and from their rooms. We looked at some peoples pre admission assessments. This assessment was not formally recorded. It would be good practice to do so, so there is evidence that this has been considered. The manager said that she also thinks about the needs of the person being assessed against others with whom they will be sharing their bedroom, when deciding whether these overall needs will be met for all concerned. However, this was not formally recorded on the pre admission assessment either. Doing so would remind staff to consider these collective needs when reviewing peoples care plans, when checking that Care Homes for Older People Page 6 of 13 the arrangements are still acceptable to all those sharing their bedroom accommodation. Two of the bedrooms, located on the top floor of the building, have ceilings of irregular shape, because they are situated in the attic. We spoke to each of the occupants of these rooms, who were satisfied with their accommodation and raised no concerns. This is good. However, as above, the shape of the rooms could be considered when carrying out the pre admission assessment for people who may be moving into them, to make sure that staff will have the space and the ability to manouevre any equipment needed, in order to meet these peoples needs successfully. Although people are satisfied with the care they receive, this care is not always reflected in their care plans. Some of the information we saw about how staff were to move and handle people were not consistent, and could lead to confusion. In some cases people with equipment, such as bed rails, did not have a risk assessment completed before they were first used, and there was no record in some plans to show that this equipment had been checked regularly to make sure it was safe, and fit for use. We asked the manager to update these care plans, and referred her to the current health and safety guidelines for their use. The moving and handling techniques used for two people were discussed with the manager. We asked her to review each of the moving and handling risk assessments for these individuals, to check that they were being moved in a safe way, and to ask the doctor for a referral to the occupational therapist if this was needed. We had particular concerns regarding one person, and the moving and handling methods adopted by staff involved in the procedure, when accessing the stair lift. There was no risk assessment completed for this procedure, to show that it had been assessed as being safe for all concerned. We asked the manager to revise and update the risk assessment. We have also sought further advice from other professionals, to see how they can assist the home in making this manouevre safer, and have informed the registered provider of this discussion. The bedrooms seen contained peoples personal belongings. Staff said that they had to plan any moves in some rooms, and move lighter pieces of furniture around in the room shared by three people, such as a TV trolley, commodes and bedside tables, before they commenced any move. Rooms had privacy curtains. One staff commented that it was sometimes difficult to use these curtains, because of the layout of the room. Therefore they had to take care again to make sure the move was well planned, so that peoples privacy and dignity was protected. We asked staff if the way they share information works well. Those who returned their surveys answered always or usually, although we were told that they do not receive a full handover report until 11am, when they work an early shift. We spoke to the manager about this, who said that staff are provided with important information about changes in care, which are documented on a handover sheet. She was satisfied that this gave staff enough information to be able to work safely and consistently until such time that they received the full handover report. We looked at an example of the information that is written down on this sheet. We have asked the manager to consider other ways of reporting on significant events, as the record seen gave collective information about a number of individuals. This means that, should one person ask to see what had been written about them on this record, they would also see what had been written about Care Homes for Older People Page 7 of 13 other people living there. This does not protect peoples right to confidentiality. We noted when we looked round the environment that a number of bedroom fire doors were wedged open. This means that, should the fire alarm sound, they would not automatically close. This increases the risk from fire spread considerably. We asked to look at the homes fire safety risk assessment, which did not consider this practice. Instead, it suggested that all fire doors are self closing, so would shut in the case of fire. We asked the registered provider to contact the fire officer for advice, which was done at the time of our visit. A subsequent call to the home has confirmed that a plan of action has been agreed with the fire authority until such time that self closing devices approved by them, and which the registered provider has ordered, can be fitted. This will help to keep people safe. 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 2. Care Homes for Older People Page 8 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 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, 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 7 13 Peoples care plans must 26/01/2010 include relevant risk assessments, and associated care plans, where any risk to them is identified. These must be kept up to date as peoples needs change, or when the assistance they require alters. With particular reference to: Specific manouvres when using the hoist, and when accessing the stair lift. Where the use of bed safety rails is being considered. Where people need help from staff to move from one place or position to another. This is so people can be assured that any risk to them has been identified, shared amongst staff, and regularly reviewed, so at all times they are cared for in a safe and consistent way. 2 38 23 Fire doors must not be held 28/01/2010 Page 10 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 open by unauthorised means, unless this practice has been discussed and approved by the fire authority officer. This is so that people are protected from the spread of fire. 3 38 13 After reviewing the moving 28/01/2010 and handling risk assessments for the two individuals discussed at the site visit, an Occupational Therapy assessment must be requested if the risk assessments identify concerns about how these individuals are assisted with moving and handling. Especially concerning the use of the stair lift. This is to ensure safe working practice. 4 38 13 A record must be kept to 28/01/2010 evidence that bed safety rails have been checked regularly by someone with the correct knowledge to do so, to make sure they remain safe and properly fitted. This will assist in making sure the equipment does not pose harm to people. Care Homes for Older People Page 11 of 13 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be amended so it includes information about how people who may share their bedroom accommodation will be provided the same level of privacy and dignity and choice in their daily lives as those who do not. Every prospective admission to the home should be offered a written copy of the Statement of Purpose and service users guide, so they can see for themselves what facilities the home provides. This will give them more information to read at their leisure, to help them decide whether the home will be suitable for them. 2 3 When carrying out the pre admission assessment, a formal record should be made to evidence that the following have been considered, to help decide whether the home will be able to meet the persons needs successfully: How people will be safely transported between floors with the facilities available. How the persons needs will be met when they will be sharing their bedroom accommodation with other people with differing care needs and lifestyle choices. How the needs of people who it is planned will move into rooms of irregular shape and layout will be successfully met. This includes the rooms with irregular ceilings. 3 37 Collective records about people should not be kept, so that their right to confidentiality is maintained. Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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