Care Home: Halstead Lodge Nursing Home

What the care home does well People living at Halstead Lodge are supported by a caring, friendly and knowledgeable staff team. The manager`s recruitment process is thorough; this means that people living at Halstead Lodge are protected by the safe recruitment of professional and friendly staff. The home welcomed visitors and encouraged residents to maintain contact with families and friends. People experienced a good standard of healthcare. Halstead Lodge has a committed manager in post, who is dedicated to working with the staff team to create good outcomes for the people living at the home. What has improved since the last inspection? A supervision programme is in place to ensure that staff are provided with the support they need in their roles. Since the previous key inspection the service has experienced considerable upheaval in the management arrangements resulting in the staff team receiving inconsistent guidance and support. The present manager has been in post since March 2009 and visitors told us they felt that `things are settling down now, at last`. What the care home could do better: Whilst it is clear that the manager and staff team have worked hard to maintain the outcomes for the people living at Halstead Lodge, the instability in the management team since the last Key Inspection in October 2006 has resulted in some shortfalls which have, unfortunately, affected the rating of the home. Daily records need to consistently provide clear information to include detail to show how peoples` support was provided and how they spent their day. Good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. Consideration needs to be given to the morning medication administration, the present arrangements mean there is a risk that people may receive the morning and lunchtime medications too close together. People told us that the standard and quality of the food at Halstead Lodge has fallen since our previous visit to this service. Family members told us of instances where they had raised issues verbally with staff, we found these had not been escalated to the management so they could be dealt with in accordance with the home`s policies and procedures for dealing with complaints. This meant that people felt their concerns were not being listened to. Some communal areas of the home are beginning to show signs of wear and tear and there needs to be a review of towels, curtains and bedding to ensure people have the use of appropriate quality items. Key inspection report Care homes for older people Name: Address: Halstead Lodge Nursing Home Hedingham Road Halstead Essex CO9 2AE     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: Jane Greaves     Date: 2 0 1 0 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 36 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 36 Information about the care home Name of care home: Address: Halstead Lodge Nursing Home Hedingham Road Halstead Essex CO9 2AE 01787478473 01787478550 manager.halsteadlodge@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Jane Elizabeth Raymond Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: One named person aged 42 years, whose name was made known to the Commission in November 2005, who requires nursing for palliative care One named person, aged 58 years, who requires nursing care for a physical disability, whose name was made known to the Commission in February 2006 Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 7 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) Care Homes for Older People Page 4 of 36 Over 65 3 30 0 0 30 7 Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 30 persons) The total number of service users accommodated must not exceed 30 persons Date of last inspection Brief description of the care home Halstead Lodge Nursing Home is registered to provide nursing care for up to a total of 30 service users. This home does not offer care for older persons with dementia. The home is a purpose-built, two-story building in the grounds of Halstead Hospital. It has 30 beds within 26 single and 2 double rooms. The double rooms have en suite toilet and basin; the single rooms have basins only. There are a variety of communal areas, including a sitting room on the ground floor and a dining room and sitting area on the first floor. The home has attractive, well-kept gardens and ample car parking is available. The home is located close to Halstead town centre. The current range of fees is between £565.53 and £1,438.54 per week. Care Homes for Older People Page 5 of 36 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: This was an unannounced key inspection site visit undertaken over 1 day. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Older People Page 6 of 36 Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents, relatives and staff. Views expressed by residents and visitors to the home during the site visit and in surveys have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the management, the staff team and visitors for the help and co-operation throughout this inspection process. This previous Key Inspection of this service was undertaken in October 2006. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Whilst it is clear that the manager and staff team have worked hard to maintain the outcomes for the people living at Halstead Lodge, the instability in the management team since the last Key Inspection in October 2006 has resulted in some shortfalls which have, unfortunately, affected the rating of the home. Daily records need to consistently provide clear information to include detail to show how peoples support was provided and how they spent their day. Good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. Consideration needs to be given to the morning medication administration, the present arrangements mean there is a risk that people may receive the morning and lunchtime medications too close together. People told us that the standard and quality of the food at Halstead Lodge has fallen since our previous visit to this service. Family members told us of instances where they had raised issues verbally with staff, we found these had not been escalated to the management so they could be dealt with in accordance with the homes policies and procedures for dealing with complaints. This meant that people felt their concerns were not being listened to. Some communal areas of the home are beginning to show signs of wear and tear and there needs to be a review of towels, curtains and bedding to ensure people have the Care Homes for Older People Page 8 of 36 use of appropriate quality items. 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 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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. People know that they will have their needs assessed and receive information about the home before they decide to move in. Evidence: A copy of the Statement of Purpose and Service User Guide were available in the entrance hall of the home together with a copy of the most recent inspection report from the Commission. The information was up to date and contained all the necessary details. The managers AQAA stated: Pre-admission needs assessments are carried out promptly by senior staff. (Nurses and the Clinical Lead Nurse). The assessment covers a range of needs, and focuses on the individual, and whether or not the Home has the capacity to meet their needs. Relevant specialists involved in the individuals lives are contacted for input, when required. Where it is possible and appropriate, preadmission needs assessments are carried out in the individuals own environment. Care Homes for Older People Page 11 of 36 Evidence: Comprehensive pre-admission needs assessments are accurately documented, and used as an information source to assist with generating the plan of care. The manager told us that they undertook the initial assessment of potential residents alongside a trained nurse from the home. It was reported that the majority of new admissions came directly from hospital. Due to the limited information received via this route the manager told us she made a point of consulting with relatives during the assessment process. Information was provided by the placing authority where they assisted with funding and examples were seen during the inspection. The information they provided was adequate. One person was admitted to the home immediately prior to this visit. After the provision of morning personal care the staff brought to the managers attention that the person was not fully mobile as the hospital had informed them and that they were barely able to weight bear. The residents mobility needs were immeduiately reassessed and the care plan amended accordingly. We looked at pre-admission assessments for two people living at the home. These contained information about medical history, personal support needs and preferences, social stimulation needs and dietary needs and preferences. People spoken to during this inspection site visit said they, or their family, had visited the home before they came to live there, and this was encouraged by the staff. The home does not provide intermediate care. Care Homes for Older People Page 12 of 36 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. Residents receive good personal support and healthcare. Evidence: We looked at care plans for three people living at Halstead Lodge. The home managed all records, such as care plans and daily progress notes, by means of the Care UK Saturn computer software. A copy of the care plans was printed out and kept in a file for access if the computer system or power should fail. However there were concerns about what happens if the computer system goes down meaning that staff would not be able to access up to the minute information such as daily progress notes etc to enable them to care for people appropriately. The computerised system captured information on all areas of the care and nursing support provided. This included areas such as moving and handling, eating, drinking, epilepsy, night care, weight monitoring, skin care and continence etc. The care plans included a record of health professional input from people such as GP, District Nursing Team, Audiologist, Ophthalmologist, Dentist etc and the outcome of these. The Dentist visited the home on this day and the nursing staff told us the GP visited the home 3 Care Homes for Older People Page 13 of 36 Evidence: times per week and undertook a full review of all residents in his care every 3 months. We noted good information included in daily progress notes we sampled for one resident although we noted that the quality of daily recording varied from carer to carer. For example one set of progress notes we looked at were very brief and uninformative detailing what the person had for breakfast and lunch and that they had a shower. This was discussed with nurse on duty who told us that the management team were aware of this and that it was being addressed through 1:1 supervision with carers. One set of computerised records we viewed stated that the person had been admitted to the home in February 2009, but the individual had told us they had been living at the home for considerably longer than that. We shared this information with the manager who confirmed that the person had indeed lived at the home since before February 2009. This told us that the we could not be completely certain that the computer records held were wholly accurate. Residents told us: Care on the whole is jolly good, They look after me very well. Relatives told us: They treat x wonderfully Care staff meeting minutes of 10/09/09 included Documentation ie nutritional, turning and monitoring charts are still not being completed properly; these are a legal requirement especially for residents who are under the dietitian. This seems to be mainly a problem during the day shifts. Records of these issues we sampled at this visit were completed properly. This shows us that management monitoring of systems is effective. The manager told us that care plan reviews took place monthly. The service operated a resident of the day scheme which meant that the qualified nurse on duty reviewed one persons care plan daily ensuring that all care plans were reviewed monthly. We saw evidence on the computer that these reviews took place. Carers contributed to the reviews by means of the daily progress notes that were reviewed by the qualified nursing staff daily. On our initial tour when we arrived at the home we saw a qualified nurse administering medications at 09:55hrs. They told us that it usually took until 10:30 to complete the medication round and the next round would be at 13:00hrs. She agreed that in some instances there could be just 3 hours between doses of medication. The Medication Administration Record sheets (MARs) showed us that medications were administered at 0800 and then routinely through the day but in reality this recording Care Homes for Older People Page 14 of 36 Evidence: does not reflect the daily practice that actually took place in the home. This meant that, in some instances, there were barely 3 hours between medication rounds. Not only did the charts not effectively provide a clear record of when people had received their medication there was also a risk that peoples medication doses may be administered too close together. The manager was conscious that where residents had their medications towards the end of the morning round that the lunchtime medications need to be administered proportionately later. She also reported that this had a knock on effect throughout the medication rounds during the day in order to keep people safe and well. The manager told us that a meeting was due to take place 21/10 with the nursing team to refresh their training and re-inforce their responsibilities, this issue would be discussed then. A GP attended the home 3 times per week and visited the home 3 monthly to do a full review of the residents health needs and medication. The manager and nursing staff agreed there is a large amount of residents medication for the morning round and this needed to be reviewed with the GP. The qualified staff team undertook a weekly self audit of medications which was then passed to the manager for monitoring. MARs charts included a photo of each resident to reduce the risks of errors in identification. A good practice highlighted was that peoples photographs were dated and renewed every six months to ensure that they reflected changes in peoples appearance. The majority of medications in the home were provided from the pharmacy in blister packs. Those medications provided in individual bottles or boxes were marked with the dated the bottle/pack was opened and the MARs sheet also highlighted when new packs or bottles were opened. We noted that the medication trolley not really large enough to cope with the amount of medication dispensed to people in the morning. We checked the controlled drugs held within the home together with a member of the nursing team. We found that one person had been administered 10mg Temazepam the previous night but the staff member responsible for this had not signed the controlled drugs register. Consequently the stock of tablets held did not agree with the register. The staff had a drugs handover sheet that they completed at the beginning of each shift. This clearly identified what shift the Temazepam had been given on. A regulation 26 visit report of 3rd August 2009 completed by a representative of Care Uk Ltd had identified that: A missing witness signature was noted for 2.08.09 22:00. Care Homes for Older People Page 15 of 36 Evidence: Nurse on duty will report to night staff who administered the medication. This showed us that despite this is still an issue despite being previously identified by an internal audit. We saw records to confirm that medication fridge temperatures were checked daily to ensure the correct temperatures were being consistently maintained. There was an air conditioning unit in the medication room to ensure an appropriate ambient temperature was maintained to keep medicines stored safely, however there were no records maintained to show this was effective. Nursing staff told us, and records confirmed that a local pharmacy provided medication training and refresher training and assessed competency of staff. We saw a communal supply of net pants that are worn to help keep incontinence pads in place in the laundry cupboard on both floors. Discussion took place with the manager about the need for people to have their own personal supply of net pants to promote their dignity. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. A resident told us I get respected. Although not fully assessed we saw that peoples end of life needs had been discussed and their wishes recorded. Completed surveys from residents, relatives, staff and healthcare professionals were returned to us prior to this inspection visit. Of the 14 completed residents surveys returned 7 told us they usually get care they needed and 7 said they always get the care they needed. Comments from family members included: we can tell that x is contented and feels safe. This is solely as a result of the excellent nursing care which x has, and continues to receive coupled with the professional but also family approach from the carers. A Social and health care professional survey response included the comment: All the staff I have spoken with appear to have good knowledge of their clients and a caring attitude. They are good at carrying out regular screening for malnutrition and responding if any of their clients have lost weight unintentionally. Staff told us via surveys: We care for people the best we can despite all the budgetary and staffing restraints imposed by a profit driven company. The home provides well rounded individual care for the residents. The staff team are Care Homes for Older People Page 16 of 36 Evidence: friendly and work well together. Halstead Lodge provides a relaxed, homely atmosphere for the residents, and the small staff team allows to residents to get to know each staff member and vice versa. So all individual needs are met. Care Homes for Older People Page 17 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their lifestyle, however there continues to be concerns about the deterioration in the standard of food. Evidence: The managers AQAA stated: An Activities Co-ordinator is employed at the Home for 30 hours per week. They work with individuals on either a one to one or group basis, to meet their needs and preferences. The available activities programme has been reviewed and updated so that the provision offered is now effectively structured and suited to the needs and preferences of the individuals at Halstead Lodge. Examples of activities undertaken include therapeutic manicures, gardening, board games, quizzes, group games, seasonal tasks etc. Support is provided to individuals who wish to go shopping in town. External resources are also accessed and used, to provide entertainment. Special events, such as Easter, Macmillan coffee morning and Christmas, are widely celebrated. Significant others are encouraged and enabled to take part in activities. We looked at the weekly activity programme and this showed us that the activity coordinator liaised with residents and staff daily about planned activity and 1:1 sessions. Examples of planned activities included painting, drawing, card making, decoration, Care Homes for Older People Page 18 of 36 Evidence: bingo, church services and trolley shop. Examples of 1:1 activity included letter writing and emailing with individuals in their own rooms, reading newspapers to people, playing scrabble and reminiscing about times gone by. We saw demi-johns in the first floor dining area. The activity person was supporting residents to make home made wine, people told us they really enjoyed this especially as there was an end result to show for their endeavours that they could enjoy. The staff team had undertaken a sponsored walk to raise funds for the residents welfare fund and the home held an autumn fayre to raise funds. The home was hosting a P party at Halloween. This was decided by the residents as most did not celebrate Halloween but felt that a party would be good. The P related to anything beginning with that letter, such as pumpkin soup, punch, pasta. We were told that staff were to dress up in fancy dress also relating to the letter P (Pirate for example) The manager was able to tell us about this and about the discussion held with residents about their choices of food, party games, outfits etc. The manager acknowledged that if this discussion had been documented this would have provided good evidence to confirm that people in the home were involved with choosing their social activities. A resident told us that the hairdresser visited the home weekly for those people that wanted. There was no dedicated salon at the home, peoples hair was set and dried in the downstairs day room. Staff told us that customers enjoyed chatting whilst they waited for their treatment. There was a trolley shop currently stocking toiletries for people to choose what they prefer. The manager discussed the intention to widen the choice of items available to possibly include a selection of greetings cards and sweets etc. The care plans we looked at identified the activities that people were interested in prior to entering the home, daily progress notes showed us that is many instances these were taking place. One person told us how they enjoyed making personalised Christmas and Birthday cards for their friends and family. The manager told us she was implementing a residents afternoon tea meeting the week following this visit to promote peoples choices. Residents and staff told us that newspapers and magazines were delivered to the home for those people that wanted them. Care Homes for Older People Page 19 of 36 Evidence: Comments in completed residents surveys included: I love the garden, group activities and the entertainment, Everything it does, it does well and New activities co-ordinator is excellent. Staff surveys told us: More financial support from Care UK to enable us to provide more entertainment for our residents and So much is restricted because of lack of finances. Residents and their relatives confirmed to us that visitors were welcomed at any time, the visitors book showed us that many people visited the home on a daily basis. The managers AQAA told us: The Home offers a varied menu, with a range of choices available for breakfast, lunch and supper. Individuals are fully supported to make their own selections, and their right to change their mind is respected. Hot and cold drinks and snacks are also available at all times. Individuals choose where they wish to eat, and meal times are relaxed and unhurried. Support is given at mealtimes in a way that is sensitive, and independence is fully promoted. The Head Chef routinely visits individual residents, to ensure that their needs are being met. Where individuals have specific dietary preferences or requirements, every effort is made to accommodate these. Completed surveys received prior to this inspection visited included comments about the food provided at Halstead Lodge. Residents surveys told us:Food is good and they provide an early breakfast to enable me to attend church. They are flexible. Relatives surveys told us: FOOD! Often food cold and late in arriving with my relative. they eat slowly and do not swallow well, food not always suitable. They take their meals in their room, lunch can be cold and late. Have mentioned this on numerous occasions but still seems to happen. Staff surveys told us: Food suppliers could also be improved. We discussed with manager about the issue identified in surveys around food being cold by the time it reached those residents who chose to eat their meals in their rooms. She reported that the chef now took the meals directly to the residents as it was dished up. We took lunch in the upstairs dining room with residents. The food was brought up from the kitchen in a hot trolley and dished up individually to people. The residents were seated either in wheelchairs or in easy chairs at dining tables of varying heights. The tables were nicely laid with linen table cloths. Each person was wearing a blue Care Homes for Older People Page 20 of 36 Evidence: plastic apron, staff told us this was because people became anxious if they spilt food on their clothes so this promoted their dignity. The Chef and kitchen assistant dished up peoples meals and the staff team served and helped people to eat. Todays choices were minced lamb or fishcakes with parsley sauce, chips or mash, cabbage and broccoli. 2 liquidised meals were seen, various elements of these had been blended separately so the person still had individual tastes and flavours to enjoy. People that needed help received it from staff sitting next to them in most cases. We noted that the food was not very warm by the time it was served up to people. We noted that condiments were not taken to peoples rooms for them to use if they wished and that the salt pot in the dining room was empty. The dining room was awkward in shape and due to the amount of wheelchairs there was little space to move. If any residents wished to sit on a dining chair there were none available. Staff told us that almost all the people needed to be hoisted from their wheelchair and this would cause them more distress and there would not be room to use the hoist in this overcrowded room. The whole experience demonstrated purely a practical eating exercise more than a pleasurable dining experience for people. Staff and management assured us that normally there was a lively atmosphere at lunchtimes. This may have been negatively affected by our presence at the home on this day. A set of sit on weighing scales were also in the dining room contributing to the cramped conditions and detracting from the environment. A number of people that remained in their rooms also required assistance with eating their meals. We saw one resident half lying dozing in bed with his lunch going cold beside him. We saw a carer take another persons plate away that was barely touched. The staff member told us the person had a full cooked breakfast and rarely ate their lunch. There was homemade soup and sandwiches for tea which the person enjoyed. One resident told us The food could be improved. Of the 7 lunches each week 2 are good, 2 are not so good and 3 are awful. I believe they are not blessed with much money for food. You can have a cooked breakfast but it is awful, the porridge is OK, at least you cant go far wrong with that. Another resident told us The food could improve, could be better quality. A relative told us: The food is diabolical. The way it is dished up, there is no attempt to make it look appetising, it is often cold and congealed. Mealtimes can vary, sometimes I see lunch being dished up as early as 11:30 am and other times it can be Care Homes for Older People Page 21 of 36 Evidence: as late as 1pm. If you could have seen this home some time ago, standards have dropped in recent times. The food used to be excellent. We spoke with the chef. Since the previous visit the provider had changed the dried food supplier. The chef told us that the quality of dried provisions was not consistent. An example given was that pears from one tin were soft where the next ones could be rock hard and needed to be cooked before they were suitable for residents to eat. We were told that the residents enjoyed fresh fruit salad during the summer months when fruit was cheaper however the budgets do not allow for this out of season. We were told that the food budget does not allow for options such as lamb chops or pork chops. The menu consists of such things as stews, mince, fishcakes and roast dinners. Care staff asked residents the day before what meal they would like from the two choices available the next day. The kitchen at Halstead Lodge was awarded a 5 star rating by the Environmental Health Officer in February 2009. The services own quality assurance report of December 2008 had identified that 14 of residents felt the food provision in the home was poor, 29 felt it was adequate, 29 said good and 28 felt it was excellent. Comments included in this survey were: A poor menu, pre frozen and poor quality and Could be improved. Care Homes for Older People Page 22 of 36 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. Residents are safeguarded from abuse however they, and their relatives, cannot always be confident that all their concerns are dealt with appropriately. Evidence: The managers AQAA stated: All concerns and complaints are recorded on the Care UK IT system Saturn. These contain details of any investigation and any action taken. Complaints are responded to promptly and effectively. In February 2009, this system was updated to further ensure the effective management of concerns and complaints. Complaints are responded to promptly and effectively, in line with requirements. The homes Statement of Purpose stated that, if at any stage people were not happy with the way any complaints were dealt with, people could contact the Managing Director of Care UK Ltd. There was no reference to the fact that if people were not satisfied with the response to the complaint they were able to contact Social Services and there were no contact details to enable people to do this. We discussed complaints with the manager. It had been identified in surveys, and relatives had told us that they had raised issues verbally and they had not been dealt with. The manager was unaware of these issues and told me she intended to address this at an upcoming staff meeting to ensure all issues were reported to her so they could be dealt with in accordance with the homes Policies and Procedures. Care Homes for Older People Page 23 of 36 Evidence: A resident told us: No-one here complains to management, they complain to their visitors though. A relative told us that they had written to the home about issues in the past couple of years since the last inspection visit and only received an acknowledgment of their letter, with no further feedback. We saw there were 4 complaints on the computer system. 1 relating to a lift malfunction. There was detail of the action taken, a record of correspondence sent and of the investigation held. Another complaint recorded was from a relative because an individual had not been given a shower. There was an audit trail to show us the correspondence and investigation of this incident. Staff recruitment files showed us that all checks, such as references and Criminal Record Bureau (CRB), were made before people started to work at the home. This means that people received their care from people that were safely recruited. Staff training records showed us that 35 of the 41 people employed to work at the home had attended training in safeguarding vulnerable adults. The manager was able to assure us that the remaining 6 staff members had attended this training in the past month. Staff we spoke with at this visit demonstrated a good knowledge of what to do if they suspected someone was at risk of abuse or being subjected to abuse. Care Homes for Older People Page 24 of 36 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 continues providing the people who live there with a homely and safe environment. Evidence: The managers AQAA told us Environmental changes have been made, based on feedback received from people who use the service. Halstead Lodge successfully secured a Department of Health Grant, which enabled exterior improvements to be made. A decking area has been built, which provides greater opportunity for residents to enjoy the beautiful surroundings of the Home, and interact with the extensive local wildlife. This work was carried out following on from consultation with residents and/or their significant others. With regard to the interior of the Home, Care UK recently invested in a refurbishment of the Home. Again, residents and/or their significant others were consulted on this. As part of this inspection we undertook a physical tour of the home. In the main the environment was in a good state of repair however some areas of the building such as some communal hallways were beginning to tire and would benefit from re-decoration to provide a brighter, fresher and more homely feel for the people living at the home. We saw glove and apron dispensers located on the walls in the hallways creating a clinical and institutional appearance to these communal areas of the home. We Care Homes for Older People Page 25 of 36 Evidence: discussed with the manager alternative places for storing these items so they would still be readily accessible for care and nursing staff but maintain a homely environment. The home was free from any malodours and was clean and tidy. Some people invited us into their rooms, we saw these were individual and reflected the personalities of the people living in them. We did note however, that some of the bedding, curtains and towels were starting to show signs of wear and tear. We noted that the dining area was small and an awkward shape to accommodate the number of people using it. We were told that the majority of residents preferred to stay in their wheelchair for meals as opposed to being transferred by hoist. Other people remained in armchairs seated at dining tables of varying heights, there were no dining chairs available. Care Homes for Older People Page 26 of 36 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. People using this service can be expect to be supported by staff who are trained and have the necessary skills and experience. Evidence: The managers AQAA told us: Staffing numbers, and gender and skill mixes, are as is required to meet the needs of the individuals at Halstead Lodge. A four-week rolling rota system is operational. The rota is flexed as required, to ensure that sufficient numbers of staff are available during peak times. A robust system is operated for staff recruitment and selection. The staff team have undertaken training relevant to their work role and responsibilities. Interactive learning and development is undertaken by of the staff team, covering the Common Induction Standards, Health and Safety, Food Hygiene, POVA, Customer Care, COSHH, Infection Control, Dementia and Fire Safety. Moving and handling instruction is also provided. A training co-ordinator, based on site, oversees delivery of this. Skills for Life and NVQ programmes are also offered. Other examples of recent learning and development undertaken include; medication training, catheterisation training, peg feed training, diabetes training, Parkinsons training and Liverpool Pathway implementation training. Completed surveys received from residents included comments such as: Caring staff Caring and mainly cheerful staff and Nursing care and friendliness of all staff is excellent. Care Homes for Older People Page 27 of 36 Evidence: Completed surveys received from relatives included comments such as: The home is understaffed as evidenced by poor response time for toileting with resulting consequences, patients often still to be dressed just before lunch, rooms/beds often not made until the afternoon and patients left unattended in residents lounge for long periods in the afternoon. Completed staff surveys received included comments such as: Have more staff so that more time could be spent with each resident, More staff on the floor in a shift as most of the residents needs are time consuming and hard work, Staff can be rushed and morale low due to staffing numbers being reduced from 6 to 5 in the morning. The majority of residents require 2 carers at all times. As 3 carers now work upstairs and there are 17 residents this can put added pressure on staff to maintain a high standard of care and The staff really do care for the residents but there are not enough on shift. If there were more staff the care would be even better, but time restricts them so much. We discussed the negative comments received in the surveys with the manager. She told us staffing numbers had been reviewed alongside the needs and numbers of the people living at the home with the result that staffing numbers had been reduced, this had caused some negative feeling from relatives and in the staff team. Rotas showed us that the daily personnel on duty at the home included: the manager, the administrator, the clinical Lead (18 hours supernumerary, works hands on for her remaining contracted hours), there was always one registered nurse on each shift, sometimes more. There were 5 care staff in the morning, 4 in the afternoon and 2 on night shift. 2 or 3 domestic staff were on duty each weekday with 1 person at weekends. There was 1 laundry person on duty every day and 1 maintenance person Monday to Friday. The activity co-ordinator was on duty 30 hours per week and there was one chef and one kitchen assistant daily. in all, there were 42 staff employed in total at Halstead Lodge, including bank staff. The manager told us there had been some agency staff usage but only when absolutely necessary. On the day of the site visit the staff team worked well together to meet the needs of the residents. We looked at staff recruitment documents for 2 people recently recruited to post. These showed us that people were safely recruited to ensure the right people were employed to work with the vulnerable people living at the home. No-one started to work at the home until satisfactory references and completed Criminal Record Bureau checks had been received. We saw one example of a reference that had not been fully completed by the referee. There was evidence to show us that the manager had contacted the referee direct and explored this issue further. We saw records to Care Homes for Older People Page 28 of 36 Evidence: confirm checks were regularly made against the NMC register ro confirm that nursing staff registrations were current. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided at the site visit indicated that out of 15 full time care staff working at the home 9 currently hold an NVQ with other staff either currently undertaking the qualification or waiting to start. The home have therefore achieved the 50 basic target. The staff training matrix showed us that people had attended basic core training such as moving and handling, safeguarding vulnerable adults, infection control, health and safety, fire awareness, food hygiene and dementia awareness but did not indicate when this training had taken place. The manager told us she was developing her own matrix to more clearly identify which staff members had achieved what elements of training and when. Overall from the information available it was possible to conclude that Halstead Lodge provides a well trained staff group. In surveys, and in discussion, relatives felt that care staff generally had the right skills to meet peoples needs. Care Homes for Older People Page 29 of 36 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. Residents live in a safe home where the team are committed to further improvements. Evidence: The managers AQAA stated: The Manager, who has been in post at Halstead Lodge since March 2009 was previously the administrator for three years working alongside previous managers so has a clear knowledge of the Home. She is currently undertaking the Leadership and Management in Care Services award. A number of different challenges have arisen over the last six months, which have all been managed promptly, and in line with requirements. These have all contributed greatly to her learning and development, in terms of providing invaluable experience. She has also undertaken a range of focused training, relevant to both her management role, and the health and social care sector. The service had experienced an upheaval in the management arrangements since the previous key inspection in 2006. Residents, relatives, staff and management told us they believed this had resulted in staff not having consistent guidance. Care Homes for Older People Page 30 of 36 Evidence: The manager was undertaking Leadership and Management in Care Services award and had achieved NVQ level 2 in care and a BTEC certificate in counseling skills. The manager had attended supervision training and Mental Capacity act and Deprivation Of Liberty training. The manager was in the process of becoming registered with the commission. The manager reported to, and was line managed by, the regional director. The manager was able to tell us she has had personal development reviews and attended monthly management meetings but could not confirm regular formal supervision sessions. Relatives told us: The manager is extremely nice. We saw a copy of homes Quality Assurance report undertaken by Care UK Head Office in December 2008. The manager told us that Head Office distributed surveys to residents and relatives. The survey responses were collated and a report was forwarded to the home identifying strengths and weaknesses in the service provision. There was no evidence to show that Care UK included the views of external stakeholders or staff in their Quality Assurance process. Some personal monies were maintained on behalf of the people living at the home. We saw that when families or representatives brought funds in for safekeeping they were given a receipt. Monies were maintained in separate wallets in the safe in the managers office. There were 2 signatures on the transaction records to confirm all entries. We checked the monies held for two people living in the home, these balanced and agreed with the records. The manager told us there was a petty cash fund available with the qualified nurse on duty in the event that residents wished to access their personal monies when the manager or administrator were not available. We saw a supervision schedule on the managers office wall, this showed us that the staff team routinely received 1:1 supervision sessions to support them in their various roles. The manager supervised the clinical lead, administrator, activities person, head chef and maintenance. The Clinical lead supervised the qualified nursing staff team. Qualified nurses supervised senior care and some care staff. Senior care supervised domestic staff, laundry staff and one care staff member each. The home managed all records such as care plans, daily progress notes, complaints, staff rotas, accidents and incidents and staff recruitment by means of the Care UK Saturn software. This was a clear and efficient system however, we shared concerns with the manager that should the system fail, or should there be power outages this could potentially leave staff providing care for people without the support of up to date Care Homes for Older People Page 31 of 36 Evidence: records. A tour of the premises showed us that the home seemed well organised, and no particular health and safety issues were identified. A fire risk assessment was in place. Fire records were maintained. Systems were tested weekly, and regular fire drills were carried out to ensure that all staff know what to do in an emergency. We saw the accidents and incident records on the computer, these related to such issues as falls and included good detail of how and why the incidents occurred and what actions to take to reduce the chances of recurrence. The service employed a dedicated maintenance person for 30 hours per week. We saw certificates to confirm that all the necessary checks were done to ensure the environment and equipment were safe for the residents, staff and visitors to the home. We saw records to show that water temperatures, window locks and bed rails were checked weekly to promote the safety and well being of the residents. Care Homes for Older People Page 32 of 36 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 33 of 36 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 15 16 The quality of food provided and peoples mealtime experiences need to be improved. This is so that people receive food they enjoy and enjoy their dining experience. 30/11/2009 2 16 17 A record must be kept of all complaints made, including those raised verbally at the home to include details of any investigation and any action taken. This is so people can be confident that their concerns are taken seriously and acted upon. 30/11/2009 Care Homes for Older People Page 34 of 36 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 35 of 36 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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