Care Home: Harrowby Lodge Nursing Home Ltd

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What the care home does well The home is in a quiet residential part of Grantham and is close to the town centre, providing access to shopping for people. A visitor commented that one reason for choosing the home was that it had an excellent reputation in the area. Local professionals were very positive about the standard of care provided, describing it as `exemplary` and the care team as `exceptional`. People are cared for in a homely, clean and comfortable environment and the decoration is to a high standard. All people spoken with made positive comments about the care they received; one said there was no comparison to other homes and another said that it was like a first class hotel. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager and senior staff work well as a team and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. Comments received from residents and their families were very positive and included praise for the staff and the manager. What has improved since the last inspection? The Gold Standards Framework of care, a nationally set and GP led palliative care system, has been implemented. All carers now have clinical supervision bi-monthly. All grades of staff now have regular meetings. An activities co-ordinator has been employed. There are individual drug cupboards in all bedrooms. The TV lounge has been completely redecorated. One of the bathrooms has been completely refurbished, including a new bath. Wrought iron security fencing has been installed around the patio. A new hoist has been purchased. What the care home could do better: No requirements or recommendation were made as a result of this visit. Key inspection report Care homes for older people Name: Address: Harrowby Lodge Nursing Home Ltd 4 Harrowby Lane Grantham Lincs NG31 9HX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Western     Date: 2 3 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 24 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 24 Information about the care home Name of care home: Address: Harrowby Lodge Nursing Home Ltd 4 Harrowby Lane Grantham Lincs NG31 9HX 01476568505 01476575872 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Harrowby Lodge Nursing Home Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service users in PD category must be 45 years of age or older. The home is registered to provide personal care, with nursing, for service users of both sexes whose primary needs fall within the following categories: Old age, not falling within any other category (OP) -32 Physical disability (PD) - 4 The maximum number of service users to be accommodated is 32. Date of last inspection Brief description of the care home Harrowby Lodge is a privately-run care home, providing personal and nursing care for up to thirty-two older people. It is housed within a late Victorian building with a purpose-built extension. It has been owned and run by the same person since 1987. The home is located in a quiet residential area of Grantham within half a mile of the town centre. Grantham is situated on a main trunk road and main train route. The local amenities include theatre, cinemas, pubs, leisure centre, schools and shopping centres. Care Homes for Older People Page 4 of 24 Over 65 32 0 0 4 Brief description of the care home The home consists of fifteen single bedrooms downstairs, seventeen of which are ensuite, five upstairs and five double rooms. Communally, there are three lounges, including a conservatory and a dining room. As well as the separate ensuite facilities, there are five toilets and three bathrooms. A passenger lift gives access to the upper floor. There are gardens including an enclosed courtyard area and there is car parking for approximately eight cars. The fees range from £400 to £650 per week. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately four hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent Care Homes for Older People Page 6 of 24 out surveys to people before we visited the service. The main method of collecting information during this visit is called case tracking, which includes following the care of a sample of four people through their records and assessing their care. We spoke to three people who use the service and saw rooms of those people who said we could and to three staff members. The manager, her sister, who manages all financial and contractual matters and the deputy manager were present throughout the visit and the general outcomes of the visit were discussed with them. Care Homes for Older People Page 7 of 24 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 24 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 24 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 who use this service have good information about the home in order to make an informed decision about whether the service is right for them. Evidence: We saw the statement of purpose which was very comprehensive and contained terms and conditions and contracts. The service user guide we saw contained useful information for people. The manager said it was due to be reviewed shortly and would include pictures for those with poor eyesight. The manager said that she or the deputy manager always visited prospective residents at home or in a care setting such as a hospital to undertake a thorough assessment of all their care needs. Records we saw confirmed this. We saw written admission records that were clear and gave staff all the information they needed to meet the needs of people. A resident we spoke with described how she had visited for the day before she was sure she wanted to move in permanently. A relative told us that this home had been Care Homes for Older People Page 10 of 24 Evidence: chosen because it had the best reputation in the area. A staff member described the admission process and the importance of making new residents and their families welcomed. Care Homes for Older People Page 11 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in enough detail to ensure that the care needs of people can be met. Evidence: Care plans we saw contained information about the health and personal care needs of people. They were kept in each persons room and were reviewed regularly. We saw that they contained signatures by people or their relatives or advocates. We looked at the medication records of the people whose care plans we tracked and found that they were clear and well documented. We saw a medication policy that was clear and comprehensive. The pharmacist visited annually and no issues were identified. People received regular visits from district nurses, Macmillan nurses, CPNs and other agencies involved with their care. Letters from GPs were very positive about the standards of care at Harrowby lodge, which they said were very high. They mentioned an exceptional staff team managing health care in an exemplary and professional way. Harrowby Lodge is part of the National Gold Standards framework for palliative care, giving excellent care to people who are dying and which the local GPs are involved in. Care Homes for Older People Page 12 of 24 Evidence: We saw staff carrying out their duties with kindness and sensitivity towards people, especially when attending to their personal needs. Care Homes for Older People Page 13 of 24 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. Social activities are regular and are tailored to suit the individual needs of residents. People have a choice of meals from a balanced and varied menu. Evidence: We found that the home has an activities coordinator, who provides a variety of activities for residents including entertainers, indoor games such as board and card games and trips to local pubs and shops. Events and activities are displayed along the walls around the building. On the day of our visit a resident was playing the piano and there were Christmas carols and songs. People we spoke with all said they had a choice of whether or not to take part. Some told us they preferred to sit in one of the three quiet lounges instead. Clergy visit the home and offer services to those who wish to attend. The activities programme is depicted in pictorial form on the notice board, to ensure that all residents are kept informed. People we spoke with all said they enjoyed the meals served; one said the food was very good and another that it she did not eat meat but they always gave her a lovely alternative. The menu for the week was displayed in the dining room and offered alternative choices of meals. The cook has the National Vocational Qualification in nutrition and food hygiene at Level 2. She was knowledgeable about the nutritional needs of service users and described cooking for people on various diets. Care Homes for Older People Page 14 of 24 Evidence: Care plans we saw showed that each person has a life history and is assessed for their needs and wishes regarding lifestyle and daily activities. Care Homes for Older People Page 15 of 24 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. The procedures for addressing complaints and for protection from abuse are clear. People and their families are confident that their comments and concerns will be listened to. Evidence: People spoken with said they did not wish to complain but knew how to make a complaint. The home had an up to date copy of the Local Authority adult protection procedures; staff members said they had read it. The training programme showed that there was a rolling training course for staff on POVA and safeguarding adults. Staff members spoken with knew what to do in the event of a serious concern.The manager said that residents and their families were regularly asked for their views regarding the running of the home. A resident said I am sure that if I had a complaint the manager would see to it and visitors spoken with said that they were given information on how to make complaints. Since the last inspection there had been no complaints. Staff spoken with confirmed that they had received training in safeguarding adults. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and pleasant environment with both private and communal space that is generally suitable for their needs. Evidence: Overall, the standard of decoration internal was high and residents said they were very comfortable in their surroundings. The gardens were well maintained and a courtyard area offered pleasant places for people to sit out in good weather. Some of the rooms had doors leading to the courtyard gardens. Outside all ground floor rooms were bird tables for people to watch the birds being fed from. Staff described how any maintenance issues were addressed quickly by the maintenance personnel. Recent improvements included new bedroom furniture, new tables, chairs and flooring in dining room, including redecoration, all residents now have a hi-lo bed which makes them easier for staff to move and all laundry equipment has been renewed. There were safety notices around the building to prevent the spread of infection and COSHH regulations were observed throughout. There is a lift and a stair lift to enable people to access the whole building. The most recent visit from the Environmental Health Officer found no issues of concern and the service had been awarded a good standard. The building smelled clean and fresh throughout. Care Homes for Older People Page 17 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well staffed and managed, which means that people receive a high standard of care and support. The systems within the home protect their health, safety and welfare needs. Evidence: The staff rota we saw showed that there were usually two trained nurses and at least five carers during the day and one trained nurse plus two carers at night. In addition the owner, who is a trained nurse and her sister, who provides administrative support, were present most days, there were four domestics, a laundry person, a cook and a kitchen assistant and a handyman. All people, visitors and staff we spoke with said that there were plenty of staff to carry out their tasks in good time. We saw training records for staff and these showed that all but four members of staff have achieved the National Vocational Qualification [a nationally recognised qualification] at Level 2. Three staff members have achieved Level 3. We spoke with staff members who described how they had an interview, gave three references and underwent CRB/POVA checks and had induction before starting work. Staff records we saw confirmed this. Training records we saw showed that the training required by law has been undertaken, with additional training on dementia, the mental capacity act and deprivation of liberties for all staff. We saw that nursing staff members all receive regular clinical supervision and carers Care Homes for Older People Page 18 of 24 Evidence: receive regular supervision and staff we spoke with confirmed this. There were also minutes of regular staff meetings, which staff members also confirmed. Care Homes for Older People Page 19 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the health, safety and welfare of people are promoted. Evidence: The manager has owned and managed Harrowby Lodge since 1987 and is a trained nurse. This is a family run home with the managers sister providing administrative support and their sons providing maintenance and other duties. People we spoke with all made positive comments about the way the manager ran the home, finding her approachable and supportive. The staff workforce is very stable, with most of the nursing staff having worked at the home for many years. Staff we spoke with said this was the best home they had worked in.The manager, her sister and the deputy manager work very much as a team and staff members spoken with said they were very approachable and accessible. There is a clearly written quality assurance procedure, with separate questionnaires given to people, their relatives/visitors and staff. The findings are discussed with residents, staff and visitors and acted upon. Health and safety policies are well documented and demonstrate a clear commitment Care Homes for Older People Page 20 of 24 Evidence: to ensuring the wellbeing of people. Care Homes for Older People Page 21 of 24 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 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 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. 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. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!