Care Home: High Peak Lodge

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What the care home does well From speaking to residents and visitors, it was clear they were happy with the care provided and liked the staff. Visitors can visit the home at any time and are made welcome by staff.The manager makes sure that before staff starts work at the home they are properly checked to make sure they are suitable to care for people living at the home. Staff have had extra training in how to care for people in a better way. What has improved since the last inspection? The activities coordinator has planned a wider range of trips out of the home and more time is spent doing one-to-one session with residents. Redecoration of the corridors and other areas of the home. The nurse`s station has been moved from the dining room and staff now have a proper office to work in. The hairdressing room has been relocated to a larger room and fitted out as proper salon. What the care home could do better: The system for the storage of additional boxes of medication requires attention. CARE HOMES FOR OLDER PEOPLE High Peak Lodge Bedford Square Leigh Lancashire WN7 2AA Lead Inspector Judith Stanley Unannounced Inspection 16th September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Peak Lodge Address Bedford Square Leigh Lancashire WN7 2AA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01942 262021 01942 261811 hpleuropeancare@aol.com www.europeancare.net European Care (UK) Limited Adele Kettle Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Terminally ill (3) of places High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 39 service users to include:up to 39 service users in the category of OP (Older People) up to 3 service users in the category of TI (Terminal Illness under 65 years of age) The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 14th September 2007 2. Date of last inspection Brief Description of the Service: High Peak Lodge is owned by European Care and offers care for 39 older people. It is situated off a main road close to Leigh town centre and local amenities and public transport runs close by. High Peak Lodge is registered to provide nursing and personal care services to 39 male and female residents. Included within those numbers the home can offer care to three residents of whom may be terminally ill. High Peak Lodge is a purpose built two storey home that offers all single rooms, all of which have en suite facilities. There is pleasant communal space comprising of lounges and a dining room, as well as quiet areas near the staircase on each floor. There is a secure, private garden at the rear of the home for residents to enjoy sitting outside. Car parking for visitors is located to the front and side of the home. The current scale of weekly fees ranges from £313:99 to £600:00. Additional charges are made for personal toiletries and magazines and newspapers and items from the tuck shop. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection included a site visit and was unannounced and was conducted over 6¾ hours on one day. Part of the time was spent looking at some of the residents records (care plans) and other records the home needs to keep to ensure that the home is being run properly, for example activity records, staff files and staff training and the general maintenance file. We (The Commission) looked around the home and spoke with residents, relatives and staff throughout the course of the day. Prior to inspection the manager was sent an Annual Quality Assurance Assessment. This provides us with information on what the home does well at and in what areas they need to develop and improve. To gain further information we sent comment cards to residents and staff and took with us to the home relatives comment cards to distribute. Five residents and two relatives returned completed comment cards; there have been none returned by staff. Resident’s comments included the following: * “The whole family were shown around the home and were given the homes brochure. All our questions were answered to our satisfaction”. “I am very happy and satisfied with the home”. “ Staff will always do their best to help”. * * What the service does well: From speaking to residents and visitors, it was clear they were happy with the care provided and liked the staff. Visitors can visit the home at any time and are made welcome by staff. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 6 The manager makes sure that before staff starts work at the home they are properly checked to make sure they are suitable to care for people living at the home. Staff have had extra training in how to care for people in a better way. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 were inspected. Standard 6 does not apply, as the home does not provide an intermediate care service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides residents and their supporters with up to date information about the home that helps them in making a decision about moving in and the services provided. EVIDENCE: The home has a statement of purpose and a service users guide. This information is available to prospective residents and to those already living at the home. The information is clear and concise and informs people about the staffing structure, the facilities and services available and life within the home. There is a range of information leaflets available that some may find useful. All this information is kept in the foyer along with the last CSCI report. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 9 During this inspection we selected four residents whose information we would work with, this is known as case tracking. We checked to see that the four case tracked residents has been given a contract/ statement of terms and conditions on entering the home regardless of how their care is funded. There was evidence of contracts for residents on file. Prior to any resident being admitted in to the home the manager carries out a pre admission assessment. This is to ensure that the home can fully meet the individual care needs of the resident. The assessment covers all aspects of care including what personal care is required, health care, mental state, dietary needs, mobility, sight, hearing and communication, medication, skin care etc. The home is caring for some residents with a dementia related illness; some staff had still to undertake training in this area. The home offers palliative care so that people nearing the end of their life can, if possible can remain at the home and be cared for by people they know and trust. The staff had undertaken extensive specialised training in this field and the home is to be accredited for the Gold Standard Framework (GSF) in palliative care. End of life choices are now more widely addressed and documented in the care plans. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and care needs were met, however there was a small error in mediation noted. Residents were treated with dignity and respect and their rights to privacy respected. EVIDENCE: We continued to work with the same four care plans. The care plans are drawn up from the initial assessment and are split in to areas of care including: maintaining a safe environment, mobility, personal hygiene, continence, nutrition, communication, spiritual needs, pressure care etc. Files contained a social profile which is written in a person centred manner such as; I was born at, I lived at, my school days, my favourite things etc. This information provides staff with background information about the residents they are caring for. There was evidence that showed weekly or monthly weights had been done as required. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 11 Supplementary information was also seen in care plans and included risk assessment, such as risk of falls, pressure care, nutrition, moving and handling and use of bedrails. There was evidence to show that residents had access to outside agencies including doctors, chiropodist, the speech and language team etc. Daily progress notes had been recorded and the care plans had been updated as required. We checked the mediation for the case tracked residents with the manager and the senior who had given out the medication that day. Most of the tablets are in blister packs and these had been given correctly. There were additional boxes of medication and for one resident the number of tablets left did not correspond to the MAR (drugs sheet) chart. For another resident it was difficult to check the paracetamol tablets that had been carried over from the last delivery. The way that some of the prescriptions are issued by one surgery is hard to keep track of as some of the items are written for a three months supply and other items as monthly. The manager agreed with the inspector that this system was difficult to check what was in the additional boxes and agreed to look in to this to rectify any overstocking. Observation throughout the inspection showed that the personal care needs of the residents were being met. Attention was given to all residents personal grooming, clothes were nicely laundered and ladies had had their hair done and the gentlemen were clean-shaven. During the inspection staff were observed to treat residents with respect and consideration. It was evident that good relationships had been formed between residents and staff. Staff at the home had undertaken training in caring for residents who are nearing the end of their life and want to stay at High Peak Lodge rather than go in to hospital. The end of life wishes are now included in the care plans. The home is to be accredited for the Gold Standard Framework in palliative care. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s interest and links with visitors are encouraged; ensuring residents live as normal a life as possible. Meals are good and the needs of the residents are well catered for with a balanced and varied selection of food provided. EVIDENCE: The home has an activity coordinator who with the help of residents, plans and delivers a wide range of indoor and outdoor activities. The home has its own mini bus, this allows residents access to more trips and outings. Activities mostly the take place in an area of the dining room. This area had been relocated from the lounge area as not all residents want to be involved in the planned activity and this has created more space in the lounge area. Activities included flower arranging, music and movement, balloon games, one-to-one chats, talking books, quizzes, bingo, dominoes and visits from entertainers. Some residents like to help with domestic tasks such as dusting. The activity file was looked at and every resident had a record of what he or she had High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 13 participated in or done or if they did not wish to take part. There are photographs around the home of events that had taken place. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contained details of residents preferred religion. The home has an open door policy. There are no restrictions on the time people visit; evidence of this was highlighted in the visitor’s book. The only time restrictions would be imposed is when requested by residents or if staff thought the residents well-being was being compromised. Six visitors were spoken with during the inspection and in the main were satisfied with the care provided. Information on a returned comment card and from a discussion with a relative both remarked about when residents ask to go to the bathroom that staff don’t come when requested. The manager is asked to look into this; it could be that staff are dealing with other residents. Visitors indicted that they are kept informed about their relatives and any issues affectiving them, one family was attending a care plan review on the day of the inspection. Where possible staff encourage and support residents to make their own choices and decisions. Information is recorded in the care plans for example when choosing to rise and retire, choice of alcoholic beverages, preference to bath or shower, wearing make up, how many pillows on beds, or if extra bedding is preferred etc. The menus are available on each table in the dining room. These show the main meal and the choices available. A flexible breakfast is served between 09:00 am and 10:00 am which allows residents to have a lie in if they wish. Early risers are offered a drink and small snack until breakfast is served. A choice of hot and cold dishes is available including, toast, preserves and tea or coffee. Lunch is the main meal of the day. Some residents come to the main dining room, some prefer to eat in the lounge and some residents were seen having trays of lunch taken to their rooms. Lunch consisted of pork steaks, carrots and swede, creamed or chipped potatoes and gravy, followed by apple crumble and custard or corned beef hash as an alternative. A lighter afternoon tea is served and residents were to be offered, soup and sandwiches or a salad followed by cherry scones. Suppers are available before residents retire including a snack of their choice with tea, coffee or a milk drink. Hot and cold drinks and snacks are available during the day. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 14 Residents spoken to after lunch expressed their satisfaction of the quality and quantity of the food served. The dining room was comfortable and the tables were nicely set with appropriate crockery and cutlery and condiments. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives knew how to complain and were confident that any complaints or concerns would be appropriately dealt with. EVIDENCE: A complaints procedure is in place, and the home has a complaints file for the recording of any complaints or concerns made and the action and outcomes taken. Information on the returned AQAA indicates there had been no complaints made to the manager since the last inspection. No formal complaints have been received by the CSCI. There have been no adult safeguarding referrals reported by the home within the last year. All staff have had training in the protection of vulnerable adults, this is updated as required. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of décor within the home is good providing residents with a clean, comfortable and homely place to live. EVIDENCE: High Peak Lodge is well maintained internally and externally. The home benefits from the services of a good maintenance man. The communal areas were suitably furnished. Ornaments and pictures enhance the homeliness of these areas. Several of the bedrooms were looked at and were found to be warm, clean and tidy. Residents had personalised their rooms with their own possessions brought with them from home. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 17 The bathrooms were clean and domestic in style to offer a relaxed atmosphere for residents when bathing. Residents have the choice of a shower or bath. On the day of the inspection the home was clean and odour control was good. Staff were seen wearing different protective clothing for different tasks. The laundry is sited away from food preparation and food storage areas and does not intrude on the residents in any way. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory ensuring consistency of care for people living in the home. Residents were cared for by staff that were safely recruited, suitably experienced and trained to meet the needs of the residents. EVIDENCE: On the day of the inspection staffing levels were sufficient to meet the needs of the residents. A written rota is maintained and showed which staff were on duty and at what times. Two relatives made comment about the number of staff on duty and that there did not seem to be enough staff around. On the day of the visit, which was unannounced there was sufficient numbers of staff including the manager, the deputy manager, senior nurse and six care staff for thirty-four residents. Care staff are supported by domestic and catering staff, an administrator and the maintenance man. It could be that staff are in other parts of the home or seeing to a resident in their room or assisting in the bathroom and therefore are not always visible. The night shift is covered by a nurse and three care staff. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 19 Several of the staff had worked at the home for a number of years; this provides good, reliable and consistent care for people living at the home. Staff morale appeared good and the staff team appeared to work well together. The atmosphere within the home was relaxed and friendly. Interaction between staff and residents were frequent, warm and natural. The files of three staff employed looked at showed all necessary recruitment checks had been undertaken. All contained: a written application form, two references, Criminal Records Bureau (CRB) check and verification of identification. Interview assessment notes were held on file the last perso to be employed at the home. A separate staff-training file for each member of staff is maintained. The training file of the three staff we checked was examined and there was evidence of up to date training and mandatory training. All new staff completes a full induction programme on commencement of work. The home meets the standard of having at least 50 of care staff qualified to NVQ level 2 in care. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and competent ensuring the home is run in the best interests of the residents. Regular maintenance and fire safety checks were carried out, promoting the health and safety of both residents and staff. EVIDENCE: The manager has worked at the home for a number of years. The manager is a qualified nurse and has considerable experience of working with the elderly. The manager is in receipt of the Registered Managers Award. There is a clear line of accountability in the home which residents and staff are aware of. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 21 During the inspection, it was observed that residents and staff had no hesitation in approaching the manager if they had anything to discuss. From the way in which the manager spoke with residents it was evident she knew them well. Internal and external quality assurance systems are in place. Regular resident/relative and staff meetings take place and are minuted. A representative from head office visits the home to audit records and speak to residents and staff and completes a monthly written report. We checked the monies of the case tracked residents, some had money held at the home. The administrator could account for resident’s money and balance sheets of any transactions were kept and were correct. Health and safety policies and procedures were in place. The maintenance man keeps up to date and accurate records of all checks he carries out, this included: any repairs, carpets, gas and water meters, fire alarms, emergency lighting, room inspections, wheelchair checks, plugs, shower heads etc. Any accidents, injuries and incidents had been recorded and the CSCI are informed as necessary. Information on the returned AQAA provided a list of maintenance checks and associated records. A number were checked on inspection including the lift, gas, electrics and water testing, the certificates were inspected and were up to date and valid. High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Requirement You must ensure that all medication is recorded correctly and all tablets accounted for. Timescale for action 17/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Peak Lodge DS0000005682.V371468.R02.S.doc Version 5.2 Page 25 - 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. 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