Care Home: Leonard Lodge

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• Claremont House
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What the care home does well Leonard Lodge provides people who live there with a homely and well maintained environment that meets their needs. The gardens are well maintained, accessible and provide a pleasant outlook and opportunity for residents. One survey contained a comment "the home is always clean, tidy and sweet smelling." People`s needs are assessed prior to admission so that they and the manager can be sure that there needs can be met at Leonard Lodge. People are welcome to visit the home as part of the decision-making process about living or placing a relative there. People we spoke to and those who provided information in surveys told us they had been given enough information to help them make that decision. Residents` care needs are recorded in a plan of care that provides current information for staff on how best to meet the individual`s needs in a safe way and in line with their preferences. Residents and relatives we spoke to told us they were satisfied with the standard of care provided at Leonard Lodge and that privacy and dignity were respected. One relative/resident survey stated that "overall the care provided is thoughtful and respectful" and another person said "overall we are very satisfied with Leonard Lodge and the care provided". Residents are offered a choice of food and drinks at all meals. Visitors told us they feel welcome to visit at any time. Residents in the upstairs unit have opportunities to participate in a range of stimulating social activities. Staff interacted well with residents and addressed them by name. Residents on the upstairs unit also knew the names of the staff supporting them. Residents and relatives spoken with throughout the home commented positively about the staff with comments such as "some staff are very competent", "they are all pleasant" and "they communicate well". What has improved since the last inspection? Care management documentation sampled was of a good standard and regularly reviewed to ensure it provided the most up-to-date information for staff and how to meet the person`s needs. As recommended at the last inspection of the service, regular fire drills were evidenced as carried out. A music therapist has been employed to provide additional support to residents. There has been ongoing maintenance to the premises, decorating and furnishings as well as the outdoor space available to residents. were What the care home could do better: Store medication appropriately to ensure it remains effective for residents and ensure that all records in relation to medication are accurately maintained.Provide appropriate support to enable people living in the downstairs unit to have their social care needs met. Review the deployment of staff and allocated tasks to ensure that adequate numbers of care staff remain actively available to residents at all times. Key inspection report Care homes for older people Name: Address: Leonard Lodge Roxwell Gardens Hutton Brentwood Essex CM13 1AQ     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: Bernadette Little     Date: 2 2 0 6 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Leonard Lodge Roxwell Gardens Hutton Brentwood Essex CM13 1AQ 01277263939 01277261433 leonardlodge@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Clare Louise Collar Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 60 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE Mental disorder, excluding learning disability or dementia - Code MD Old age, not falling within any other category - Code OP Date of last inspection 60 60 0 Over 65 0 0 60 Care Homes for Older People Page 4 of 30 Brief description of the care home Leonard lodge is a purpose built, two storey Care Home with Nursing set within its own well maintained grounds, on the outskirts of Brentwood. It is situated close to a local bus route and is close in proximity to all community amenities and services. Car parking spaces for several cars are located to the side of the property. Leonard Lodge is decorated, furnished and maintained to a good standard throughout and provides nursing care for 60 Older People including those living with dementia. Residents are accommodated on two floors and a separate EMI unit looks into a garden courtyard. The Service User Guide and Statement of Purpose are available for residents and their representatives and they are provided with this information. The manager stated that the home has current Commission for Social Care Inspection reports are available to review. At the time of the key inspection report the inspector was advised that the scale of the homes charges and fees range from £750.00 to £1200.00 per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was undertaken on 28th September 2007. We also undertook an annual review of the service on 19th August 2008 and 17th March 2010. This key inspection site visit was undertaken over a nine hour period on one day as part of that key inspection. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report The registered manager submitted an Annual Quality Assurance Assessment (AQAA) as required by law prior to the site visit. This gives them opportunity to tell us their assessment of how the service they provide meets the needs of the people using it, what has improved and what they plan to do better. The AQAA contained a satisfactory level of clear information that was considered as part of the inspection process. Prior to the recent annual service review we sent the manager a variety of surveys to Care Homes for Older People Page 6 of 30 distribute to residents, staff and health/social care professionals. In response completed surveys were received from five residents/their relatives, five staff and two health professionals. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The registered manager had recently gone on leave. The current manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the manager and clinical nurse manager and opportunity given for clarification were necessary. The assistance provided by all those involved in this inspection process is appreciated. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Store medication appropriately to ensure it remains effective for residents and ensure that all records in relation to medication are accurately maintained. Care Homes for Older People Page 8 of 30 Provide appropriate support to enable people living in the downstairs unit to have their social care needs met. Review the deployment of staff and allocated tasks to ensure that adequate numbers of care staff remain actively available to residents at all times. 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 30 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 30 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 using the service are assessed and reassured that their needs can be met. Evidence: The service provides a statement of purpose and service user guide. These documents give people information about the service to help inform their decision about living at Leonard Lodge. The service user guide contained required information. It did not indicate that it was available in other formats, for example easy read large print or pictorial, to make it more accessible to people who have different needs and this should be considered. There is a formal preadmission assessment format and procedure in place to ensure that the persons needs can be met at Leonard Lodge. The managers AQAA tells us that a comprehensive preadmission assessment of potential residents is carried out by a suitably qualified person using a recognised assessment tool to ensure that they have the appropriate facilities, staffing and specialist input available for the person on Care Homes for Older People Page 11 of 30 Evidence: admission. The clinical nurse manager confirmed that the administrator sends out information on the service to people on enquiry and also writes to them to confirm that, based on their assessment, the service can meet the persons needs. We looked at three peoples files and all contained evidence that a preadmission assessment had been undertaken and provided sufficient information and detail. Additionally assessment was supported from associated information provided by external stakeholders where this was available. Information recorded within these documents is used to inform and provide the basis for the individual persons individual plan of care. Surveys we received from residents/relatives told us that they had been given enough information about the home before they moved in. The managers AQAA states that prospective residents and their relatives are invited to come and enjoy lunch/dinner at the home should they wish to assess the suitability of the facility for themselves. This was confirmed by people we spoke who told us they had been welcome to come and visit to see what the home was like before deciding to live there/place their relative there. Intermediate care is not offered at Leonard Lodge. Care Homes for Older People Page 12 of 30 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 can expect that their general personal and health care needs will be monitored and met however some shortfalls in medication management may impact on resident wellbeing. Evidence: There is a formal care planning system in place at Leonard Lodge. This informs staff of the health and care needs of the individual person and how to meet these in a way that safely meets the persons needs and preferences. Care plans are supported by formal admission assessments including in relation to communication, moving and handling, nutrition, tissue viability, falls, continence and considers peoples diversity including relationships and cultural needs. We looked at the care management documentation for three people. Each was observed to have a plan of care in place and this was devised from the information obtained as part of the preadmission assessment. Care plans provided clear information for staff on how to meet the persons needs and cross-referenced relevant issues. This included for example the care plan in relation to mobility and dexterity Care Homes for Older People Page 13 of 30 Evidence: referring to a history of falls prior to admission and then cross-referencing with the care plan on moving and handling, the risk assessment for falls and moving and handling and safe working practices assessments. Care management documentation of people living with dementia also indicated how this impacted on other aspects of their care needs and daily living. Short-term care plans were in place for specific issues, which is good practice. Preventative steps were evidenced where residents were at risk of developing pressure sores, with appropriate equipment documented, and care plans supporting good nutrition and hydration in place. Nutritional profiles were maintained that had been completed regularly and reviewed. Daily care records were informative. Care plans and risk assessments assessed showed that they had been regularly reviewed and that changes in the persons condition had also been monitored, recorded and actioned including obtaining a medication review following a fall. We received two completed surveys from healthcare professionals that told us they viewed that the care services assessment arrangements ensure that accurate information is gathered and the right service planned for people, peoples social and health care needs are properly monitored, reviewed and met by the service and that the service respects peoples privacy and dignity. Information recorded within the care plans showed us that regular healthcare support was provided for the people living at Leonard Lodge and this was confirmed by residents and relatives spoken with. Health care records reviewed showed assessments for example by the physiotherapist, music service, and interventions by GP, chiropodist, optician and psychiatrist as appropriate. Surveys we received from residents/relatives told us that they usually or always receive the care and support they need including medical care. One person commented that this is because of their familys involvement and commented that the social aspect of peoples care in the downstairs unit is limited at times because of staff availability. Residents and relatives we spoke to at the time of the site visit indicated clearly that they are satisfied with the personal and health care received/ provided at Leonard Lodge. One resident told us that this can be affected on days where there are not sufficient staff and gave an example that there was no hostess to serve breakfast that day but also told us personally I think this is a good home. A relative told us that in their view the care is spot on. Staff spoken with told us that they are given good information about the care needs and personality of each resident and ensure that new staff always receive this information. This included ensuring peoples privacy and dignity is respected, for example taking people to their rooms when providing personal care and where Care Homes for Older People Page 14 of 30 Evidence: necessary asking the family to wait outside. Surveys received from staff also confirmed that they were generally given up-to-date information about the needs of the people they care for. Discussion with residents confirmed that people feel that their privacy and dignity is respected at Leonard Lodge. Each resident had a care plan in place in relation to medication and to pain management and their abilities/ways to communicate where this was appropriate. We looked at the practices and procedures for the safe handling, storage and recording of peoples medicines. Medicines are stored securely for the protection of residents in a dedicated room on each floor. The temperature of the storage room on the ground floor is monitored and recorded regularly and was acceptable, but the temperature of the room on the first floor was found to be above the recommended maximum, is recorded infrequently and also was recorded as being above the recommended maximum. The failure to store medicines at the correct temperature may result in people receiving medicines that are ineffective. The temperatures of the fridges used to store medicines are also monitored and recorded and, although acceptable, the recording was infrequent on the first floor. Only the current temperature is recorded but it is recommended that the maximum/minimum thermometers in use are used to record the temperatures as this would give an indication that the temperature may have been out of range outside the recording period. There is dedicated storage for controlled drugs provided on each floor, but the size of the cupboard on the first floor is insufficient to hold all supplies and controlled drugs had been stored outside of the legal requirements. The records made of controlled drugs were accurate. We looked at the records made when medicines are received into the home and when they are disposed of. These were of a reasonably good standard. We also looked at the records made when medicines are given to people, but found some problems with these records, including but not limited to: gaps in the records giving no indication whether medicines had been given to people or not, and if not, the reason why was not always recorded; discrepancies between the actual amount of medication remaining and what should be left if the records were accurate; the amount of medication left over to the new recording period is not always recorded and so it is difficult to account for all medicines in use; medication given at different times to those indicated on the prescribed instructions; special instructions for the administration of medicines may not have been followed which may put people at risk. We also found that for some people, whose medication requires close monitoring and variable dosages, we could not find verification of the dosage to given in care records. Care Homes for Older People Page 15 of 30 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. Residents can expect to have a choice of meals and lifestyles but cannot always be reassured that their needs for meaningful occupation and social interaction will be met. Evidence: The managers AQAA states that there are 60 hours of activities staff weekly and that they plan to employ a music therapist. It was evidenced at the time of the site visit that the music therapist has been employed and records indicate that this opportunity is available to residents in the downstairs unit twice a week. A survey received from a relative since the completion of the managers AQAA indicates that there used to be 60 hours of activity coordinator support provided per week and that while activities remain supported in the upstairs units, people living in the ground floor unit do not appear to have any activities arranged for them and they do not appear to be offered any stimulation. A resident spoken with at the site visit also told us that the activity organisers hours had been reduced. Four of five resident/relatives surveys received told us that there are always activities available that they can take part in if they want to. One person commented the meals and entertainment are good and another person commented on what the home does Care Homes for Older People Page 16 of 30 Evidence: well arranging activities and a good atmosphere. These may refer to people living on the first floor of Leonard Lodge who are currently supported by an activities coordinator. We spoke to the activity coordinator who confirmed that they are employed to work 25 hours per week and are currently providing support in the upstairs unit. Residents spoken with in that unit clearly appreciated the enthusiasm and skills of the activity coordinator. Residents had available their own copy of the weekly activities programme that included information on when the hairdresser, chiropodist, outside entertainer and children from the local school would be on-site, group activities such as dominoes, exercise session, board games, ice cream in the garden and residents meeting as well as individual room visits and manicures. The current manager confirmed that the post of activity coordinator for the ground floor is vacant and it is hoped that it will be taken up very shortly by a carer from the unit who is interested in the role. However they cannot yet to be released until full recruitment checks have been obtained for newly recruited care staff who can take over that persons role as a carer. Observation in the downstairs unit indicated that staff did interact with residents when they had opportunity. There were reasonable periods of time that only one carer was present in the lounge and so this also limited the opportunities for social interaction and stimulation for residents. A relative commented in a survey that the home does not appear to be as friendly and welcoming as previously. Relatives spoken with told us that they always feel welcome to visit. Residents spoken with told us they feel their visitors are always made welcome. Residents spoken with and able to comment confirmed that their rights to make choices in everyday life is respected. A resident said you can do exactly what you want, go to bed when you want as you are able to get up and choose your own clothes. A visitor told us that staff speak to residents appropriately and with dignity, and that they try to encourage their relative to dress appropriately, will try to persuade them but understand that you cannot make them. Another told us that staff accommodate care to individual peoples needs and not the other way round. Part of the breakfast meal was observed in the upstairs unit and the lunchtime meal was observed in the downstairs unit. It was a busy but relaxed environment with people given assistance in a sensitive and unobtrusive manner. Copies of the menus showed us there was an option of a cooked breakfast daily, two options for the main meal of the day and a cooked option or sandwiches at supper time. This was observed Care Homes for Older People Page 17 of 30 Evidence: in practice and confirmed by residents spoken with. The chef served the lunchtime meal and people were clearly offered choices. Comments received from surveys included the menu is quite varied, plentiful and looks and smells appetising. Residents we spoke to told us that the food was fine and another person said we do have choices, and you can ask for something else, the food is generally very good, plentiful and you can have more and tea and coffee whenever you want, you just ask, you can have a beer or sherry with dinner, they will get for you what they can. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their concerns to be listened to and acted upon and to be safeguarded by the knowledge of staff and supporting systems. Evidence: The complaints procedure was clearly displayed and includes current contact details for the Commission. Information on complaints and suggestions is included in the service user guide which states they encourage all residents and family members to express their views about the quality of care and services. It provides reassurance that Barchester Healthcare will consider disciplinary action for any employee who is found to discriminate against residents or visitors who voice complaints. The Commission have been aware of a number of complaints received by the service and has been provided with a summary of the complaints and their outcomes by the registered manager. One of these was confirmed as upheld in part in relation to not supporting the residents to manage their own medication as was initially agreed and an apology was issued. Elements of complaints, for example relating to care, food and activities, were recorded as partly upheld. There were also elements of complaints relating to medication identified as upheld or upheld in part. Surveys received from residents and relatives and our discussions with residents and relatives at the site visit told us that overall people know how to make a complaint, that there is somebody they can speak to informally if they are not happy and that Care Homes for Older People Page 19 of 30 Evidence: they feel able to raise concerns. Two complaints were also referred under safeguarding by relatives and included elements of concern regarding the care of residents. Initial investigation by the safeguarding team was advised as not finding particular concerns and, at the time of the site visit, the current manager advised that the safeguarding referrals had been closed with no further action. The registered manager had referred appropriate issues to the safeguarding team, for example medication errors, took appropriate action to suspend staff and inform the Commission. Medication was assessed as part of this inspection process by a specialist pharmacist inspector and, as noted earlier in this report, the standard was assessed as being almost met, with requirements in relation to storage and records. One safeguarding issue was notified to the Commission just prior to the site visit. The current manager confirmed that a safeguarding referral had been made to the safeguarding team, was being investigated and that an outcome was not yet available. The registered managers AQAA confirmed that the home has a protection of vulnerable adults policy, that staff receive induction and annual training in respect of this and that the home follows local policies and procedures for the protection of vulnerable adults. The staff handbook contains clear information for staff on whistleblowing, and reporting abuse is identified as a condition of their employment. Training records indicate that staff have received training in relation to safeguarding. Staff spoken with confirmed that they had undertaken training, and demonstrated a good awareness of adult safeguarding. They told us that they would report any incidents to a senior or manager. Care Homes for Older People Page 20 of 30 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. Leonard Lodge provides residents with a pleasant, safe and clean environment that meets their needs. Evidence: Leonard Lodge is a purpose-built care home that was decorated and furnished to a high standard. There is a central communal seating area on entering the home with tea and coffee facilities available. Accomodation for residents is on two floors and the first floor is accessible by shaft lift. A separate hair dressing room is available. A call box type telephone is available with seating for residents on each of the units and some residents told us that they had their own telephone installed, while others used their own mobile phones. The home is set in its own well maintained grounds that were accessible to and used by residents. A resident who lives on the upstairs unit told us that they had been busy with the activities coordinator planting in their downstairs garden. This had raised box beds for accessibility and provided opportunities for seating. Each unit has its own communal areas for sitting and dining as well as a satellite kitchen. We noted positively that the furniture was arranged in small seating groups, moving away from the institutional approach and presenting as more homely. All bedrooms are single and ensuite. Residents spoken with said they were satisfied with Care Homes for Older People Page 21 of 30 Evidence: their own rooms and the communal areas available. They told us they found them comfortable and they had been able to bring personal items with them to make the place feel more homely. Not all bedroom doors were fitted with locks. One resident told us they would like to lock their room when leaving it if this facility was available. The manager confirmed they would review this. The manager told us that they plan to install a working kitchen in the downstairs Memory Lane unit for people living with dementia to support life skills. The unit provides a physical environment that is supportive to the specific needs of the people who live there. Residents bedroom doors had large clear photographs or relevant images to help them with orientation and to recognise their own private space. Residents had access to an enclosed and secure garden. There are a number of toilet and assisted bathing facilitilites on each floor. Bathrooms and toilets viewed were clean and provided appropriate facilities. A resident told us bathroom doors are locked by staff who support them with bathing to ensure the residents privacy and dignity is maintain the ed. No health and safety concerns were observed. Upstairs window sampled were fitted with restrictors and hot water temperatures sampled were satisfactory. Staff were seen to wear appropriate protective clothing to promote effective management of the risk of cross infection. Information provided by the manager indicated that the majority of staff have attended infection control training and updates. All areas of the premises viewed were clean and free from odours. Information from surveys and discussion with residents and visitors indicated that the home is kept clean and fresh. Care Homes for Older People Page 22 of 30 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. Residents can expect to be cared for by competent, friendly and safely recruited staff and would benefit from a review of staff deployment. Evidence: The manager told us they were 51 people living at Leonard Lodge at the time of the site visit. The clinical nurse manager confirmed the information provided by the manager that on each unit they are currently funded for five carers and one nurse during the morning, three carers and one nurse during the day and two carers and one nurse at night, this being based on resident dependency levels. This is in addition to a range of ancillary staff. The clinical nurse manager stated that there are occasions where this day staffing level is not met however advised that there are currently nine vacant rooms and staffing levels have not been reduced to reflect this. The rota was not accurate to the staff on duty and did not include the names of all people seen to be present at the site visit. Surveys received from residents/relatives told us that staff are generally available when they need them although two surveys said that something the home could do better was to provide more staff at night. Rotas and discussion with staff and residents indicate that night staffing levels are routinely met. A resident told us that staff always undertake the night checks agreed and that this is important to them. Care Homes for Older People Page 23 of 30 Evidence: The manager confirmed the information provided by residents that there have been issues on occasions in providing hostess staff to support mealtimes. It has also been identified that the activity coordinator post on the Memory Lane unit is vacant. A number of staff work long-day shifts and while breaks are organised in a considered way, it still means that the full staff quota is not available to residents for periods of time during shift. The lack of availability of on duty staff on Memory Lane unit during the morning was queried and we were told that while one care staff would always be available on the lounge, other care staff were busy making beds. One member of staff had been taken off the unit to positively provide an escort for a resident from the other unit to attend an appointment, however this was not addressed for some time by an additional member of staff being provided on Memory Lane unit. These factors are considered to impact on the availability of staff to support positive outcomes for residents, particularly on Memory Lane unit and the deployment of staff and allocation of tasks are recommended to be reviewed. Documentation provided by the manager told us that over 50 of the care staff at Leonard Lodge have achieved either NVQ level II or level III and additional staff are currently undertaking this training. The recruitment files of two staff were reviewed. This was to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for residents of Leonard Lodge. Both files contained evidence of required information and checks were obtained prior to employment commencing to evidence robust recruitment procedures to safeguard residents. Surveys received from staff confirmed that their employer carried out appropriate checks before they started work and overall their induction covered everything they needed to know to do the job when they started. Staff spoken with confirmed that they had appropriate induction, and received all mandatory training and regular updates including in relation to fire, moving and handling, safeguarding, managing challenging behaviour, dementia care, food hygiene infection-control and health and safety. This was confirmed in documentation provided by the manager and also confirmed on staff files reviewed. Residents and visitors spoken with were complimentary about the staff told us they were friendly and its first names all round, they try to accommodate us, staff do pop in and have a chat with me and another person said they talk to me, staff are very good and very friendly and speak to residents appropriately. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Leonard Lodge can expect a well managed service that is run in their best interests. Evidence: Leonard Lodge has an experienced and qualified manager registered with the Commission and who has recently gone on long term leave. A survey received commented that the manager needs to be more hands on and more involved with staff and patients. People spoken to at the site visit indicated that the manager is approachable. The service is being managed currently by an experienced and qualified manager who has previously managed at Leonard Lodge and confirmed that they are a registered general nurse as well as having appropriate management qualifications. A clear management structure is in place. There is a head of unit for each of the upstairs and downstairs units who report to a clinical nurse manager who in turn reports to the manager. The registered managers AQAA confirms that regular customer satisfaction surveys Care Homes for Older People Page 25 of 30 Evidence: are undertaken. It also tells us that the home provides effective quality assurance procedures supported by the organisation from which managers develop action plans. This leads to a programme of development in key areas of the home and ensures improvements in outcomes for residents. The current manager provided evidence of monthly audits that include nutrition, pressure ulsers, incidents, accidents and complaints. They also made available a copy of the minutes of the most recent meeting for residents and relatives. The activities programme displayed for the week of this site visit indicated that a further residents meeting was planned. We saw reports of regular monitoring visits by a representative of the registered provider. These identified issues relating to residents care, the environment, medication etc and provided an action plan with dates for improvements to be made. They also confirmed that the views and experiences of people living at Leonard Lodge are sought. As at the previous inspection, Leonard Lodge did not maintain any personal monies on behalf of the people living there. Families were invoiced monthly for such expenses as hairdressing, chiropody, newspapers etc. No health and safety concerns were noted during the inspection. Aspects of health and safety management were reviewed. The maintenance engineer undertakes a daily walk around and checklist of the premises. A random selection of service and maintenance records were sampled and assessed to be well organised and in good order. Records were available to demonstrate that fire drills are regularly undertaken and that there are regular checks of the fire doors, fire escape routes and water outlets. Current safety inspection certificates were available for the gas, electrical fixed wiring, lift, emergency lighting, fire equipment and the fire alarm. A current liability insurance certificate was displayed. Care Homes for Older People Page 26 of 30 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 27 of 30 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 9 13 Medicines controlled under the Misuse of Drugs Act 1971 must be stored in accordance with the Act and associated Regulations. This will prevent unauthorised access, prevent diversion and comply with legal requirements. 31/07/2010 2 9 13 Medicines must be stored under suitable environmental conditions and records must be kept to evidence this. This will ensure that medicines given to people are of suitable quality. 15/07/2010 3 9 13 The records made when 15/07/2010 medicines are given to people must be accurate and complete. Care Homes for Older People Page 28 of 30 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 This will demonstrate that people receive their medicines as prescribed. 4 12 16 Provide support for social stimulation and meaningful occupation for all residents at Leonard Lodge. To ensure residents needs are met. 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 06/08/2010 1 9 The temperatures of the refrigerators use to store medicines should be monitored and recorded using the maximum/minimum temperatures and reset between recording periods. Ensure the full hours of social activity staff hours stated are provided to residents. The full name of all staff on duty to be recorded on the rota and the rota to be maintained as an accurate record. The deployment of staff should be reviewed to best meet the needs of people using the service. 2 3 4 12 27 27 Care Homes for Older People Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - 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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