Care Home: Lodge The Residential Care Home

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What the care home does well People get a good assessment before they are admitted to The Lodge. They get the chance to have a look round, and are given written information to read at their leisure. This assessment helps the home to make sure they have the right resources to meet people`s needs, and that the people themselves are involved in the decision about whether they should move there. People are cared for by a group of staff who know their needs well. Care plans written for them are completed in an individual way, which recognises people`s right to privacy and dignified care. Staff speak to people in a respectful way, and people respond well to this. People can make some choices in their lives, which helps to keep them independent, and recognised as individuals. Their spiritual needs are catered for, and they are able to maintain links with family and friends that are important to them. People get a choice of food, fresh vegetables and fruit, prepared in the home`s kitchen, which has been assessed by the Environmental Health Officer as providing excellent standards. The communal sitting areas provide choice for people. They are interesting, warm, and comfortable. What has improved since the last inspection? There have been several improvements made since the last key inspection. The previous registered manager has left, but the deputy managers and the responsible individual, alongside the input from an outside consultancy firm, are looking at ways to move the home forward. Some of these improvements have been made, and some are planned. These include improvements to the environment, and an emphasis on updates in training. Work has also been done to meet the requirements made at the last inspection. People`s care plans are now regularly reviewed, and the systems in place for managing people`s medication are now generally satisfactory. Staff have received a lot of training, including compulsory training in fire safety, safe moving and handling, infection control, food hygiene and first aid. They have also received training to help them understand about abuse, behaviour which challenges others, dementia awareness, and in some cases, National Vocational Qualifications in Care. This collective training will help to reinforce good safe care practices at The Lodge. Systems have been put into place so that people`s views, and those of their families, can be formally sought. The management look at the information from these surveys to see where changes need to be made, based on people`s views. What the care home could do better: Staff could make sure that they always complete a person`s initial assessment in full, so that important information about them is not overlooked when the care plans are written. And risks to certain individuals could be better monitored, and the right professionals contacted promptly for advice, when the evidence shows that these risks are beginning to affect the person`s health and well being. Staff could make sure they always use the right equipment when helping someone who cannot manage on their own, to move. This will help to avoid injury to the person, or to the staff themselves. Medication could be better monitored so it is only given for as long as the doctor ordered. Bottles containing liquid medicine could be kept in a better state so that staff are able to read the instructions on the bottle. The activities programme could be tailored more to people`s individual needs, and requests by people for outside trips could be met more regularly. People could be offered more drinks, to aid digestion, and so that they keep well hydrated. The complaints policy could be written in a more user friendly way, so more people can understand it. The policy about abuse at the home could be revised to show who the management must report to if any allegation of abuse is made. Staff could be refreshed about these outside contacts, who they too can report to if they wish. The restraint policy needs to be amended, because staff have not had training in restraint, therefore are unable to follow the policy safely. Those bedrooms identified by the management could be redecorated as priority so that everyone enjoys the same good standard of accommodation. And bath temperatures could be restored in two bathrooms so that people have a better range of facilities when they choose to bathe. The recruitment procedure could be more thorough, to make sure people are protected from potentially unsuitable workers. And new staff could have their induction completed, so it is assured that they are working towards good, common aims, and to at least the national minimum standard. Some environmental health and safety matters could be managed better, to keep people safe from unnecessary risk. During this time of management change, it is important that clear lines of communication and accountability are maintained at the home, so staff can air their views. This way, management will be able to deal with any issues arising promptly. Key inspection report Care homes for older people Name: Address: Lodge The Residential Care Home Lodge The Residential Care Home Heslington York YO10 5DX     The quality rating for this care home is:   one star adequate 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: Anne Prankitt     Date: 2 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 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 38 Information about the care home Name of care home: Address: Lodge The Residential Care Home Lodge The Residential Care Home Heslington York YO10 5DX 01904430781 01904870430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Colourscape Investments Limited T/A The Lodge Residential Home Name of registered manager (if applicable) Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Lodge is a care home registered by Colourscape Investment Limited to provide accommodation and personal care to up to twenty four older people who may have dementia. The home consists of a large, detached pre Victorian house with a newer purpose built extension. It is situated in the village of Heslington and is within walking distance of local facilities. The amenities of York city centre are also accessible by transport. Twenty of the rooms provide single accommodation, and two are shared. None of these rooms has en suite facilities. There are however sufficient bathroom and WC Care Homes for Older People Page 4 of 38 Over 65 24 24 0 0 2 3 1 0 2 0 0 8 Brief description of the care home facilities for people, that are located close to bedrooms and communal areas. Bedrooms are situated on the ground and first floors, the latter being accessed by one of two staircases. The home does not have a passenger lift but one of the staircases has a stair lift. There is ramped access to the home. The home has a large well maintained garden and there is an area of hard standing for parking to one side of the building. We were told on 27 October 2009 that the current weekly fees were £495. People pay extra for chiropody, newspapers and hairdressing. The inspection report is made available upon enquiry from the home. Care Homes for Older People Page 5 of 38 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: one star adequate 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 key inspection included a review of the following information to provide evidence for this report: Information that has been received about the home since the last key inspection. A self assessment, called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the management think outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned by seven people living at The Lodge and three staff. We sent surveys to health and social care professionals, but none were returned. A site visit to the home carried out by one inspector over approximately eight hours on 27 October 2009. Care Homes for Older People Page 6 of 38 During the visit to the home, we talked to a number of people living there, some staff, two relatives, the deputy managers and the responsible individual. Two care plans were looked at in detail, and a further three care plans were looked at where we wanted to see specific information. We also looked at some staff records, including recruitment files and some records about health and safety. We looked around some of the premises, and visited the kitchen. We also spent some considerable time watching the general activity at the home, to get an idea about what it is like to live there. Both deputy managers and the responsible individual were present when we provided feedback at the end of the day. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted, or carried forward into this report as recommendations - but only where it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? There have been several improvements made since the last key inspection. The previous registered manager has left, but the deputy managers and the responsible individual, alongside the input from an outside consultancy firm, are looking at ways to move the home forward. Some of these improvements have been made, and some are planned. These include improvements to the environment, and an emphasis on updates in training. Work has also been done to meet the requirements made at the last inspection. Peoples care plans are now regularly reviewed, and the systems in place for managing peoples medication are now generally satisfactory. Staff have received a lot of training, including compulsory training in fire safety, safe moving and handling, infection control, food hygiene and first aid. They have also received training to help them understand about abuse, behaviour which challenges others, dementia awareness, and in some cases, National Vocational Qualifications in Care. This collective training will help to reinforce good safe care practices at The Lodge. Systems have been put into place so that peoples views, and those of their families, can be formally sought. The management look at the information from these surveys to see where changes need to be made, based on peoples views. Care Homes for Older People Page 8 of 38 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. Care Homes for Older People Page 9 of 38 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 10 of 38 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 11 of 38 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 are properly assessed before they are admitted to The Lodge, to make sure their needs can be met. Evidence: Peoples needs are assessed by an appropriate staff member from The Lodge, before a decision is made about whether the home will be able to offer them a place. As part of this assessment, information is also collected from health or social care professionals who may have already been involved in the persons care. This helps to make sure that important information is not overlooked when deciding whether the home can meet the long term needs of the person concerned. The results of the assessment are written down, so staff who will be providing care, can see in advance what sort of support the person will need when they arrive. People are also given a copy of the service users guide, which provides written Care Homes for Older People Page 12 of 38 Evidence: information about what the home does, and how. This gives people and their family the opportunity to read about The Lodge at their leisure, when deciding whether the home will be right for them. Of the four people asked in their survey, all said they received enough information before they moved in. A copy of the guide is also left in peoples rooms for when they arrive, so that they can refer to this information whenever they wish. The home told us in the information they provided before we visited, that people can visit and have a look round before they are admitted. We spoke to a visitor, who confirmed that their relative had spent the day at The Lodge before deciding whether it would be the home of their choice. This gives people the chance to meet others who already live at The Lodge, and also staff who may provide them with care and support in the future. The deputy manager confirmed on the day that intermediate care is not provided. Therefore standard six is not applicable. Care Homes for Older People Page 13 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get satisfactory care from staff who know them. Though more care could be taken to eliminate and monitor possible risks. Evidence: People have a more in depth assessment completed once they are admitted. This assessment had not always been completed in full, which meant that important information about someones medical history, and a specific risk, had been overlooked. So these had not been commented upon in their risk assessments and care plans, which are the documents used when staff look at peoples ongoing care needs. Generally, though, there was good information in the care plans, some of which were very individual, and considered peoples choices, privacy and dignity. One explained xxx is a very private man and will only wash below the waist if staff leave the room. Another explained what gender of staff the person likes to receive care from. Another explained xxx is capable of making an informed choice. This shows that staff have thought carefully about these areas of need, and peoples rights to make decisions for Care Homes for Older People Page 14 of 38 Evidence: themselves. It was agreed though that more could be written about peoples social care needs. Doing so would help to make their interests better known, and would help staff to design social activities to better meet them. Some omissions were seen in peoples records about areas which would help make their care consistently good and safe. For instance, for people who need support to keep their teeth clean, and for those who may choose to leave the building without telling staff, possibly putting themselves at risk. We discussed other areas with the management on the day, which we also asked them to put right: There were records to show that health professionals are contacted where advice is needed. The doctor had visited someone recently, but their instructions had not been followed by staff, because the person was not wearing the support stockings prescribed for them, nor had they been encouraged to elevate their feet. This was put right on the day, but staff should know, and carry out these orders, as a matter of course. Bed safety rails had not been fitted correctly to an occupied bed. Nor was there a risk assessment completed to show why these were needed, or a record kept of safety checks, to make sure the rails remained safe to use. The deputy manager said the rails had been supplied and fitted by visiting health professionals. However, the rails can become loose, and the home remains responsible for the ongoing safety of people living there. This equipment must be properly monitored and maintained. We told the management that the rails must be checked straight away, and the current guidance for their safe use followed. We received feedback that this has been done, that the rails now meet current safe practice guidance, and that they will be checked regularly. Moving and handling risk assessments and care plans did not give enough information to ensure safe, consistent practice. One person was being moved in an unsafe way, with equipment not designed for how it was being used. We told the management that this must stop straight away, and a safer way of moving the person introduced. We also said that the risk assessment and care plan must be reviewed. We were told that staff find it difficult to provide care for two people who spend much of their time in bed, because the beds are too low. This was also discussed with the responsible individual, who assured that they will refer this issue to the health professionals to see whether more suitable equipment can be provided. One person needs full assistance from staff with their meals and fluids. Staff are expected to fill in a form kept in the persons room to show that this had been done. Because it had not been filled in properly, it was not possible to see what the person Care Homes for Older People Page 15 of 38 Evidence: had been offered, and when. Staff said that the family visit regularly, and take on some of these responsibilities. However, the person has experienced unexplained weight loss. We told the management to ask the doctor if they may have advice from the dietitian. This will help to make sure that the person is getting the right nutritional support. People who returned their surveys gave mixed replies of always, usually or sometimes, when asked if they get the care and support they need, and whether staff listen and act on what they say. They made positive comments about their care though, like Staff very friendly and helpful. I am very happy with how things are, I feel happy and safe most of the time, Everything is nice and when I ask for anything I usually get it, Everything is always very good. One the day, staff spoke to people respectfully, and personal care was provided discreetly, and in private. One person said They look after us very well - no problems. A visitor said that the care was generally OK, and that they were basically happy with it. They said that the home was fairly good at keeping them informed about their relative. Another spoken with said they were very happy, and that they have never had any issues. They said that they rest easy when they are not there. Staff look after peoples medication on their behalf. We were told that all staff have received training on the safe handling of medication, which has recently been updated. This is good, because it keeps staff up to date with current good practice. There were good systems in place for recording what has been received and sent back to the pharmacy. The following matters were discussed at the time of our visit: Staff had continued to administer an ear spray for twelve days, which had only been prescribed for seven. The deputy manager said she would take this out of circulation. Paracetamol tablets were dispensed by the chemist in large bottles, which did not give expiry dates. Therefore it was not possible for the staff to see when the tablets should be disposed of. They management should ask for these tablets to be supplied in containers which give the expiry date of the medicine. One liquid controlled medicine had dripped down the side of the bottle so it was no longer possible to read what the bottle contained, or to whom the medicine belonged. The deputy manager agreed to send this back to the supplying chemist. Care Homes for Older People Page 16 of 38 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. People can maintain important links with their families and friends. Further improvements in the activities for people would help to make their lives more interesting and fulfilled. Evidence: When asked if the home arranged activities for them to join, two people said usually, three said sometimes, and two said never. Social activities are provided by care staff. A staff member said that if fully staffed, then the activities go ahead. Another said that although activities are well thought out, more scheduled outings could be organised on a more regular basis. The home does not have a programme of planned activities. Instread, it advertises a list of sample acivities. Telling people in advance what will be happening in their home would be better, because it allows them and their visitors to plan ahead, and attend the activities they most enjoy. When we arrived, people were preparing pumpkins for the forthcoming Halloween party, to which family and friends were invited. Some attended a meeting in the afternoon, to see what food they would like at the party. Others played cards, and Care Homes for Older People Page 17 of 38 Evidence: some were content reading the paper, or watching a classic film. One person said that they were allowed to carry on with the individual activities that they enjoy, such as gardening and helping set the tables for lunch. People have said in their meetings at the home, and in the surveys they have completed, that they would like more trips out, more entertainment, and would like to reconnect with the community. The management have already recognised that this is an area for improvement. Although the information provided by the management prior to the site visit told us that sometimes peoples condition, and staffing constraints, restricted the number of trips that take place. There should be sufficient forward planning to make sure that peoples wishes are met, so they can enjoy a full and interesting social life. Staff explained ways in which they try to provide people with choices. One gave an example whereby two people that day had enjoyed a lie in, and a late breakfast in their room. Steps have been taken to meet peoples spiritual needs. Members of the clergy visit the home on request, and and a service is held monthly there. People can have their visitors when they wish. Staff were seen to greet visitors in a friendly manner. The majority of people who answered their survey said that they always liked the meals. We received comments like have nice food, nice meals. One person thought there could be more choice of menu. But another said The food is nice. We get plenty of choice. The dining area was nicely set out. People had a pleasant relaxed mealtime. Staff showed people a plate of each meal alternative, so they were able to see it, and decide which one they would like to eat. This visual prompt helps people with dementia to make decisions for themselves more easily. People were offered seconds when they finished their meal. However, they were only offered one drink. Staff should make sure people get offered plenty of fluids at mealtimes, and throughout the day, so they remain well hydrated, and do not get thirsty. Staff do not give people their medication at mealtimes. This makes the mealtime feel more social. A staff member said that the routine has become less institutionalised, and people now get their breakfast served to them as they get up, so they do not have to wait for long periods of time at the table. This flexible approach is good practice. We visited the kitchen and spoke to the cook. She said she is given sufficient Care Homes for Older People Page 18 of 38 Evidence: information about people from staff so she can be sure she is providing the proper diet for them. She said that budget is no object, and that she orders, and receives, a regular supply of fresh meat, vegetables and fruit. She confirmed that the kitchen is open at all times so staff can make snacks for people if they get hungry. Care Homes for Older People Page 19 of 38 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 have confidence that their complaints are listened to. The policies at the home in place for protecting people need to reflect practice, in order to ensure a consistent approach to protection. Evidence: The complaints procedure is displayed in the hallway. The print is small, and may be difficult for those with poor vision to read. Of those surveyed, only one person knew how to make a formal complaint. However, all but one said they know who to speak to if they are not happy. The management should think of ways in which they can make the complaints procedure more easy to read, so more people can understand it. The home has received one formal complaint since the last site visit, which was recorded. This was about the way things had been stored in a persons room. There was a record made about what had been done to resolve this. We spoke to someone on the day who said The staff would sort out my problems I think. Another said We cant grumble. Everyones nice here. A relative said they had never had any issues. Information received prior to this site visit from someone who was anonymous was considered during the course of the day. This related to concerns about insufficient staffing, that the responsible individual is not known to staff, that the home is Care Homes for Older People Page 20 of 38 Evidence: deteriorating, that areas of the environment were poor, that people do not use the outside furniture because there are insufficient staff to take them out, that there are insufficient activities, and that peoples bedding is not satisfactory. These concerns have been referred to in the relevant outcome group within this report. The management were unsure as to whether they had a copy of the multi agency policy for the protection of vulnerable adults. This guidance, produced by the local authority, is essential information, because it tells staff how they should work with the local authority when dealing with allegations of abuse. The management said they would get a copy. The policy at the home should then be amended to reflect their role in supporting the local authority by promptly reporting to them any allegation, or incident which may arise there. The local authority are not mentioned in the policy, which could be confusing for staff. Despite this omission, a recent incident where one person living at the home had presented with behaviour which challenges others, had been correctly reported to both the local authority, and to the commission. There has been one other safeguarding investigation, which the local authority had not completed at the time of this site visit. The home has assisted during this investigation, and they informed the commission in the annual quality assurance assessment that an investigation has taken place. All of the staff spoken with said they have received training in safeguarding in the last year. This training has told them about what to do if they suspect or witness any mistreatment of anyone living at the home. This training is in the form of a video, followed by a questionnaire. However, some staff were not clear on questioning about the role of the local authority. They need to know this, in case they ever need to refer direct to them. We suggested that staff receive an update in forthcoming supervision, or meetings, to make sure they have a common understanding about their responsibilities. The management has recently had all of the policies and procedures at the home reviewed by an outside company. The restraint policy is very detailed, but it advises staff on physical interventions that they may undertake should this be necessary. The policy was not appropriate, especially since staff have not received training in restraint. This needs to be reviewed. The responsible individual stated that restraint is not used at the home, and was not satisfied with the content of the policy when it was brought to her attention. She intends to review and amend the policy. Care Homes for Older People Page 21 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued refurbishment of the home will make all areas equally pleasant for those who live there. Evidence: The home is situated close to the centre of Heslington, which has a number of amenities including shops, a bank, and pubs. The premises has a garden and car parking space. A sensory garden has just been created which has plants, mobiles and a illuminated water feature. One person was seen enjoying this area, which is situated in the enclosed courtyard. The accommodation is provided on two floors. There is no passenger lift to the first floor. Instead, there is a stair lift. Staff need to remember this when assessing people who will be admitted to the first floor of the home, as some may find it difficult to use this facility. There is a large sitting dining area, and also a separate smaller sitting area. Both areas were nicely decorated and furnished, and contained interesting things for people to look at, such as pet birds, and old pictures to help people remember days gone by. There were no call bells in the main communal area. The responsible individual said she would organise for these to be fitted. This will allow people to alert staff when they need attention. Staff said however that there is always one of them present in Care Homes for Older People Page 22 of 38 Evidence: this area. This was witnessed on the day we visited. The hallway has recently been decorated. One person said I love the chandelier. Communal areas, such as the toilets and bathrooms, now have signs on the doors, so people can find their way to these facilities easily and more independently. People in their surveys said that the home was always or usually fresh and clean. One said It is comfortable. I like all the flowers round the home. Its very nice. I enjoy living here. A relative said that when they visited, the home was always clean and tidy, and that there were never any odours. A staff member said that generally all areas of the home were now acceptable, although said that one or two rooms could do with a lick of paint. Another said they thought there were no areas for concern within the decoration. People now have memory boxes outside their room where they or their relatives can place pictures which are familiar to the person. This is good practice, because it helps people to identify their rooms independently. Those bedrooms seen, where people gave us permission to enter, contained personal belongings. Some were better decorated than others, although all appeared to be cleaned to a reasonable standard. The responsible individual is aware that some bedrooms need to be decorated. Three in particular are at the top of her priority list. She has given assurance that these will be given attention. We looked at the bedding in three random rooms. This was satisfactory. We looked round the communal bathroom and toilet facilities. The flooring in one of the toilets was lifting round the edges. This would make it difficult to keep clean. We were told by the management that refurbishment of the bathrooms is imminent, when this flooring will be replaced. Communal soap and nail brush was found in one of the bathrooms. This increases the risk from cross infection. The deputy manager recognised that this was poor practice, and said they would be removed. This was an issue at the last site visit, and must stop. The call bell had come off the wall in one of the toilet area. This would make it difficult for anyone using the room to call for assistance if they needed help. This was fixed back onto the wall on the day we visited. The temperatures of two of the baths were recorded as being below body temperature. This may make it uncomfortable for those using the bath, and should be Care Homes for Older People Page 23 of 38 Evidence: adjusted. Staff said that these particular facilities were not used often. However, by correcting the temperature, people will have a better choice of facilities. The laundry facilities were adequate, and there was equipment in place to reduce the risk from cross infection. There has however been one outbreak of diarrhoea and vomiting since the beginning of the year. The majority of staff, except for new starters, have completed training in infection control. Further training is planned for the remaining staff. Care Homes for Older People Page 24 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent staff recruitment will help to promote consistent care, and additional training will keep staff informed about current good practice. However, staff recruitment does not sufficiently protect people from unsuitable workers. Evidence: There were a number of staff vacancies which have now been recruited into. The remaining vacancies include a cleaners position and bank staff. These posts are being advertised. On the day of our unnanounced visit, there seemed to be sufficient staff to provide care without people having to feel rushed. This was also the case at the lunch time meal, when those who needed help were assisted sensitively. We spoke to some staff about working at the home. One said I love it. They said they have enough time to give people the care that they need. Another agreed that there were enough staff. And a third said that this was normally the case. And two out of three staff who returned their survey said that there was usually enough of them. One of these said I feel The Lodge takes care of the residents daily needs really well. And offers staff support. We also spoke to some people and relatives. One person said There are plenty of staff. They come when needed. Another said Theyre all very nice. A relative also Care Homes for Older People Page 25 of 38 Evidence: said that there were plenty of staff, and that they listen. However, one of the staff who returned their survey thought that there were never enough of them. They said The Lodge tries to care for the clients well, but only if theres enough staff on duty on a shift. We also received two comments that staff have had to work long hours and numerous continuous shifts over their contracted hours in order to fill the gaps, so people received consistent care. Someone said that they were sick of there being no staff and of feeling that they should cover extra shifts. We were told that this had affected staff morale at the home, although it was accepted that this would be less of a problem now new staff have been recruited. Problems created by previous shortfalls in staff numbers should be alleviated now that more staff have been recruited. However, staff should not feel obliged to cover shifts beyond what they feel capable of working. It will be of further advantage to the service therefore when all vacancies are filled. Recent recruitment files looked at showed that staff employment history was not checked in full, nor had a reference been obtained in all cases from the persons current employer. In some, insufficient information was asked for at the time of recruitment, to confirm that these people were suitable workers. In one case, the person had started to provide care before the full police check had been returned. Any anomalies found during this process must be discussed, and recorded, so there is a clear evidence trail to show what steps have been taken to protect people living at The Lodge. Staff induction files were either missing, or had not been completed. This induction is important, because it provides new staff with an introduction to minimum standards when providing good care. It also provides a grounding when progressing onto other training, such as National Vocational Qualifications in Care. This shortfall should be addressed to help promote good consistent care at the home. The responsible individual has introduced a number of training opportunities at the home in the last twelve months. Staff asked, said that they have received a lot of training. This has included training in dementia awareness, abuse awareness, National Vocational Qualifications at levels 2 and 3, and understanding behaviour which challenges others. The kitchen staff confirmed that they too were due to enrol on National Vocational Qualifications in catering. Other forthcoming training will include understanding nutrition and diet, death and dying. Much of this training is provided in video form, followed by a questionnaire. We Care Homes for Older People Page 26 of 38 Evidence: received comment that it would be helpful to staff if this training was followed up with a group discussion, or talked about in supervision, so that it has more meaning. It would also ensure that staff have a full and common understanding of the information they have been given. Care Homes for Older People Page 27 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views are considered when deciding how the home should be run. There are some areas around health and safety which need to be monitored to make sure people remain safe from avoidable risk. Evidence: The registered manager, who held this post for a number of years, has recently resigned from her position. The post is currently being advertised, and the responsible individual has already interviewed some people in relation to the post. This position needs to be filled as soon as possible, so that people can be assured that the home is being managed by someone who has been assessed as being fit to do so. The home is currently being managed by two established deputy managers. They said they get regular support from the responsible individual, who they say is present at the home regularly, and is always on the end of the phone if needed. We were told communication between the management team is good, and that recently, there have been a lot of changes made in order to move the home forward. In support of this, the Care Homes for Older People Page 28 of 38 Evidence: company has employed a consultancy firm to oversee and monitor the practice and procedure at the home. Two of the three staff surveys returned said that they regularly get support from the managers, who meet with them to discuss how they are working. One of these, when asked what the home does well, said they are offered staff support. When we visited, we also spoke to some staff about working at the home. We received comments like I love it. The management listen and will sort out any problems. They have great communication skills with the residents. One said that staff meetings take place with the management, which are quite productive, and that they had received supervision recently. Another said that the new management arrangements were working OK, and they seemed to be getting on better with new ideas at the home, for example more activities. They said the home felt less institutionalised. A further comment was made that the communication with the management was good, and better than before. However, a third staff survey told us that the managers never give them enough support, or meet to discuss how they are working. They said Staff need someone they can go to and discuss any problems and be listened to. And information from two separate sources suggested that communication between management and staff was not sufficient, and that this had caused low staff morale. These views are contradictory. It is essential therefore in this time of management change, that the management remain very aware of staff views, which they should remain sensitive to, so undercurrents of dissatisfaction can be sorted out before they become major problems. People and their families are now given surveys, so that their views about the home, and how it is operating, can be collected and considered, when deciding what changes are needed to the way it runs. The recent surveys returned from relatives answered mainly excellent or good when asked about the service the home provides. People living at the service identified that they would like more activities, and this is something the management are aiming to improve. It would be good practice to collect the views of visiting health and social care professionals as well, so that they too can comment upon how they think the home is operating. So far, the results have not been published. This was discussed with the responsible individual on the day. Doing so will help to assure people that their views and comments are taken seriously, and acted upon. Residents meetings are also now held. People said in a recent meeting that they would Care Homes for Older People Page 29 of 38 Evidence: like to reconnect with the local community This is important for people, and should be facilitated. The responsible individual, and the manager from a sister home, also carry out audits of various areas of the home. Recently, they looked at the staff files, environment and the kitchen. This helps to check that systems at the home are operating as they should, and means that any shortfalls can be put right promptly. The home will look after peoples personal allowance if they wish. This is kept secure, and records are kept when money is received or spent on peoples behalf. People can have access to this money at any time. People also have lockable facilities where they can keep valuables if they wish. From information provided prior to the site visit, and from records seen on the day, it was confirmed that the premises are kept maintained, to help keep the home safe for those who live there. In house checks are also completed, for instance, to make sure the fire alarm is in working order, and that the water is stored at suitable temperatures for people. The management said on the day that they were waiting for the manufacturers to deliver some emergency lighting which had been identified as needing replacement. We have been informed that this work has now been completed. The Environmental Health Officer visited recently, and awarded the kitchen five stars (excellent) for their practice. The following shortfalls were however identified relating to health and safety: The door into the laundry was unlocked. There were chemical stored within, and the hot water supply was not regulated. There was a sign on the door telling staff to keep the room locked. This was done at the time. Two fire doors were wedged open. This is not safe practice, because it means that the doors would not shut if the fire alarm sounded. This could increase the risk to people from the spread of fire. During the course of the day, the deputy manager sought advice from the fire officer, and had self closers recommended by them fitted to the doors. This will keep people safer should fire break out. The fire safety risk assessment was completed by the home in 2006, and there was no evidence that it had been updated since. Advice should be sought from the fire officer to see how often this should be reviewed. Since the last key inspection, we have received information from other sources, which the home should have told us about. We have reminded the staff to complete what we Care Homes for Older People Page 30 of 38 Evidence: call Regulation 37 notifications for these incidents, so we have a full history about what has happened at the service about matters which affect those who live there. In one case, people went missing from the home without the knowledge of staff. The missing persons procedure at the home was not followed, which states the commission should be informed if such an incident happens. Neither were we informed of an outbreak of diarrhoea and vomiting at the home. We need this sort of information so that we can continually monitor the home, and check there are suitable safeguards in place for people. Care Homes for Older People Page 31 of 38 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 32 of 38 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 37 Incidents which have occured which affect peoples welfare, which the home is required to inform the commission about, must be reported promptly. This is so we are able to assess that appropriate measures are in place to safeguard people living at The Lodge. 30/11/2009 2 7 13 People must have full and 05/11/2009 proper risk assessments in place where risk to them has been identified. Particularly with regard to moving and handling, and the use of bed safety rails. This is so staff work with the right equipment in a safe and consistent way. 3 8 13 The person with unexplained 05/11/2009 weight loss must be referred to their doctor to request dietitian advice. Page 33 of 38 Care Homes for Older People 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 is so all steps have been taken in order to maintain good nutrition for the person concerned. 4 9 13 Staff must not continue to administer medication beyond its prescription. Medicine must not be given from bottles where the label which states who the medication is for, what it is, and when it must be administered, cannot be clearly read. This is so people receive the correct medication at the correct dosage as prescribed by their doctor. 5 18 13 The restraint policy at the 31/12/2009 home must be amended. Otherwise staff expected to exercise restraint must have training before this policy comes into force. This is so people are protected from unsafe practice. 6 29 19 The recruitment procedure must be thorough and must include: Exploring gaps in employment. 30/11/2009 05/11/2009 Care Homes for Older People Page 34 of 38 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 Keeping a record of discussion surrounding returned police checks. Obtaining a reference from the persons current employer. Ensuring that those who begin to work before the full police check is returned are fully supervised, and that the arrangements for this supervision are documented. This is so people are protected from potentially unsuitable workers. 7 38 23 Fire doors must be kept shut, unless held open by equipment which has been authorised by the fire officer. This is so people are protected from the spread of fire. 8 38 13 Areas which are unsafe for people living at the home to enter must remain locked when not attended. This will make sure that people remain safe from avoidable risk. 05/11/2009 06/11/2009 Care Homes for Older People Page 35 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Staff should make sure peoples initial assessment is completed in full, and that it includes all information already collected about the person. This will help to make sure that already identified needs and risks to people are not overlooked. So people always receive medication which is in date, staff should not accept loose medication in containers which do not give a date by which the medication expires. People should be offered an activities programme incorporating their choices. This would make sure that extra staff can be planned in advance where the activity necessitates this, so there is less chance of people being disappointed because of an activity having to be cancelled. People should be offered more drinks at mealtimes, to aid good digestion, as well as plenty of fluids throughout the day to keep them well hydrated. The complaints procedure should be produced in different formats, such as larger print, so that it is more easy for people to read and understand. The home should obtain a copy of the local authority guidelines on the protection of vulnerable adults. The policy at the home should be amended so it makes reference to the role of the local authority, to whom any allegation or suspicion of abuse must be reported. Staff should then have an update, so they are aware of their own responsibilities, and those of others. Those bedrooms requiring redecoration should receive attention. This is so that so that everyone living there can enjoy the same good standard of accommodation. Bath temperatures should be restored to a comfortable temperature, so people have a good choice of facilities when they choose to bathe. Communal toiletries and nail brushes should not be used, as this increases the risk from cross infection. The staffing levels at the home should be kept under constant review, and care taken to make sure that staff do not work long hours which may affect the delivery of care to the people they support. Staff induction should be completed in full, so people get a Page 36 of 38 2 9 3 12 4 15 5 16 6 18 7 19 8 25 9 10 26 27 11 30 Care Homes for Older People 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 consistent service from workers who understand the ethos of the home, and the standards they must work to. 12 31 In the absence of a registered manager, the management in place should ensure that there are clear lines of communication and accountability maintained within the home, and a clear structure in place for staff to air their views about how the home runs, so the people living there receive a consistent service. Visiting health and social care professionals should be surveyed periodically, so their views about how the home is operating can be considered when decisions are made about how the home should be run in peoples best interests. 13 33 Care Homes for Older People Page 37 of 38 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. 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