Care Home: Lostock Lodge

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What the care home does well The home was being run by a team of staff who were keen to provide a good service, the residents said, "Its lovely here" - "Its great" and "They do their best" People living at Lostock Lodge were mostly happy with the care and attention they received. People were getting attention for health care needs, they were being treated with respect. Most people were happy with the arrangements for activities, "I like joining in with the dominoes and bingo" commented one person. Visitors were being made welcome and daily routines were flexible. Mostly positive comments were made about the homes catering arrangements, people`s likes and dislikes were known and specific diets could be catered for. To help make sure staff provide good care, arrangements were in place to provide ongoing training and development. The residents expressed an appreciation of the staff team, describing them as "Helpful" and "Very obliging". "I have been surprised by the kindness of the staff" said one person. The home was clean and fresh smelling, most furnishings and decor were of a good standard, providing a comfortable place for people to live. "I like my bedroom very much" was one comment made. What has improved since the last inspection? Progress had been made in providing training for staff on the protection of vulnerable adults, safe working practices and NVQs (National Vocational Qualifications) Peoples` individual care plans were being reviewed more often, which meant their changing needs were being given more consideration. Another person had been employed to offer further opportunities for activities. Parts of the home had been decorated and new carpets fitted, security cameras had been fitted outside for the protection of residents, visitors and staff. Better facilities had been provided for people who have dementia, for example relaxing colour schemes had been used. What the care home could do better: Some improvements were needed in finding out about peoples` individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure people get individual care and attention in the way they prefer.To make sure people are properly and safely supported with their medication, some medication practices needed attention. Residents meetings should be held so people can be consulted and kept informed about life in their home. Catering arrangements could be improved to provide people with more choices. To make sure people have clear information about how to go about raising concerns, the complaints procedure needed to be made more available. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty. To show the action taken to protect people using the service, better recruitment records should be kept. The laundry facilities and arrangements should be improved, to promote better hygiene and laundry practices. To help provide safe support, some matters needed to be carefully considered and action taken to reduce risks to the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lostock Lodge 34 Wateringpool Lane Lostock Hall Preston Lancashire PR5 5AP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Pearson     Date: 0 3 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Lostock Lodge 34 Wateringpool Lane Lostock Hall Preston Lancashire PR5 5AP 01772626141 01772465909 care@lostocklodge.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Lostock Lodge Limited care home 32 Number of places (if applicable): Under 65 Over 65 0 32 dementia old age, not falling within any other category Additional conditions: 32 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Lostock Lodge is a residential care home providing 24 hour personal care and accommodation for up to 32 older people and older people with dementia. The home is situated close to the centre of Lostock Hall, near to shops, pubs, a post office and other amenities. It is a large detached property with a purpose built extension set in its own gardens. Accommodation is mainly on the ground floor and there is a passenger lift to the first Care Homes for Older People Page 4 of 29 Brief description of the care home floor accommodation. All the bedrooms rooms are single and have en-suite facilities. Assisted bathing facilities are provided. There are lounges a conservatory and a dining room, there is separate accommodation for people with dementia. The home is a none smoking residence. At the time of the inspection visit the range of fees was from £415 to £488 per week. Written information to help people make a choice about using the service was available in the home. The service website address was www.lostocklodge.com Care Homes for Older People Page 5 of 29 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: An unannounced inspection which included a visit to the service was conducted at Lostock Lodge on the 3rd September 2009 . The visit took 9 hours and was carried out by one inspector. The last main inspection was completed on the 26th June 2007. An annual service review of the home was carried out on the 25th July 2008. Prior to the inspection visit, people using the service were invited to complete surveys, to tell the Commission what they think about the support and care provided at the home, 8 were returned to us. Care Homes for Older People Page 6 of 29 Before the visit the manager was asked to complete and return to us an Annual Quality Assurance Assessment (AQAA). This was to enable the service to show how they were performing and provided details about arrangements, practices and procedures at the home. The files and records of 2 people were examined as part of case tracking, this being a method of focusing upon a representative group of people using the service. We spoke with people using the service, the manager, owner and staff. Various documents, including policies, procedures and records were looked at. Parts of the home were viewed. What the care home does well: What has improved since the last inspection? What they could do better: Some improvements were needed in finding out about peoples individual needs and wishes, before they moved into the home and assuring them that their needs can be met. Progress was needed with the residents care plans, to make sure people get individual care and attention in the way they prefer. Care Homes for Older People Page 8 of 29 To make sure people are properly and safely supported with their medication, some medication practices needed attention. Residents meetings should be held so people can be consulted and kept informed about life in their home. Catering arrangements could be improved to provide people with more choices. To make sure people have clear information about how to go about raising concerns, the complaints procedure needed to be made more available. To ensure people receive good quality care, staffing levels should be continually monitored to make sure there are enough staff on duty. To show the action taken to protect people using the service, better recruitment records should be kept. The laundry facilities and arrangements should be improved, to promote better hygiene and laundry practices. To help provide safe support, some matters needed to be carefully considered and action taken to reduce risks to the residents. 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 set out 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 29 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 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process did not always ensure peoples needs, abilities and preferences were known and planned for before they moved into the home. Evidence: There was an indication in the AQAA (Annual Quality Assurance Assessment) that systems were in place to support an effective admission process. For example, mention was made of providing good written information, contracts of residence and carrying out detailed initial assessments they can provide the care and environment the person needs. The admission process was discussed with the manager, who said that the aim was to gather as much information as possible from various sources, about peoples needs, abilities and past life experience. The manager said people were visited in their own Care Homes for Older People Page 11 of 29 Evidence: environment, usually by two people, including herself, deputy manager or senior care staff. Prospective residents and their families were being encouraged to visit the home, to see the accommodation available and meet with current residents and staff on duty. We encourage people to call anytime said the manager. One resident spoken with explained how they had previously stayed at the Lostock Lodge for short breaks, which had helped them get used the home, I wanted to come back here she said. We looked at assessment information of two people and found assessments had been completed, with information being obtained as appropriate, from Social Services. Peoples personal and social care needs and wishes had been considered. However, some of the homes own assessment notes were quite brief and had not been dated, which meant it was not clear all needs had been considered and planned for, also staff may not understand the particular needs of the person. Discussion took place in relation to ensuring assessment procedures routinely consider peoples capacity and in particular identifying those people who may be at risk of deprivation of liberty. The manager agreed to ensure this matter was addressed. The manager said she was not aware of the requirement to write to people following their assessment, clarifying whether or not the home can meet their needs. This is to assure the person that the home can provide for their individual support and care needs. At the time of this inspection visit, Lostock Lodge did not provide intermediate care. Care Homes for Older People Page 12 of 29 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. Most health and personal care practices helped to ensure peoples needs are sensitively met. Evidence: Three residents completing surveys, said they always get the care support they need, four said they usually did, two indicated they sometimes did. People spoken with during the inspection visit made mostly positive comments about the care and support provided at Lostock Lodge, they said, They look after me well, all my basic needs and wants and They are very helpful they will do anything if you ask them The care plans seen provided a fair amount of good information and detail, however, they did not give clear directions for staff to follow to ensure peoples needs were responded to, in the way the person preferred. Some needs such as social and spiritual care, also relationships and family involvement had not been included as care plan issues. The manager and staff spoken with, described some very specific approaches when providing support in response to different behaviours, also in recognising Care Homes for Older People Page 13 of 29 Evidence: behavioural triggers. However, these approaches had not been effectively communicated within individual care plans. Regular reviews of care needs were being carried out and it was apparent residents were being consulted about the content of their care plans. Residents completing surveys indicated they always or usually get the medical care and attention they need. Records and discussion showed people were getting attention as necessary from health care professionals such as GPs and District Nurses. Various health care assessments had been carried out, for example in relation to nutrition, behaviours and risk of falls. Staff responsible for medication administration had received training. Medication administration policies and procedures were available, however, there were no policies and procedures in relation to when necessary/variable dose medication or covert administration, the manager therefore agreed to introduce these. It was advised current Royal Pharmaceutical Guidance for Care homes be obtained for reference. Medication storage was seen to be clean and secure. There were some discrepancies in medication administration records. For example, one prescribed item had been signed as taken, prior to it being administered and there were several unclear records in relation to when necessary items which meant it was not clear if the person had been offered their medication or not. There were no individual written instructions in relation to when necessary medication, which meant people may not be appropriately offered/given their medication. One item was being offered when necessary which was at variance to the prescribed instructions. Some items had a variable dose, however, there were no clear instructions explaining how much to offer. Where people were managing their own medication, some assessments had been carried out with them. However, assessments had not been carried out in relation to some items, which suggested peoples ability and agreement to manage their medication had not been properly considered. The manager was very proactive in her response to these findings and agreed to address the matters as soon as possible. Observations of care practices, showed peoples privacy needs were respected, personal care was carried out in the privacy of the persons own bedroom, or bathrooms. Staff were seen to provide support and interact with people in a very friendly and courteous manner. I think the staff are respectful was one comment made. Most residents completing surveys indicated that staff always listen to them and act upon their requests. The AQAA (Annual Quality Assurance Assessment) indicated that a key worker system was in place, which linked residents to a specific staff member to provide a more personal service and promoted the monitoring of peoples health and well being. Care Homes for Older People Page 14 of 29 Evidence: Care Homes for Older People Page 15 of 29 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 living at Lostock Lodge had lifestyles which generally matched their expectations. Evidence: People spoken with during the inspection were generally satisfied and content living at Lostock Lodge, comments made were, I am quite happy at the moment, On the whole its okay and Its lovely here Most residents completing surveys indicated there were always, or usually suitable activities on offer at the home, some people indicated they were not interested in activities. There were two part time activity organisers working at the home, providing group and one to one activities, such as bingo, dominoes, crafts and reminiscence discussions. A musician visits the home every couple of months to entertain the residents. A number of people spoken with said they had enjoyed the recent barbecue. The manager said residents meetings had previously been held, but not many people had joined in, ways of encouraging group discussions were therefore suggested. Residents spoken with mentioned the contact they had with relatives and friends. Care Homes for Older People Page 16 of 29 Evidence: Visiting arrangements were outlined in the homes guide, people could visit at any reasonable time. One relative commented that they liked the flexible visiting times and that they had been invited to the home for Christmas day lunch. Representatives of various religions were making regular visits to the home and some residents were being supported to attend Church. One resident wrote, I love joining in with the Church Of England Communion service Social and spiritual care, also relationships needed to be properly included in the care planning process to promote a more effective response to peoples individual needs and preferences. The AQAA (Annual Quality Assurance Assessment) showed consideration was being given to providing further outings for the residents. Routines at the home seemed very flexible, it was apparent people could spend time in their bedrooms as and when they wished. People spoken with said they could get up and go to bed whenever they wanted. They had been enabled to personalise their rooms with their own belongings, such as, photographs, pictures and ornaments which had helped create a sense of home and ownership. Most people completing surveys indicated they always liked the meals at Lostock Lodge. Those spoken with said, I cant grumble about the food- The meals are very good- Sometimes its extra special, sometimes its moderate. The cook spoken with was aware of peoples specific , likes and dislikes, specific diets could be catered for. Breakfast was offered flexibly, in response to individual preferences and could be served in peoples rooms. A number of hot and cold meal options were routinely offered at teatime. The menu was usually displayed in the dining room, however, it was noted it had not been completed, which meant people may not be aware of the meals on offer. A set meal was provided at lunch time, alternatives were available on request, however, it was advised further options be routinely offered to further promote choices. The dining room provided a pleasant environment for people to eat and socialise. At the time of the inspection there was not always cook on duty at teatimes, with care staff having designated responsibilities for some cooking and meal preparation, however, the manager indicated consideration was being given to full time cook hours which would be best practice. Care Homes for Older People Page 17 of 29 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. Most polices, procedures and practices supported the complaints process and provided safeguards for people living at Lostock Lodge. Evidence: Six people completing surveys indicated they were not aware of the homes complaints procedure and how to raise concerns. The procedure for making complaints was seen displayed in the home, however, it was suggested a copy be placed in each persons bedroom. The procedure should also be routinely discussed within residents meetings. The procedure explained how complaints could be made, however, there was no indication of the expected timescales involved, it was therefore advised this information be included to ensure people are aware of the process for dealing with concerns. It was also suggested the contact details of Social Services be included for information. The manager said any issues or concerns raised would be dealt with promptly and would be followed up with a written response. Senior staff were dealing with any day to day problems. Complaints processes were discussed further, including keeping appropriate records, devising investigation strategies and ensuring an objective approach to any issues raised. Care Homes for Older People Page 18 of 29 Evidence: Records and discussion showed half of the staff team had received protection of vulnerable adults training, the manager said this training was ongoing. Policies were available which included definitions and indicators of abuse also the procedure for making safeguarding alerts to Social Services. The local authorities safeguarding information was also available. The manager and staff spoken with expressed an awareness of safeguarding and protection issues. The staff reporting bad practice policy provided some good information, however, the contact details of the Commission and Social Services were not included, the manager agreed to rectify this matter. Care Homes for Older People Page 19 of 29 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 accommodation at Lostock Lodge provide people with a clean and comfortable place to live. Evidence: The residents spoken with were satisfied with the accommodation provided at Lostock Lodge, I like my bedroom very much said one person. All bedrooms were single with en-suite facilities, a number of residents had keys to their rooms. The communal rooms were pleasantly decorated and furnished to a good standard. The AQAA (Annual Quality Assurance Assessment) indicated that parts of the home had been decorated and new carpets fitted. The home provides separate accommodation for people with dementia, the manager explained that careful consideration had been given in to colour schemes and carpets. There was some freedom of movement in the home, people were not being confined to one area or lounge, so they could join in with activities and use the communal dining room. Some areas of the home were seen to be in need of improvement, for example, the first floor corridor and stairs carpet appeared marked and some lounge chairs were in need of replacement, however, the AQAA showed the home had a rolling programme Care Homes for Older People Page 20 of 29 Evidence: of re-refurbishment and the owner said these matters were being addressed. Most people completing surveys indicated the home is always fresh and clean. The home was found to be clean and free from unpleasant odours, the cleaner spoken with said they had appropriate cleaning materials and equipment to get through the work. There was an indication in surveys that the laundry systems were sometimes inefficient, with peoples clothing going missing or getting lost, this issue was discussed with the manager who provided assurances that progress was being made. The laundry area was quite small with one washer and one dryer being available, the floor covering and walls appeared easy to keep clean. The wash basin was not easily accessible to staff to wash their hands and the liquid soap dispenser was empty. Infection control polices and procedures were available. Care Homes for Older People Page 21 of 29 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. Staffing arrangements needed some improvement to ensure people receive effective care and support. Evidence: Most resident expressed an appreciation of the staff team at Lostock Lodge, they said, Staff are pretty good - Very helpful they will do anything if you ask them - The staff are very obliging -They are alright, they do their best- Most of the staff are friendly and helpful Staffing levels seemed to be mainly good, records and discussion showed there were usually four care staff and a senior carer on duty throughout the day, with one carer being based in the dementia unit, three staff were on duty each night. Good arrangements were in place for handover discussions between shifts and staff spoken with said the rota was nearly always covered. However, five people indicated in surveys that staff were usually available when they were needed. One comment from a relative was that staff were not always easy to find. The staff rota showed there were less care staff on duty two afternoons each week. An issue arose during the inspection, whereby one resident had to wait a while for staff attention, as they were busy with another person. The manager explained staffing levels were constantly being reviewed at the home, and that they would be looking into providing additional cover. Care Homes for Older People Page 22 of 29 Evidence: Records and discussion showed staff training and development was on going at Lostock Lodge. Half the carers had NVQ (National Vocational Qualifications) level 2, or were working towards this qualification. Some staff had progressed to NVQ level 3 and NVQ level 4. All care staff had received dementia awareness training. Various training courses in safe working practices such as, First Aid and Infection Control had been completed or arranged. Moving and Handling training had been provided in- house, the manager said this had not been certificated training, however, two senior staff were due to complete a key movers course, which would enable them to appropriately instruct staff. All care staff had received dementia awareness training. Policies and procedures were available to support the staff recruitment process. The staff recruitment records seen indicated the required checks had been carried out. However, records had not been kept to show some specific matters had been effectively explored and considered. It was also advised, further consideration be given to the suitability of references and the requesting of additional references. The possibility of involving the residents more fully in the staff selection process was discussed with the manager, who agreed to pursue this matter. New staff were being given initial training, records showed an induction programme was been completed which included, fire procedures, smoking policies, care values, care plans, recording systems and personal care. One staff spoken with didnt recall receiving structured induction training and the records to support this were unable to be located, the manager agreed to pursue this matter. Care Homes for Older People Page 23 of 29 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. Most management and administration practices were effective in ensuring the home is run for the benefit of people using the service. Evidence: The manager had several years experience in care management, had obtained relevant qualifications and was continuing to up date her knowledge skills and ability, by attending appropriate training courses, such as dementia care awareness. It was suggested training in Deprivation Of Liberty Safeguards would also be useful. The manager considered she was well supported by the home owners. The manager was very proactive in her response to the findings of the inspection and expressed a sensitive awareness of the needs, abilities and personalities of people using the service. The atmosphere in the home was found be relaxed and supportive. The residents spoken with, made positive comments about the management team at Lostock Lodge Care Homes for Older People Page 24 of 29 Evidence: one person said, The managers are very good. Staff spoken with considered the manager to be approachable and confirmed staff meetings were being held. Satisfaction surveys had been carried out with people using the service and their relatives covering questions on management, personal support, catering, and daily living. Survey results were being collated and made available, showing areas of good practice and development. It was advised consideration to be given to introducing staff surveys, the manager said consideration was being given to a suggestion box. The owner was carrying out regular monitoring visits, to the home reports of the findings were seen to be available. The AQAA did include some useful information, but was lacking in sufficient detail to show how the home was operating and was not entirely reflective of the findings of this inspection. There was limited information on what the home could do better and plans for future improvements were brief. This meant, we were not given sufficient assurances that they are able to self evaluate their performance and develop the service. Quality assurance was discussed further with the manager, including appropriately using the AQAA as part of the process and ensuring the results of consultation surveys are included. The manager agreed to give this matter attention. A number of wheelchairs were seen to be in use without foot plates in place, this presented as potentially hazardous. This matter was brought to the attention of the manager, who said staff had been told footplates were to be used. One service user was said to not want foot plates for specific reasons, however, appropriate risk assessments had not been carried out. Health and safety risk assessments had been carried out, however, outside areas had not been considered. It was noted not all windows had restricted openings, which could compromise some peoples safety and well being, there were no individual health and safety risk assessments in respect of this matter. As previously indicated, training in safe working practices was ongoing or being arranged. Information in the AQQA showed the servicing and checking of equipment and installations. Care Homes for Older People Page 25 of 29 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 26 of 29 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 13 Appropriate risk assessments and risk management strategies are to be in place for people managing their own medication. This will help ensure they are properly and safely supported with their medication. 13/11/2009 2 13 Clear individual protocols must be defined and introduced in relation to all variable dose and when required items of medication. This will ensure people are properly supported with their medication. 13/11/2009 3 3 14 Following assessment, prospective service users must be written to confirming the home is suitable for meeting their needs. 30/10/2009 Care Homes for Older People Page 27 of 29 This will provide written assurances that their needs can be met at the home. 4 38 13 Effective arrangements must 13/11/2009 be made to identify and reduce potential risks and hazards to people using the service. This will promote their wellbeing and safety. 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 Care plans should be more person centered and sufficient in detail to provide clear instructions to staff, of the actions to be taken to meet the residents, personal, health and social care needs. To ensure medication is appropriately and safely managed for the well being of the residents, action should be taken to ensure the auditing system effectively identifies and resolves inappropriate practices. The laundry facilities and arrangements should be improved, to promote better hygiene and laundry practices. 2 9 3 26 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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