Care Home: Nazareth Lodge Ltd

What the care home does well People living at the home told us they were well cared for by competent, well trained staff. They said: "Staff are always friendly and helpful. The general atmosphere is welcoming and usually bright and cheerful. Visitors are greeted well." "The team here are excellent." "Staff are wonderful." Residents are supported to maintain contact with family and friends, enabling people living in the home to continue to enjoy relationships that are meaningful to them. People told us that they enjoy the activities provided and that the food is very good. The menu offers choice and staff are aware of the likes and dislikes of those living there. The complaints and adult protection procedures ensure that residents and their representatives well-being and comfort is important to the home and that any concerns raised will be properly investigated and resolved. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the care needs of people. Recruitment procedures are good ensuring that staff are suitable to work in the home and residents are well protected. The quality assurance processes are very good and ensure that the home is run in the best interests of those living there. Financial procedures within the home also ensure that residents interests are protected. What has improved since the last inspection? This is the first inspection of this home under the new registration. What the care home could do better: This is a well run home. During discussion with the Miss Trimble and Mrs Ambrose it was agreed that there could be some improvement in care documentation so that staff had all the up to date information they need to be able to meet the needs of the residents. However people living in the home told us that they were very well cared for and staff were very kind and caring. Key inspection report Care homes for older people Name: Address: Nazareth Lodge Ltd Nazareth Lodge Penny Street Sturminster Newton Dorset DT10 1DE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Amanda Bell     Date: 0 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Nazareth Lodge Ltd Nazareth Lodge Penny Street Sturminster Newton Dorset DT10 1DE Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ann Marie Ambrose Type of registration: Number of places registered: care home 24 Nazareth Lodge Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 24 The registered person may provide the following category of service Care home only code PC to service users of either gender whose primary care needs on admission to the home are within the category Old age, not falling within any other category Code OP Date of last inspection Brief description of the care home Nazareth Lodge is a well-established, purpose built care home located in the small town of Sturminster Newton. It is owned by Nazareth Lodge Ltd and the Responsible individual is Miss Camilla Trimble, who takes an active interest in the home and is well known to residents. The registered manager, Mrs Ann Ambrose, is responsible for the day to day running of the home. It is registered to provide care and accommodation Care Homes for Older People Page 4 of 25 Over 65 24 0 Brief description of the care home for a maximum of 24 people, age 65 and over. Nazareth Lodge is within a short walk of the town centre and is set in its own peaceful landscaped gardens adjacent with direct access to St Marys church. There are attractive flower boarders and a rose garden at the front of the house and a spacious parking area for visitors use. The accommodation is arranged over two floors with access by two staircases and a passenger lift is available for residents with mobility problems. There are 22 bedrooms in the home (18 single and 4 double) and one room is entirely dedicated to providing a respite care service throughout the year. Communal rooms include a large lounge which has been thoughtfully set out with a TV area and a quiet area leading to a conservatory, overlooking and accessing the back and side gardens. There is also a separate dining room, which has french windows which open on to a further garden area and a terrace where barbecues are held. There is a small meeting room for residents to receive visitors in private, if they so wish. Care staff are on duty at all times and include wakeful night staff. In addition to personal care and support, the service provides all meals, laundering of clothes, and housekeeping. A good range of social and leisure activities are provided and enjoyed by residents. At the time of inspection the weekly fees ranged from £575 to £695. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection took place on the 6th April 2010 and took approximately five hours. The purpose of the inspection was to assess all of the key standards. This home was registered with us in November 2009 when the provider registered the service as a limited company. Whilst this is a new registration due to the legal change in circumstances there was no change in the individuals concerned with managing the home, the responsible individual and the registered manager. Prior to this date the home had a sustained track record of delivering good performance which we have taken into account in making our overall judgement of quality. The inspection was carried out by one inspector however the term We is used throughout the report to reflect the findings of the Care Quality Commission, (CQC). Care Homes for Older People Page 6 of 25 The Registered manager, Mrs Ambrose and the Responsible Individual, Miss Trimble, were on hand throughout to aid the inspection process. We gathered information in a variety of ways, which included reports made to CQC by the home; the annual quality assurance assessment, (AQAA), completed by the Registered Provider; a tour of the premises and discussion with those people living and working at the home. We also reviewed a number of care records, recruitment and training records and maintenance documentation. We were made extremely welcome throughout our stay. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 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. New residents move into the home having had their needs thoroughly assessed and been assured that these needs will be met fully. Evidence: The annual quality assurance assessment (AQAA), submitted to us by the home state: We spend a great deal of time with prospective service users and their families/advocates prior to admission. We invite them to view the home to enable them to get a feel for the environment.... Further information in the form of our service user guide is always made available as well as an invitation to call us at any time should they have any further questions. We read the service user guide and found that it gave very clear information about the care and facilities available at Nazareth Lodge. This could help prospective residents make an informed choice about where to live. We reviewed the care documentation for two people who had recently moved into the Care Homes for Older People Page 10 of 25 Evidence: home. We saw that pre-admission assessments had taken place and the home was able to meet the needs of these individuals. People told us that they were happy with their choice of home. Some people had stayed at Nazareth Lodge for periods of respite care prior to making the decision to stay permanently. Care Homes for Older People Page 11 of 25 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. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. Evidence: The home provides a good standard of care to the people living there. Residents expressed a high level of satisfaction with the service provided. We reviewed the care files for four residents and they contained most of the relevant assessments and care plans needed so that staff had the information to be able to give a good standard of care. However there were some shortfalls in documentation. The home needs to implement a nutritional screening tool so that staff can identify if/when a resident becomes nutritionally compromised. The standard of care planning was variable. One file contained a very detailed plan of care which provided staff with all the information they needed to ensure that the resident was well cared for. However other files we looked at contained care plans which had not been updated as needs had changed. This meant that staff did not always have the correct information Care Homes for Older People Page 12 of 25 Evidence: about what care was required. People living in the home told us:The care staff here are so well trained and if by any chance management are not present, the routine is exactly the same and everything goes to plan. Care and attention is given at all times. The team here are excellent. During the inspection we saw staff treat residents with respect in a cheerful and professional manner. Where the need for specialist equipment was identified it was provided. It was clear from discussions with staff and residents that they have access to the health services they needed. There was evidence to show that residents get support from General Practitioners, district nursing services, dentists, hearing aid services, chiropodists and other health care professionals. A visiting health care professional told us that they work very well with the team of staff at Nazareth Lodge and the home carried out the advice given to them. They reported any healthcare issues promptly and appropriately. We reviewed the medication precedures and found them to be well organised. The medication administration records were clear and completed correctly, which showed us that people living in the home received the medication they needed. We recommend that where medicines need to be refridgerated the minimum - maximum temperature of the fridge is recorded daily. When the temperature readings are too high or too low action is taken so that the medicines remain safe. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported to maintain their life skills and are encouraged to make choices as far as possible. Social, spiritual and recreational activities meet the needs of the residents very well. Evidence: The home provided an excellent level of social, religious and recreational support to residents. People told us that they were very happy with the lifestyle that living at Nazareth Lodge afforded them. Some chose to spend time on their own but knew they could join in with any organised activities if they so wished. Activities were based on the preferences of the residents and were recorded. Designated staff were employed to undertake activities and they were supported by a group of volunteers who visited the home. A programme of events was distributed to each resident every month and for April this included such things as the gardening club, a reminiscence session with a memory box, discussion groups, a film evening with buffet supper, outings to places of local interest, visit from Birds of Prey, a quiz evening followed by hot dogs and the knitting group. During the inspection a gentle exercise class was underway. People told how much they enjoyed it. One to one sessions were available to those not wishing to join in group events and Care Homes for Older People Page 14 of 25 Evidence: we were told that one resident was teaching a member of staff how to play chess. In addition to the in-house programme information was available about local events and people told us that they were supported by staff if they wanted to attend events outside the home. A newsletter was produced quarterly and distributed to residents and visitors. We read the one for Autumn/Spring 09/2010 and found it very informative. It told the reader how the home had made or was making improvements to the service and of the homes continuing success in staff training, activities, provision of food and fundraising for charities. Residents said that they could entertain their visitors in private and that they were always made very welcome. We saw several complimentary letters to the registered manager saying how welcome people had been made when visiting the home. People told us that they were free to choose whether they wanted to handle their own financial affairs. Some preferred to have a family member to act on their behalf. All the people we spoke with confirmed they enjoyed the food provided. Records showed that residents likes and dislikes with regard to food were known and people were aware that alternatives to the main menu were always available, this included a healthy option dessert. Food was regularly discussed with residents and alterations were made to the menu according to peoples wishes. Care Homes for Older People Page 15 of 25 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 who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. Evidence: People living at Nazareth Lodge told us that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. There had been one complaint made in the last year, which had been fully investigated and action taken in accordance with the homes complaints policy. The home had written policies and procedures for the protection of residents from abuse or neglect and provided all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. Care staff told us that they had received such training. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment at Nazareth Lodge is good providing residents with an attractive, homely and safe place to live. Evidence: The AQAA completed by the home told us: The home is purpose built, light and inviting and clean and is very easy for most residents to negotiate. It benefits from lovely gardens that envelop the house. The home is very well maintained and is on a continual refurbishment programme. The decor is inviting and informal with comfortable seating in the communal areas planned to ensure a degree of privacy if required. The home has warm and welcoming atmosphere created by both staff and residents alike. During our inspection we found this to be the case. We toured the premises and reviewed maintenance documentation and found the home continued to be well maintained inside and out. There was a plentiful supply of specialist equipment to meet the needs of people living there and it was serviced regularly. Residents rooms were of a good size and furnished appropriately. The home continued to refurbish various rooms as the need arose. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture. One person told us that they had wanted to change to a larger room and had been able to as soon as one became available. Care Homes for Older People Page 17 of 25 Evidence: All areas of the home seen during the inspection were clean, bright and free from any unpleasant odours. Surveys completed indicated that the home was always kept clean. The laundry continued to be well managed. Adequate supplies of clean linen were seen to be available. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient care staff, are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are given the training and support so that they can give a high standard of care to the residents living at Nazareth Lodge. Evidence: At the time of inspection staff rosters demonstrated that there were sufficient staff on duty. Staffing numbers were determined by the needs of residents and more staff were on duty at times when people living there needed more help, particularly in the morning and evening. During the inspection staff were on hand to meet the needs of the residents. People told us that staff responded to their needs promptly. One person said: Care and attention is given at all times. The home had an ongoing training programme, which included NVQ level 2 and 3 in care and approximately 60 of the care staff hold the minimum of a level 2 award in care. We reviewed the recruitment files for three new members of staff. The files were well ordered and contained all the information required by law. Enhanced Criminal Record Bureau checks had been obtained for all new staff. Most of the staff employed in the home had worked there for a number of years and those we spoke with told us how Care Homes for Older People Page 19 of 25 Evidence: much they enjoyed working at Nazareth Lodge. Training files showed us that staff were receiving induction training. Staff told us that they were encouraged to take up training opportunities provided and we saw evidence that the home had gone to great lengths to support individuals through their training. Recent training included fire safety; the protection of vulnerable adults and safe handling of medicines. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well organised and the daily management and running of the home centres round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. Evidence: Mrs Ambrose had been in post for a number of years and has the skills and experience to manage the home very well. She confirmed that she was supported well by the Responsible Individual, Miss Trimble, both of whom had a thorough understanding of the needs of people in their care. A management meeting is held on a monthly basis and the Responsible Individual and Registered Manager worked well together to maintain extremely high standards within the home. Everyone we spoke with had the highest regard for Miss Trimble and Mrs Ambrose and said they were very approachable and responsive to any suggestions made. Residents told us that they spoke with someone within the management team everyday. They also told us that they liked the quarterly newsletter, which included information on activities, the refurbishment programme, staffing and training. Care Homes for Older People Page 21 of 25 Evidence: It was evident that the home was managed in the best interests of those people living there. Robust recruitment practices were in place to ensure only suitable staff were employed. There had been very little staff turn over and most people working in the home had been employed there for a number of years. There was a quality assurance and quality monitoring system in place. The home had taken steps to review its performance regularly and residents views were sought and comments put forward were acted upon appropriately. We were told that residents either dealt with their own finances or had a representative to do so. The home held small amounts of money for people at there request and clear records of any monetary transactions were held. Staff told us that they had regular supervision sessions and were clear about their roles and how they were performing. Clear written records confirmed this procedure was in place. Records showed that staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and appropriate action was taken as necessary. Care Homes for Older People Page 22 of 25 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 23 of 25 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 7 14 The registered manager must ensure that a written plan is drawn up in sufficient detail to meet the health and welfare needs of service users. To ensure that staff have accurate and detailed information to meet each persons health needs. 06/07/2010 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 8 A system of nutritional screening should be implemented so that staff will be aware if a resident is becoming nutritionally compromised. The maximum/minimum temperature of the medication fridge should be recorded daily. Where the temperature is too high or too low action should be taken so that the medicines remain safe to use. 2 9 Care Homes for Older People Page 24 of 25 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. 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