Care Home: Nutley Lodge

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What the care home does well This was a positive inspection. The manager and providers representative were both keen to share the improvements made at the home and to respond to our findings and were already acting on some issues at the time of inspection. We were told that Nutley Lodge provides people with the `loving care` and `kindness`. We were told that people could not praise the staff or service high enough. The admission procedure is good and shows that staff make sure they can meet the person`s needs before they are admitted. Relatives tell us that their family members were `welcomed into a homely atmosphere`. People receive a good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way. Staff at the home ensure people see healthcare professionals when they need to. People have access to activities and are able to maintain contact with their family. People are supported to maintain their spiritual beliefs and where available people enjoy the activities provided by the home particularly the opportunities for quizzes, music, entertainment and exercises. People particularly like the walks and manicures provided by staff. People tell us that the food is good at the home. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. The kitchen is well maintained and the menu is varied and full of home cooking. People who use the service and their relatives can be confident that if they complain. Their concerns will be listened to and acted on. Complaints are kept to a minimum because of the presence of the manager and provider. Relatives said they had never needed to complain. Recruitment, induction and training is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary pre employment checks, risk assessments and training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as `marvellous``lovely` and `very good`. Interactions are appropriately affectionate, sensitive and appropriate for each person. Nutley Lodge is a safe and clean place to live and work. Maintenance systems are very well managed and a satisfactory level of decor and furnishings is provided at the home. The Provider, manager and staff group have suitable qualifications and experience to care for people who require personal care. The home is well-managed. What has improved since the last inspection? Communication has improved at the home. A new website has been made available for families, enabling them to e-mail people in the home. The brochure, the statement of purpose and service user guide have been updated and leaflets and information are available in the hall way. A key worker system is proving popular at the home, and means that named staff are responsible for specific duties and communication for each resident. This system is monitored and documented efficiently. The management of falls has improved with the introduction of detailed falls risk assessments which can be performed on people before they move to the home. Infection control processes have improved at the home. The manager has obtained reassurances that the washing machines are able to destroy pathogens when washing foul laundry. Colour coded baskets have been introduced to the laundry and personal protective equipment such as gloves and aprons are now more readily available. Activities have improved with the purchase of new equipment and the introduction of new and varied activities. Activities also now include occupational tasks such as folding napkins, setting tables, and dusting. Recruitment at the home is more robust to ensure that all checks are completed prior to new staff commencing employed. Induction and training at the home have also improved. The induction training is now more in-depth and are links to NVQ training if staff are to pursue this pathway. A member of the management team is now responsible for manual handling training and this is working efficiently. The home also use the specialist knowledge and skills of a consultant who provides training in dementia awareness. Records and record keeping have also improved. Training records have improved to show what training has been given. The key worker system is monitored and recorded. Recruitment records are more robust ensuring all checks have been completed prior to new staff working. Recording of activities has improved to show what activities have been offered and declined. The new complaints procedure has been updated. Records to show maintenance checks have also improved. An administrator has been employed to assist with records and administration at the home and a new deputy manager have been employed to support the registered manager. Environmental changes now mean people have more access to all parts of the home. A new wheelchair accessible ramp and improved existing ramp mean that people using wheelchairs and walking aids are able to access the garden easily. The gardens are also more accessible with the provision of a wooden deck area and raised flower beds. The exterior of the home has been repainted as part of the routine maintenance programme. Internally improvements have also continued with the redecoration of hallways and day lounge. New carpets had been installed in the lounge areas. This carpet has minimal pattern to help prevent visual disturbances for people with dementia type illnesses. Bedrooms continued to be redecorated as part of the routine maintenance programme. New carpets have also been fitted into bedrooms, and new curtains and bedding had been installed in one bedroom. What the care home could do better: The admission assessment process could be improved by ensuring the pre-admission assessments document contains maximum information. This will ensure staff have detailed information regarding each resident. Minor improvements are suggested to reduce the risks of errors being made when prescriptions are being copied from the prescription to the medication administration record. Two staff signatures would mean that any errors are spotted and corrected. People can also be protected by ensuring risk assessments performed when bed rails are in use, include a risk assessment regarding the equipment. Systems should be introduced to highlight any staff that persistently fail to attend mandatory training. this will mean all staff have the necessary skills and knowledge are performed their roles in a safe way. People at the home should be aware of what meal they are to be served. This will mean they have an opportunity to say if they dislike what is on the menu and have time for an alternative to be sought. Systems should be in place to ensure that people`s preferences for meals are respected. Key inspection report Care homes for older people Name: Address: Nutley Lodge 43 Sherford Road Elburton Plymouth Devon PL9 8DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 0 7 0 7 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 31 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 31 Information about the care home Name of care home: Address: Nutley Lodge 43 Sherford Road Elburton Plymouth Devon PL9 8DA 01752402024 01752408059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Lynwen Miles Woodcock,Mr Jeremy Woodcock care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 25 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender 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(E)) Physical Disability (Code PD) Date of last inspection Brief description of the care home Nutley Lodge is a detached, extended property, situated in the village of Elburton, near Plymouth. It is set in its own grounds with level access for people, although there is a slope on the drive way. 25 0 25 Over 65 0 25 0 Care Homes for Older People Page 4 of 31 Brief description of the care home The Home is registered to provide accommodation and personal care for up to 25 older people with physical disabilities and dementia. The home is owned Mr Jeremy and Mrs Lynwen Woodcock and the registered manager is Mrs Allison Thompson. The home has 23 single bedrooms and 1 double bedroom, 14 of the single bedrooms and the double bedroom have en-suite toilet facilities. On the ground floor there are two lounge rooms and a large dining room with a further seating area in the entrance lobby. A shaft lift and a stair lift provide access to the first floor. There is a call bell system throughout the home. People are enabled to access any health or social care services they require and various social activities are arranged by the home. The garden is attractive, spacious and has disability access. Current fees are range between three hundred and eighty pounds and four hundred and ten pounds. Additional charges are made for chiropody, hairdressing, newspapers and other personal items. The most recent inspection report can be found in the entrance hall. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection the Provider had sent us with a well completed annual quality assurance assessment for inspection (well within timescales). The AQAA is a selfassessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service.. This key inspection included a visit to the home on Tuesday 7th July 2009. During this time we spoke to the registered manager,providers representative, deputy manager, administrator, cook, two staff and two relatives. We inspected this service with an expert by experience. The Care quality commission Care Homes for Older People Page 6 of 31 consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service and spoke with five people. This helps us get a picture of what it is like to live in or use the service. We case tracked two people who use the service. This means we looked at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, four staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Nutley Lodge. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Communication has improved at the home. A new website has been made available for Care Homes for Older People Page 8 of 31 families, enabling them to e-mail people in the home. The brochure, the statement of purpose and service user guide have been updated and leaflets and information are available in the hall way. A key worker system is proving popular at the home, and means that named staff are responsible for specific duties and communication for each resident. This system is monitored and documented efficiently. The management of falls has improved with the introduction of detailed falls risk assessments which can be performed on people before they move to the home. Infection control processes have improved at the home. The manager has obtained reassurances that the washing machines are able to destroy pathogens when washing foul laundry. Colour coded baskets have been introduced to the laundry and personal protective equipment such as gloves and aprons are now more readily available. Activities have improved with the purchase of new equipment and the introduction of new and varied activities. Activities also now include occupational tasks such as folding napkins, setting tables, and dusting. Recruitment at the home is more robust to ensure that all checks are completed prior to new staff commencing employed. Induction and training at the home have also improved. The induction training is now more in-depth and are links to NVQ training if staff are to pursue this pathway. A member of the management team is now responsible for manual handling training and this is working efficiently. The home also use the specialist knowledge and skills of a consultant who provides training in dementia awareness. Records and record keeping have also improved. Training records have improved to show what training has been given. The key worker system is monitored and recorded. Recruitment records are more robust ensuring all checks have been completed prior to new staff working. Recording of activities has improved to show what activities have been offered and declined. The new complaints procedure has been updated. Records to show maintenance checks have also improved. An administrator has been employed to assist with records and administration at the home and a new deputy manager have been employed to support the registered manager. Environmental changes now mean people have more access to all parts of the home. A new wheelchair accessible ramp and improved existing ramp mean that people using wheelchairs and walking aids are able to access the garden easily. The gardens are also more accessible with the provision of a wooden deck area and raised flower beds. The exterior of the home has been repainted as part of the routine maintenance programme. Internally improvements have also continued with the redecoration of hallways and day lounge. New carpets had been installed in the lounge areas. This carpet has minimal pattern to help prevent visual disturbances for people with dementia type illnesses. Bedrooms continued to be redecorated as part of the routine maintenance programme. Care Homes for Older People Page 9 of 31 New carpets have also been fitted into bedrooms, and new curtains and bedding had been installed in one bedroom. 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 10 of 31 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 31 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. The information provided means people have the information they need to decide whether Nutley Lodge is the care home for them. The admission procedure is good. Improvements to the assessment would mean that staff have sufficient information to decide whether they are able to meet the needs of the person. Evidence: The AQAA told us there has been a new brochure including information on dementia provision. The AQAA also states information regarding the Nutley Lodge website which provides information about events in the home with regular updates. This brochure and supplementary information (including the statement of purpose, copy of contract, complaints procedure and covering letter was inspected and contained all information needed for people to decide whether Nutley Lodge was the right home for them. Care Homes for Older People Page 12 of 31 Evidence: Relatives told us they were able to look around a few homes before their mother was admitted and knew Nutley was the right home when they walked into the home. One relative said I liked the hustle and bustle and knew it would be right for her The Manager told us a pre-screening check was performed over the telephone before the manager or deputy go out to see the person to perform an assessment. Preadmission assessment documents were seen. These were in formal notes suitable for each person and did not contain prompts for a full needs assessment. Information is sought from other healthcare professionals and family members to get a full picture of what needs the preson has. This information is then used to make a plan of care for each person. Each person is provided with a contract from the home in addition to contract from social services if relevant. These contracts contain the room to be occupied fees charged and other responsibilities of both the home and person. The AQAA told us We continue to take many of our service users from referrals via outside professionals. Prospective clients families tell us we are good on fees and they prefer our home. Thank you letters seen at the home read As son as we visited Nutley we knew it was the right place. When I bought mum to you she was welcomed with warmth. There was a welcoming homeley atmosphere. Staff told us they felt they were given enough information about the needs of people when they are admitted and have specialist training. The AQAA told us Dr Anwen Whitham (consultant clinical psychologist) provides dementia training for staff. The home care for people with mobility difficulties and history of falls. The managr showed a new falls risk assessment which is being introduced for people who are to be admitted in the future. In addition to the the manager explained that a new door and ramp have been installed to help people access the garden if they are unable to negotiate stairs or uneven floors. New signage and pictures have been installed to help people orientate themselves around the building. Care Homes for Older People Page 13 of 31 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. The personal care people receive is of a good standard and provided in a respectful way. The care planning systems are good and show needs are recorded in a clear and consistent way. The management of medications is generally good. However minor improvements would minimise risks. Evidence: People living at Nutley Lodge have an access to a range of health care services both at the home and in the community. People have access to the local NHS services including screening programmes. Each person is designated a general practitioner who attends when staff request. Visits from other healthcare professionals are also available via the GP.The AQAA told us We regularly use outside agencies such as Vision Call Opticians, NHS Dental Services and Chiropody for those wishing to use these services. Care Homes for Older People Page 14 of 31 Evidence: During inspection people looked very well cared for with the finer details such as eye care, nail care and appropriate foot wear present. One relative told us that she attended the home regularly and found people in the home to be very well cared for always looking clean and well presented. Thank you letters seen at the home read Thank you for all your kindness to mum through the years and A belated but heartfelt thank you for all the care you gave to mum whilst she was with you. People in the home were complimentary about the care they received, with one person saying staff take care of the people in the Home who have dementia very well. Care needs for people are communicated both verbally between staff and within care plans. Staff told us that there are handovers where relevant information is passed between staff. Care is also recorded in well written care plans. The manager explained that care plans have been updated since the last inspection. each person has a plan, which sets out his or her specific needs. Each plan contains assessments relevant for that person and include issues such as falls, nutrition, and more general risks. The AQAA told us Care Plan reviews take place according to a standard schedule to enable clients and family to contribute. The AQAA also told us We have improved recording and monitoring of the Key Worker system. Specific duties for the key worker include weekly duties, bedroom checks, ensuring people have sufficient toiletries, liasing with families, organising laundry repairs and communication between the familiy and manager. Staff told us some people were being cared for in specialist beds that were fitted with bed rails. The deputy manager informed us that in these few cases risk assessments are performed which include obtaining consent. Discussion was held regarding the benefit of using the Health and safety risk assessment. The AQAA told us about the purchase of new electric hoist. Staff said most people were mobile but a small number of people need the hoist for transfer. Staff also informed us that slide sheets, handling belts, frames and sticks are also used for the safe transfer of people. We were told that regualr chair exercises take place which people enjoyed. Care Homes for Older People Page 15 of 31 Evidence: Specialist health care professionals are sought for advice and guidance. Examples of healthcare professionals included chiropodist, GP, continence care nurse, physiotherapist, occupational therapist, reablement team, mental health team, comunity psychiatric nurses and district nurses. The management of medications is performed well. Staff have had training in medication. There are clear records to show the receipt and return of medications in to and out of the home. Medicines are transported around the home in a metal medication cupboard. Medication is are supplied within blister packs from a local independent pharmacist. Extra medications, creams, and dressings are stored within other locked cupboards in the home. Controlled drugs are stored appropriately and a spot check confirmed sorage and recording processes are robust. Some medications have to be written on the medicine administration record. Discussion was held regarding the added safety of obtaining two signatures to ensure the prescription had been copied to correctly. The medication trolleys were clean and tidy. Medications needing to be stored in a fridge are stored in a designated fridge with records of temperatures maintained. Clear policies and procedures were availble for reference along with the patient information leaflets supplied with medications. The manager provided evidence of an audit performed by the supplying pharmacist. Care Homes for Older People Page 16 of 31 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. The routines of daily life are performed in accordance with the wishes and feelings of people in the home. The satisfactory activities programme means that people have access to meaningful stimulation at the home. Improvements to the management of meals would show that people are aware of the meal and able to request alternatives Evidence: The home appeared very quiet, with limited interaction between people; staff were around and did try to engage in conversation with people. Music was playing constantly throughout my visit, it was very soporific music, which changed little, it was there constantly in the background. Discussion was held about the volume and peoples ability to hear if they had hearing problems. It was very quiet for those with good hearing. The AQAA told us there has been improved activities, daily notice board supplying information on activities and service providers and described the system as being Care Homes for Older People Page 17 of 31 Evidence: more structured which is documented, promoting client choice and independence. Thank you letters seen at the home read The regular activities that are arranged for each day are a valuable stimulation. You managed to include mum even with her memory problems. Most of the people we spoke with had family who visited fairly frequently. Activities provided are both formal and informal. The informal activities included daily walks, manicures, hairdressers and video sessions. More formal activities include arranged games and quizes, board games and basket ball. Posters were also advertising clothes show, musicians and summer fetes. We were also told of the local donkey sanctuary who visited the home to seee the people. People told us this was quite fun. One person we spoke with said I enjoy having my hair done and my nails she showed us her nails, which she said the staff had manicured and applied nail varnish for her. After coffee was served mid morning, staff offered opportunities for people to engage in activities, dominoes, skittles or individual walks in the grounds with a member of staff. Staff did play dominoes with people and one or two went out for a walk in the grounds. People told us that they liked to read and enjoyed the quizzes they had and the occasional game of Bingo. Several people told us how they had enjoyed the visit from the Donkey Sanctuary Donkey, although this had been some time ago. People told us they enjoyed being able to spend time with other people in the home and two people told us that they sometimes went out with their family. No one mentioned activities out side the Home and one person said that there are no trips now There was a board, which listed afternoon activities which were to be a Film and a Quiz. The Provider has a dog Scamp who vists the home on a regular basis and even has a photograph on the staff notice board! People appeared pleased to see the dog and liked him being in the home. Realtives told us a religious minister comes to the home on a regualr basis to perform a service. Staff said all people had a Christian faith or expressed no views. Staff said it would be possible to meet the needs of other faiths. Interactions between staff and people in the home were very positive. The use of appropriate affection, sensitive approach and light banter was noted to be particularly popular with people. Staff told us routines were flexible at the home and wholly depended on who wanted Care Homes for Older People Page 18 of 31 Evidence: to get up or go to bed. The staff we spoke with were very knowledgeable about both physical and social needs of the person and were keen to improve the activities and opportunities for people in the home. The AQAA told us there has been an updated menu The AQAA read Our menu has been recently updated and service users have been asked how they liked the menu and anything they would like to see on it not already provided. We noted a menu was on display showing a different meat for the roast. The reason for this was clearly explained. When we met with people during the morning, no one was aware what was for lunch that day. When roast pork was served two people told us they did not eat pork. Staff confirmed this dislike was recorded in care plans but had not been followed by care staff when serving lunch. People told us that they had eaten breakfast in their rooms and this had been cereals and toast. People said the food is good I have no complaints about the food the choice of food is not bad I was told that three meals a day were provided, followed by a warm drink of their choice in the evening before going to sleep. Most people we met with had lunch in the dining Room and those who spent time in their room were encouraged to come to the dining Room. Our expert ate lunch with a group of three people in the dining Room; the room was bright and airy, with the tables set with cloths, table mats, cutlery and condiments. People were offered a choice of fruit squash or water to drink. There was plenty of staff to help. Their approach was one of promoting independence and offering support as needed. Lunch was served ready plated, with roast pork, carrots, cabbage, peas and roast potatoes, it looked appetising and was tasty. Nutritional risk assessments were located in care plans to monitor weight loss or gain. Meal times are recorded as being approximate. Breakfast on the day of inspection was informal and took place over an extended period of time. The kitchen was clean, well managed, with cleaning schedules and food maintenance programmes well conducted. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be well managed at the home. The training and staff knowledge helps to protect people from abuse. Evidence: The care quality commission has received no formal complaints regarding Nutley Lodge since the last inspection. The provider also confirmed that the home have not received any complaints either. The AQAA stated that the Complaints Procedure is on back of each service users door The complaints procedure is also located within the entrance hall and communal areas of the home. Contact details for the care quality commission were contained on this document. There is also a complaints and suggestions book located by the visitors book in the entrance hall. Relatives we spoke to said that they had never needed to make a complaint and that had been always happy with the standard of care provided at Nutley Lodge. This relative said that they knew how to make a complaint that communication had been good to prevent this occurring. Care Homes for Older People Page 20 of 31 Evidence: Staff recruitment process helps to protect people by ensuring that criminal records bureau checks (police checks) and protection of vulnerable adults checks are performed on all staff. The AQAA told us that staff had had retraining on the Protection of vulnerable adults and have watched the DVD Behind Closed Doors. Staff are provided with in-house training on the protection of vulnerable adults, and senior staff had attended a deprivation of liberties and mental capacity act training. All staff spoken to were aware of the correct reporting procedures is allegations of abuse are made or witnessed. This included how to report the provider and manager externally. During the inspection we saw no examples people being restrained. Some people were being cared for in bed using bed rails. Some risk assessments had been performed but this could be improved. This is reported on an earlier section of this report. Relatives told us that staff do not manage their financial affairs. The administrator informed us that small number of people have a small amount of cash was held for the person. This is reported upon in a later section of the report. Care Homes for Older People Page 21 of 31 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. Nutley Lodge is a pleasant, clean, and safe place to live and work. Evidence: Nutley Lodge is a carehome for up to 25 people. The original house has been extended and comprises of 23 single rooms and one double which is bein used for single occupancy. The rooms are found on two floors which can be accessed by passenger lift and stair lift, although some people still opt to use the stairs. A tour of the home showed that the environment was a safe and well maintained place to live and work. A programme of routine maintenance and renewal of the decoration of the home had continued since the last inspection. All areas of the home appeared fresh, clean and orderly, with no unpleasant smells. Many of the rooms had views overlooking the garden. The communal rooms were small with different arrangements of chairs, although the larger communal areas had chairs set around the edges of the rooms. Clear signage has been installed to help people with dementia type illnesses find their way around the home. The AQAA also informed us of improvements with comments including there has been a new door and raised ramp and level for improved access, new carpet, redecoration Care Homes for Older People Page 22 of 31 Evidence: of main lounge and new lights. We were also told of the completion of themed areas within the home, new lights in all hallways and the exterior of the house being painted. Staff also told us all hallways have been painted and new carpets have been fitted in two rooms with another room being provided with new curtains and bedding. Work on new raised beds in garden for people to access has been started, and a bird feeding station is proving popular for people to be able to watch the birds. The AQAA told us there has been New door and raised ramp and level for improved access, new carpet, redecoration of main lounge and new lights. We were also told of the completion of themed areas within the home, new lights in all hallways and the exterior of the house being painted. Staff told us confirmation had been obtained from the environmental health department that the washing machines are suitable for washing foul laundry. Staff explained that a dissolvable bag system is used to reduce the spreead of infection. Staff also told us colour coded laundry baskets are now used and a new sink has been provided for dirty water to be dispossed of. The AQAA told us there has been An increase of housekeeping at weekends. Other improvements reported included improved recording and monitoring of infection control. The AQAA also informed us that staff have had an opportunity to use the health protection agency training light box for safe hand washing technique. All areas of the home were clean, tidy and free from the risks. Furnishings throughout the home were of a good standard and domestic in style. Bedrooms were clean, tidy and contained varying amounts of personal memorabilia and furniture. People who are more mobile are able to wander around the home freely. There are walking aids, lifts, and stair lifts available for those with mobility problems. The home is fitted with alarms and pressure sensors which are triggered when people get out of bed, leave their bedrooms at night or attempt to leave the home. This enables people to freely wander, whilst protecting them by allowing staff to be aware that they are walking around the home unattended. Maintenance records showing the home has routine and ad hoc checks are well maintained. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The robust recruitment induction and training programmes mean that people are cared for by staff who are suitable to work with vulnerable adults. Evidence: The AQAA told us Our staff on the whole have been with us a number of years, therefore providing continuity of care, which is reflected in the happy atmosphere of the home. The interactions between staff and people in the home was very positive throughout the inspection. Comments from people in the home in relation to staff included staff are lovelyeverybody is good and staff in the home are very good. Relatives were very complimentary about the staff at the home. Comments included they are marvellous and they are very welcoming. Staff files were well completed and contained information such as application form, two written references, forms of identification, health assessment, interview record and completed criminal records bureau check and Protection Of Vulnersble Adults check. Staff told us they felt they had enough support, experience and knowledge to meet Care Homes for Older People Page 24 of 31 Evidence: the different needs of people who live at the home. One member of staff said what training havent I had, we are always training. The AQAA told us about the Improved training on key issues to health and personal care e.g. dementia and drug administration. The AQAA also informed us that there has been an improvement in staff training with a designated training room being made availiable. The AQAA listed training including Infection control, Dementia, Moving and Handling, Administration of Medicines, First Aid Awareness, Food Hygiene, Awareness of the mental capacity act and Equality Act. The AQAA told us the Induction has improved in the content of information provided. Induction records showed that the induction was more in depth and provided staff with more specific information as well as the emergency procedures and day to day information. Records showed that the ajority of care staff have an NVQ 2 at least with some having NVQ 3. Staff told us they thought there were sufficient staff on duty. One member of staff said enough to keep us on the go but enough to be able to be there for the residents. People told us they never had to wait long to have their requests met and always got their medicines on time. Care Homes for Older People Page 25 of 31 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. The Provider, manager and supporting team have the skills to run the home in an efficient way. Minor changes are needed to show that the management of personal money is robust and protects both the person and the staff in the home. Evidence: The Providers have owned Nutley Lodge care home for 25 years and strive to maintain a family feel to the business. The Providers employ their son to oversee the home on a day to day basis. He is responsible for the day to day administration and overall management of the home. He also performs the moving and handling training in the home. This is managed well. The manager is registered with the care quality commission and has over 13 years experience of working and managing care homes. She has NVQ level 4 in management and level 3 in care. She has also done a dementia management course. Care Homes for Older People Page 26 of 31 Evidence: Staff told us the management team are very good and approachable. One member of staff explained she had previously worked in another home belonging to the providers but when they sold it she wanted to move to Nutley to be with the Providers. The AQAA told us of the appointment of new Deputy Manager who has NVQ 2,3 and 4 and administrator to assist with documented record keeping. Staff said there were clear lines of accountability and plenty of opportunities to express their views. This is doe at report at the beginning of each shift, at team meetings or face to face with the manager. We were told there was a very low turnover of staff at the home and that morale amongst staff was good. Health and safety is taken seriously by the manager. Falls are of particular interest to the manager since a very small number of people fell at the home. Since these explained incidents the manager has sought advice and is performing in depth falls risk assessments to reduce and risks.The AQAA told us they use the services of an adviser who assists with care audits and offers advice. The home is well maintained with systems in place to monitor issues such as ensuring window restrictors are effective and and environment checks are performed. Wheelchair checks are also performed on a regular basis. Maintenance certificates were provided to show the home had regular services and checks on gas, electric, specialist equipment, lift equipment, fire systems and hoists. Recent Environmental Health inspections did not find any issues of concern. The home also employ a maintenance man who was busy throughout the day performing tasks at the home. The AQAA stated Any maintenance repairs are reported and recorded in the maintenance book. These are then checked and actioned daily. Staff informed us that they had attended mandatory training or were booked on upcoming sessions. Records and training tables were maintained which show which staff are due training. Inspection confirmed one or two staff that had persistently missed mandatory training. The manager explained that training was free and staff were paid to attend this training. We were told that where people are unable to maintain control of their finances and Care Homes for Older People Page 27 of 31 Evidence: personal affairs help is sought fro either relatives or other advocates. The Provider told us they do not act as appointee for people at the home. We were told that a small amount of personal money is held fro some people who are unable to pay themselves for hairdresser or chiropodist. Inspection of the process showed that each person has a record of transactions with clear records of who has received services of the hairdresser or chiropodist. The balance is then collectively stored in a cash tin. In four cases people were in deficit. Collectively this debt amounted to just under forty pounds. The administrator explained that a float of forty pounds was available to prevent other peoples money being used to fund the transactions of other residents. A discussion was held over the importance of ensuring the system worked to prevent other peoples money being used. In response to this the providers son, who was present, immediately increased the float and agreed a monthly audit would be performed to ensure the float was sufficient to cover any shortfalls. We were told that quality assurance was performed in a variety of ways. The manager explained that because her and the Providers were around on a daily basis many issues are raised informally which changes the service continually. The AQAA told us there have been improvements in the service user, families, staff, and professionals quality assurance forms. The quality assurance surveys were seen which reflected positive feedback. Care Homes for Older People Page 28 of 31 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 29 of 31 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 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 3 The manager should ensure the pre admission assessment contains sufficient prompts to obtain sufficient detailed information on people being admitted. The manager should use a recognised risk assessment for bed rails which covers consent and equipment usage. Two signatures should be obtained when copying prescriptions on to the medication administration sheet to minimise errors. Systems should be in place to ensure people are aware of what meal is available to enable them to chose an alternative and to ensure care staff follow care plans in respect of food preferences. Systems should be in place to ensure peoples money is not used to pay for transactions for other people. Systems should be introduced to ensure staff do not miss mandatory training. 2 3 8 9 4 15 5 6 34 38 Care Homes for Older People Page 30 of 31 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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