Care Home: Risedale At Lonsdale Nursing Home

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well We judged that Risedale at Lonsdale was providing an excellent service to people. The home had good assessment and admission procedures which helped people to know if Lonsdale would be able to meet their needs. The planning and delivery of personal care was very individual and met with people`s expectations and wishes. The quality of nursing care was high and staff were well able to manage people with complex needs and conditions. There were good arrangements in place for people to access general and specialist health care and advice. Risedale employ a number of nurses with specialist skills and knowledge to support people with complex needs and to act as a resource for staff. Staff were trained in end of life care and were able to provide effective palliative care and symptom control. People told us they were "very well cared for" and "treated with dignity and respect". The home was sufficiently staffed and all grades of staff received good quality training suitable to their role, and staff felt they were supported to do their jobs well. Recruitment procedures were robust to ensure only suitable staff were employed. People were happy with the range of activities and entertainment provided, and these were tailored to suit individual needs and wishes. The provision of meals was highly praised, with plenty of choice and a good variety of foods served. Special diets were catered for and staff supported people who needed help to eat and drink. The home was well maintained, clean and comfortable. Infection control procedures were good and people were pleased with the laundry service. There were suitable adaptations and equipment to assist people with mobility problems. The service had a low incidence of complaints, but was able to demonstrate they listened to people and took any concerns seriously. Staff were knowledgeable about safeguarding procedures and understood their role in protecting people from harm. People told us they felt safe in the home. The service was well managed, and sought out people`s views through quality surveys and discussions. There was evidence that people`s suggestions and comments were acted on. There were good health and safety arrangements in place to keep the home safe for people to live and work in. What has improved since the last inspection? Since the last inspection a number of improvements had been made in the home. The majority of bedrooms had been decorated, and some also had new flooring and lighting. The dining lounges had been decorated and provided with new dining chairs and tables, new armchairs, new curtains and wall mounted televisions. The beverage / kitchen areas in the dining lounges had been replaced with new units and equipment. Two bathrooms had been upgraded with new decoration and bathing equipment, and four new hoists had been purchased. There was also some new equipment in the kitchen and laundry. A number of these improvements had been made in response to the quality surveys the manager sent out to people last year asking for their views. As a result of this menus had also been changed to include some new dishes people suggested. The activity organiser had been supported by an occupational therapist to review the range of activities and entertainment provided in the home. The Risedale group had appointed a Continuing Health Care Liaison Nurse. She oversees the care of people across the groups homes with complex nursing needs who are in receipt of continuing health care funding. This new role had already proved beneficial to some residents and staff at Lonsdale. Staff training had continued with some new subjects such as Mental Capacity Act and Deprivation of Liberty Safeguards being added. Training materials in all subjects were routinely updated to ensure staff were taught current best practice. The home had increased the number of care staff with a National Vocational Qualification (NVQ) in care to 83%. What the care home could do better: No requirements or recommendations were made following this inspection. The manager and staff continually monitor the quality of the service, and make improvements by listening to people who use the service, and by keeping up with professional developments. Key inspection report Care homes for older people Name: Address: Risedale At Lonsdale Nursing Home Albert Street Barrow In Furness Cumbria LA14 2JB     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: Jenny Donnelly     Date: 1 8 0 3 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 29 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 29 Information about the care home Name of care home: Address: Risedale At Lonsdale Nursing Home Albert Street Barrow In Furness Cumbria LA14 2JB 01229870050 01229822955 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Risedale Estates Limited Name of registered manager (if applicable) Mrs Anna Liza B. Paule Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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. Physical disability - Code PD (maximum number of places: 1) The maximum number of people who can be accommodated is: 45 Date of last inspection Brief description of the care home Risedale Estates Limited operates Risedale at Lonsdale Nursing Home. The registered manager is Mrs Anna Paule. Lonsdale is a 45 bed nursing home which shares the site with its sister home, St Georges. Both homes are registered and managed separately, but share the main kitchen and laundry. It is situated in the town of Barrow in Furness, a short distance from the main shops and amenities. Lonsdale is purpose built over Care Homes for Older People Page 4 of 29 0 1 Over 65 45 0 Brief description of the care home two floors and has a passenger lift. There is a mixture of 31 single and 7 shared bedrooms, each with en-suite toilet and wash hand basin. There is a large dining/lounge on each floor, and a conservatory. There are five bathrooms with specialist bathing facilities. There is a planted garden with seating and a water feature. The weekly fees at the time of this inspection were £422.00 plus any registered nursing care contribution entitlement. Information including the statement of purpose, service user guide and inspection reports can be obtained from the care home. 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: 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: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some of the people who live in the home and to the staff. We received six completed staff surveys and four from people living in the home. Jenny Donnelly made an unannounced visit to the care home on 18th March between the hours of 09.30 and 16.30. During this visit we (the Care Quality Commission) toured the building and spent time in the dining lounges where we watched meals being served. We spoke with people living in the care home and their visitors. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 6 of 29 Since the last key inspection in May 2007, we have completed two Annual Service Reviews, in 2008 and in 2009. An annual service review is where we look at all the information we have gathered about a service in the last year, including the managers Annual Quality Assurance Audit and surveys that we send to people who live in the home. From this we make a judgement about whether the home is continuing to provide a good service to people, or whether we need to inspect sooner than planned. We received positive feedback on Risedale at Lonsdale at each annual service review, and did not alter our inspection plan. Copies of all these reports are available on request from us, or from the care home. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection a number of improvements had been made in the home. The majority of bedrooms had been decorated, and some also had new flooring and lighting. The dining lounges had been decorated and provided with new dining chairs and tables, new armchairs, new curtains and wall mounted televisions. The beverage / kitchen areas in the dining lounges had been replaced with new units and equipment. Two bathrooms had been upgraded with new decoration and bathing equipment, and four new hoists had been purchased. There was also some new equipment in the kitchen and laundry. A number of these improvements had been made in response to the quality surveys the manager sent out to people last year asking for their views. As Care Homes for Older People Page 8 of 29 a result of this menus had also been changed to include some new dishes people suggested. The activity organiser had been supported by an occupational therapist to review the range of activities and entertainment provided in the home. The Risedale group had appointed a Continuing Health Care Liaison Nurse. She oversees the care of people across the groups homes with complex nursing needs who are in receipt of continuing health care funding. This new role had already proved beneficial to some residents and staff at Lonsdale. Staff training had continued with some new subjects such as Mental Capacity Act and Deprivation of Liberty Safeguards being added. Training materials in all subjects were routinely updated to ensure staff were taught current best practice. The home had increased the number of care staff with a National Vocational Qualification (NVQ) in care to 83 . 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission arrangements help people to understand the services and facilities offered, and the assessment process gives people confidence the home will be able to meet their needs. Evidence: There was good written information for people about the care home, detailing the services and facilities offered. People were welcome to visit the home to look around and speak with the staff and people living there. We looked at the admission arrangements for new people and saw that the manager or senior nurse had assessed their health, personal and social care needs in detail before offering them a place in the home. The service also obtained copies of social worker assessments, and community nurse assessments for any entitlement to free nursing care. All this information was used to make a decision about whether the home would be able to meet the persons needs, and the manager wrote to the person Care Homes for Older People Page 11 of 29 Evidence: confirming this and enclosing a copy of the assessment. The manager kept admission check lists to help her make sure all admission documentation was fully completed. We saw that people had been issued with a copy of terms and conditions of residency, and there was a contract in place stating the level of fees and who was responsible for payment. People were asked to sign their agreement to occupy a shared room. The thorough assessment process helped staff prepare for new people arriving in the home, and enabled them to have any necessary equipment ready. Each person was allocated a primary nurse and a key worker carer, to take a special interest in their care, and this helped people settle into the home quickly. One person we spoke with told us their family had made all the admission arrangements and had been to view the home on their behalf. This person said they had been made very welcome, had settled in quickly and got along well with the person they shared a room with. There was a review meeting after the first four weeks of admission, to make sure the placement was working well and the care plan was correct. The service does 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People with complex high nursing needs were receiving good quality health and personal care, in accordance with their wishes. Evidence: Each person had a full written care plan drawn up from their assessment, and this set out their individual health, personal and social care needs. We looked at four care plans in detail, for people living in different parts of the home and with different care needs. Each person had a primary nurse responsible for planning and overseeing their care, and a key worker carer to take a special interest in them. We saw the care plans were very individual to the person and took account of their personal wishes and choices. This helped people receive care in a way, and at a time, that was acceptable to them. Care plans had been reviewed and updated each month, and where possible people had agreed to their plan of care. A number of people living in the home were very dependant and needed high levels of nursing input. People we spoke with told us they were, very content here, enjoyed bathing in the Care Homes for Older People Page 13 of 29 Evidence: big comfortable bath and, felt very well looked after. The surveys we received indicated people experienced a high level of satisfaction, saying they always received the level of care, support and medical attention they needed. Visitors we spoke with, told us they were very happy with the care provided to their relatives, saying people always looked cared for and had clean clothes on. One person said there was sometimes a wait to be taken to the toilet. Risk assessments were completed for peoples moving and handling needs, skin care, nutritional needs and risk of falls. These had been updated monthly and plans put in place to reduce any identified risks. We looked at the management of skin care and saw that people with wound care needs had detailed wound assessments and clear treatment plans in place. These had been evaluated frequently and treatments changed as necessary to ensure healing was taking place. We saw there was good liaison with a wound care nurse specialist and an infection control nurse. People who needed them, had pressure reducing mattresses and seat cushions. Some people were in receipt of one to one care through continuing health care funding. We saw these people were attended to by their own specific carer throughout the day. The Risedale group had recently appointed a Continuing Health Care Liaison Nurse, who oversees the management of people with complex care needs across the Risedale homes. She supports staff with planning peoples care and takes part in funding reviews and deprivation of liberty assessments. This new role was already proving beneficial in speeding up peoples access to specialist care. We saw that peoples weight was monitored and professional advice was sought as necessary to help people maintain a healthy weight. Records showed people had good access to outside health care and had seen their doctor as necessary. The chiropodist visited on the day of our inspection, and the community physiotherapist had visited the day before. The records we saw showed people had been seen by the optician and dentist. The Risedale group maintains a skills register of staff with specialist skills and knowledge in particular areas of care such as nutrition, wound management, continence care and safe moving and handling of people. This means staff can always access specialist advice for people with complex care needs. Nursing staff also had a range of advanced clinical skills including taking blood, inserting catheters, passing nasal tubes and managing stomach tube feeds. We looked at the management of medication and saw all nurses completed comprehensive medicines training. There were written guidelines in place covering the Care Homes for Older People Page 14 of 29 Evidence: ordering, receipt, storage, administration and disposal of medicines. We looked at medicines records and storage, and stock checked a few items which showed the amount of medicines received, the amount administered, and we found the amount left was correct. We also saw that medicines due at odd intervals, such as alternate days, once a week or in variable doses were well managed. Privacy and dignity was given a high profile in the home and was included in all staff training events. People we spoke with were happy with the way staff treated them, and felt their privacy and dignity was maintained. Staff knocked on bedroom doors before entering and people who shared bedrooms had their privacy maintained by the use of curtains or screens across the room. Some people liked their bedroom to be kept open while they were in bed and this was recorded in peoples care plans. All toilets and bathrooms had door locks fitted. The Risedale group has implemented the NHS Gold Standard Framework for end of life care and staff have been trained in palliative care. They employ an end of life care nurse specialist, and nursing staff have been trained in the use of syringe drivers, core drugs and are able to verify death. We saw that end of life care wishes had been discussed with people and their wishes documented. The home used the NHS Preferred Priorities of Care document, so people could have a record of their wishes that would be respected by all health and social care staff once the person was no longer able to speak for themselves. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a good range of activities and entertainment both in and outside of the home. The provison of food was highly praised and people were involved in the menu planning. Evidence: The home employs a full time activities organiser who works with the activity organsier from Risedale St Georges next door, to provide a varied programme of activities and events. Activity records showed that the following had taken place, theatre and shopping trips, pub outings, church services and hymns, bingo and other games. There were indivudal sessions with people who stayed in their bedrooms, such as nail care and massage. On the day of inspection there was a visiting entertainer next door at St Georges and many people from Lonsdale went over to attend. These big events alternated between the two homes and people said they liked this as it made a nice change, it also meant those people who did not wish to join in could have some quiet time. People were asked about their social and recreational interests and the activity organiser used this information to ensure he provided something suitable for Care Homes for Older People Page 16 of 29 Evidence: everyone, taking into account their choice, religious and cultural needs. There was a salon for visiting hairdressers to use. People told us they were able to spend the day as they wished, and get up and go to bed when it suited them. Staff said a number of people liked an afternoon lie down, some people liked to go to bed straight after tea and others chose to stay up late and watch television. Last year Risedale employed an occupational therapist to support the activity staff across their homes, and this enabled staff to access new ideas and information. The manager told us the activity orgainser was due to attend training in chair aerobics. People who completed our surveys told us there were always activities arranged that they could take part in. We spoke with several visitors in the home, who told us they were always made welcome, could visit at any time and were offered refreshments. Some visitors told us they regularly had meals in the home with their spouse. We asked people about the provision of meals, looked at menus, and observed breakfast, lunch and tea being served. Supper was offered later in the evening. There was a four week menu, which had been updated following talks with people about what they liked to eat. There were cooked items served for breakfast each day, and two choices of main meals and desserts at lunch and again in the evening. People were asked to make their choices one day in advance and the kitchen had copies of these order sheets. We saw there were additional alternatives should people not want either of the main dishes. Catering and care staff were aware of peoples nutritional needs and preferences, and special or restricted diets were catered for. People we spoke with confirmed they happy with the food sayiing they enjoyed the meals, the food is very good, and its all really nice. The completed surveys we received told us people were always happy with the meals served. We saw that all staff were present at meal times to serve and help people with their food. We saw people being assisted discreetly and with patience. Nutritional assessments were in place and peoples food and fluid intake, and weight was monitored. Care plans were in place for people with swallowing difficulties and staff were trained in how to support them to eat safely. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service listened to people and managed complaints promptly in a positive manner. Staff understood safeguarding procedures and peoples rights were protected. Evidence: There was a complaints procedure on display describing how to raise complaints or concerns. A copy of this was given to each person living in the home, or their relatives at the time of admission. People we spoke with, and those who completed our survey told us they knew how to complain, but had not found it necessary to do so. The manager told us she had received one complaint in the last year. We looked at the details of this and saw the manager and director of nursing for Risedale had visited the family who complained to listen to their concerns. The home carried out a detailed investigation and found there were some improvements to be made in monitoring peoples fluid intake and output. A training plan was drawn up for staff and the family were kept informed of this, and invited to comment on the training plan. They were also given the opportunity to come and talk to the staff group about their experience. This shows the company have a very positive attitude to managing complaints and handles problems well by listening to people and learning from what they say. There was guidance for staff on recognising and reporting suspected abuse, and staff received training on this in their initial induction and through ongoing annual updates. Care Homes for Older People Page 18 of 29 Evidence: All staff had received training on the Mental Capacity Act, Deprivation of Liberty Safeguards and managing challenging behaviour. A number of senior staff were trainers in these subjects. The manager and registered provider work well with the commission and with the local authority, and have been pro-active in making safeguarding referrals and deprivation of liberty referrals when they have been concerned for a persons welfare. This shows they have a good understanding of the safeguarding process and of their responsibilities not only to protect people, but to ensure they get the professional help and support they need. 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. People live in a very clean home that is comfortable and has suitable adaptations and equipment to help those with mobility problems. Evidence: Risedale at Lonsdale is a purpose built care home. There are two floors separately staffed and served by a passenger lift. There was a five year development plan in place setting out a planned maintenance and renewal programme. The home employed a full time maintenance man and there was a lead engineer and a health and safety manager for the Risedale group. There were 31 single and 7 shared bedrooms, all with an en suite toilet and hand basin. The shared rooms had screens in place to maintain peoples privacy. The majority of bedrooms had been decorated since the last inspection, some also had new flooring and lighting. Some people declined to have this work done and their rooms remain as they were. There was a large dining lounge on each floor, and a small conservatory upstairs. New flooring had been laid in the dining lounges at the last inspection, and since then further improvements had been made. The kitchen bays had been completely replaced, and the rooms had been decorated and provided with new curtains, new dining tables and chairs and new armchairs. There were also new wall mounted Care Homes for Older People Page 20 of 29 Evidence: televisions. There was good access to a small garden with a water feature and gazebo. The garden was level for safe walking and wheelchair access, and there was seating provided. There were five assisted bathrooms, two of which had been redecorated and refurbished with new equipment since the last inspection. The manager told us they planned to refurbish the remaining bathrooms and reduce the number of shared rooms, as part of the homes five year plan. There were sufficient spacious toilets located near to the main living areas in the home. There were sufficient aids and adaptations to help people with mobility problems including handrails in the corridors and bathrooms. The home had purchased four new electric hoists, one with built in weighing scales. There were assisted baths with seats, electric profiling nursing beds and a range of specialist mattresses. People also had their own personal equipment such as wheelchairs and walking frames. There was a hair salon fitted with back wash basins. Staff received compulsory annual training in infection control which included basic hand washing practice and updated information on the management of infectious diseases and illnesses. There were good hand washing facilities around the home, with each room supplied with liquid soap and paper towels. Staff had ample supplies of gloves and aprons, and there was a contract in place for clinical waste disposal. There were plenty of domestic staff and the home was clean and fresh throughout. The laundry was well organised and operated a one way system, with dirty laundry coming in to the washing area via one door, then moving through the drying and ironing areas before leaving by a second door. This is a good way to keep dirty and clean items separate and reduce cross infection. People told us they were satisfied with the laundry saying, my clothes are are washed quickly and come back nicely ironed. Laundry staff confirmed there were good supplies of bedding and towels, and said these items were washed at high temperatures to reduce infection. A name labelling machine and some new cleaning equipment had been purchased. The kitchen had new fridge freezers, a new cold store and a new catering size food mixer. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for and supported by a highly skilled and caring staff team. Evidence: We found staffing numbers and skill mix were appropriate to meet peoples needs. The two floors of the home were staffed separately with more nursing input on the first floor where people were generally more dependant. Rotas showed that staffing generally comprised of 3 registered nurses and 8 care staff during the morning, reducing to 2 nurses and 3 carers at night. On the day of this unannounced inspection there were also 2 care staff working solely with people in receipt of one to one care, a work experience student, a college student and a trainee nurse. There was also the activity organiser, 3 kitchen staff, 4 domestics, a receptionist and the maintenance man. The manager worked Monday to Friday office hours, but was available at other times as needed. Risedale operate their own accredited training department and run the majority of their staff training in house. New care staff work a number of shifts in addition to normal staffing numbers and complete a short induction which covers fire, moving and handling, health and safety and infection control. They are then enrolled on a 10 day full induction course based at the Risedale training department. This induction course runs four times a year, and incorporates the Care Sector Alliance and Social Care Training programmes. Care Homes for Older People Page 22 of 29 Evidence: Care staff were also supported to gain National Vocational Qualifications (NVQ) in care, and 83 of carers had completed this to at least level 2. Another 2 care staff were due to start the course. Catering and domestic staff were also supported to gain an NVQ relevant to their roles. For all staff there was a compulsory annual training programme. The manager monitors staff attendance at these events and we saw individual training records were in place for each staff member. For the registered nurses there was a skills carousel where they could update their clinical skills, such as taking blood and compression bandaging. We spoke with a range of staff including carers, registered nurses and students. They told us they received good training and felt well supported at Lonsdale. They told us staffing levels were good and enabled them to look after people properly. The staff surveys we received told us; Lonsdale provides a good standard of nursing care for residents from the nurses ... residents are given choices ... there is a high standard of care from care staff. We are given good training throughout our employment ... excellent care is given to residents. The home has a very good training programme ... training is excellent and the home is flexible to the changing needs of residents and staff. One person thought they could have more quality time with residents and not have to rush so much. We looked at staff recruitment practice and saw that robust procedures were followed. These included criminal records bureau checks, written references, and interviews. Staff received a statement of terms and conditions and were provided with thorough induction and ongoing training. Risedale regularly employs newly qualified registered nurses and provides good post registration training and support to help them settle into their new professional role. The service plans ahead and has good strategies in place for covering staff absence so they never need to use agency staff who do not know the home. People we spoke with during the day told us they liked the staff very much, and described them as wonderful and marvellous. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home is managed safely and demonstrates a strong commitment to excellence based on the views of the people living there. Evidence: The registered manager Mrs Anna Paule has been the manager at Risedale at Lonsdale since January 2009. She is a registered nurse and has completed the Registered Managers Award. She was previously a senior nurse at Lonsdale. She is registered with the Care Quality Commission and has demonstrated she is suitably qualified and competent to the manage the service. The manager is supported by senior nurses and by the Risedale directors, who make regular unannounced day and night visits to the home. She attends the Risedale group managers meetings to keep up to date with changes within the organisation. We found the manager was knowledgeable about the people living in the home and had a good understanding of their individual situations and care needs. Staff told us the manager was approachable and open to their ideas and suggestions. We saw that Care Homes for Older People Page 24 of 29 Evidence: regular staff meetings took place for all grades of staff. The company operated a comprehensive quality assurance system which included out of hours visits by the manager and directors, surveys and audits. The manager had sent out resident/relative surveys in May 2009 and was planning to send them again shortly. Last years surveys showed generally high levels of satisfaction. The manager had drawn up an action plan to address any issues raised, which had mostly been about decoration, replacement of furniture and suggestions for the menu, which had been put in place. It was evident that the manager took notice of the survey results and tried to make the changes people asked for. Monthly audits were carried out by the manager and senior staff to check on care planning, management of medicines, kitchen hygiene, the general environment and safety of equipment, and any accident reports. This is good practice and helps to ensure that high standards are maintained in all areas of the service. We saw that the manager had correctly referred one person for a Deprivation of Liberty Safeguard assessment. There was documentation in place from the authorities detailing how this persons liberty was to be restricted to keep them safe. Staff were aware of this and the situation was under constant review. There was a five year development plan in place for the service detailing planned refurbishment and renewal of equipment. This included plans to refurbish the remaining bathrooms and to reduce the number of shared bedrooms. There was clear evidence of strategic planning, and ongoing investment and improvement in the service. The manager holds spending money on behalf of some people and we looked at the way this was managed. The individual records, receipts and monies were held securely, and audited regularly by two staff. We checked a sample of records and money and found these were correct. There was formal staff supervision in place, with staff having five individual supervision sessions per year with their allocated senior, and one annual appraisal. The records of these were held in staff training and development files. Staff confirmed they received regular supervision, and the nurses who acted as supervisors told us they had received sufficient training to take on this role. Risedale employ a health and safety manager who has dedicated time to deliver staff training and meet regularly with the maintenance team to ensure the health and safety of residents and staff is protected. We saw the service records for the home which showed that hoists, bath seats, lifts, fire safety and other equipment underwent regular safety checks and inspections. Care Homes for Older People Page 25 of 29 Evidence: Health and safety training for staff was robust and took place at frequent intervals including fire safety, moving and handling, infection control, food hygiene and management of challenging behaviour. All shift leaders were qualified 1st aiders. The kitchen had been awarded an excellent food safety rating by the environmental health officer. All staff were trained in food handling. We judged the health, safety and welfare of residents and staff was being sufficiently promoted and protected. Care Homes for Older People Page 26 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 27 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 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 Care Homes for Older People Page 28 of 29 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!