Care Home: Shire Lodge Nursing Home

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What the care home does well People have access to the information they require to make an informed choice about whether to move to Shire Lodge. A combined statement of purpose & service user guide sets out information about the aims of the home and the services provided. People who use the service receive the care and support they require. Records indicate that staff seek advice from relevant professionals where concerns are identified. People who use the service are treated with respect. Staff members use people`s preferred form of address, which is recorded in their individual plans. People appeared to enjoy the activities that were provided on the day of the visit. Two designated members of staff undertook craft activities with people on a one to one basis. Activity organisers also spent time playing games and dancing with people. Staff members are well trained. Records indicate that they receive training on a range of safe working practices as well as other issues relevant to their work. Information provided prior to the visit indicates that eighty five per cent of staff have obtained National Vocational Qualification level two and above or are in the process of obtaining such an award. When asked what the home does well, people who use the service stated: `Most things`; `Overall care excellent`; `It does all things in a kind, cheerful and efficient manner`. The comments of staff members included the following: `Care for people in a compassionate, kind & friendly manner. Provide care and change care according to the needs of the individual. Communicate well with relatives and stakeholders. A homely and happy environment`; `Shire Lodge provides excellent care for its residents`. Health care professionals stated that: `The staff at Shire Lodge keep up to date with their skills and outlook and are willing to take on responsibilities to provide excellent care outcomes for their client group. Recently they have taken on the Liverpool Care Pathway to provide excellent end of life care`; `Everyone at Shire Lodge from reception to matron make a positive welcome and give high professional standards. The atmosphere of the home is excellent with a united approach to providing the best possible care for the people living there`. What has improved since the last inspection? Amended risk assessments relating to the use of bed rails and reclining or specialist chairs have been implemented since the date of the last inspection. New wound assessment charts and care plans have also been introduced. Staff members have received training on the Liverpool Care Pathway and this has been implemented for people requiring end of life care. Many areas of the home have been redecorated. The registered manager stated that work would continue to address other areas of the home. New beds and pressure relieving mattresses have been purchased. A system of monthly audits has been introduced, which looks at issues such as care planning, medication, monitoring charts and accidents. What the care home could do better: Further improvements must be made to care planning processes. Some of the amendments that have been made to individual plans have been added to existing documents and are not in chronological order. This may make it more difficult to identify up to date information about people`s needs. A revised care plan should be completed when people`s needs change to ensure that up to date information is easily accessible. A letter from a person`s GP authorised the covert administration of medication as long as his family and other relevant professionals were in agreement. The registered manager stated that the issue had been discussed with all of those involved but acknowledged that their agreement had not been recorded in one place, making it difficult to locate. The medication has since been discontinued. The agreement of people`s family members and relevant professionals to the covert administration of medication should be recorded in a separate care plan relating to its use. A number of fire doors were wedged open at the time of our visit. Magnetic door guards should be fitted to doors to enable them to be left open if required. A number of people who use the service and staff raised issues about staff shortages, noting that absenteeism appeared to be a particular issue. The registered manager stated that disciplinary action has been taken against people who repeatedly fail to turn up for work and reported that the home is in the process of recruiting more staff. This issue needs to be kept under review. Key inspection report Care homes for older people Name: Address: Shire Lodge Nursing Home 281 Rockingham Road Corby Northants NN17 2AE     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: Martin Hefferman     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Shire Lodge Nursing Home 281 Rockingham Road Corby Northants NN17 2AE 01536200348 01536447873 birchesterplc@yahoo.co.uk helenrussellrgn@AOL.com Birchester Medicare Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon Lorraine Goodall Type of registration: Number of places registered: care home 50 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: Four named service users who are below the age of 65 years. In the category Personal Care only 3 named residents may be accommodated in the category Physical Disability PD under the age of 65 years. Of the 50 residents, up to 20 may be in the category of Personal Care only in the categories OP, DE(E) and PD(E). To accommodate one named service user who is under the age of 65 years within the category of DE (E) Date of last inspection 2 1 0 7 2 0 0 9 0 0 0 Over 65 10 50 40 Care Homes for Older People Page 4 of 23 Brief description of the care home Shire Lodge Nursing Home is registered to provide care for up to fifty older people requiring personal care, nursing care and dementia care. The home is a converted & extended farmhouse and is situated on the outskirts of Corby within walking distance of community resources including churches, shops and pubs. Accommodation is provided across two floors. The home is divided into several areas, each area consisting of bedrooms and lounge / dining facilities. The home has a rear garden, which is accessible to people who use the service, and car parking is available at the front. At the time of the inspection, weekly fees ranged from £310 to £770 plus any nursing contribution. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit took place on 14th April 2010. The main method of inspection used was case tracking which involved selecting two people who use the service and tracking the care they receive through review of their records and discussion with them (where possible) & staff and observation of care practices. This inspection has also taken into account all of the information we have received since the date of the last key inspection, including the outcome of a random inspection (which took place on 21st July 2009) and the providers annual quality assurance assessment. Comment cards were received from four people who use the service, five members of staff and two health care professionals. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? Amended risk assessments relating to the use of bed rails and reclining or specialist chairs have been implemented since the date of the last inspection. New wound assessment charts and care plans have also been introduced. Staff members have received training on the Liverpool Care Pathway and this has been implemented for people requiring end of life care. Many areas of the home have been redecorated. The registered manager stated that work would continue to address other areas of the home. New beds and pressure Care Homes for Older People Page 7 of 23 relieving mattresses have been purchased. A system of monthly audits has been introduced, which looks at issues such as care planning, medication, monitoring charts and accidents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they require to make an informed choice about whether to move to Shire Lodge. Evidence: A combined statement of purpose & service user guide has been produced, which sets out information about the aims of the home and the services provided. The registered manager agreed to update contact details for the Commission contained within the document. All of the people who completed comment cards indicated that they had received enough information to decide the home was the right place for them. Copies of pre-admission assessments were available for the people who were chosen for the purposes of case tracking. Information provided prior to the visit indicates that the home involves other professionals in the admission process, where possible. Both of the health care professionals who completed comment cards indicated that the homes assessment arrangements ensure that accurate information is gathered and Care Homes for Older People Page 10 of 23 Evidence: the right service is planned for people. Care Homes for Older People Page 11 of 23 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. Action has been taken to help ensure that peoples needs are met and they are protected from harm. Evidence: Individual plans were available for the people who were chosen for the purposes of case tracking. Records indicate that they have been kept under review. Further information has been added to peoples plans since the date of the last inspection. Some of the amendments that have been made were not in chronological order. This may make it more difficult to identify up to date information about peoples needs. Risk assessments have been completed on issues such as falls, moving & handling, nutrition and pressure area care. Amended risk assessments relating to the use of bed rails and reclining or specialist chairs have been implemented since the date of the last inspection. New wound assessment charts and care plans have also been introduced. These records have been kept under review. Records indicate that staff have sought advice from relevant professionals, including community psychiatric nurses, consultant psychiatrists and dieticians, where concerns have been identified. Care Homes for Older People Page 12 of 23 Evidence: All of the staff who completed comment cards indicated that they are given up to date information about the needs of the people they care for. People who use the service indicated that they generally receive the care and support they need. They reported that the home always makes sure they get the medical care they require. Health care professionals reported that peoples health & social care needs are always properly monitored, reviewed and met by the service and that the service always seeks advice & acts on it to meet peoples health & social care needs and improve their well being. Medication administration records have been completed to a satisfactory standard. A letter from a persons GP authorised the covert administration of medication for one of the people who were chosen for the purposes of case tracking as long as his family and other relevant professionals were in agreement. The registered manager stated that the issue had been discussed with all of those involved but acknowledged that their agreement had not been recorded in one place, making it difficult to locate. The medication has since been discontinued. People who use the service were treated with respect during the course of our visit. We noted that staff members used peoples preferred form of address, which is recorded in their individual plans. Both of the health care professionals who completed comment cards indicated that the service always respects peoples privacy & dignity and that it supports people to live the life they choose wherever possible. Staff members have received training on the Liverpool Care Pathway since the date of the last inspection and this has been implemented for people requiring end of life care. A health care professional reported that the staff at Shire Lodge keep up to date with their skills and outlook and are willing to take on responsibilities to provide excellent care outcomes for their client group. Recently they have taken on the Liverpool Care Pathway to provide excellent end of life care. Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a wider range of social activities as a result of the improvements that have been made to the daily life of the home. Evidence: People who use the service appeared to enjoy the activities that were provided on the day of the visit. Two designated members of staff undertook craft activities with people on a one to one basis. Activity organisers also spent time playing games and dancing with people. Information about peoples hobbies and interests is recorded in their individual plans. In the past, people have told us that they are able to have visitors whenever they want. On this occasion, we noted that a number of people visited the home to spend time with their relatives and in some cases to take them out. All of the people who completed comment cards indicated that they like the meals provided by the home. People appeared to enjoy the meal provided on the day of the visit, which consisted of a meat pie served with fresh vegetables. Care Homes for Older People Page 14 of 23 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. Action has been taken to ensure that people who use the service are protected from abuse and their rights protected. Evidence: A copy of the homes complaints procedure is displayed in the reception area. All of the people who completed comment cards indicated that staff generally listen to them and act on what they say. They reported that there is someone they can speak to informally if they are not happy and that they know how to make a formal complaint. Both of the health care professionals who completed comment cards indicated that the service always responds appropriately if people raise any concerns. Information provided prior to the visit indicates that the home has received one complaint in the past twelve months, which was not upheld. Staff members stated that they have received training on safeguarding adults as part of their induction. They were aware of the action they should take if they suspect someone is being abused. We have been notified of two safeguarding alerts since the date of the random inspection. An investigation by the home into an allegation of verbal abuse found that it was substantiated. The care assistant has been dismissed and referred to the Independent Safeguarding Authority. We have yet to receive an outcome for the other alert. Care Homes for Older People Page 15 of 23 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 who use the service live in a spacious and homely environment. Evidence: The home was generally decorated and furnished to a satisfactory standard. Many of the areas that were inspected have been redecorated since the date of the last inspection. The registered manager stated that work would continue to address other areas of the home. She reported that plans have been drawn up to build an extension, which will provide larger communal areas for people living in Tudor Hall (a separate area for people with dementia) and increase office & storage space. New beds and pressure relieving mattresses have been purchased since the date of the last inspection. People who use the service indicated that the home is generally fresh & clean. A number of fire doors were wedged open at the time of our visit. Care Homes for Older People Page 16 of 23 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. People who use the service are protected by arrangements for the recruitment and training of staff. Evidence: Records indicate that appropriate pre-employment checks have been completed for staff members. New members of staff complete induction training to the standards set by Skills for Care. Records indicate that staff receive training on a range of safe working practices including fire safety, first aid, health & safety, infection control and moving & handling. They also undertake courses on issues such as challenging behaviour, dementia, diabetes, dignity, end of life care, pressure ulcers, mental health & illness, motor neurone disease, multiple sclerosis and Parkinsons Disease. Information provided prior to the visit indicates that eighty five per cent of staff have obtained National Vocational Qualification level two and above or are in the process of obtaining such an award. All of the staff who completed comment cards indicated that their induction covered most or all of the things they needed to know to do the job when they started. All of them stated that they are given training that is relevant to their role, helps them understand & meet the individual needs of people and keeps them up to date with new ways of working. Both of the health care professionals who completed comment cards indicated that managers & staff have the right skills & experience to support Care Homes for Older People Page 17 of 23 Evidence: peoples health & social care needs. People who use the service indicated that staff members are usually available when they need them. When asked what the home could do better, a number of people who use the service and staff raised issues about staff shortages, noting that absenteeism appeared to be a particular issue. This was confirmed by the staff we spoke to. The registered manager stated that disciplinary action has been taken against people who repeatedly fail to turn up for work and reported that the home is in the process of recruiting more staff. Care Homes for Older People Page 18 of 23 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. Action is being taken to ensure that the home is run in the best interests of the people who live there. Evidence: The registered manager has worked at the home for over eighteen years. Both the manager and deputy manager are registered nurses and both have completed level four National Vocational Qualifications in Management. A qualified nurse leads each shift. A system of monthly audits has been introduced since the date of the last inspection, which looks at issues such as care planning, medication, monitoring charts and accidents. Surveys are sent to people who use the service and staff twice a year. An action plan has been drawn up to address the issues that were identified during the last survey. Staff members receive training on a range of safe working practices including fire Care Homes for Older People Page 19 of 23 Evidence: safety, first aid, health & safety, infection control and moving & handling. Records indicate that tests of the fire alarm system and emergency lighting have been completed. Care Homes for Older People Page 20 of 23 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 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Further improvements must be made to care planning processes to ensure that current information contained within all plans is easily accessible. This is to ensure that staff have access to the information they require. 31/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 A revised care plan should be completed when peoples needs change to ensure that up to date information is always easily accessible. The agreement of peoples family members and relevant professionals to the covert administration of medication should be recorded in a separate care plan relating to its use. Magnetic door guards should be fitted to doors to enable them to be left open if required. 2 9 3 19 Care Homes for Older People Page 22 of 23 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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