Care Home: Stanley Lodge Residential Home

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What the care home does well The majority of people we consulted both in writing and during our visit, expressed satisfaction with the home and made some very positive comments. These included; `Good food, always warm, nice staff.` `The home treats residents with respect, friendly staff.` `Communicates well with the residents.` `The home is a great example to all - everything is first class - no complaints.` `The home is beautifully clean - involves the residents in numerous activities.` `Always a caring word for residents.` `Everything is to our satisfaction.` Throughout our visit we observed carers going about their duties in a cheerful and pleasant manner. There was a relaxed, friendly atmosphere in the home and residents and carers appeared to get along very well. We noted that carers addressed residents in a courteous and respectful manner. People we spoke with during our visit told us that they were happy with their care and the way it was provided. One resident told us that carers were always quick to seek medical advice on her behalf when necessary. Residents` daily diary notes also showed that carers were quick to identify and take the necessary action when residents were unwell. Residents` care plans showed that staff at the home worked well with other professionals such as community health care professionals and social workers. Where advice had been provided by community professionals we found that this was included in the relevant person`s care plan. People we spoke with during our visit told us that they were satisfied with the quality and variety of meals provided. One resident told us ``I always look forward to meal times, the cook is very good.`` We observed a meal service and noted that people`s meals looked nicely presented and appetising. We carried out a tour of the home and found all areas to be clean, warm and comfortable. People who live at the home benefit from very well maintained spacious gardens and furniture had been provided to enable people to sit out in the finer weather. Residents` bedrooms were nicely decorated and personalised with their treasured possessions such as pictures and ornaments. In addition, we were able to confirm that all residents` bedroom doors are lockable and that anyone wishing to carry their own key is provided with one. What has improved since the last inspection? Following the last inspection of the home we made a number of requirements and recommendations. We found during this visit that the majority of requirements and some recommendations had been addressed, although there were still some matters outstanding. In line with a requirement made following the last inspection, written guidance has now been made available for staff to follow in the event that a resident is admitted on an emergency basis. This will help ensure that all the necessary assessment and care planning processes are followed in these circumstances. There have been efforts to move towards more person centred practice in the home. This means exploring people`s individual needs and preferences in more detail and planning their care accordingly. We found evidence that the manager had attempted to obtain social histories for residents and a better level of information in areas such as people`s valued pastimes and relationships. We found that the home had made good progress in improving systems for managing residents` medication. Safer systems for storing and monitoring people`s medicines as well as improved record keeping have helped ensure that the health and wellbeing of people living at the home is protected. There have been improvements in the provision of activities and efforts have been made to ensure that all residents have more opportunity to take part in trips outside the home. However, we have made some recommendations to support further development in this area. We were able to confirm during this visit that residents are now able to choose from at least two menu options for each meal on a daily basis. This increases people`s opportunity to make choices in their daily lives. People who took part in our written survey and those we spoke with during our visit, told us that staffing levels at the home had improved. The manager commented that due to the increase in staffing levels, carers now have more opportunity to spend time with residents on a one to one basis. The home has an acting manager who has been in post for approximately one year. The home has benefited from this stability and the consistent management has enabled them to make the improvements described. Staff who responded to our written survey told us that they felt well supported by the manager and described her as helpful and approachable. What the care home could do better: The Service User Guide is an important document that provides various information for people considering a move to the home (or their relatives). During this visit we were concerned to find that the manager didn`t have any guides available and did not routinely provide them to residents or people making enquiries. We asked the manager to ensure that the guides are made available without delay and have made a requirement in relation to the matter. We found that there had been some improvements to residents` care plans but still noted some examples where information in care plans did not consistently reflect people`s needs. However, in discussion carers showed good understanding of residents` individual care needs and the action required to ensure their needs were met. As such, we were satisfied that the problem was in the record keeping as opposed to a failure to provide appropriate care. We talked to the manager about how gaps in people`s care plans could potentially lead to gaps in their care and made a requirement in relation to the matter. For residents who have more complex, behavioural needs it is important that there are very detailed guidelines in place to enable staff to support them in a consistent manner. We found that this level of information was not provided in all cases. We found some improvements to the way that people`s medication is managed within the home but identified some areas where further improvements could be made. In discussion the manager advised us that there were no processes in place to formally assess the competence of people who are responsible for administering medicines. It is important that such assessments are carried out and regularly reviewed so that the manager can satisfy herself that any staff member dealing with medication has the necessary skills and knowledge to do so safely. Despite being identified at the last inspection, record keeping in relation to recruitment is still in need of much improvement. We were eventually able to identify that safe recruitment processes are followed by the home but had to wait for the provider to send us various pieces of information after the inspection. We strongly recommend that every personnel file contains all the documentary evidence of their recruitment process including evidence of Criminal Records Bureau checks and where relevant POVA/ISA checks. This information should be maintained in the home and available for inspection at all times. Records relating to the induction of new staff members and supervision throughout their probationary period should be kept and regularly updated. This is so that the manager can ensure that all new staff members are provided with adequate supervision and support. Ongoing supervision needs to take place more frequently, ideally six times per year. In addition, where issues are identified in relation to a staff member`s performance, these should be addressed without delay, in line with the home`s disciplinary procedures and through supervision. The area of staff training requires further development. In particular, training in relation to key health and safety areas such as moving and handling needs to be provided to all staff and regularly updated. We also noted that despite a recommendation made following the last inspection, only two staff members have been provided with training in the area of safeguarding. Further, the home has now fallen below the fifty percent target for staff holding National Vocational Qualifications at level two or above. Training was discussed with the manager and we made some requirements and recommendations in relation to the area. Key inspection report Care homes for older people Name: Address: Stanley Lodge Residential Home School Lane Bay Horse Lancaster Lancashire LA2 0HE     The quality rating for this care home is:   one star adequate 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: Marie Cordingley     Date: 2 5 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 34 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 34 Information about the care home Name of care home: Address: Stanley Lodge Residential Home School Lane Bay Horse Lancaster Lancashire LA2 0HE 01524791904 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Unlimitedcare Limited care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 23 Date of last inspection Brief description of the care home Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster. Stanley Lodge is a detached property set in landscaped gardens and has uninterrupted views of the surrounding countryside. The majority of the residents have been admitted from the surrounding area. There are strong community links, which the management and staff endeavour to maintain. The accommodation comprises 23 single rooms, 20 of which have en-suite facilities. There are two conservatories, a lounge, and a dining room; these communal areas provide Care Homes for Older People Page 4 of 34 Over 65 23 0 Brief description of the care home residents with a choice of where to sit and who to sit with. All the personal needs of the residents are catered for by care staff. The residents general practitioners and district nursing staff manage any medical needs. Chiropodist, dental and optical treatment is arranged for residents. Care Homes for Older People Page 5 of 34 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: one star adequate 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 inspection of this home included a site visit which was carried out on an unannounced basis. This meant that the manager and staff did not know the visit was to take place until we arrived. During the visit we spent time with residents, talking to them and observing their daily routines. We also held discussions with staff at the home and the acting manager. We carried out a tour of the home looking at communal areas and a selection of residents private accommodation. We also viewed a variety of paperwork including residents care plans and staff personnel files. Prior to our visit we wrote to the manager and asked her to complete a very comprehensive self assessment. This gave us a lot of information about how the home is managed. In addition, we wrote to a selection of residents and staff and asked them Care Homes for Older People Page 6 of 34 to take part in a written survey about their opinions of the service provided. Care Homes for Older People Page 7 of 34 What the care home does well: The majority of people we consulted both in writing and during our visit, expressed satisfaction with the home and made some very positive comments. These included; Good food, always warm, nice staff. The home treats residents with respect, friendly staff. Communicates well with the residents. The home is a great example to all - everything is first class - no complaints. The home is beautifully clean - involves the residents in numerous activities. Always a caring word for residents. Everything is to our satisfaction. Throughout our visit we observed carers going about their duties in a cheerful and pleasant manner. There was a relaxed, friendly atmosphere in the home and residents and carers appeared to get along very well. We noted that carers addressed residents in a courteous and respectful manner. People we spoke with during our visit told us that they were happy with their care and the way it was provided. One resident told us that carers were always quick to seek medical advice on her behalf when necessary. Residents daily diary notes also showed that carers were quick to identify and take the necessary action when residents were unwell. Residents care plans showed that staff at the home worked well with other professionals such as community health care professionals and social workers. Where advice had been provided by community professionals we found that this was included in the relevant persons care plan. People we spoke with during our visit told us that they were satisfied with the quality and variety of meals provided. One resident told us I always look forward to meal times, the cook is very good. We observed a meal service and noted that peoples meals looked nicely presented and appetising. We carried out a tour of the home and found all areas to be clean, warm and comfortable. People who live at the home benefit from very well maintained spacious gardens and furniture had been provided to enable people to sit out in the finer weather. Residents bedrooms were nicely decorated and personalised with their treasured possessions such as pictures and ornaments. In addition, we were able to confirm that all residents bedroom doors are lockable and that anyone wishing to carry their own key is provided with one. Care Homes for Older People Page 8 of 34 What has improved since the last inspection? What they could do better: The Service User Guide is an important document that provides various information for people considering a move to the home (or their relatives). During this visit we were concerned to find that the manager didnt have any guides available and did not routinely provide them to residents or people making enquiries. We asked the manager to ensure that the guides are made available without delay and have made a Care Homes for Older People Page 9 of 34 requirement in relation to the matter. We found that there had been some improvements to residents care plans but still noted some examples where information in care plans did not consistently reflect peoples needs. However, in discussion carers showed good understanding of residents individual care needs and the action required to ensure their needs were met. As such, we were satisfied that the problem was in the record keeping as opposed to a failure to provide appropriate care. We talked to the manager about how gaps in peoples care plans could potentially lead to gaps in their care and made a requirement in relation to the matter. For residents who have more complex, behavioural needs it is important that there are very detailed guidelines in place to enable staff to support them in a consistent manner. We found that this level of information was not provided in all cases. We found some improvements to the way that peoples medication is managed within the home but identified some areas where further improvements could be made. In discussion the manager advised us that there were no processes in place to formally assess the competence of people who are responsible for administering medicines. It is important that such assessments are carried out and regularly reviewed so that the manager can satisfy herself that any staff member dealing with medication has the necessary skills and knowledge to do so safely. Despite being identified at the last inspection, record keeping in relation to recruitment is still in need of much improvement. We were eventually able to identify that safe recruitment processes are followed by the home but had to wait for the provider to send us various pieces of information after the inspection. We strongly recommend that every personnel file contains all the documentary evidence of their recruitment process including evidence of Criminal Records Bureau checks and where relevant POVA/ISA checks. This information should be maintained in the home and available for inspection at all times. Records relating to the induction of new staff members and supervision throughout their probationary period should be kept and regularly updated. This is so that the manager can ensure that all new staff members are provided with adequate supervision and support. Ongoing supervision needs to take place more frequently, ideally six times per year. In addition, where issues are identified in relation to a staff members performance, these should be addressed without delay, in line with the homes disciplinary procedures and through supervision. The area of staff training requires further development. In particular, training in relation to key health and safety areas such as moving and handling needs to be provided to all staff and regularly updated. We also noted that despite a recommendation made following the last inspection, only two staff members have been provided with training in the area of safeguarding. Further, the home has now fallen below the fifty percent target for staff holding National Vocational Qualifications at level two or above. Training was discussed with the manager and we made some requirements and recommendations in relation to the area. Care Homes for Older People Page 10 of 34 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 11 of 34 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 12 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensure that they have a good amount of information about residents before they are admitted, but prospective and new residents are not always provided with the appropriate information about the home. Evidence: All homes are required to provide a Service User Guide for residents, their representatives or people making enquiries about the home. During our visit we asked to view the homes Service User Guide and were advised by the manager that she did not have one available. The manager confirmed during discussion that a Service User Guide was not routinely provided to people living at the home or people making enquiries. This was despite information we were given in the homes Annual Quality Assurance Assessment. We asked the manager to ensure that the guide be made available as soon as possible Care Homes for Older People Page 13 of 34 Evidence: and also asked her to ensure that the guide included all the appropriate information such as the services provided at the home and fees charged, for example. As part of our case tracking exercise we looked at the pre admission assessments for several residents. We found that the assessments were of a satisfactory standard and in general, contained a good level of information about peoples care needs and the support they required. We also noted that where appropriate, peoples representatives had been present at their assessment and had been involved in the process. This is important to help ensure that the views of prospective residents are taken into account during the assessment process. Care Homes for Older People Page 14 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carers understand peoples needs and the support they require but gaps in care planning information could potentially lead to gaps in the care people receive. Evidence: We viewed a selection of residents care plans as part of our case tracking exercise. In general we found that peoples care plans contained a good level of information about most aspects of their care. We also noted that efforts had been made to include more person centred information such as peoples preferred daily routines and their valued relationships and hobbies. The manager advised us that the home had introduced a keyworker system to further support person centred practice. Whilst we found good levels of information regarding some aspects of peoples care we did note some basic areas of peoples daily needs which were not referred to in their care plans. These included areas such as foot care, oral care and eye care. However, when viewing peoples daily diary notes, it was apparent that these aspects of support Care Homes for Older People Page 15 of 34 Evidence: were being provided and as such, we were satisfied that the gaps in care plan records had not led to gaps in the care provided. We viewed the care plan of one resident who had some complex needs in relation to their mental health. We found that there was some information and guidance for carers about the residents complex needs but that this information needed to be expanded on to provide more prescriptive guidance. This would help carers approach the residents more complex needs in a consistent and confident manner. The home have processes in place to assess the risks faced by each resident in areas such as falling or developing pressure sores. We found that the manager ensured that these risk assessments were carried out for all residents and were regularly updated to take into account peoples changing needs. However, when we viewed examples of the homes falling risk assessment we did identify some problems with the format which could potentially lead to inaccurate assessments. We pointed this out to the manager and asked her to review the document as soon as possible. The home have systems in place for the safe receipt, storage, administration and disposal of peoples medication. We viewed a number of records relating to medication and found these to be in good order and well maintained. We also noted that medicines were stored, safely and securely. We found some general improvements in the way medicines records and stock were organised. Records of medicines received, given to people and disposed of were clearer and a better system of stock control had been developed that made accounting for medicines much more straight forward. We checked a sample of medicines and found they usually added up showing they had been given correctly. We found no discrepancies in the stock and records we checked. We also found that errors made by the dispensing pharmacist had been identified by carers who had taken the appropriate action to have the problems rectified. This demonstrated that carers check records carefully when administering medication. Some people who live at the home are prescribed medicines on an as and when required basis. We advised the manager to ensure that comprehensive information about how and when such medicines should be given is in place in all cases. We looked at how medicines were checked and audited. We saw evidence of checks but these were not as regular as we would recommend. We advised the manager to implement more frequent audits so that any mistakes would be quickly identified and Care Homes for Older People Page 16 of 34 Evidence: rectified. In discussion the manager advised us that there was no process in place for assessing the competence of people who administer medication to residents. We advised the manager that all staff who manage peoples medicines must be assessed as being competent to do so and that their competency must be regularly reviewed. This is to help ensure the health and wellbeing of people who live at the home. During our visit we viewed a general communication book used by staff at the home. We found that the book which identified people by their room numbers and sometimes by their name, contained examples of personal information and therefore compromised peoples privacy. We also found examples of inappropriate comments made by carers about residents. These issues were discussed with the manager during our visit. Care Homes for Older People Page 17 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities programme has improved but needs to be constantly evaluated to ensure that it meets every residents individual needs and preferences. Evidence: We noted that the home had made more efforts to explore peoples social care needs and the majority of peoples care plans we viewed contained information about their social histories, preferred daily routines and valued hobbies and pastimes. It was apparent when talking with residents that the manager had achieved some improvement in the quality and variety of activities provided. Residents we spoke to told us that there were more trips out organised. Some residents told us about a trip to a local farm days earlier, which they had enjoyed very much. In discussion the manager advised us that she hoped to increase opportunities for trips out and also commented that she wanted to ensure all residents benefited from the chance to take part in the trips. The manager explained that more efforts were now being made to involve residents in the daily running of the home, and that some residents were being involved in tasks like gardening and serving snacks. Care Homes for Older People Page 18 of 34 Evidence: Records are kept in the home of the activities provided for residents and these showed that people had been able to take part in events such as quizzes, crafts and singalongs, as well as numerous celebrations within the home for birthdays or occasions such as Halloween. However, records were still patchy and it was difficult to assess how individual residents had responded to various activities or even if they had chosen to take part. In discussion, residents were very complimentary about the quality and variety of food served. In addition, people told us that there was always a choice of main meal on a daily basis and this was evidenced when we viewed menus and records of meals served. We observed a lunch service and noted that the dining room was very pleasant. Tables were nicely set, with suitable condiments and flowers. The meal time was a sociable occasion and residents appeared to enjoy their meal which looked nicely presented and appetising. Care Homes for Older People Page 19 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to raise concerns and their concerns are taken seriously. Carers may fail to take appropriate action to safeguard residents if they are not provided with adequate training in this area. Evidence: The home has a complaints procedure in place which is clearly written and easy to understand. We viewed the procedure and found that it contained all the appropriate information required and contact details of relevant people. In discussion, the acting manager advised us that the procedure has now been made available in large print. In addition, we were advised that work was ongoing to make the procedure available in other formats such as audio, so that more people have access to the information. We also noted that the manager had made efforts to ensure that all residents and their relatives were aware of the procedure. At the most recent relatives meeting the manager had gone through the procedure with the attendees and had also discussed the procedure with individual residents. The home keeps a record of all complaints or concerns raised. We viewed this and found that all complaints made since the last inspection had been dealt with appropriately and in a timely fashion. We made a recommendation that the record be Care Homes for Older People Page 20 of 34 Evidence: maintained in a book as opposed to its current loose leaf folder design, to ensure that information is not lost. The manager and staff we consulted showed a good understanding of Safeguarding procedures. Carers were aware of whistle blowing procedures and told us that they felt confident that any reports of abuse or bad practice would be dealt with appropriately. However, when we viewed the homes whistle blowing procedures we noted that they didnt contain any information for staff about their rights under the Public Interest Disclosure Act 1998 - we made a recommendation that this be added so that staff have a full understanding of their rights in the event that they make a disclosure. Following the last inspection of the home we made a recommendation that all staff be provided with training in Safeguarding adults. We viewed records of training held within the home and were unable to find evidence that this training had been provided. However, we did note that there were courses booked in the near future for all staff in this area. Care Homes for Older People Page 21 of 34 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 live at the home are provided with comfortable and homely accommodation. Evidence: Stanley Lodge is a spacious home with a variety of communal areas and well maintained grounds for the residents use. All accommodation is offered on a single room basis and all but three of the bedrooms have en suite facilities. We carried out a tour of the home and found that all areas of the home were clean, warm, and comfortable. We also noted that the home was furnished and maintained to a satisfactory standard. We saw some evidence of improvements that had been carried out since our previous inspection. These included the provision of a new stair lift and new garden furniture. We viewed a selection of residents bedrooms and noted that these were nicely personalised, decorated and furnished in line with peoples individual tastes and contained personal items such as pictures, ornaments and other treasured possessions. The home employs a maintenance staff member whose time is split between Stanley Care Homes for Older People Page 22 of 34 Evidence: Lodge and other homes owned by the same provider. We viewed the maintenance book and noted that when some requests had been written in by the staff at the home, there appeared to be a time scale of several weeks in some cases before issues were attended to. We discussed this with the manager and asked her to ensure that all requests were dealt with promptly. The home has guidance in place in relation to infection control and staff we spoke with were aware of the procedures to be followed. However, records of training showed that not all staff had received training in infection control. We advised the manager to address this matter as soon as possible to ensure that staff are aware of the measures needed to protect peoples health and wellbeing. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Processes for monitoring the recruitment and training of new staff need to be improved to protect the safety and wellbeing of people who live at the home. Evidence: We viewed personnel files for several staff members to ensure that the home carry out the appropriate background checks for all new employees. As with previous inspections, we found that there was missing documentation mainly in relation to the receipt of Criminal Record Bureau Disclosures for several staff members. The documentation was provided at a later date by the owner of the home but was not available for inspection in the home as we have previously requested. It is important that such documentation is available in the home at all times so that the manager can demonstrate that the correct recruitment procedures have been followed and so that personnel files can be properly audited. People who responded to our written survey and those we spoke to during our visit told us that staffing levels had improved. Rotas showed that there had been an increase in staffing hours and in discussion the manager advised us that this had enabled her to improve the provision of activities for residents. We looked at records of induction and training for carers. We noted that whilst carers Care Homes for Older People Page 24 of 34 Evidence: were provided with induction, this was brief, in house induction. The manager was not familiar with The Skills for Care induction standards which should be provided to all carers at the start of their employment. Training records showed that this area had not improved a great deal since the last inspection. We were concerned to note that a number of carers had still not been provided with training in key health and safety areas such as moving and handling and fire safety, despite being employed at the home for a significant amount of time. In addition only two carers had been provided with training in Safeguarding adults despite our recommendation after the last inspection that this training be rolled out to all carers. Records also showed that the home have fallen under the 50 percent target for carers holding National Vocational Qualifications in care at level 2 or above. We discussed the above findings with the manager and have made several requirements and recommendations in relation to the matters. Care Homes for Older People Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff must be trained in safe working practices to help ensure the safety and wellbeing of people who live at the home. Evidence: At the time of our inspection the home was without a registered manager. However an acting manager has now been in post for around a year and is due to begin the process of registration with the Commission. We were advised by the manager that she had recently enrolled on management training and that she was planning to undertake the Leadership and Management Award. We received the homes Annual Quality Assurance Assessment (AQAA) within agreed timescales and this document was completed to a good standard. However, we noted that some of the information provided in the AQAA did not always reflect working practices within the home. There are some systems in place to assist the manager in assessing quality within the Care Homes for Older People Page 26 of 34 Evidence: home and residents and their families are involved in these processes. Regular meetings now take place with residents and satisfaction surveys are carried out on a regular basis. We advised the manager to ensure that results from resident satisfaction surveys be published in the homes Service User Guide. We looked at records of supervision -where staff members have the opportunity to meet with their manager on a one to one basis - and found that the manager was attempting to ensure that all staff were given this opportunity. We made a recommendation that the manager ensure that supervision be provided regularly and more frequently when there are issues about a staff members performance. Some people who live at the home need assistance to manage their day to day finances. We viewed samples of records relating to residents finances and found these to be well maintained and in good order. The home has a health and safety policy in place which is supported by a number of separate procedures in areas such as fire safety and COSHH (control of substances hazardous to health). We also viewed a number of certificates during our visit confirming regular inspection and maintenance of equipment and utilities within home. Training records viewed confirmed that not all staff members had been provided with training in the key health and safety areas such as moving and handling and fire safety. This was despite a requirement made following a previous inspection, that all staff be provided with training to enable them to carry out their roles well and safely. Care Homes for Older People Page 27 of 34 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 28 of 34 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 1 5 All new and prospective residents must be provided with a Service User Guide which contains all the information as specified in Regulation 5 of The Care Homes Regulations, 2001. This is so that people have sufficient information about the home. 25/05/2010 2 7 15 Peoples care plans must clearly state the action required by carers to ensure that all aspects of their health, personal and social care needs are met. This is so that people receive the care they need. 25/06/2010 3 9 18 All staff who manage residents medication must be regularly assessed as being competent to do so. 25/04/2010 Care Homes for Older People Page 29 of 34 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 This is to help ensure that residents medication is administered safely at all times. 4 10 12 Personal information about residents must be recorded in their personal files and not general communictaion documents. This is to help protect residents privacy and dignity. 5 18 13 All staff members must be 25/06/2010 provided with training in the area of Safeguarding Adults. This is to help ensure that residents are protected from abuse. 6 30 18 All staff must be provided with training in the key health and safety areas. This is to help ensure that staff work safely and in a manner that protects the health and safety of people who live at the home. 7 38 13 All staff must be made aware of the homes health and safety policy and supporting procedures in individual areas such as fire safety. 31/05/2010 25/09/2010 25/04/2010 Care Homes for Older People Page 30 of 34 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 This is to help ensure that staff work safely with people and in a manner that protects their health and wellbeing. 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 1 The homes Service User Guide should be made available in a variety of formats. This is so that more people have access to the information. The manager should ensure that any significant changes in residents weights are investigated and a record made of the findings. The care plans of people who have complex behavioural needs should contain very clear guidance for staff in how to support them in this area. This is so that carers can deal with situations confidently and consistently. The falling risk assessment used by the home should be reviewed to ensure that it provides accurate and meaningful outcomes. The manager should review the frequency of medication audits to ensure that they are carried out at appropriate timescales. As part of the medication audit the manager should ensure that there are clear up to date plans in place for any resident who is prescribed a medicine on an as and when required basis. Individual records for each resident should be kept in relation to activities they have taken part in. This will help ensure that every resident is provided with the chance to take part in activities that are in line with their individual needs and preferences. 2 7 3 7 4 8 5 9 6 9 7 12 Care Homes for Older People Page 31 of 34 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 8 9 16 18 A record of complaints should be kept in a bound book so that information cannot be removed or lost. The homes whistleblowing procedures should include guidance to staff on their rights under The Public Interest Disclosure Act 1998. This is so that staff have a full understanding of their rights under the act. Consideration should be given to the removal of the communal cubicle toilets on the ground floor of the home. Processes should be reviewed to ensure that any maintenance jobs reported for attention are dealt with in a prompt fashion. The homes rota should identify staff members poistions. This is so that the manager can demonstrate that there is an appropriate skill mix on duty at any one time. At least 50 of carers should hold National Vocaional Qualifictaions in care at level 2 or above. This is so that people receive their care from suitably qualified staff. All staff members should be provided with induction that is in line with Skills for Care standards. Clear records should be kept of the monitoring and supervision of staff members throughout their probation period. It is strongly recommended that all staff records as listed in Schedule 2 of the Care Homes Regulations 2001, are maintained within the home and made available for inspection at all times. All staff should be made aware of the General Social Care Council code of conduct and their responsibility to work in accordance with it. The manager should apply for registration with the Commission. This is to help ensure that the home benefits from consistent and stable management. The manager should complete the Leadership and Management Award. This is to help ensure that the home benefits from effective leadership. All results from quality assurance exercises should be published and provided to residents, their relatives and other stakeholders. Page 32 of 34 10 11 26 26 12 27 13 28 14 15 29 29 16 29 17 29 18 31 19 31 20 33 Care Homes for Older People 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 21 22 36 37 Formal one to one supervision should be provided to all staff at least six times each year. The manager should familiarise herself with all the homes policies and procedures. This is to help ensure effective and consistent leadership. All recording of the procedures relating to fire safety should be improved. This is so that the manager can demonstrate that all appropriate processes are carried out on a regular basis. 23 38 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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