Care Home: Stonedale Lodge

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What the care home does well People told us that they were happy living at the home. They`re comments included " I love it here, it`s my home" and "I wouldn`t move from here". One person who had recently moved to Stonedale explained that the staff had been very kind and were "always making sure I`m alright and not worrying about anything". Another person stated, "I don`t have to worry about anything- its all taken care of". Staff have the skills to make sure people stay healthy and well and are quick to seek expert advice from G.P.s and other health care specialists when peoples needs change. One person said" I`m well looked after- they always get the doctor out if there`s anything wrong". In particular we found that the staff on one unit (Anderton) were very aware of people needs and interacted extremely well with people when supporting them to meet these needs. People told us that they like and trust the staff and staff have had training so that they can keep people safe and promote their basic health and welfare needs. Relatives are informed of any changes in people`s needs and care and feel welcomed by staff whenever they visit the home. One relative said" the staff work very hard but they always make time for me if I`ve got any questions". The home has an open visiting policy, which means that people are free to choose to visit whenever they wish within reasonable hours. Staff support relatives and representatives to take people on an outing if they wish. The people who live at the home told us that they are offered choices around personal care, food, bed and rising times which helps them to feel in control of their lives. One persons told us "the staff are good- they do what I say". Each unit has its own staff team with many staff working at the home for some time. One member of staff told us " I`m happy here- its a good place to work". The manager takes all complaints and concerns seriously and people believe that staff will listen to them and try to solve their problems. The manager is also very aware of what constitutes abuse and how to protect people from this occurring. The home is very clean and smells pleasant. BUPA have provided good quality furnishings and fittings and people are supported to make their bedrooms their own. What has improved since the last inspection? BUPA have introduced new records and procedures for staff to follow when someone is admitted to the home. They have been commended for this within the report as the assessment is very comprehensive and is repeated on three occasions. This is greater than the national minimum standards expected. The new records have extended to care planning, which means each person has a plan of care which clearly identifies their health and social needs. These plans are reviewed monthly to ensure staff have access to up to date instructions about the care each person needs and how they would like this care delivered. Staff have improved wound care skills since the last visit which means that people who have developed wounds are receiving the correct care to promote healing. Staff are also consulting with specialists in this area if wounds are not healing well and are keeping clear records to show the care they have given. This means that wound care is consistent which promotes people`s health and well being. Senior management within BUPA have recognised that the provision of activities across the units is insufficient and are implementing plans in the near future to address this. Staff have received training on how to keep people safe who are presenting with challenging behaviour and how to diffuse these situations to prevent these episodes escalating out of control. This helps to promote peoples well being. What the care home could do better: Medications are managed reasonably safely by the home however procedures could be improved to ensure that two nurses sign records when medication is destroyed. We identified that one unit was not completing records properly to show whether medication had been given or refused and that this unit did not have pain killers in stock for people who had been prescribed them. This could seriously impact on people`s health and welfare and must be resolved. Staff should make efforts to ensure people or their relatives/representatives sign their plan of care. This would demonstrate that these people are involved in deciding how they receive care and would help to make people feel in control of their lives.Staff should also ensure that all instructions within the care plans are updated when they review the document each month. For example one plan told us that a person was thinking about whether they wished to be buried or cremated. However they wished to discuss this matter with their family before making a final decision. Staff had not followed this up and the person is now too ill to make a decision. This is a missed opportunity, which could have promoted this persons peace of mind. Staff should ensure that they record the actual care given and not use phrases such as " dignity and respect given" as this is a meaningless phrase as people`s interpretation of what this means could differ from person to person. Audits must be undertaken to ensure everyone who lives at the home is offered the same experience at meal time. One unit ensured that support was provided in a dignified and unhurried manner whilst another appeared disorganised and disjointed with staff not knowing whether people had had sufficient to eat. Staff support for people on this unit appeared rushed and staffing levels at meal times should also be considered. Efforts must be made to address this to promote quality of life and well-being. The nutritional content of the choices of food offered must also be reviewed to ensure that people are being offered a nutritious diet. Ways should be explored to introduce extra vitamins and fibre e.g. fruit smoothies. Some of the units are dealing with their own complaints and concerns rather than passing them to the manger. This is good practise and good staff development. However staff are not always letting the manager of the home know when complaints have been made nor are they keeping records to show the details of the concerns or the action taken. This must be addressed so that an accurate record is available showing people progress and action taken. BUPA has made plans to refurbish all of its multi site homes within the next five years however plans must be developed to ensure that the units are maintained to a good decorative standard in the meantime. The units that provide dementia care should have the environment adapted to meet people`s needs. Examples could include painting bathroom doors a different colour from bedroom doors so that they are clearly visible to people and providing a large faced clock so that people can orientate themselves with time.Stonedale LodgeDS0000025178.V357766.R01.S.docVersion 5.2Page 9Staff have had basic training to meet people needs however training now needs to be implemented which gives the staff the skills to support people with their individual needs. For example we visited one unit, which had five people living there who suffered from diabetes yet none of the staff had received training in this subject. CARE HOMES FOR OLDER PEOPLE Stonedale Lodge 200 Stonedale Crescent Liverpool Merseyside L11 9DJ Lead Inspector Mrs Joanne Revie Key Unannounced Inspection 4th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonedale Lodge Address 200 Stonedale Crescent Liverpool Merseyside L11 9DJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 549 2020 www.bupa.com BUPA Care Homes (CFHCare) Ltd Mr Roger William Edwin Merchant Care Home 180 Category(ies) of Dementia - over 65 years of age (90), Old age, registration, with number not falling within any other category (90) of places Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 27 OP (N incl 5 palliative care - Blundell) 3 named females under 65 years of age (N - Blundell) 29 OP (N - Townley) and 1 named male under 65 years (N - Townley) 30 DE/E (N -Dalton) includes one named female under 65 years of age 30 DE/E (N- Clifton) 29 DE/E (PC - Anderton) and 2 named female under the age of 65 years with dementia (DE) 29 OP (PC - Sherbourne) and 1 named male under 65 years of age (PC - Sherbourne) Two named service users under the age of 65 years (palliative care) Date of last inspection 30th May 2006 Brief Description of the Service: Stonedale Lodge offers personal and nursing care to 180 residents, and is situated in the Croxteth area of Liverpool. Local amenities are a short walk away, as are numerous bus routes and shops. Stonedale Lodge comprises six separate houses, each with 30 beds. Five of the houses offer nursing and personal care and one offers EMI nursing care. The houses are set in the large landscaped garden, with conservatories and patios, there is also a sensory garden for all to enjoy. All the rooms are single and have an assistance alarm fitted. Stonedale benefits from having in-house activities organisers, who arrange entertainment and regular trips out. A hairdressing salon is also on site. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to the site visit taking place we (the commission) asked the manager to complete a document called an AQAA. This is a document, which gives information about the services strengths and weakness, and future plans for the service to develop. Once the AQAA was received, we sent out surveys to the people who live at the home. 6 surveys were returned from relatives of people who live at the home. The staff and the people who live at the home did not know that we were going to arrive on the day. The inspection took place over two days and involved two inspectors. Four of the six units were visited. During the site visit, we had discussions with eighteen people who live at the home, and some of their visitors. We also held discussions with fourteen staff, the manger and the regional manager for the home. Their views have been included within the report. A variety of records were looked at which told us about the health and welfare and care received by the people who live at the home. This review also included looking at staff records. We watched how well staff interact with the people who live at the home and how staff deliver care. One of the inspectors carried out a two hour observation as part of the inspection on Anderton Unit, which supports people who have dementia. A specialist tool for dementia care was used to do this, which highlights levels of staff interaction, peoples well being and engagement with surroundings of the people observed. The findings are used in parts of the report. The cost of living at the home ranges from £315.50 to £ 700.85 per week depending on the persons needs. Items such as toiletries, newspapers and hairdressing are not included in the fees. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 6 What the service does well: People told us that they were happy living at the home. They’re comments included “ I love it here, it’s my home” and “I wouldn’t move from here”. One person who had recently moved to Stonedale explained that the staff had been very kind and were ”always making sure I’m alright and not worrying about anything”. Another person stated, ”I don’t have to worry about anything- its all taken care of”. Staff have the skills to make sure people stay healthy and well and are quick to seek expert advice from G.P.s and other health care specialists when peoples needs change. One person said” I’m well looked after- they always get the doctor out if there’s anything wrong”. In particular we found that the staff on one unit (Anderton) were very aware of people needs and interacted extremely well with people when supporting them to meet these needs. People told us that they like and trust the staff and staff have had training so that they can keep people safe and promote their basic health and welfare needs. Relatives are informed of any changes in people’s needs and care and feel welcomed by staff whenever they visit the home. One relative said” the staff work very hard but they always make time for me if I’ve got any questions”. The home has an open visiting policy, which means that people are free to choose to visit whenever they wish within reasonable hours. Staff support relatives and representatives to take people on an outing if they wish. The people who live at the home told us that they are offered choices around personal care, food, bed and rising times which helps them to feel in control of their lives. One persons told us ”the staff are good- they do what I say”. Each unit has its own staff team with many staff working at the home for some time. One member of staff told us “ I’m happy here- its a good place to work”. The manager takes all complaints and concerns seriously and people believe that staff will listen to them and try to solve their problems. The manager is also very aware of what constitutes abuse and how to protect people from this occurring. The home is very clean and smells pleasant. BUPA have provided good quality furnishings and fittings and people are supported to make their bedrooms their own. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Medications are managed reasonably safely by the home however procedures could be improved to ensure that two nurses sign records when medication is destroyed. We identified that one unit was not completing records properly to show whether medication had been given or refused and that this unit did not have pain killers in stock for people who had been prescribed them. This could seriously impact on people’s health and welfare and must be resolved. Staff should make efforts to ensure people or their relatives/representatives sign their plan of care. This would demonstrate that these people are involved in deciding how they receive care and would help to make people feel in control of their lives. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 8 Staff should also ensure that all instructions within the care plans are updated when they review the document each month. For example one plan told us that a person was thinking about whether they wished to be buried or cremated. However they wished to discuss this matter with their family before making a final decision. Staff had not followed this up and the person is now too ill to make a decision. This is a missed opportunity, which could have promoted this persons peace of mind. Staff should ensure that they record the actual care given and not use phrases such as “ dignity and respect given” as this is a meaningless phrase as people’s interpretation of what this means could differ from person to person. Audits must be undertaken to ensure everyone who lives at the home is offered the same experience at meal time. One unit ensured that support was provided in a dignified and unhurried manner whilst another appeared disorganised and disjointed with staff not knowing whether people had had sufficient to eat. Staff support for people on this unit appeared rushed and staffing levels at meal times should also be considered. Efforts must be made to address this to promote quality of life and well-being. The nutritional content of the choices of food offered must also be reviewed to ensure that people are being offered a nutritious diet. Ways should be explored to introduce extra vitamins and fibre e.g. fruit smoothies. Some of the units are dealing with their own complaints and concerns rather than passing them to the manger. This is good practise and good staff development. However staff are not always letting the manager of the home know when complaints have been made nor are they keeping records to show the details of the concerns or the action taken. This must be addressed so that an accurate record is available showing people progress and action taken. BUPA has made plans to refurbish all of its multi site homes within the next five years however plans must be developed to ensure that the units are maintained to a good decorative standard in the meantime. The units that provide dementia care should have the environment adapted to meet people’s needs. Examples could include painting bathroom doors a different colour from bedroom doors so that they are clearly visible to people and providing a large faced clock so that people can orientate themselves with time. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 9 Staff have had basic training to meet people needs however training now needs to be implemented which gives the staff the skills to support people with their individual needs. For example we visited one unit, which had five people living there who suffered from diabetes yet none of the staff had received training in this subject. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home does not provide intermediate care therefore standard 6 was not assessed. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s needs are fully assessed and their wishes considered before and after they move into the home. People meet with staff and are given information, which helps them to decide whether the home is the right place for them to live. EVIDENCE: We visited four units and looked at records that belonged to eight people. These showed us that senior staff from the home visit people before people decide whether they want to move in. During the visit staff record all the persons health needs and wishes. They also get a copy of any other records that have been completed by other health care professionals such as social workers, district nurses etc. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 12 Daily life activities such as whether people can manage their own post, and whether they need support to practise their religious beliefs or require support to take their medication is also recorded. This assessment is repeated when the person moves into the home. All of this information is then used to make a plan of care, which tells staff how to care for the person in the way that they would choose. The assessment is repeated six months after the person moves in. This is very good practise and is greater than the national minimum standard required. Staff told us that BUPA has a variety of booklets, which they take with them to show people before they move into the home, and that people are welcome to come for a trial visits or stay for a meal to see if they like the home. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Everyone has a plan of care so Staff have clear written instructions which tells them how to care and support people. Staff care about peoples health and involve specialist whenever needed. People are treated with respect and dignity. Some people are not getting their prescribed medication, which could affect their health and welfare. EVIDENCE: We looked at eleven plans. Each was reviewed regularly, which shows that staff have up to date instructions to follow about each persons care. The plans provided clear information and guidance to staff on how to support the person safely and some contained very clear details on how the person wanted to be supported, which is good practise. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 14 For example one plan stated that the person preferred a male carer and daily records confirmed that this support was provided to him. Some plans were written as though a story was being told which made reading them easier and gave a feeling of what the person was like. This is good practise. Staff are keeping daily records of the care and support they have given to each person and how they have spent their day. These varied in standard with some staff recording a lot of detail and other staff writing phrases such as “ dignity and respect given”. Staff should avoid using key phrases as they can be seen as meaningless. It would be better to record how staff had respected people and promoted their dignity rather than just recording that this had occurred. We also looked at records that showed that nursing staff have the skills and the understanding of how to encourage wounds to heal. This is an improvement since the last inspection. The plans also contained risk assessments which showed if people were at risk of falling, developing pressure sores or at risk of becoming malnourished. Staff were providing care to reduce these risks, but were not always writing down what this care was or how it should be given. For example three plans contained information, which showed that people were at risk of developing pressure sores. None of these people had developed pressure sores but staff had not recorded how they were preventing sores from occurring. This means that the person care plan was not an accurate picture of the care that they needed. Care plans were not always signed by the person that they belonged to or their representative. This is important as signing a care plan shows that people have been involved in how they would like to receive care and support and that they understand why staff are supporting them in a particular way. This helps to ensure that people are given as much control as possible over their daily lives and the support they are receiving. People spoken with said that staff support them with their personal and health care. One person explained, ”We are well looked after”. Staff support people to see other health professionals such as their GP, Opticians and Dentists when needed. Records showed that staff are quick to request doctor’s visits when someone becomes ill and that relatives are informed of any changes also. One person said” they always get the doctor if I’m not well – in fact I only have to ask and if I’m worried they ill sort it out for me”. Throughout the visit staff were seen to talk to people respectfully and with dignity. Records and observing staff showed that people had requested to be called by a particular name and staff were following this request. Staff were seen to knock on doors before entering. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 15 All bathroom doors and toilets are fitted with locks, which can be opened by staff in an emergency. One issue was identified because staff on one unit had placed a sign on the outside of a persons wardrobe door stating what type of pads this person used as a continence aid. The management of the home agreed that this was inappropriate and would arrange for the signs to be removed and staff reminded of how people’s privacy should be respected and their dignity promoted. We looked at how medication is managed on three units. Medication is stored correctly and systems are in place for checking it. However one unit visited showed that staff had failed to ensure that people had enough medication for their pain relief. Records also showed that staff were signing to show that people had refused their medication when in fact this medication was not available. This gives an inaccurate picture of the person’s medication history, which could impact on the medication that they receive in the future. Records showed on the other two units that staff were ensuring medication was available and that they were giving it as prescribed. However only one member of staff was signing records to show that medication had been destroyed when it was no longer needed. Good practise states that two staff should complete this task and this should be adopted to ensure that all destruction of medication is safe. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provision of activities does not meet everyone’s expectations however everyone believes that their friends and family can visit when they choose. People believe that they are supported to exercise choice and control over their lives. The presentation and nutritional value of food could be improved and not everyone receives the support that they need at mealtimes. EVIDENCE: Visitors told us that they are welcome to visit the home at all reasonable times. We saw that all lounges are equipped with TVs and people can personalise their rooms with TV’s and music centres, as they prefer. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 17 Most units have staff assigned to support people with activities for some part of the week. A notice board in the main foyer advertised forthcoming events such as a mother’s day party, Easter party, sing-a-long and trip to the local safari park. Currently the home are recruiting for an activities coordinator for Dalton unit and Sherbourne unit and people who live on these units told us that there was little in the way of arranged activities to occupy their time. One person explained there was nothing to do,” apart from the TV”. Staff told us that they were struggling to provide meaningful activities as well as provide care and support to people. Even when the post is filled each unit will receive an activities coordinator for two and a half days a week. Many of the people who live on one of the units are unable to engage in group activities and would benefit from individual support, which would be difficult for one part time activities person to fulfil. We discussed this with management who were aware of this need and told us that they will be restructuring how activities are offered across the home in the near future. Although care plans contain information about a persons social preferences and their past life there was little evidence in the daily records that we looked at to show that staff supported them with these interests. This could lead to people becoming bored and unoccupied. Staff were able to describe support given with small activities such as supporting people to read a daily newspaper. However activities records did not reflect this. Monthly activities records were being made on one unit which stated” had a chat” or visited by family”. This could highlight a break down in communication between activities staff and care staff and could result in people not spending their time how they would choose. The people living at Stonedale told us that they are always offered a choice of meals. Their views on meals varied from,” not bad most of the time” to “okay” to “very good”. They also told us that they could choose to eat with others or in their bedroom, as they prefer. The support at meal times varied from unit to unit. The lunchtime meal was observed on one unit. Staff supported people to choose food that they like and provided people with the right cutlery and dishes so that they could eat their meal without help. Staff knew people’s preferences and reassured people in a quiet, unhurried manner. The meal time was a social occasion with people chatting to each other whilst they ate their food. Everyone ate at the same time and made positive comments such as “ this soup is lovely- nice and hot”. Staff appeared organised and were quick to recognise which people required extra support. A menu was written in large writing on a notice board in the dining room. This showed that three choices of food were available at each mealtime during the day. The menu also showed that snacks are available through out the night if people are hungry or unable to sleep. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 18 The lunchtime meal was also observed on another unit. Protected meal times are in place across the home. This means that disruptions are kept to a minimum to enable people to eat their food in a relaxed and calm atmosphere. During this meal time, the phone was ringing, a fire alarm test was carried out, staff chatted loudly in the kitchen and a member of staff walked through the dining room, sang out loud and asked other staff, “does she need her hair doing today”. This is both disruptive and disrespectful to the people living on this unit. Only six of the people living on the unit sat in the dining room to eat, and only 12 dining chairs were available for people to use. Other people ate their meal in the lounge area. Some good practice was seen in that a member of staff sat quietly with a lady supporting her to eat a meal, and another member of staff sat with a second lady chatting with her and encouraging her to eat. However a lack of staff in the dining room meant people did not always get the support they needed. One person was seen to drop their food on the floor then pick it up to eat. A second person was seen to sit with their sandwiches in front of them, and after eighteen minutes a member of staff removed these without any alternative being offered. The dessert of custard tarts was served upside down on a plate to people as staff had tipped the tarts out of the foil case. During this time we saw that one person fell asleep at the dining table and was there for over ten minutes before staff were able to support them. Another person dropped their soup. Staff quickly went to assist this person, which meant the person they had been supporting, dropped their beaker of soup also. Staff did not realise this had occurred and this persons beaker of soup was taken away some time later with staff not knowing whether the person had enough to eat or not. People were offered a choice of four types of sandwiches or sausage roll and beans for lunch on this unit. This didn’t appear nutritious as the sandwiches had plain fillings without fresh salad or vegetables. We looked at the medication administration records for 28 of the people who live on this unit and this showed us that a high percentage of people are prone to becoming constipated. This could be addressed by exploring different ways of introducing fibre to peoples diet e.g. fruit smoothes, home made soup, fruit milkshakes etc which could reduce the need for medication and promote peoples health and welfare. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People believe that staff listen and act on their concerns. Staff have the skills to people safe and protect their rights. EVIDENCE: The people living at Stonedale told us that they are aware of how to raise any concerns or complaints and that they are confident the staff team will address these. Staff spoken with had a good understanding of how to recognise and deal with any adult protection issues that arose and records showed that they had had training on this subject. This helps to ensure that the people living at Stonedale feel safe. The manager has kept us informed of any potential abuse issues and each time has taken appropriate action to safeguard the people who live at the home. The manager of a local social work team told us that they also held this view. Staff told us that they try to deal with any complaints as soon as they arise however they are not keeping records of any action taken and are only informing management if they feel unable to address the concerns. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 20 Records showed us that the manager does investigate all complaints within timescales that are made to him and that he lets the complainant know in writing of any action he has taken to resolve their concerns. Each of the units had displayed a copy of the homes complaints procedure telling people how to complain and what would happen to address their concerns. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well furnished but could benefit from redecoration in some communal areas. Some people would benefit from having their environment adapted so that it is more suitable for their needs. EVIDENCE: We saw that everyone living at Stonedale has their own bedroom which they can personalise as they choose. A number of bedrooms have a patio door, which faces onto the grounds and provides a pleasant view. Although no ensuite facilities are available, all bedrooms have a washbasin and there are sufficient bathrooms and toilets throughout the home for people to use. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 22 All areas of the home are on ground level, which makes it easy for people with mobility difficulties to get around. In addition there are a number of aids and adaptations to support people with their mobility and personal care. This includes a nurse call system, bath chairs, grab rails and hoists. Communal space consists of shared living and dining areas with some units having an additional small quiet lounge. Each unit has an enclosed room designated for smoking. Outside there is a car park and grounds large enough to go for a short walk in. In addition units have enclosed courtyards with seating, which were well maintained. Some areas of the home are beginning to look shabby and would benefit from re-decoration. The area manager advised that the company are aware of this and have a five-year plan to redecorate and refurbish the home. The home provides specialist support on some units for people with memory problems. We saw that on these units there was little evidence of environmental changes to support people in their everyday life. An example of this would be to paint bathroom and toilet doors a different colour from bedroom doors so that they are easily recognised. Each bedroom had a memory box outside the door. These can be filled with photos or objects to help the person recognise their room. We saw that the home has provided good quality furnishings and fittings to the units and that a dedicated team of domestic staff are available to keep the home clean. Some people who live at the home praised how hard these staff work. Everywhere we went smelt pleasant and was warm The home has a large laundry with staff that are employed purely for this purpose. It is equipped with industrial style machines and care is taken to deal with one unit’s clothes at a time to try to avoid confusion and reduce the risk of clothing becoming lost. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People receive care and support from staff that they like who have had the basic training to deliver care. Robust recruitment processes help to ensure peoples safety. EVIDENCE: We looked at staff files, which showed us that before anyone starts work in the home a series of check are carried out. This includes obtaining a full application form, references and Criminal Records Bureau check (CRB). These checks help to ensure that staff are suitable and safe to work with the people living at Stonedale. Over half of the staff working at the home have obtained a qualification in care (NVQ) and there are plans in place for other staff to obtain this award. Staff spoken with had taken part in basic courses such as moving and handling people, fire prevention, food hygiene and emergency aid. This training helps to ensure staff are aware of how to support people safely. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 24 The manager explained that they are currently supporting a number of staff to take part in training around supporting people with dementia and people who can challenge. A member of staff was able to explain how she had found this training valuable in her everyday work. However we also found that there was little evidence of other more specialist training for staff. For example a Nurse on a unit for people with dementia said they had had little recent training in this area and did not have access to relevant journals or publications that could help staff keep up to date. Many of the people living at Stonedale have specific health needs such as diabetes and up to date training in these areas would help to ensure staff can support people in line with best practice guidance which would promote peoples health and welfare. The majority of people we spoke to were positive about the staff who supported them. They told us that they get the help they need when they need it. Their comments included,” staff are good to me” and “staff are kind”. However on one unit a couple of people said that they were not always happy with all of the staff. These comments were passed to the home manager to look into more thoroughly. From the general observations that we made and the more specific observations using the two hour observational tool it was clear that most staff have very good skills and provide individual care to the people living at the home. The exception to this was the support staff provided at lunchtime on one unit and some staff’s lack of in-sight into how this should be provided to maintain peoples right to dignity and privacy. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced manager who makes sure that Stonedale is a safe place to live manages the home. EVIDENCE: We looked at certificates and records, which showed us that a series of checks are carried out on the environment and equipment at Stonedale to ensure it is safe. This includes regular checks of water temperatures and fire equipment. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 26 A clear system is in place for supporting people to manage their money. Where possible the home do not act as appointee for peoples benefits. Clear invoices are provided for peoples fee contributions and any sundries such as the on site hairdresser. Where the company act as appointee for people benefits they ensure that once the fee contribution is paid, the money belonging to the person is transferred into their account. These clear processes help to ensure people’s money is managed safely and well. A series of audits and checks are in place to check the quality of the service provided. This includes regular reviewing of peoples care plans, checks on how people’s money is looked after and monthly visits by a senior manager. In addition surveys are carried out to obtain the views of the people living at Stonedale and their relatives. These checks and surveys help to ensure that the service is meeting standards and quickly identify and address any issues that arise as well as helping plan future improvement. Stonedale is managed by Mr Roger Merchant who is a qualified general and mental health nurse with many years experience of management within a care setting. He is registered to manage the home with CSCI, which means that a number of checks have been carried out to ensure he is suitable for the role. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 29 STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action People who live at the home 10/04/08 must have access to their prescribed medication at all times. Staff must keep accurate records of stock available and whether medication was refused or given. Nursing staff must ensure that two staff destroy medication together and sign records to show this has happened. These steps will ensure that people receive their medication as prescribed and will also produce an accurate audit trail of what happens to all medication that arrives at the home. Meal times must be audited on 30/04/08 all units and action taken to address any shortfalls so that people are offered a relaxing experience with adequate staff support. Staff must keep records of all 30/04/08 complaints made to them and details of any action taken to resolve these concerns. A training plan must be drawn 30/04/08 up and implemented. This should include more specialist areas of training based on the support needs of the people living at DS0000025178.V357766.R01.S.doc Version 5.2 Page 30 Requirement 2 OP15 13(4) 3 OP16 22(2) 4 OP30 18(1) Stonedale Lodge Stonedale. This will ensure that staff are equipped with the skills and knowledge to support people safely and well. The manager must explore the 30/04/08 comments raised by visitors regarding staff as discussed during feedback with the inspectors and take any necessary action to ensure people are safe. 5 OP27 22(1) Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations People or their representatives should be encouraged to sign their care plan to show that they have been involved in planning their care and that they agree with how they are to be cared for. This will help people to feel in control of their own lives. Staff should write the care and support given to each person in the daily records rather than writing phrases such as” dignity and respect given” which are meaningless. Staff should ensure that they record how they are preventing people’s health from deteriorating. This will help to ensure that the persons care plan is an accurate reflection of all the care that they need. Staff should be reminded of the importance of not displaying personal information about peoples needs in their bedrooms. Displaying this type of information does not support the person’s privacy or respect their dignity. Arrangements should be made to offer all people who live at the home meaningful activities to prevent boredom and promote quality of life. Records used to document activities should be improved to reflect this. Ways of introducing fibre and nutrition to the menu should be explored so that the home is offering five fresh portions of fruit and vegetables per day as recommended by the governments health eating guidelines. This will help to promote the health and welfare of the people who live at the home. Staff should inform the manager of any concerns that have been raised to them and provide details of any action they DS0000025178.V357766.R01.S.doc Version 5.2 Page 32 2 OP7 3 OP8 4 OP10 5 OP12 6 OP15 7 OP16 Stonedale Lodge 8 OP19 9 OP19 have taken to resolve these concerns. An assessment of the environment should be carried out on the units, which support people with dementia. This should take into consideration good practice guidance around environments for this client group, e.g. different coloured doors to identify bathrooms etc. This would help people orientate themselves and may help to promote their independence. Management should consider auditing the communal areas of the units and redecorating where necessary rather than waiting for the full refurbishment of the home. This would promote a more homely environment for the people who live there. Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stonedale Lodge DS0000025178.V357766.R01.S.doc Version 5.2 Page 34 - 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. 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