Care Home: Victoria Lodge Care Home

Similar services:

• Maple Lodge
• Heathlands
• Aston Court Nursing Home
• Breme
• Ravenhurst
• Bank House
• Inspirations
• Ashcroft Hollow Nursing Home

What the care home does well The service had recruited an experienced manager, who had carried out audits and had achieved considerable achievements in a short period of time. A person told us "she is always about and talks to us." People looked well groomed, cared for, wearing their preferred clothing, to promote their self esteem and well being. The home had a friendly and welcoming atmosphere where people were encouraged to personalise their rooms to reflect preferences and tastes. All bedrooms were en suite, spacious, light and airy. A person said, really like my bedroom." There was an open visiting policy and people were welcomed, so people living at the home were able to maintain important friendships and relationships. Relatives told us they were always offered drinks. People told us they enjoyed the activities, particularly entertainers and `pub nights`. People had a good choice at mealtimes and people who required help with eating and drinking were given appropriate assistance. A person told us, "the food is always very good." Another person told us she had put on too much weight because of the good choice of food." Staff were caring and gave sensitive assistance to promote each person`s dignity and choice. Comments from relatives and people included, "majority of staff are golden", and "staff are helpful and kind". What the care home could do better: There has been a high staff turnover during the past year, and high dependency on agency staff. In order that people have effective continuity, consistent care and support, all staff must be appropriately trained, supervised and competent at all times to meet the individual needs of people using the service. The service`s quality assurance systems must effectively and consistently identify areas requiring improvement, with timely actions. The recent improvements must be sustained so that people living at the home are safeguarded and will receive a good quality service, which promotes their health and well being. Random inspection report Care homes for older people Name: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB zero star poor service 05/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 2 5 0 8 2 0 1 0 Information about the care home Name of care home: Address: Victoria Lodge Care Home Bent Street Brierley Hill West Midlands DY5 1RB 01384572567 0138479658 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rosina Skelton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Select Health Care Limited care home 61 Number of places (if applicable): Under 65 Over 65 0 61 dementia old age, not falling within any other category Conditions of registration: 61 0 The maximum number of service users to be accommodated is 61. The registered person may provide the following category of service only: Care Home with Nursing - Code N 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, Dementia - Code DE Date of last inspection Brief description of the care home Victoria Lodge, a purpose built home was opened in the summer of 2007. It is registered to provide personal and nursing care to people who have dementia and Care Homes for Older People Page 2 of 14 1 0 0 2 2 0 1 0 Brief description of the care home people who have other care needs associated with old age. It can accommodate a maximum of 61 people at any one time. The home is located near to Brierley Hill High Street with easy access to main bus routes and a range of shops and other amenities. The premises consist of three separate floors, with dementia care provided on the first floor and nursing care provided on the second floor. Each floor has communal areas, a dining room and lounge, bathrooms and toilets. All bedrooms are single occupancy with en-suite facilities. There are hoists and pressure relieving equipment available. A passenger lift provides assisted access to all floors. There is a main kitchen and small kitchenettes on each floor. There are also laundry facilities. The small garden areas are accessible to people using wheelchairs. Care Homes for Older People Page 3 of 14 What we found: We, the Care quality Commission (CQC) undertook this random unannounced inspection visit to monitor two Statutory Requirement Notices served on 22 July 2010. These related to proper provision for the health and welfare, care and where appropriate, treatment, of all persons using the service. This included the prevention and management of pressure ulcers, appropriate support to access monitoring and treatment from health professionals and the safe handling and administration of medication. We use Statutory Requirement Notices as part of our enforcement strategy to obtain improvements in the quality of the service provided for the safety and well being of people living at the home. The home did not know that we were coming. Two compliance inspectors and a pharmacist visited the home from 13:50 to 19:15. A range of inspection methods were used to obtain evidence and make judgements including: discussions with the manager, responsible individual, nurses and staff on duty during the visit, and discussions with some of the people at the home. We also spoke to relatives and visitors. We looked at the medication systems, a sample of care records, staffing and management arrangements, including quality audits. We looked at how people were supported and given assistance to meet their daily needs; and how peoples healthcare needs were being managed. We looked at some peoples bedrooms, particularly pressure relieving equipment and bedrails. Other information was considered before this inspection visit including a complaint and notifications sent by the home about incidents, accidents and events concerning people living at the home. There were 46 people living at the home, some of these had a diverse range of needs. Because of some peoples communication difficulties it was not possible to talk to them to them about their experiences of living in the home. So we spent short periods of time in the lounges watching interactions between staff and people on the dementia and nursing units. This is a home that we have assessed as providing poor outcomes for people. A Notice of Proposal to cancel the homes Registration was served on the provider on 19 March 2010. The provider lodged an appeal to the First Tier Tribunal. The outcome has not been determined at the date of this inspection. We looked at some care records and at how the needs were being met for some people on each of the three units at the home. We saw that since the last inspection that these had improved. The manager told us that additional clinical support was being provided from a supernumerary registered nurse with managerial experience. She told us that assessment information had been difficult to locate. However everyones needs had been reassessed and all care plans and the majority of risk assessments had been reviewed and rewritten with the involvement of people using the service and or their representatives so that they reflect their individual needs and preferences. A random sample of assessment information, risk assessments and care plans showed that each persons needs were accurately reflected, with appropriate guidance for staff, which was easy for people to read and understand. Staff spoken to were able to tell us about the care needs of people we discussed. We saw that people were given appropriate and sensitive assistance, in accordance with care plans. Care Homes for Older People Page 4 of 14 We looked at the new care plans of a person with a history of pressure damage. We noted that the information about pressure relieving heel protectors had not been transferred from the previous care plan. We discussed this with the manager and nurse who were able to give us assurance that appropriate pressure relieving measures were in place. The omission in the new care plan was rectified immediately. The manager gave us evidence that following the inspection on 16 June 2010 she had contacted the Primary Care Trust Tissue Viability Nurse. Following her advice the new manager had purchased repose heel protectors for the person prone to pressure damage. We were told the person was happy to wear the repose heel protectors whilst in bed, the person said they were very comfortable, like sleeping on air. The revised risk assessment showed that the protection was not necessary during the day. We also saw that the persons risk assessment and care plan for sleeping had been reviewed so that they received attention at two hourly intervals during the night, instead of hourly. This meant that the person received suitable assistance but was not unduly disturbed throughout the night. We saw that wound care records had been revised and improved. These showed details about the condition of the wound, type and frequency of dressings and progress of healing or deterioration, and any action taken. This meant staff had information so that people received continuity of wound care to promote healing. The manager told us that previously care staff had not read risk assessments and care plans but they were now more involved. She had also introduced a key worker system so that each person had an allocated member of staff responsible for making sure their needs were met in the way they preferred. We spoke to a nurse and three care staff during the inspection visit, who were able to tell us about the needs of the people they were caring for. This meant that there was improved knowledge about what care should be provided and how to meet each persons individual care needs. We looked at the risk assessments and care plans for two people with diabetes. These had been rewritten and contained comprehensive information about their individual diabetic conditions. There was guidance for staff about the individual monitoring and checks each person needed to keep them well. We saw that there were very detailed evaluations of the care plan. These showed dates when the care staff had consulted the nurse on duty at the home when they had observed the person to be unwell and appropriate monitoring had taken place. There were also records of health professional contacts showing that people had access to the health care they need to keep them well. The manager had introduced a quality assurance system to demonstrate, that each service user is given the highest standard of holistic care. A relative had contacted us prior to this inspection to raise concerns about whether the service could meet the needs of their parent. They were concerned that the person might not be receiving medication as prescribed and gave us details of an incident when they had found medication left in the persons bedroom. We looked at the persons care during the inspection and discussed the concerns with the manager. She acknowledged that the incident related to the medication had been raised by the relative. This had been dealt with appropriately. We found that the persons medication was administered appropriately as prescribed and the clinical nurse specialist was liaising with the relative about their concerns about the persons needs. We looked at a sample of bedrooms and saw that pressure relieving equipment was maintained appropriately and corresponded to records. This meant that the equipment Care Homes for Older People Page 5 of 14 was being used effectively to prevent pressure damage to the persons skin and would be as comfortable as possible. We also saw that there were new risk assessments for the use of bedrails. These appropriately recorded the individual risks, associated with each person. We looked at a sample of bedrooms where there were suitable beds provided to meet the needs of people using the service. We were told at a previous inspection that new full length bedrail bumpers had been purchased and we saw that these were in place. An exception was one bedroom on the dementia unit, where the person was resting on the bed and the bedrail bumpers did not cover the rails at the top and lower part of the bed. This meant that there was a potential risk of injury, especially to the persons legs. The manager told us that the person did not move about the bed but agreed full length bumpers should be in place. She immediately found appropriate replacement full bedrail bumpers and assured us that staff would be instructed to use the correct equipment and monitoring would be carried out. The manager gave us information about the regular checks carried out by the maintenance person, who had received training from an external trainer. She acknowledged that staff had not received training related to bed rail safety but told us the plan was for the maintenance person to cascade training to staff. We informed the manager that at inspections prior to her employment we had given the service details of the Heath and Safety Executive (HSE) website, which had detailed information and online training for the safe use of bedrails. The pharmacist inspector visited to check the management and control of medicines within the service. The purpose of this inspection was to check compliance with a Statutory Requirement Notice (SRN) relating to medicines. We looked at medication storage on all three floors and Medication Administration Record (MAR) charts. We looked at medicine storage on each floor. We saw that medicines were stored safely securely and at the correct temperature. We found that there was appropriate documentation and recording of medicine records. We looked at three MAR charts, one from each unit. They were documented with a signature for administration or a reason was recorded if medication was not given. All of the checks were correct and this showed that the person had been given their medicines as prescribed, checked to ensure the person was being given a safe dose. We were told by the manager and saw evidence of regular weekly checks of peoples medicines to ensure they are being given safely and as prescribed. This meant that there were arrangements in place to ensure that medication was administered as directed by the prescriber to the person it was prescribed, labelled and supplied for. We found that there had been improvements in the management of medicines to ensure that medicines were given to people safely and as prescribed. We gave feedback to the manager and explained that the service had complied with the Statutory Requirement Notice relating to medicines. During our observations in the lounge areas on the dementia and nursing units we saw positive interactions between staff and people with dementia who could not communicate verbally. Staff spoke to people in a way and at a pace to help them understand, using eye contact and gestures. One person who needed to drink plenty of fluids had been provided with a jug of juice and staff encouraged the person to use a cup, giving assistance as needed. Another person who needed to use the toilet was sensitively helped Care Homes for Older People Page 6 of 14 by a member of staff, without drawing attention to them, so that their dignity was maintained We saw that a person got up and dressed later in the day, about 2.30pm, as this was their choice, at the time their relative visited. Staff had saved dinner for them and contacted the kitchen for it to be reheated and an apron was used to protect the persons clothing from food spills. Throughout the process staff told the person what they were doing, and as the meal was served staff asked if the person wanted salt and pepper. This demonstrated a sensitive approach, maintaining personal dignity and choice. We saw a sing a long session taking place led by activity staff that also included dancing with individual people if they wished. We heard people being complimented about their appearance, such as saying how nice a persons hair looked, which meant their self esteem was enhanced. At another time we saw activity staff talking to a person about the orientation board and looking out of the window, talking about what was happening in the street outside. We heard staff asking people if they wanted a drink, including a visitor and observed individual drinks were made in the kitchenette on the unit. At another time we also a member of staff came into the room and sit with a person to do some colouring. Later a child who was visiting another person joined in and the member of staff helped them both, whilst encouraging conversation with each other. At one point the TV was on without any sound and no-one seemed to be watching, though there was lots of talking between people living at the home, staff and visitors. This meant the people living at the home were engaged and stimulated. During the teatime meal we observed three care staff in the dining room. We noted that there were six people who all needed help to sit down or were wandering around. We saw staff taking trays to some peoples rooms so that they could have their tea where they chose. A care assistant put soft, appropriate, background music for the mealtime. Members of care staff were very busy but continued to talk to people in a calm, patient manner. We saw that people were offered several choices at tea time and some people we spoke to in other areas of the home told us they enjoyed the food. The staffing rotas showed that there were sufficient numbers of staff available, though there was still dependency on agency staff to provide cover for several shifts on each unit throughout the month of August. This may mean people were not supported by people who know them well. There has been a high turnover of staff in the past 12 months. The manager told us that two nurses had left the homes employ since the inspection on 16 June 2010. This meant that all of the nurses in post at the inspections in December 2009 had left the homes employ. A new experienced nurse had been recruited and was on duty during the inspection visit. During our discussions she was calm, confident and could tell us about peoples needs even though she had only worked at the home for a short time. We looked at a random sample of staff personnel records, including records for agency staff, and found that there were appropriate recruitment processes and checks to make sure people employed at the home were suitable to work with vulnerable people. The manager acknowledged that the staff supervision system was not yet in place. She told us some staff lacked skills to understand their role and that there was a need for staff training, support and development. She gave us a copy of the training matrix. This Care Homes for Older People Page 7 of 14 showed gaps particularly in areas of mandatory training. The manager told us there was training planned, using the Local Authority training provision, external trainers and the organisations E-Learning. The manager had conducted competency assessments for all staff involved in medication administration as a priority because there had been a number of medication errors. This meant that staff now had the skills to administer medication safely and as prescribed. We looked at accident records and the accident audit, which evaluated the records to highlight trends and minimise risks where possible. This meant appropriate action was being taken to safeguard people from harm. We asked to see the Regulation 26 reports. These are required to show unannounced visits are undertaken to monitor the running of the home and assure the quality provided for people using the service. We were shown a report dated June 2010. The report, signed by an area manager, did not give a prioritised action plan for improvement. Examples in the report dated 14 June 2010 were, Quality assurance ticked. medication audits yes ticked. The report failed to identify the lack of compliance related to outcomes for peoples health and welfare and medication administration we identified at the random unannounced inspection on the 16 June 2010. The report dated also recorded, Staff training to date yes ticked. most staff now fully trained in all mandatory training. Manual handling practical required for new starters. The statement was inaccurate and the action was not specific, measurable or time bound. The staff training matrix supplied at this inspection showed gaps in all areas of mandatory staff training. There was no report available at the home for a visit in July 2010. The manager told us that a visit had taken place. She had not received a copy of the report. The purpose of Regulation 26 reports is to form an opinion of the standard of care provided in the care home. The outcome of the July 2010 visit and report should have been available as a priority for the home manager. This meant that the provider was not demonstrating an effective oversight and monitoring of the running and performance of the home to assure the safety, health and well being of people at the home. The new manager had been employed at the home since 24 May 2010. We reported at the inspection on 16 June 2010 that she had spent her first weeks conducting an audit of all areas of the home. From her findings she had identified what she recorded as 57 requirements, with objectives for improvements. The evidence we found at this inspection visit demonstrated that she had made considerable improvements particularly in relation to compliance with the Statutory Requirement Notices we served on 22 July 2010. The organisation had recently recruited a new director of operations. This meant people using service could have more confidence that improvements would be monitored and sustained. The manager told us that she felt she received support from the Provider, particularly a director to whom she could go for decisions. She was also supported by a supernumerary, experienced nurse, with dementia care and management expertise, recently employed by the organisation. We were told he would remain in his role at the home until the service was sufficiently improved. The manager told us that the provider had agreed to fund a supernumerary unit manager for each of the three units. The post holders had been promoted from the senior teams and usually worked from 8am - PM, though two unit managers were on annual leave during the inspection visit. The manager told us she felt the creation of these posts had been beneficial in supporting care staff and monitoring the quality of care. This view was supported by comments from a relative visiting the dementia unit, he said, things were improving, especially since the unit manager had returned to manage the first floor unit, it needed a strong figure to make Care Homes for Older People Page 8 of 14 changes for the better, staff were better, more knowledgeable and with residents more, X has good days and bad days, but feel she is looked after properly, the home has right sort of staff at the moment, no complaints but could make a complaint if needed to the manager and feel would be listened to dealt with. Another relative expressed some concern about whether improvements would last. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 13 To provide appropriate, up to 01/11/2009 date policies and procedures, and safeguarding training for all staff, with monitoring arrangements to ensure the homes and Safeguard and Protect procedures to protect vulnerable people are implemented and followed diligently at all times. This is to safeguard all persons living at the home from risks of harm. 2 27 12 To demonstrate that all staff 01/10/2009 on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 3 33 24 To implement effective 01/10/2009 quality monitoring systems, which demonstrate that positive quality outcomes are consistently achieved for all persons living at the home. This is to safeguard the health, well being and safety Care Homes for Older People Page 10 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action of people living at the home. 4 38 23 All staff, and especially night 01/02/2010 staff must receive fire training and attend fire drills at frequencies approved by the West Midland Fire Service. This is to safeguard people at the home from risks of harm from fire. Care Homes for Older People Page 11 of 14 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, 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 30 18 All staff must receive training 01/10/2010 so that they have the knowledge and skills to meet the individual and collective needs of people using the service. This is to maintain the health and welfare of each person living at the home. 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 8 Advice and training from the diabetic specialist nursing service should be sought with records kept of staff training attendance. This is a previous unmet Good Practice Recommendation. It is recommend that care plan goals in this area should be made clear, and that key workers evaluate actual opportunities offered, taken up or declined each month. This should then provide a sound basis for future planning and goal-setting. This Good Practice Recommendation was not assessed at this Random Inspection. 2 12 Care Homes for Older People Page 12 of 14 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 3 18 Dudley MBC multi-agency Safeguard and Protect procedures for vulnerable adults, and that that staff signatures should be obtained to demonstrate they have read these documents. This Good Practice Recommendation was not assessed at this Random Inspection. The plans to ensure the environment meets the needs of everyone living at the home should be implemented in a prioritised timescale. This Good Practice Recommendation was not assessed at this Random Inspection. 4 19 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 14 of 14 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!