Care Home: Victoria Lodge Nursing Home

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What the care home does well The home makes sure that all prospective service users and their families or representatives have the information they need before deciding to move into the home. Good healthcare arrangements are available with GPs and other healthcare specialists visiting the home when asked to. What has improved since the last inspection? Menu choices have improved and there has been some redecoration and new carpets laid in various areas of the home and the installation of a malibu bath. A second activities co-ordinator has been employed and a good range of social activities is provided and service users are asked if they want to take part in them or to opt out if they wish. What the care home could do better: The written care plans should contain more information so that all members of staff can know they are meeting all of peoples needs. The mealtimes continue to need reviewing so that service users have everything they need throughout their meals and individual teapots should be used in place of one large teapot and the dining room chairs are in need of replacement. Service users money held for safekeeping should not be stored together in one large amount. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria Lodge Nursing Home Leechmere Road Sunderland SR2 9DJ     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Eileen Hulse     Date: 2 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Victoria Lodge Nursing Home Leechmere Road Sunderland SR2 9DJ 01915237530 01915237524 victoria.lodge@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Tamaris Healthcare (England) Ltd care home 46 Number of places (if applicable): Under 65 Over 65 30 0 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 16 Victoria Lodge Nursing Home is a purpose built, two-storey home. It is registered to provide nursing and personal care for up to 38 older people, and 12 physically disabled people between the ages of 18-60 years. All rooms are single occupancy and have ensuite toilet facilities. Corridors and door widths are wide to allow easy access for wheelchair users throughout the Home. A passenger lift provides access between floors. Baths and showers are provided in sufficient numbers on both floors, and have adaptations and equipment to assist those who need it. A number of lounges of varying sizes and decor are available between both floors and dining facilities are provided on each floor. A separate smoking lounge is also provided. The Home shares the location site with another Home and has access via a car park, which is at the front of the building. There is a garden and secluded area at the rear of the home that service users can use for recreational purposes. The home is set in a residential area but has public transport, shops and other amenities close by. The weekly fees are #359:00 to #412:00 per week depending upon care needs. Additional charges are made for Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 18 April 2007 This is an overview of what the inspector found during this inspection The quality rating for this service is 2 STAR. This means that people who use this service experience GOOD quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit on 18 April 2007 How the service dealt with any complaints and concerns since the last visit. Care Homes for Older People Page 6 of 26 Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service their relatives and staff. During the visit we observed staff practice and talked with people who use the service and looked at how well their needs are met. We looked at other records which must be kept. Checked that staff had the knowledge skills and training to meet the needs of the people they care for. We looked around the building to make sure it was safe clean and comfortable and checked if any improvements had been made. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good assessments are included within the plans of care for all service users that help to form the basis of the individual care plan, this ensures that before admission takes place the home is able to know if the care needs can be met by them. The home does not provide intermediate care. Evidence: All service users living in Victoria Lodge have had needs assessments carried out by a care manager and the Manager of the service prior to their admission. The home accepts referrels from Care Managers, Palliative Care Nurses, Hospices and from family members and when a vacancy occurs, the home Manager will visit the prospective service user and using the homes assessment documentation will assess if the service can meet all of the care needs. The care manager will also provide the home with assessment information and a plan of care. The assessment records are then used to Care Homes for Older People Page 10 of 26 Evidence: help develop a person centred care plan. The person can then visit the service and spend time there to decide if they would like to move in and ensures the correct equipment and care plans are made available prior to moving in. Following the assessment time, the service user, Care Manager and family are contacted and a letter is then sent to the service user to offer a place in the home or to explain the reasons why the home cannot offer a place at this time. Case tracking of three of the individual care plans showed service users had up to date contracts and the homes brochure and statement of purpose had been given to them or their families prior to moving into the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users living in the home have individual plans of care, however, they are not always fully completed and therefore do not give staff the guidance they need to ensure the care plans are followed and the care needs met. The medication administration and management procedures ensure that service users are given their medication safely. Evidence: All service users have an individual care plan that is completed by staff and gives the staff guidance on how the care needs of people living in the home will be met. Of the care plans case tracked, they do not contain sufficient information for staff to follow. Each plan of care has an identified need and a goal to meet the need but the information recorded does not always tell staff how to do this. One care plan states (name) requires full assistance but does not detail what staff need to do and needs assisstance with transfers but again gives no detail as to what the transfers are or what equipment is needed to carry out these transfers safely. Care Homes for Older People Page 12 of 26 Evidence: Each plan of care in monitored and evaluated but the monitoring consists of daily notes and this makes information difficult to find or to highlight any changes that need to be made when evaluating the care plans on a monthly basis. Another care plan stated that (name) requires positional changes whilst on bedrest, again there was no information recorded as to what positions are used or how long the person remains on bed rest. The care plans are organised but they contain some out of date information that needs to be tranferred to a holding file as it is difficult to know what is active recording and information that is current. The home follows a detailed policy and procedure on the administration of medication with only Registered General Nurses administering medicines to service users. Each service user has a medication administration record and these are up to date and well maintained and an audit of some of the medicines held confirmed records and medication was correct, Controlled medication was also checked against the controlled drugs register and also correct. The home uses a monitored dosage medication system that is delivered to the home from a pharmacy on a monthly basis. Gel boxes are used for any unwanted or unused drugs and a waste company collects the boxes monthly. Care Homes for Older People Page 13 of 26 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. A good range of social activities are made available and this gives people the opportunity to exercise some choice and control over their daily lives and provide social stimulation. However, some of the dining arrangements need to be reviewed and improved to promote the general health and well being of service users. Evidence: The home has recently employed a second activities co-ordinator so that both floors of the home can benefit from this. Activity co-ordinators work monday to friday and offer service users a broad range of activities. The activity room is well equipped and records now hold profiles of service users that detail their choice of activities, when they participate, and the out come of the activity chosen. All service users are involved in the activity programme regardless of their age, gender or abilities and new activities have been introduced to enable more one to one sessions. Each service user has a daily record that details good information but it does not record when a service user has been asked but declined to take part. A programme of activities is on display in a position where it can be seen by service users and their families so that everyone knows what is going on in the home for the coming week. Care Homes for Older People Page 14 of 26 Evidence: Records showed that recent activities chosen by service users had included one person having swimming lessons, three people had enjoyed a holiday in Blackpool, cinema and theatre visits and several differant areas of craft making. The service shares a mini bus used for outings with four sister homes in the area and because of the increase in the number of drivers staff have stated it is being used a lot more. Service users and relatives spoke positively about the activities offered and comments included, I have started painting again which I really enjoy There seems to be a lot more going on when I come in these days There is more things to do to occupy my time instead of just sitting watching television I like going for a trip out in the bus A lunchtime meal was taken with service users in the ground floor dining room and it was observed staff were helpful and attentive to service users throughout the meal in a discreet and sensitive manner, staff sat with service users giving help and support when it was required throughout the two lunch sittings. The meal consisted of sandwiches or soup and rice pudding but no alternative sweet was made available to people, the soup was barely warm and the rice was served without staff asking if anyone would like milk and there were no milk jugs available on the tables. Tea was served from a large communal teapot that is institutionalised and dangerous practice and tables were set with odd items of cutlery. The bucket type chairs in the dining room need to be replaced, they were low making it difficult to reach the table. The dining arrangements need to be reviewed to ensure it is a pleasant ocassion for people living in the home. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints procedure that is made known to service users and their families and good adult protection procedures. These ensure that any complaints are handled effectively and service users are protected should an abuse situation arise or be suspected. Evidence: The home have detailed procedures regarding complaints and concerns to follow should anyone wish to raise a concern or complaint about the service they receive. Service users spoken with clearly knew how to make a complaint and clearly stated, If I am not happy about something I speak to (name) and they always sort it out for me I dont have any complaints but if I am worried about something my family sees someone Sometimes my laundry gets mixed up but the staff are good and deals with it All complaints are clearly recorded. When the home receives a complaint or concern, a letter is sent to the complainant within forty eight hours and information is held on a month by month file for reference, the service is currently dealing with a complaint made to them effectively. All staff have received Protection of Vulnerable Adults training and in discussions with Care Homes for Older People Page 16 of 26 Evidence: staff they clearly know what to do should an abusive situation take place or be suspected. Care Homes for Older People Page 17 of 26 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. The home provides a good standard of accomodation, good infection control procedures are available and this offers service users a comfortable and safe place to live. Evidence: Victoria Lodge is a purpose built property with accommodation provided over two floors and service users single bedrooms are accessible to meet their mobility needs that are furnished and personalised to suit their individual tastes and choices. A maintenance plan is currently being carried out to renew laminate and carpets in the downstairs bedrooms chosen by service users and at the visit half of the bedrooms had been completed. Work completed since the last inspection includes the refurbishment of two shower rooms, the installation of a Malibu assisted bath into one of the bathrooms and the purchase of profile beds for the downstairs bedrooms. All decoration to the building has now been completed. Staff have completed training in Infection Control and domestic staff keep the home at a good standard of cleanliness and free from odours. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good staffing levels and service users are protected by good levels of staff training and a good recruitment policy and procedure is used when employing new staff. Evidence: The duty rota reflected the numbers of staff on duty on the day of the visit, staffing numbers were adequate to meet the needs of the people living in the home. Staff on duty included a senior nurse, a qualified nurse and four care staff on each of the two units. Most of the staff now hold a care qualification and the staff training maitrix on the office wall evidenced A large amount of training is made available to the staff team. Inspection of personal files of the two most recently recruited members of staff contained all of the necessary information that is required to be kept and the senior nurse on duty was able to describe the process in detail when new staff are being recruited into the home. Staff made the following comments, I have worked at the home for eight months now and recently completed two courses Care Homes for Older People Page 20 of 26 Evidence: on medication All my mandatory training is up to date and I have attended pova training also I have been on pova, customer service and moving and handling Its my first job in care and I really enjoy it, starting my NVQ soon I like going out with service users either escorting them somewhere or socially Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced Registered Manager who is appropriately qualified and this enables the service to run in the best interests of service users. However, service users personal money held by the home for safe keeping should be stored individually and not pooled together. Evidence: The Manager of the service is a Registered General Nurse and has been in post for over two years and is now registered with the Care Quality Commission. On the day of the visit the Manager was not present as she was on annual leave. The home employs a full time financial administrator who deals with all of the finances of the service. Money held by the home for safekeeping at the request of service users is managed by the administrator and records relating to these funds are held individually on the computer and can be printed should service users request this information. However, money is not held individually and therefore an audit could not Care Homes for Older People Page 22 of 26 Evidence: be carried out. Service users money is held jointly in a no interest bank account and the money stored in the home is pooled together in one tin. Care Homes for Older People Page 23 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must include sufficient information that will guide staff in their practice to meet service users needs 01/08/2007 2 15 12 The mealtime arrangements must be reviewed to ensure service users have everything they need 01/08/2007 3 35 20 Service users money held by 01/08/2007 the home must be stored individually and not pooled Care Homes for Older People Page 24 of 26 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 15 12 Individual teapots should be in use To give service users the option of serving themselves safely 01/07/2009 2 15 14 The dining chairs should be replaced so that service users are made comfortable when in the dining room 26/08/2009 3 35 20 service users money must not be pooled together in the same place service users must have access to their own money at all times 29/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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