Care Home: Wellington Lodge

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What the care home does well The people we spoke to during our visit agreed that the home was being managed well and that recent changes to the way that the service was provided were positive and in the best interests of the people accommodated. People enquiring about living in the home had been carefully assessed and given sufficient information to make a decision about whether the home would be the right place for them to live. Each person admitted to the home was involved in developing a plan of care that described the support they would receive in accordance with the preferences of the individual. Several relatives praised the standard of care provided by staff and a person living in the home said, `I am looked after very well.` The views of the people accommodated and their representatives were listened to and taken seriously. Prompt action had been taken by staff and management when the need for improvements were identified. Staff respect each person`s diverse needs and preferences. This was evident in the way that cultural and religious needs are celebrated by involving people in planned `theme` days, especially in relation to providing food from different nationalities and religions. This was commended as an example of best practice in person-centred support. The home was also commended for the care taken in assisting people to look after their personal spending money and possessions that are important to them. Good procedures in this area means that people can be confident their finances will be kept in order. The home also has good procedures for the assessment of risks and guidance for staff on how to keep people safe from harm. Staff told us that they receive the support they need to provide good quality care and staff are provided in sufficient numbers to meet the needs of people living in the home. What has improved since the last inspection? There were no requirements outstanding from the last inspection. What the care home could do better: We made two recommendations for improvement, based on current good practice. One of the six medication records we looked at did not record an accurate balance of a medicine that was being held for a person accommodated. This should be checked regularly to ensure that accurate records are in place for all medication held in the home. Keeping accurate medication records provides evidence that people living in the home are receiving their medication as prescribed by their doctor. One of the staff files we looked did not contain the required two written references. This is important in providing evidence that new staff have been checked as being suitable to work with people using the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wellington Lodge 334a Waterloo Road Cheetham Manchester M8 0AX     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: Val Bell     Date: 2 0 0 2 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: Wellington Lodge 334a Waterloo Road Cheetham Manchester M8 0AX 01617408549 F/P01617408549 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchor Trust Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 32 Number of places (if applicable): Under 65 Over 65 25 7 old age, not falling within any other category sensory impairment Additional conditions: 0 0 The home may accommodate seven named service users with sensory impairment who are also over sixty five years of age should any of these service users no longer require the accommodation provided at the home the places will revert to the category old age (OP). The maximum number of service users requiring personal care only by reason of old age shall be 32. The service must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection Brief description of the care home Wellington Lodge is a purpose built home, owned and managed by Anchor Trust. The home offers 24-hour personal care and accommodation is provided in single bedrooms with en suite facilities. Care Homes for Older People Page 4 of 26 Brief description of the care home The home is situated within extensive landscaped grounds with ample car parking provision to the rear of the building. It is located in the Cheetham Hill area of Manchester, within 2 miles of the city centre and in close proximity to local shops, facilities and bus routes. 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: This was an unannounced key inspection, which means that the manager was not told that we were coming to visit. We visited the home over two days, 13 and 20 February 2009. Inspection visits are usually concluded in one day. However, on this occasion several relatives were keen to spend time talking to us about their experiences of recent changes in the way the home was being managed. We also looked at other information we had about the home, including events that the home had told us about since our last visit. We spoke to health and social care professionals that know the home to ask their views of the quality of the service being provided. The manager completed an Annual Quality Assurance Assessment, prior to our visits. This is a selfassessment document that gives us up to date information about the way the home is being managed. Care Homes for Older People Page 6 of 26 During our visits we spoke to visiting relatives and people living and working in the home. We looked at written policies, procedures and care records and assessed the quality of the environment provided for people using this service. What the care home does well: What has improved since the last inspection? What they could do better: We made two recommendations for improvement, based on current good practice. One of the six medication records we looked at did not record an accurate balance of a medicine that was being held for a person accommodated. This should be checked regularly to ensure that accurate records are in place for all medication held in the home. Keeping accurate medication records provides evidence that people living in the home are receiving their medication as prescribed by their doctor. One of the staff files we looked did not contain the required two written references. This is important in providing evidence that new staff have been checked as being suitable to work with people using the service. Care Homes for Older People Page 8 of 26 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 9 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 10 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. People thinking of moving into the home received sufficient information to decide if the home would be the right place for them to live. Evidence: People enquiring about living in this home have their needs assessed before deciding if the home would be the right place for them to live. We examined the pre-admission assessment for a person who had moved into the home three days before our visit. A copy of the care managers assessment had been obtained and a senior member of staff working in the home had visited the person to undertake an in-house needs assessment. People were also encouraged to spend time in the home before deciding if it would be the right place to live. At the same time people were provided with written information about the home and the services that were provided. The home did not offer an intermediate care service. Care Homes for Older People Page 11 of 26 Care Homes for Older People Page 12 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice so people living in the home can be confident they will be well cared for. Evidence: Each person living in the home had been asked about their needs and how they would like these to be met. This information had been developed into a plan of care that informed staff what they must do to meet each persons assessed needs. The people accommodated had been assigned a member of staff, called a keyworker, to look after their interests and the keyworkers were responsible for keeping the care plans up to date. We looked at six care plans. Risks to the delivery of care had been assessed and written guidance had been provided to tell staff how to keep people safe from harm. Care plans had generally been reviewed regularly, although one of the plans had not been reviewed every month. The manager explained that this had been identified and action was being taken by supervising the keyworker responsible. The manager had also identified that some reviews of care plans did not contain sufficient detail. Staff Care Homes for Older People Page 13 of 26 Evidence: were to receive training in this area. During our two visits we observed that staff treated people with dignity and respect and that personal care was provided in private. We spoke to several people living in the home and visiting relatives who praised the quality of care provided. One relative said, The staff are wonderful. They have such a lot of patience and are very caring. They dont get enough recognition for what they do. They let me know if they are concerned about mum. One person living in the home said, I am looked after very well. We looked at medication records held for the six people to see if they were receiving their medicine correctly. Five of the records appeared to be accurate and up to date. We found some shortfalls in the remaining record relating to a medicine called Warfarin. The level of Warfarin in stock did not agree with the balance in the record. This appeared to be an error in recording and there was no evidence that the person had not received the correct dosage of this medicine. This can be improved by ensuring that the number of Warfarin tablets held in the home is accurately recorded each time a supply is received from the pharmacy. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had choice and support to meet their expectations and preferences in a personcentred way. Evidence: Care plans provided good information about the interests and preferences of each person living in the home. We spoke to the member of staff responsible for organising activities in the home. Activity sessions were held every afternoon during the week and these had been planned to provide interest and stimulation and to meet the preferences of people living in the home. Regular trips out were provided and people were supported to do their own shopping wherever possible. Special occasions, such as birthdays and religious feasts had been celebrated and people were encouraged to become involved in preparing for these occasions. For example, people living in the home made hearts to decorate the lounge in preparation for the celebrations held on St Valentines Day. Photographic evidence of these activities was held and detailed recordings were made of each persons experience of being involved. There were no visiting restrictions imposed in the home and relatives were observed to come and go during the time we spent there. Care Homes for Older People Page 15 of 26 Evidence: We joined three people for their midday meal on the day of our first visit. People were given a choice of two meals and one person said, Alternatives are also available, particularly if you have lost your appetite. Staff will go out and buy your favourite foods if you ask them. This provided good evidence of person-centred care. We asked the chef questions about the dietary needs of some of the people whose care plans we had looked at. She was very knowledgeable about their food preferences. It was particularly pleasing to find that food from different countries and cultures had been provided to celebrate religious feasts and other occasions. We commended this as evidence of best practice in recognising and valuing the diverse needs of the people living in the home. Care Homes for Older People Page 16 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. This home has good procedures that enable people to express their concerns and be listened to, to protect their rights and safeguard them from harm. Evidence: The home had a complaints policy and procedure that detailed the timescales for investigating and responding to concerns and complaints. The home received one complaint in the previous twelve months and this was resolved within 28 days. People living in the home knew who to talk to if they had concerns and were confident that these would be dealt with appropriately. One person said, I can talk to staff if I have any problems and they will do their best to sort things out. It was evident that the views of people living in the home were listened to and taken seriously. Suggestions had been responded to by taking the appropriate action to improve the quality of the service wherever possible. The home also had procedures in place to safeguard the welfare of people from harm. New staff were trained in these procedures and other staff were currently receiving refresher training in this area. Three safeguarding referrals made in relation to people living in the home had been investigated by Manchester Social Services during the previous twelve months. We spoke to a member of the monitoring team from Social Services and they told us that the shortfalls identified during the investigations had been managed well by the home. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 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. Wellington Lodge provides a safe and comfortable environment that is maintained, decorated and furnished to a good standard. Evidence: During our first visit the deputy manager took us on a tour of the home. We found the environment to be well maintained, clean and hygienic, with no unpleasant odours present. The manager told us about her plans for improvements to the home, which would take place after April 2009. This will enhance the decor and fabric of the home and provide additional facilities for the benefit of people living in the home. We talked to the person responsible for managing the laundry. Care was taken to ensure that personal items of clothing were returned to their rightful owners. Soiled linen was laundered separately following good practice guidelines in the control of infection and personal protective equipment, such as gloves and aprons were freely available. No health and safety issues were found during our visits. 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 people who live at Wellington Lodge are supported by a trained staff team, who know them well and respect their individual needs and aspirations. Evidence: During our two visits to this home we found that sufficient staff had been deployed to meet the assessed needs of the people accommodated. A training and development plan, which included National Vocational Qualifications, had been implemented to make sure that staff had the knowledge and skills to provide appropriate care and support to people living in the home. The staff we spoke to, understood peoples needs and demonstrated a commitment to providing a service that valued the different needs and aspirations of each individual living in the home. A relative said that staff respond well to concerns about his mothers welfare. He commented, Staff rang us up when mum refused her medication and they took advice from her doctor. This shows that staff take the required action when peoples needs change. We looked at the personnel records for two members of staff that had recently been recruited to work in the home. These records generally contained all the preemployment checks that must be obtained to make sure that the staff selected are suitable to work with people living in the home. However, one personnel file contained one, instead of the required two written references. The manager said that she Care Homes for Older People Page 20 of 26 Evidence: thought this had been obtained, but not filed in the records. Care should be taken to make sure that the required documentation is in place prior to confirming new members of staff in post. 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. Wellington Lodge is being run in the best interests of the people who live there and their welfare is both promoted and protected. Evidence: A new manager had been appointed since our last visit to Wellington Lodge. The manager was suitably qualified and experienced and she was in the process of applying for registration with the Commission. People living in the home, relatives and staff that we talked to, said the manager had made positive changes to the way the home was run. Relatives were pleased with the standard of care provided. One of the relatives said, The staff are wonderful. They let me know if they are concerned about my mum and mum says that you couldnt get better meals in a 5-star hotel. Staff valued the good support and training that they received. A senior member of staff stated that the manager had communicated clear aims and objectives to the staff team, with a vision of working to achieve a personCare Homes for Older People Page 22 of 26 Evidence: centred service. This means that people are valued as individuals and that their needs will be met in a way that suits their preferences. The manager was described by two members of staff as, supportive, inclusive and marvellous to work for. The views of people living in the home and their representatives were listened to by involving people in assessments and care planning and by holding residents and relatives meetings on a regular basis. Satisfaction surveys had been issued prior to our visit. The manager said that views and suggestions contained in the completed surveys would be used to inform the future development of the service. We looked at the system in place to assist people with looking after their personal finances. Each bedroom was fitted with a safe for use by people looking after their own money and valuables. This had been carefully assessed to make sure that individuals belongings were safe. A financial accounting system, managed by the homes administrator, was available for people needing assistance with looking after their money. Stringent protocols had been put in place so that people could be confident their money would be looked after well. The system used provided evidence of best practice and this was commended. We looked at a sample of health and safety records and found these to be accurate and up to date. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 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 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 9 A system should be developed to accurately record the balances of all medication held on behalf of people living in the home. This will provide evidence that people are receiving their medication as prescribed by their doctor. 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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