Inspection on 08/04/09 for Lanercost House

This is the latest available inspection report for this service, carried out on 8th April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lanercost House 03/07/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lanercost House Berkley Grange Carlisle Cumbria CA2 7PW     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: Diane Jinks     Date: 1 5 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 30 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 30 Information about the care home Name of care home: Address: Lanercost House Berkley Grange Carlisle Cumbria CA2 7PW 01228595138 01228597227 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) : Barchester Healthcare Homes Ltd care home 82 Number of places (if applicable): Under 65 Over 65 39 43 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 3 The registered person may provide the following categories of service only: Care home with nursing: Code N, to people 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 Physical disability Code PD The maximum number of people who can be accommodated is 82 Date of last inspection Brief description of the care home Lanercost House was previously operated by Westminster Healthcare, and was taken over by Barchester Healthcare in February 2007. Lanercost is a purpose built care home, all on the ground floor, providing nursing care and accommodation for up to 82 people in the categories of old age, dementia and physical disability. The home is divided into units, each with its own lounges, dining rooms and bathrooms. There are 74 single and 4 twin bedrooms, all with ensuite facilities. There is ample outdoor space including parking and a secure garden. Care Homes for Older People Page 4 of 30 2 3 1 0 2 0 0 8 Brief description of the care home The home produces an information brochure and welcome pack that details all the services offered. These documents are available from the home manager, together with information about the weekly charges for this service. Care Homes for Older People Page 5 of 30 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 assessment of this service took place over several months. We have considered information from a variety of sources, including the improvement plan sent to us by the organisation following our last inspection of this service. The home was visited by three inspectors, Diane Jinks, Margaret Drury and Simon Hill (pharmacist inspector). During our visit to the service we looked at a selection of records that the home is required to keep, we looked at the way in which medicines are managed and we spoke to some of the people that live, work or visit Lanercost House. We sent and received surveys back from members of staff, people who live at the home and some of their relatives. We also received six letters from relatives and one from a person that lives at Lanercost House. Surveys and letters provide us with Care Homes for Older People Page 6 of 30 information on peoples views and experiences of the service. We asked the manager to complete an Annual Quality Assurance Assessment (the AQAA). This provided us with information about the service, where improvements have been made and where the manager intends to make further improvements. What the care home does well: What has improved since the last inspection? Following our last inspection of this service, the organisation produced an improvement plan to tell us how and when improvements to the service would be made. There is a new management team at Lanercost House now. An experienced manager has been transferred from one of Barchesters other homes and two new heads of unit have been appointed. We found that assessment processes, care planning, risk assessments and the ways in which medication is managed have all improved considerably since our last visit to the home. There is evidence to show that people and their relatives are involved in the development of individualised care plans. People using this service have a named nurse and a keyworker assigned to them and this helps to ensure that care and support is provided in a consistent manner. Staff have noticed the improvements to care plans, one person said; Care plans havent always been up-dated but now these are much better. This means that people receive the care and support they actually need with their independence being respected. Improvements have also been made to the ways in which staff are trained and supervised. A trainer has been appointed at the home and she has devised a training and development plan to help ensure staff at the home have the skills necessary to meet the needs of the people that live there. The staff training programme has commenced and includes subjects relating to care planning, working with people with dementia illnesses and health and safety matters. Senior staff have received training to help them supervise staff effectively. Staff supervision helps to make sure that staff are working safely, following good practice guidelines and providing a good, safe service to the people that live at Lanercost House. We saw that the general record keeping at the home has greatly improved. The manager has kept us informed of events that affect the well-being of people who use this service and where necessary social workers and healthcare professionals have also Care Homes for Older People Page 8 of 30 been contacted or consulted for help and advice. 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 9 of 30 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 30 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 using this service have their care and support needs assessed and reviewed. This helps to ensure that the home will be suitable and will meet their needs appropriately. Evidence: The manager at Lanercost House has reviewed and updated the information about the home. This helps to make sure that people thinking of using this service are provided with accurate details about the home to help them with their decisions and choices. There is a detailed admission process at the home, which includes arrangements for people who may need to be admitted in an emergency. People are able to visit the home to have a look round prior to making their decision to move in. Most of the people who completed a survey and the people we spoke to told us that they were able to make an informed decision about their move into Lanercost House. One person told us, my family visited the home without an appointment before making a final Care Homes for Older People Page 11 of 30 Evidence: choice of home. They were made very welcome by the manager and shown round on a fairly detailed tour, and a relative said, as you can imagine moving mum into a nursing home was quite traumatic experience. The staff made us both very welcome from day one. We looked at a sample of care records for some of the people that live at Lanercost House. We found that people recently admitted to the home have detailed assessments of their care and support needs. Where appropriate, the manager has ensured that care needs assessments of existing residents have been reviewed and updated. These processes help to ensure that people thinking of moving into Lanercost House are able to discuss their care and support needs and requirements with the manager at the home and helps to make sure that the home will be suitable and able to meet their needs and expectations appropriately. Care Homes for Older People Page 12 of 30 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. People using this service have detailed plans of their care and support needs including details of the action staff should take to meet those needs. This helps to ensure that people using this service experience good care and good quality outcomes. Evidence: The manager told us that people have their care plans reviewed at least monthly. She told us that people using this service are involved with this process and where appropriate, a family member or representative is also involved. We spoke to some of the staff that work at the home during our visit. They were able to discuss individual residents with us and were knowledgable about their needs and of the information that is recorded in care plans and assessments. They told us of the training they have received to help them with care planning and care provision. One member of staff told us that they have more input into their job now, and that their work is more structured and organised. There have been lots of improvements and we get good support from the manager. Staff training records confirm that many staff have received recent training in person Care Homes for Older People Page 13 of 30 Evidence: centred care planning and in the principles of care. This helps to ensure that when care plans are developed and written, they take into consideration the wishes and expectations of people using this service and are developed to meet each persons individual needs. People using this service have been allocated a named nurse and a keyworker. This means that care is usually provided by familiar staff and helps to ensure that it is provided in a consistent manner. We looked at a sample of eight care plans. We found that care needs assessments and care plans have been reviewed and re-written. Great improvements have been made to the quality and detail of information contained in these documents. The detailed care and support plans cover every aspect of peoples daily needs and requirements. The plans clearly record the support required by individuals and of the things they can manage to do by themselves. This helps to demonstrate that people using this service are treated with respect and are encouraged and supported to be as independent as possible. The plans show that peoples end of life wishes have been discussed with them and their relatives. This helps to make sure that staff know about peoples final wishes and will be able to carry these out with respect and sensitivity. Care plans include some element of risk assessment, particularly in relation to mobility, nutrition, skin care, medical conditions and behavioural issues. These are areas that often require specialist intervention and advice. There are instructions for staff to follow to help ensure people receive the support they need, safely and in a timely manner. Where issues have been identified there are records to show that concerns are being regularly monitored with advice and assistance being sought from other health care professionals when necessary. Short term care plans have also been developed for use where people may have specific needs such as wound care and pressure care. Some of the people we spoke to during our visit and the people who returned surveys, told us that staff always listen and act upon what they say and that there is usually enough staff available to meet their needs and requirements. One relative told us, the staff are always willing to discuss any questions or queries we have. They encourage us to communicate any problems. They assess my fathers needs regularly and discuss with us his care. They do this in a very professional manner with dignity protected. As part of the inspection a pharmacist inspector visited on 8th April 2009 to check how medicines were being handled. We found medicines stock and records to be well organised and securely stored. Our checks of the records and current stock showed medicines were being given and recorded correctly. A clear system of stock control was in place that helped make sure medicines did not run out of stock and helped make sure they could be fully accounted for. We checked how controlled drugs, medicines that can be misused, were handled. The cupboards used for storage were secure and special registers were used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure Care Homes for Older People Page 14 of 30 Evidence: storage and detailed records help prevent mishandling and misuse. Medicines were regularly checked and detailed records of this were made, any mistakes that were found were acted upon immediately to try and prevent them happening again. Staff had received regular medicines training and their competency in handling medicines had been formally assessed. Nursing and care staff said they felt well supported by the manager and any training needs were met by formal training sessions, regular meetings and direct supervision by senior staff. Regular checks on medicines, relevant training and competency checks help make sure staff have the necessary skills to handle medicines safely. We looked at a sample of peoples care plans and found good information about their medicines. A detailed summary of each persons medicines was kept with the main records to help make sure staff knew what they were prescribed for. Care plans for people that were taking when required medicines for agitation, pain, epilepsy and swallowing difficulties were detailed about how and when they should be used. When we spoke with staff and checked the records we found these care plans had helped improve the way these medicines were being handled. This is a good improvement from our last inspection that helps make sure people receive their medicines correctly. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are offered choices in the way they live their life. Evidence: We received a number of letters and surveys from people who live at Lanercost House, their relatives and staff who work at the home. They told us that there are a variety of activities available at the home and that they can participate in them if they wish. One person living at the home told us since the activities person has been appointed there has been an improvement. Once there was nothing but now there are quite a few activities. The activities organiser was on holiday at the time of our visit but staff members had been allocated the task of organising daily activities to ensure that these carried on regardless of the organiser not being there. The manager told us that this is an area that she hopes to further improve, especially for the people who have dementia illnesses. We noted that there are activities organised for most days and a monthly programme is on display throughout the home. The activities for April included trips out, church services, communion, Easter themed activities, entertainers in the home, baking, singing, egg decorating and clothing sales. People using this service are asked about their hobbies and interests when they come Care Homes for Older People Page 16 of 30 Evidence: to live at Lanercost. Where people are unable to do this themselves, we saw that relatives had been asked. A relative told us; I believe my mother is well care for, with dignity and that the staff are aware of her needs. It is obvious that they spend time talking with her and that efforts are made to stimulate her both physically and mentally. The staff are aware of her past life and make use of the scrap book I made for this purpose. The home has purchased new televisions for the communal areas and some people were enjoying watching these, other people were sitting in one of the lounges listening to the radio and music was playing in the Priory Unit main lounge where some residents joined in singing. We saw people taking part in gentle exercise sessions, a beauty therapist was at the home and many of the ladies were having manicures. People living at Lanercost House are able to see their visitors at any time, either in the privacy of their own room or in one of the communal areas. We spoke to some relatives and received written comments from some others. One person told us; when I visit I am always offered refreshments and I can bring our pet dog to visit. Many of the residents enjoy seeing and petting the dog. Another person told us The staff encourage us to come in at any time. There is always a friendly welcome and tea or coffee. Many relatives told us that they are kept up to date with various aspects of their relatives care and support. We saw that some care plans had been agreed and signed by relatives making decisions and acting on behalf of the person receiving the care and support. The care records we looked all contained nutritional assessments and where necessary individual care plans have been developed to help ensure people using this service receive the correct support with their diet, eating and drinking. Where concerns have been identified, the manager has sought assistance and advice from the doctor, dietician or the speech and language therapist. During our visit to the home we observed the service of the lunchtime meal in Priory Unit. The interaction between staff and residents was very good, staff explained to residents when procedures such as moving and handling were required. They checked that people had everything they needed to eat their meal as independently as possible, for example specialised cutlery, spoons or plate guards. Where people did need assistance with eating and drinking staff sat at the table with the person and helped with sensitivity, chatting to the resident all the time, making the meal time a sociable event. Just before the meal, one person became quite vocally aggressive and a member of staff went to play a game with them to try to ease the situation. We spoke to one of the kitchen assistants who told us that she thought the meals, menus and pureed food had very much improved recently. She told us, alternatives to the menu are always available. Some people have nutritional supplements such as Ensure and the chef knows of the people needing special diets, fortified meals and drinks. Care Homes for Older People Page 17 of 30 Evidence: We also spoke to the chef. He has reviewed the menus recently with residents and families at two meetings. Different dishes have been tried to help ensure people using this service have a variety of foods and choices. Some people were not keen on some of the choices and have suggested other alternatives. All the cakes and puddings are made on the premises and the chef said that there is a good budget available for the food purchases. The chef told us that the Organisation has good systems and procedures in place regarding the kitchen and food service. We saw evidence that systems are followed and the chef ensures that records are maintained as required. Many people made comments on the quality, quantity and choice of the food available. One person who lives at Lanercost told us; I always like the meals but cant eat the amount given!Another person told us; the food is good quality and usually nicely cooked. The chef listens to any comments and deals as best he can with residents requests. Care Homes for Older People Page 18 of 30 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. People living at Lanercost House know about the complaints process and know who to raise their concerns with. They are confident that their concerns will be listened to and taken seriously. Evidence: There is a complaints process in place at the home. This information is included in the documents given to prospective residents and their relatives at the time of admission to Lanercost House. People using the service tell us they know about the complaints process and they know who to speak to about concerns. Most of the people we spoke to or received surveys from told us that they have never had to make a complaint and are happy with the service so far. One person said I know about the process but I have nothing to complain about. Relatives told us the staff are always willing to discuss any questions or queries we have. They encourage us to communicate any problems, another said we are encouraged to discuss any issues. We have done this and our suggestions or questions are always attended to immediately. People also told us that they attend the residents/relative meetings at the home. These meeting provide people with an additional forum to raise concerns, complaints of suggestions. The manager has received 2 complaints since our last visit. She has ensured that clear records have been kept of the action taken to address the complaints and the outcome of the complaints. The home provides access to advocacy services for the people that live at Lanercost Care Homes for Older People Page 19 of 30 Evidence: House should they need this support. The manager has told us that she intends to ensure that staff receive training regarding complaints and how to deal with them, this will be reinforced during staff meetings. The manager has made improvements to ensure that incidents affecting the well-being of people using this service are reported to us as required. She has reported some events to the local authority safeguarding team and social workers when necessary. The home has a copy of the local safeguarding procedures to help ensure they report matters in the correct way. Staff have received training in safeguarding vulnerable adults (abuse) and this helps to ensure that people using this service are protected from harm. We found that risk assessments have been formulated and are in place, especially where residents have been identified as needing extra care or supervision. This helps to ensure that everyone living and working at the home is protected from the risks associated with abuse. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service live in a warm, safe and comfortable environment. Evidence: We looked around the home during our visit to Lanercost House. We found that all areas of the home were clean, tidy and free from any unpleasant smells. The people that live at Lanercost House are able to and encouraged to personalise their own rooms and space. We saw that people have brought in their own televisions, radios, pictures, photographs and ornaments to help make their rooms more homely and familiar. The rooms are furnished to a good standard and the bed linen was clean and fresh. Where people need specialised equipment such as beds, mattresses or chairs, this has been obtained. The home is generally equipped with a variety of aids and adaptations to help people using this service access all areas of the home as independently as possible. during our last visit to the home we noted that many of the communal bathroom areas had been used to store handling equipment, this problem appears to have been addressed and on the day of our visit the communal areas were easily accessible and free from potential hazards. The home is equipped with nurse call bells throughout communal areas and in personal bedrooms. We noted that some of the call bells in the communal areas are tied up and Care Homes for Older People Page 21 of 30 Evidence: out of the reach of people. This means that people may not always be able to summon the help or assistance of care staff when they need them. There are a variety of communal areas throughout the home including, dining rooms, lounges and individuals private rooms and people are able to choose where they spend their time. The people we spoke to or made comments in surveys, all told us that the home is always warm, fresh and clean. One relative said; We often arrive unannounced and the environment is pleasant and happy. Another person told us; I notice that when I am visiting work is being done in and around the home e.g. decorating and planting flowers. There are garden areas at the home and although some improvements have been made, the manager hopes to develop these areas further. The manager told us that she plans to encourage the people that live at Lanercost House to become more involved in the decisions relating to the decor of the home. She told us that there are plans for improvements over the next year to develop the environment on Priory Unit, in line with good practice guidelines for people with dementia illnesses. There are infection control policies and procedures in place at the home. Staff are provided with protective clothing and they tell us that they have received recent training regarding the control of infection. These measures help to ensure that people using this service are protected from the risks associated with poor hygiene. Care Homes for Older People Page 22 of 30 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. Staffing levels and skill mix reflect the care and support needs of the people that use this service. Evidence: On the day of our visit there appeared to be a sufficient number of staff on duty to meet the needs of the people that use this service. We looked at one of the staffing rotas kept at the home. This shows that staffing levels are planned in advance, it also shows that some staff work many hours and long shifts at times. This needs to be monitored by the manager to ensure that staff and residents are safe. Some of the people we spoke to and the information contained in returned surveys, say that there are usually enough staff on duty at the home. Some of the staff indicate that there are times, for example staff sickness, when staff shortages may occur. Some staff raised staff sickness as an issue and one member of staff told us; sometimes you cannot account for sickness but this is an issue that is being looked into carefully as the same ones are off everytime and often. Our new head of unit is dealing with this situation. We discussed this with the manager during our visit to the home and she told us of the progress she has made and the strategies that have been put in place to help address these concerns. The home is staffed by qualified nurses and care assistants. There is a programme in place for care assistants to complete National Vocational Qualification training (NVQ). Care Homes for Older People Page 23 of 30 Evidence: Some staff at the home have completed NVQs in a variety of subjects including care and food service. Others are in the process of or have expressed an interest to undertake this type of training. One member of staff said; I have done my NVQ 2 and 3 whilst I have been here, they help me to meet the differing needs of people. We looked at the recruitment records for three members of staff who are about to start working at the home. The records show that the manager follows the recruitment procedures and this helps to make sure that only suitable staff are appointed. Prospective staff complete application forms, attend for interviews and are required to provide details of their previous experience and qualifications. Before people are allowed to work at the home the manager ensures that references are obtained, Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks are made. This helps to make sure that people using this service are protected from people that may be unsuitable to work with vulnerable older people. During our last visit to the home, we found that staff training and training records had not been kept up to date as it should be. During this visit we looked at the staff training arrangements, training plans and training records. We found that the new manager has made improvements to this important area. The home has employed a training co-ordinator to help ensure that all staff receive the training and refresher training they need to do their job competently and meet the needs of the people that use this service. A training and development plan has been created with some of the training courses already taking place. Training records show that many staff have completed training in dementia awareness, principles of care, person centred approaches to care, fire training, infection control, first aid, team building, moving and handling and safeguarding adults (abuse). The manager told us about the new induction programme for new staff and showed us some examples of the course content. We spoke to the training co-ordinator about the work she has done already at the home. She showed us plans of the training courses she intends to deliver and records of the ones already completed, including clear details of the course content. We spoke to a number of the staff and some staff also returned completed surveys to us. They told us about the training that they have recently received and that they now feel well supported by the manager. One person told us; I recently attended a wound care training course which was a really good, very helpful and useful course. I have also been provided with training on supervision to help understand my role as a supervisor and supervise staff effectively. Another person said; I have had supervision training, person centred care planning training and noticed improvements in the management of the home. We didnt know we were doing things wrong until we were told, if youre not told you dont know do you? Some relatives also made comments about the staff at Lanercost House. One person said; From evidence I have seen and past experience of other care staff in other establishments, I would say the staff are very experienced, another person said, Care Homes for Older People Page 24 of 30 Evidence: whenever we visit there always appears to be a good mix of varied skilled staff. The experience of senior staff give us confidence that the correct care is given. The care assistants always appear confident in their skills. Care Homes for Older People Page 25 of 30 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 is run in the best interest of the people that use this service. The health, safety and welfare of people who live and work at Lanercost House is promoted and protected as far as possible. Evidence: At our last visit to the home, we found that the home had not been always been managed effectively or in the best interests of the people that lived and worked at Lanercost House. We met with senior managers from the Barchester organisation to discuss our findings and assessment of the home at that time. The management team took our findings very seriously and provided us with a plan of how they intended to make improvement to the service provided by Lanercost House. As part of their improvements, senior managers at Barchester reviewed the management arrangements at the home. A new manager was transferred to Lanercost House from another of Barchesters homes. When these changes were implemented by the organisation, in February 2009, we received letters and surveys from some relatives Care Homes for Older People Page 26 of 30 Evidence: and staff telling us of their concerns with the changes. The new manager at Lanercost House is a registered nurse, a qualified nurse practitioner and has completed the registered managers award. She has over 8 years experience of nursing home management and is a qualified NVQ assessor and internal verifier. The manager told us that since her appointment to Lanercost she has had good support from the organisation and that there are good support systems in place to help ensure this continues. As part of our assessment of this service, the manager is required to complete an annual self assessment of the service (the AQAA) and return it to us. In this document the manager told us of the improvements that have been made at the home and of the plans for further improvements over the next 12 months. There have been some difficulties with staff since the change of manager but these are starting to be resolved, particularly with regard to staff absenteeism, low morale and uncertainty. One member of staff told us; We have a new head of unit who is improving things which need sorting out. We found that staff supervision, training and staff meetings have started to take place. These measures help to ensure that staff are competent, are following the policies of the organisation and are working with people using this service in a safe and positive way. Staff issues that have been brought to the managers attention are being dealt with via disciplinary processes or initially by more informal job chats. Most of the staff we spoke to made various comments such as; things are more organised now, there have been lots of improvements and we get good support from management, and we have a strong manager and as a qualified nurse I am able to have more input into my job now. We found that the staff were much more positive about their work and the home than had been indicated in the surveys we received earlier this year. We also found that many of the issues they had identified are now being actioned by the manager. We looked at a variety of the records that the home is required to keep by law. We found that the information recorded was much improved. Clear details are recorded and where necessary records have been reviewed, updated and are regularly monitored. This helps to ensure they are as up to date as possible and reflect the current situation. During this visit to the home we also looked at a selection of safety records, such as equipment servicing and testing. We found that these had been undertaken as required to help ensure the environment at the home is not only clean but safe. Staff training records show that staff have started to receive training or updates in essential safety training such as moving and handling, fire training, first aid and infection control. We looked at the accident book. The dates and records correspond with the individual care records of some of the people that use this service and other incidents that the manager has reported to us or to social workers. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 14 Where relatives and advocates are involved in decision making processes on behalf of a person using this service, you should ensure that clear records are maintained in line with the requirements of the Mental Capacity Act 2005. You should make sure that people using this service have access to nurse call bells at all times. This will help to make sure that people using this service can summon the help and assistance of staff quickly, when necessary. The organisation should ensure that the home is managed by a person registered with the Care Quality Commission. 2 22 3 31 Care Homes for Older People Page 29 of 30 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). 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. Care Homes for Older People Page 30 of 30 - 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!