Inspection on 15/10/09 for Lanercost House Care Home - Carlyle Suite

This is the latest available inspection report for this service, carried out on 15th October 2009.

CQC found this care home to be providing an Adequate 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.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Lanercost House Care Home - Carlyle Suite Berkeley Grange Newtown Road Carlisle Cumbria CA2 7PW Lead Inspector Unannounced Inspection 09:30 15 October 2009 th DS0000072849.V377008.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lanercost House Care Home - Carlyle Suite Address Berkeley Grange Newtown Road Carlisle Cumbria CA2 7PW 0207 3522224 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Barchester Healthcare Alison Farran Care Home 15 Category(ies) of Dementia (15) registration, with number of places Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: Dementia- Code DE The maximum number of people who can be accommodated is: 15 Date of last inspection This is the first inspection of this service. Brief Description of the Service: The home is owned by Barchester Healthcare Homes Ltd. and it is registered to provide nursing and personal care to people requiring assistance with all aspects of their care needs due to a dementia related illness. The recently built accommodation comprises of 15 single rooms all of which have full en-suite facilities and are accessible for wheelchair users and there is a lift to the first floor. There is one assisted bath at the home. Communal areas consist of a large lounge/dining area and there is a small kitchen where light snacks and drinks can be prepared. The main catering services for the Carlyle Suite are brought in from Lanercost House a Barchester Nursing Home service on the same site. On the ground floor are therapy rooms including a kitchen and a sensory room. There are secure garden and patio areas, which are accessible from many of the bedrooms and all of the communal areas. There are car parking facilities at the home. All communal areas of the home are NON SMOKING areas. Residents may smoke in their own rooms, but this is subject to an assessment of safety. Further information about the Carlyle Suite and the charges are available from the home on request. There are extra charges for hairdressing, magazines, chiropodists and other personal items that people using this service may wish to have. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The assessment of this service took place over several weeks. We, the Care Quality Commission, made a visit to the home. Some of the people using this service, staff and visitors were asked for their views and opinions about the home, either during the visit or by completing questionnaires. We also looked at a selection of care records, staff records and some of the records relating to health and safety at the home. The manager completed an Annual Quality Assurance Assessment (the AQAA). It is a legal requirement that providers complete this document and return it to us when asked. The AQAA helps providers to identify areas of the service that they have improved and areas where further improvements could be made. The information in the AQAA helps us to target our inspection and helps to verify and inform aspects of the inspection process. What the service does well: The home has been purpose built and has only recently opened to residents. The manager has tried to introduce new residents to the home on a phased basis to help them settle in better. The environment at the home is excellent and it is furnished and decorated to a high standard. People living at the home said that it is always clean and fresh. We found the home to be in a very clean and hygienic condition when we undertook our visit. We spoke to some of the people that use this service and some of their relatives made comments too. These included the following: • ‘The staff are kind to me and look after me nicely’. • ‘The food is good and there are always choices, my wife joins me for lunch often.’ • ‘The home is first class and the carers are very well mannered and helpful.’ • ‘We get excellent care and support in homely surroundings with a friendly staff. • ‘My room is really nice. The staff are very friendly to all my visitors and make them tea.’ • ‘We are very happy with the care our relative is given. The staff are friendly and caring and he has settled in very well and we find him much calmer.’ Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 6 The staff recruitment process at the home is managed very well. The manager ensures that proper and thorough checks are carried out on all prospective employees before they are allowed to work at the home. This helps to make sure that people using this service are supported by suitable care staff. 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 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. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3 and 4. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home may not always have sufficient staff with the skills and experience to deliver the services and care that the home offers to provide. This means that people using this service may not receive the care and support they require. EVIDENCE: All of the people that returned surveys to us told us that they received enough information about the home to help them with the decision to move there. The home does produce a statement of purpose, a service user guide and a variety of brochures about the Carlyle Suite and the services offered. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 9 The text and format of the service user guide could present difficulties for some of the people that may want to use this service. The manager should consider reviewing this document to help ensure that it is in a format suited to the communication needs of people wishing to use this service. The statement of purpose says that the home ‘caters for those with diagnosed dementias which still require active treatment where the staff feel that their needs can be fully met within the care home setting.’ It also states that ‘staff have the competencies to provide for the assessed care needs, particularly relating to challenging behaviour.’ Registered nurses and care workers are employed at the Carlyle Suite. On the day of our visit there were, at first three staff on duty later rising to four, including a registered nurse. The manager told us that most of the people that use this service needed two or more staff to help them with their care, both at night and during the day. We also looked at a selection of staff training records. We found that very few members of staff had received specialist training in dementia care or dealing with challenging behaviour and aggression. This means that there may not always be sufficient staff on duty in the Carlyle Suite that have the skills and experience to deliver the services and care that the home offers to provide. People are able to visit the home before they make their decision to move in, but the manager says that this has not often happened in practice. People taking part in the assessment of this service said that they have received a copy of their terms and condition of residence at the Carlyle Suite. This helps to ensure that people know what to expect from the service. The manager tells us that there are comprehensive assessment procedures in place. This is an area that has recently been strengthened to help ensure that the home only admits people whose needs they can meet properly. We looked at a sample of care records during our visit to the home. We saw that the home undertakes their own admission assessment and people referring prospective residents to the home are asked to complete a document outlining any relevant information that may affect the admission process. Where other health or social care professionals are involved with people thinking of moving to the home, the manager obtains copies of their assessments too. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the 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 care and support plans that detail their needs and requirements. The skill mix and experience of some of the staff working in the home may mean that these needs are not always met in the most appropriate way. EVIDENCE: We looked at a sample of care records during our visit to the home. We found that detailed care plans have been developed for all aspects of people’s daily living activities including; communication needs, assistance with personal hygiene, mobility and manual handling, hopes for the future and social interests. We saw that they have been reviewed and updated at least monthly or when people’s needs change. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 11 Care plans are developed in line with the information obtained during the preadmission assessments carried out before people come to live at the Carlyle Suite. The plans we looked at have all been agreed and signed by the resident or by their relative. This helps to ensure that people are aware of the care and support they can expect to receive. Care plans are generally informative, written to promote independence and take into account the wishes and preferences of the people who use this service. We spoke to some of the staff that work at the home. They have access to care records and were able to give us verbal updates about the needs of some residents. People using this service have a plan of care to help manage and support their needs during the night. Nutritional assessments form part of the care plan and are monitored regularly. Where people are identified at risk of poor nutrition, advice and dietary supplements have been obtained from health care professionals. We saw that end of life wishes had been discussed with residents and their family members. Identified wishes have been recorded. We did see one decision that may not have been made with the best interests of the resident in mind. We discussed this with the manager during our visit as she needs to make sure that people’s end of life wishes are properly considered and clearly documented. We spoke to some of the people that live in the Carlyle Suite and others completed surveys with the help of their family members. Some of the comments we received include the following: • • ‘I get excellent care and support in homely surroundings with a friendly staff.’ ‘My relative has only been at the Carlyle Suite for just over 2 weeks. We are very happy with the care he is given. The staff are friendly and caring and he has settled in very well.’ Daily notes confirm that people have access to a range of health care professionals such as doctors, community nurses, physiotherapists, podiatrists, specialist nurses and consultants. As part of our assessment of this service we looked at a sample of the records kept in respect of medication administration. We found that only qualified nursing staff are responsible for the administration of medication and that they have received training in the safe administration of medicines. This helps to ensure that medicines are managed and administered safely. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 12 The sample of resident’s medication records we looked at contained photographs to help with identification. We saw that each person’s doctor had written to the home regarding the administration of non-prescribed medicines for the treatment of minor ailments. This benefits people as it allows staff to treat minor ailments such as minor pain promptly without needing to call out a doctor. Medication records contain full details of the medicines, creams and lotions prescribed. Medication care plans have been devised and include instructions for use and information about common side effects. We saw that the home has devised a method for trying to establish whether people with limited communication are suffering from pain. This includes the use of large print documents and pictures. We looked at the medication administration record (MAR) sheets. The samples we looked at are not maintained as accurately as they should be. One person had recently been prescribed an antibiotic medicine to be administered four times a day. The records showed that one dose had been missed. Another person’s MAR sheet had hand written instructions for a medicine prescribed for ‘as and when needed’ (PRN). The records indicate that the medication is not being given routinely, but the instructions are not clear and need to be reviewed to help ensure staff administer this medicine as the doctor intended. We also looked at the way in which controlled drugs are managed. These medicines are stored appropriately and are checked weekly by a registered nurse. This helps to ensure that they are not mishandled. There was only one person at the home receiving this type of medication on the day of our visit. We looked at the records for administration and audited this against the medicine in stock. We found this part of the record to be correct, but we found that the administration records had not always been signed by two people as required. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People using the service experience adequate 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 do not always have sufficient opportunities or support in making decisions and choices about their life. EVIDENCE: Care plans are generally informative and written to promote independence. The wishes and likes of service users are taken into account and some records had detailed ‘pen pictures’ that have been provided by their close family members. This helps to ensure that staff are aware of people’s past life, interests, hobbies and social contacts. The staff we spoke to were able to give verbal accounts of the residents they support. Most of the people that live at the Carlyle Suite require some one to one support to help maintain their lifestyle. Information about this is recorded in the care planning process. However, during our visit to the home we observed that people were provided with very little stimulation throughout the day. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 14 One person was calling out for much of the day and although some staff did try to reassure them and find something of interest for them to do, this was not done consistently. Staff sat with residents watching the television. We observed that there was very little conversation and long periods of doing nothing despite the one to one. One person had been admitted the day before our visit. Staff spent little time with them trying to get to know this person and he paced the corridors for most of the day. Despite these negative aspects, we did see some staff reading the newspaper with a resident and, after lunch, some people sat down to play a game. One of the people we spoke to during our visit told us; ‘I can’t complain I am happy with the staff and my care. I don’t like this room, it is noisy.’ This was due to a variety of reasons including the fact that it overlooks the car park of the home and people are always coming and going. Another person told us that the ‘food is good and there are always choices. My wife joins me for lunch often and my visitors are always made welcome.’ We were told that the mobile library visits the home and we saw some talking books that had been borrowed. One person we spoke to said that they have been out in the garden weeding and that they sometimes go out for a walk with staff or relatives. They added that; ‘there is not usually much going on in the home, there are sometimes games that we can join in.’ We observed the service of the lunchtime meal. The menus generally show that people are offered a wide variety of food and there are always several choices at each meal. People were guided to the tables and asked what they would like for lunch by the staff. Meals were well presented and people seemed to enjoy them. Staff provided assistance with eating and drinking where needed and encouraged people to be as self managing as possible. Staff were mindful of giving resident’s meals that might be too hot to eat straight away. We did overhear a comment about the day’s menu and the fact that all the meals that day contained cheese. This could have been a problem for people that did not like cheese. Generally staff spoke to residents respectfully and politely, although there was one person who did speak loudly at times and could have appeared to be abrupt or shouting on some occasions. We brought this to the attention of the manager during our visit. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place at the home, but the staffing levels, skills and experience may not always be sufficient to ensure that people using this service are properly protected from harm. EVIDENCE: The manager has told us that the home has policies and procedures in place regarding complaints, safeguarding vulnerable adults (abuse) and the use of restraint. Since the home opened in June 2009, there have been no complaints made either to the home or to us (Care Quality Commission). People taking part in the assessment of this service told us that they know who to speak to if they have a concern about the service. They told us that staff listen and act upon what they say. However, the manager should give consideration to producing the complaint process in alternative formats to help meet the communication needs of people using this service. Due to the nature of the illnesses of some of the people that live at the Carlyle Suite there have been several incidents of physical abuse occurring between Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 16 residents. The manager has always notified us and the social work team about these matters, as required by law. This helps to make sure that appropriate safeguarding strategies are put in place to help reduce the risks of harm to people using this service. Although the care records we looked at have action plans in them to help staff manage people who may, at times, display behaviour that can be challenging, it is evident that the staffing levels, skills and experience may not always be sufficient to ensure that people using this service are properly protected from harm. Records show that although most staff have received training in safeguarding adults, few staff have received specialist training in dementia awareness and in responding to people who may display aggression and challenging behaviour. This type of training helps to ensure staff understand the specialist needs of people with dementia and protect vulnerable people from the risk of harm. The manager is aware of the law in respect of the Mental Capacity Act and the Deprivation of Liberty. We saw evidence to confirm that where concerns have developed, the manager has referred people to a social worker for assessment. We also saw that people have had their best interests represented by an independent advocate. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all of the above standards. People using the service experience excellent 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 warm, comfortable and safe environment for the people that live there. EVIDENCE: The home is newly constructed and is in excellent decorative and furnished condition. On the day of our visit the home was clean, tidy, warm and free from any odours. The accommodation is comprised of fifteen single rooms all of which have full en-suite facilities. Most of the bedrooms have access to a secure outside area, either the garden or patio. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 18 The accommodation is well furnished and tastefully decorated. People are able to bring in some of their own possessions to help make their own room more personalised. Medication is kept in each person’s own room within a locked medication cabinet. On the day of our visit all the doors to bedrooms, bathroom and kitchen were locked and if people wanted to go to their room they had to ask a member of staff to unlock the door. Not everyone in the home would be able to do this. Once inside their own room, people are able to lock their doors from the inside, if they choose. There are communal areas in the home, a large lounge/dining area, an assisted bathroom for people unable to access their shower or prefer a bath. There are extra communal areas on the ground floor where activities can take place. These include a sensory room and a kitchen. There are nurse call bell facilities throughout the home so that people may call for assistance if needed. The home is purpose built and has facilities to help people maintain their independence and mobility as much as possible. There is handling equipment such as hoists available at the home should they be needed. The sluice area of the home was clean and tidy on the day of our visit. The waste bins are colour coded to help ensure that waste is disposed of safely and appropriately. Meals are prepared in the kitchen on site at the main home – Lanercost House. Similarly, the laundry is undertaken on this site. We have previously visited the kitchen and laundry at Lanercost House and found them to be well organised, clean and hygienic. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at all the above Standards. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited safely and are provided with some training to help them do their job properly. There are some gaps which could result in lack of understanding of the needs of people using this service. EVIDENCE: The staff team consists of qualified nurses and care assistants. The staffing levels are kept under review and we were told they were due to be increased as more people move into the Carlyle Suite. Staff have been provided with a variety of training to try to provide a suitable skill mix to meet the needs of the people that use this service. This is an area that would benefit from further improvement to ensure staff have the specialist skills to provide the services outlined in the home’s statement of purpose. Staff work 12 hour shifts and they do not have formal breaks within this period. Breaks and meals are taken with the residents. The nurse in charge did say that staff are able to take time out if needed. We also spoke to some of the staff about the shift patterns. One member of staff said that the shifts ‘were not so bad as they only work 36 hours per week Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 20 – three days on and four days off.’ She told us that she felt well supported and given suitable training to help her do her job efficiently. She told us that she had received some training to help her with her job, including dealing with challenging behaviour and aggression. We looked at a sample of three staff records during our visit. We found that staff had been carefully and safely recruited. Prospective staff had completed application forms and attended formal interviews. The manager had carried out checks on their integrity and suitability for the job by taking up references, obtaining Criminal Record Bureau (CRB) checks and checks against the Safeguarding Vulnerable Adults list (SOVA). Where people are registered nurses, their qualification is checked with Nursing and Midwifery Council. During our visit to the home we spoke to the home’s training co-ordinator. She told us about the training that is in place at the home and she showed us a selection of the records that are kept with regard to training. These include the dates of training, the course content, the duration of each session and the names of staff attending. She told us that the home has a training plan but this is to be reviewed as ‘it did not quite work as planned.’ The training coordinator told us that she had found some of the staff training was out of date and had not been updated for some time. Staff training has had concentrate on mandatory training such as health and safety, moving and handling, infection control and food safety. This has caused a delay to the provision of more specialised training for staff. The training co-ordinator told us that staff induction training had changed recently. This now takes several weeks to complete and includes shadowing shifts, training courses and e-learning. We saw evidence of this training on some of the staff files we looked at. Training such as working with people with challenging behaviour is provided by specialist trainers. E-learning is used for some topics and a wide variety of courses have been developed by the organisation for this method of training. Certificates issued following training include information about the content of the course and the topics covered. E-learning is monitored by the training officer to make sure people are completing the training as required. The staff training records we looked at varied in content. Some staff had undertaken induction training to help them settle into their new job, whilst others had not. There were noticeable gaps in the training for staff working with people with dementia or with people who may be aggressive or challenging. However, we were told that some people have undertaken this type of training and that further training has been planned for the future. Staff attendance at training is now monitored by the manager. Failure to attend can lead to disciplinary action being taken. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 36 and 38. People using the 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 managed by a qualified and experienced person. This will help to ensure that the home is run in the best interests of the people that use this service and with their health, safety and welfare in mind. EVIDENCE: The manager of the home is a qualified registered general nurse. She has many years experience of managing a care home. The manager has a variety of further qualifications, mainly relating to nursing and care. She is currently looking to undertake a Certificate in Management. The manager is supported Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 22 in her duties at the Carlyle Suite by the head of unit and is further supervised and supported by the organisation’s operations manager, who visits the home frequently. The Carlyle Suite opened in June 2009. The manager tells us that there are plans to involve people using this service in running of the home by implementing resident meetings, annual quality assurance processes and by the evaluation of any comments/complaints received. The staff records show that staff have their practice monitored and are regularly supervised by their manager. We noted that recently recruited staff attend a supervision meeting at the end of their probationary period. This helps to ensure staff are well supported in their work and that any training and development needs are identified and actioned accordingly. Some of the staff we spoke to during our visit to the home told us that they feel they are supported by their managers and that they can discuss any concerns or problems with them. The manager told us that all of the safety checks such as services for gas appliances, central heating, handling equipment and fire detection systems have all been completed. We looked at a sample of some of the records that the manager is required to keep in respect of fire safety and accident/incident recording and reporting. We found that all staff receive regular fire safety training and that records of this are maintained. There is a fire risk assessment in place at the home, which has been updated. The document would benefit from a review now that people have started to move into the Carlyle Suite. Individual fire evacuation plans are included in each persons care file to help ensure staff know the level and type of support people would need should it become necessary to evacuate the building. The accident book is maintained and we saw that the sample of accidents/incidents recorded in individual care records were also recorded in the accident book. Staff training records show that staff have access to health and safety training, including infection control, moving and handling, first aid and food hygiene. This helps to minimise the risk of harm or accidents to staff and to the people they support at the home. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 2 X n/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 3 4 4 4 3 4 4 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 3 Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 18 Requirement There must be a sufficient number of suitably qualified, competent and experience people working at the home at all times. This will help ensure that the health and welfare of people using this service are properly supported and that the aims and objectives of the Statement of Purpose are met. 2 OP9 13 Medicines must be administered as the doctor prescribed and intended. Staff must be provided with training appropriate to the work they are to perform. This includes, but is not limited to dementia care, dealing with aggression/challenging behaviour and physical intervention. People using this service must be properly protected from the risk of harm or abuse. Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 25 Timescale for action 30/11/09 30/11/09 3 OP18 13 31/12/09 4 OP38 23 The fire risk assessment in place at the home must be reviewed and updated now that there are people using this service. 30/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Service User Guide would benefit from a review to help ensure that the format is accessible to people thinking of using this service Consideration should be given to using a clearer font type and large print. All records for administration of medication should be kept free from errors. This will help ensure that residents are protected from mistakes that could cause harm to their health and well-being. You should ensure that the end of life wishes of people using this service comply with current good practice guidelines and legislation. People using this service should be provided with stimulating opportunities through leisure and recreational activities both inside and outside of the home to suit their individual needs, preferences and capacities. Consideration should be given to producing the complaints procedures in a more ‘user-friendly’ version to help meet the understanding and communication needs of the people that use this service. There should be suitable arrangements in place to ensure that the personal space of people using this service is kept private and that they can access their own rooms when they wish. 2 OP9 3 OP11 4 OP12 5 OP16 6 OP24 Lanercost House Care Home - Carlyle Suite DS0000072849.V377008.R01.S.doc Version 5.2 Page 26 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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