Inspection on 22/05/08 for Lady Elsie Finney House Home for Older People

This inspection was carried out on 22nd May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lady Elsie Finney House Home for Older People Cottam Avenue Cottam Preston PR2 3XH Lead Inspector Mrs Marie Cordingley Unannounced Inspection 22nd May 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lady Elsie Finney House Home for Older People Address Cottam Avenue Cottam Preston PR2 3XH 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) 01772 721 072 01772 721 073 Lancashire County Care Services Mr Bennett Mott Care Home 45 Category(ies) of Dementia (45) registration, with number of places Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - code PC, 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: 45. N/A Date of last inspection Brief Description of the Service: Lady Elsie Finney House is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 45 people who have Dementia. The purpose built home is divided into three separate units, each with an open plan lounge and dining room. All accommodation at the home is provided on a single room basis and all bedrooms have en-suite facilities. In addition, there are ample numbers of well equipped bathrooms for the residents’ use. The home has been designed to provide easy access for people with limited mobility and there is a passenger lift to enable residents to access the first floor accommodation. The provider of the home is Lancashire County Care Services, a direct services organisation who operate a number of care homes in the area. Care is provided on a 24 hour basis including waking watch care throughout the night. The majority of carers employed at the home hold National Vocational Qualifications in care, at level 2 or above. At the time of our inspection we were advised that fees for care and accommodation range from £394 - £411 and are assessed in accordance with people’s individual needs. All this information and more can be found in the Service User Guide which is available on request from the home. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 1 star. This means that people using this service experience adequate quality outcomes. The inspection of this home included a site visit which was carried out over one day. This visit was unannounced meaning that the manager, staff and residents did not know it would be taking place until the inspector arrived. During the visit we spent time talking with and observing residents, staff and the registered manager. We also had the opportunity to consult several visitors who had come to see their relatives. In addition, we viewed a selection of paperwork, including a sample of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point that they moved into the home. Prior to our visit, we wrote to the registered manager and asked him to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. A number of completed surveys were returned to us. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 6 What the service does well: We received a number of responses to our written survey and also had the opportunity to consult some residents and their relatives during our visit. People told us that they were very satisfied with the care provided at Lady Elsie Finney House and spoke highly of staff and managers. Comments people made included “I could not give Lady Elsie Finney House anything but the highest of praise.’’ “Staff are excellent and the manager is excellent.’’ ‘‘I will be pleased if the home carry on as they are doing.’’ “The staff and managers at Lady Elsie Finney House are absolutely excellent.’’ “I am very pleased with all aspects of care and cannot think of how the home could improve.’’ We spoke with a number of carers during our visit and observed them as they went about their daily routines. It was apparent during discussion that carers were very committed to their roles and were well motivated. Carers demonstrated a good understanding of the residents’ needs and went about their duties in a professional manner. The home has a good approach to staff training and there is a comprehensive core training programme in place for carers. This includes all the mandatory health and safety areas, such as moving and handling and first aid, as well as additional training such as positive dementia care and safeguarding. At the time of our visit we were advised that 31 out of the 36 care staff employed at the home hold National Vocational Qualifications in care at level 2 or above. This is a good achievement and exceeds the national target of 50 . Prior to our visit we asked the manager of the home to complete a comprehensive self assessment. This was completed within agreed timescales and to a very good standard. The manager provided a good amount of information and demonstrated that he had a good understanding of the need to constantly monitor quality in all areas. The assessment also showed that the manager had identified areas for development and had some very good ideas as to how these areas could be addressed. It was evident in discussion with the manager that he is very knowledgeable about the area of dementia care and he was also able to give examples of how he keeps up to date with developments in the area, good practice and relevant changes in legislation. During our visit we noted that residents were familiar with the manager and appeared very comfortable in his presence. In addition, the manager clearly had a good understanding of individual residents’ needs and was also able to demonstrate that he shared very positive relationships with residents’ families. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 7 People we spoke to told us that the manager of the home was very approachable and supportive. One relative told us “He always has time for us, I’m always happy to approach him if I need to discuss something.’’ A carer said of the manager, “He brings a lovely atmosphere to the home, he makes us feel very appreciated.” What has improved since the last inspection? What they could do better: The Service User Guide is an important document which assists people to make an informed choice about where to live. Currently, the guide is only available in a standard written format. We talked to the manager about how this information could be made more accessible and recommended that it be made available in a variety of formats, such as large print and audio. Care planning is an extremely important tool when providing care for people who have Dementia. Some people with Dementia will find it difficult to communicate their needs and wishes, or their preferences in relation to daily life. However, detailed care plans that are well researched, sensitively written and recognise the person’s individuality can assist staff in providing person centred care. Some care plans we viewed lacked detail about people’s social histories and failed to address people’s personal views and preferences. In some examples, there was little information about people’s communication needs or their personal experience of dementia. We discussed our findings with the manager who advised us that he had identified the area of care planning for development. We have made a requirement in relation to this matter. The home has a process in place to assess the risk to individual residents in areas such as falling and developing pressure sores. We found that the process had not been followed in all cases. We viewed the care plan of one resident who was quite clearly at high risk of developing pressure sores, but we were unable to locate a risk assessment in relation to this. We were however, able to determine that carers were providing preventative pressure care for the resident as general good practice. Where appropriate, risk assessments must be completed and any action required as a result of assessed risk must be transferred to people’s daily care plans. This is to ensure that staff have clear guidance on how to keep residents safe. We have made a requirement in relation to this matter. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 8 We found that, in general, safe procedures are followed when managing residents’ medicines. However, we did identify some areas that need to be addressed to further protect the safety and wellbeing of residents. When viewing residents’ medication administration records we found some errors. For example, on one record, staff had signed to confirm that they had administered a tablet in the morning, when it should have been administered in the evening. In some examples, errors such as this had been repeated for several days, demonstrating that staff are not always checking records carefully when administering medication. Some residents at the home are prescribed medication on an ‘as and when required’ basis. We found that, in some examples, there was little or no written information for staff about what the medicines were for and when they should be taken. It is important that this information be clearly stated so that staff can ensure residents receive their medication when they need it. We have made a requirement in relation to this matter. A number of people we talked with during our visit expressed concern about the lack of activities provided for residents at the home. We viewed daily care records for a number of residents which confirmed that activities are not being provided on a regular basis. In discussion, it became apparent that the reason for the lack of activities was due to low staffing levels. Carers told us that they simply didn’t have time to support residents to carry out activities and felt that staffing levels only provided for basic care. Recent studies have shown that there is a direct link between the wellbeing and contentment of people with dementia and the opportunities they have to engage in the world around them. Some carers told us that they felt residents had little opportunity to engage with stimulating tasks or other people. We discussed this with the manager who was aware of the issues and advised us that he was currently in discussion with Lancashire County Care Services about the home’s staffing levels. We have made a requirement in relation to this matter. Lady Elsie Finney House is a purpose built and well equipped home which has been completed to a high standard. The home is modern and airy and all accommodation is provided on a single room basis. There are a number of communal areas for residents to access, including a safe garden. However, some communal areas, including the garden, are located on a different level to the majority of residents’ main living accommodation and, as such, residents need staff support to access them. We were told that due to low staffing levels, residents have little opportunity to access these areas. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 9 As a result, residents currently have little choice but to spend their time on their individual units, which consist of an open plan lounge and dining area. We talked to the manager about how this situation can be improved. We strongly recommend that some consideration be given as to how residents can be enabled to move about the home more freely. In addition, we made a recommendation that corridors outside the residents’ daily living areas be utilised in a more effective way, for example, by providing seating and objects of interest to encourage people to use these areas. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 10 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 Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Thorough assessment procedures ensure that carers have a good understanding of people’s needs before they move into the home. This means that people can be assured they will receive the care they need straight away. EVIDENCE: In discussion the manager confirmed that a Service User Guide is provided to anyone who expresses an interest in moving to the home. This is a document that provides information about daily life at the home, such as mealtimes and activities. It also covers areas such as fees and facilities available. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 12 We confirmed that, currently, the Service User Guide is only available in a standard written format. We made a recommendation that the document be made available in a variety of different formats, such as large print and audio, so that everyone has equal access to the information. There are processes in place to ensure that pre-admission assessments are carried out with people before they move into the home. This means that the manager can ensure that a person’s needs will be met and that the home is right for them before they move in. It also means that staff have a good understanding of the care needs of new residents and can provide the right level of support straight away. In discussion, the manager explained that every effort is made to ensure that pre-admission assessments include the input of family members and other professionals involved in people’s support such as social workers. This is to ensure that people who may not be able to express their views and opinions themselves are represented by people that know them well. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ care plans don’t always contain enough detail for staff to provide person centred care in line with their individual needs and preferences. Errors when administering or recording medicines could place the health and wellbeing of residents at unnecessary risk. EVIDENCE: People we spoke to and those who responded to our written survey told us that they were happy with the standard of care provided. We consulted a number of carers who all demonstrated a good understanding of residents’ daily care needs. However, the care plans that we viewed did not contain enough information for staff to provide person centred care and did not always accurately reflect the care being provided. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 14 In several cases, we found a particular lack of information about the residents’ individual experience of dementia and how this may affect their ability to communicate or make their needs and preferences known. It is particularly important when caring for people with dementia that care plans are well researched and detailed so that staff can provide care which is in line with people’s individual needs and wishes. We discussed our findings with the manager and made a requirement in relation to the matter. We tracked the care of one resident who had some complex behavioural needs. Whilst this area of need had been addressed in the resident’s care plan to a certain extent, information was brief and there was little in the way of guidance to staff in dealing with challenging situations. We made a recommendation that more detailed and individualised guidance about how to approach complex behaviours be put in place, so that carers can deal with such situations confidently and consistently. There are procedures in place to assess the risk to residents in certain areas, such as falling or developing pressure sores. However, in some cases, we found that these procedures had not been followed. In one example, we failed to locate a pressure sore risk assessment and preventative care plan for a resident who was quite clearly at high risk of developing pressure sores. However, we were able to determine that staff were providing preventative pressure care for the resident as general good practice. There are written guidelines for staff in the safe receipt, storage, administration and disposal of medicines. We found that, in general, the home followed safe practices but we did identify some issues in relation to the management of residents’ medicines that need to be addressed. When viewing medication administration records we identified some errors, for example, when staff had signed for medicines at the wrong time. This indicates that staff are not always checking records carefully when administering medicines which could potentially put residents at risk. A number of residents were prescribed certain medicines on an ‘as and when required’ basis. However, in some cases there was little or no information about what the medicines were actually for. This information is essential to ensure that residents are given the medicines when they actually need them. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff understand that residents benefit from the chance to take part in enjoyable and stimulating activities. However, due to low staffing levels, they are not always able to provide them. EVIDENCE: During our visit we talked with the manager and staff about activities and also looked at daily care records for several residents. Whilst we were advised that residents take part in a variety of activities, there was no evidence available during our visit to confirm this. In discussion with managers and staff, it is apparent that they are aware of the importance of providing people with regular opportunity to take part in enjoyable and stimulating activities. To this aim, people’s preferences in relation to activities are ascertained at the point of assessment. However, current staffing levels do not allow carers time to spend with residents for this purpose. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 16 In discussion, one staff member told us “I feel guilty when I go home sometimes, because I know all I’ve done is met people’s very basic care needs. I feel like we should be doing so much more.’’ We were also able to confirm during our visit that residents have not been offered the opportunity to take part in any organised trips or outings since the home opened in November 2007. We discussed our concerns about the lack of activities with the manager who recognised that this is an area that needs to be developed. The manager advised us that he was currently in negotiation with the provider of the home (Lancashire County Care Services) about staffing levels and how these could be improved. People who responded to our written survey told us they were happy with the quality and variety of meals provided. We viewed a selection of menus and found that these were varied and provided a good deal of choice on a daily basis. However, some people we spoke to during our visit told us that they felt menus didn’t include enough fruit and vegetables and lacked nutritional value. We discussed this issue with the manager and advised him to seek advice about menus from relevant professionals. We also talked to the manager and staff about how people are made aware of choices available to them. Written menus or verbal information may not be particularly helpful to someone in the more advanced stages of dementia and, as such, we asked the manager to consider other ways in which people could be enabled to make daily food choices such as pictorial menus, for instance. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are enabled to voice concerns and the manager takes any issues raised seriously. EVIDENCE: The home has a procedure in place that gives advice about how to go about making a complaint and the action that will be taken by the home in this event. The procedure is clearly written and easy to understand but, currently, only available in a standard written format. We made a recommendation that the procedure be made available in a variety of different formats, such as audio and large print. In discussion, the manager demonstrated a very positive view of complaints and had a clear understanding of the need to monitor complaints received as part of the home’s quality assurance procedures. The manager was able to demonstrate that he communicates regularly with residents and their relatives and encourages them to voice any concerns they may have. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 18 A record is kept of any complaints raised and this showed that there had not been any formal complaints received since the home was registered in November 2007. There are robust procedures in place relating to safeguarding and the protection of vulnerable adults. We consulted a number of staff members who demonstrated a good understanding of their responsibilities in this area and were also aware of the home’s whistle blowing procedures. In addition, staff were confident that the manager of the home would deal with any issues they reported effectively. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home is well equipped and maintained to a high standard. However, residents don’t benefit from the space available because they don’t have the opportunity to move about freely. EVIDENCE: Lady Elsie Finney House is a purpose built home which has been constructed to a very high standard. It is a two storey building with the majority of residents’ living accommodation located on the first floor. The home is separated into three units each designed to accommodate 15 people. The communal living and dining area on each unit is of an open plan design. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 20 There are some additional communal areas for residents to access on the ground floor of the home. These include safe outdoor space and a large lounge. However, we were advised that due to current staffing levels, residents rarely get the opportunity to access these areas, as most would require staff support to make their way downstairs. As a result, residents spend much of their day in the open plan living /dining area and have little opportunity to move independently to other communal areas. There is some space outside each lounge/diner that residents could move around or sit in, but during our visit residents didn’t seem to use these areas. We talked with the manager about how these spaces could be better utilised for residents and recommended that they be made more inviting by providing seating and objects of interest. The accommodation at the home is well maintained and is furnished to a very high standard. The home has a modern, airy feel but some areas are quite clinical. The manager is looking at ways a more homely feel could be achieved and has started to obtain items, such as pictures for walls in the communal areas. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People receive their care from carefully recruited, well trained staff. Current staffing levels at the home do not enable carers to regularly provide support in areas such as social activities. EVIDENCE: A large number of people we consulted told us that they did not think the staffing levels at the home were adequate. In general, people felt that current levels were enough to meet residents’ basic health and welfare needs, but didn’t allow staff to spend time with residents or support them in social activities. Staff we consulted confirmed that activities were not being provided on a regular basis because they simply didn’t have the time to do them. Rotas showed that for the most part of the waking day, three staff are allocated to a unit accommodating 15 people. However, there are times throughout the day, (during handover) when there are only two staff on duty. We talked to the manager of the home about staffing levels and advised him that they needed to be reviewed to ensure that they are in line with the needs of residents. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 22 There are thorough processes in place to ensure that only suitable people are offered employment. The manager confirmed that candidates must undergo a series of background checks before they are offered a post within the home. Such checks include a full employment history, a Criminal Records Bureau disclosure and written references. We viewed a number of staff files that also confirmed the checks are carried out on a routine basis. We consulted a number of staff members during our visit and observed them going about their duties. Carers appeared well organised and went about their duties in a professional manner. In discussion, carers told us that they felt very well supported by their manager and described him as very approachable. One staff member said ‘’He makes you feel very appreciated.’’ Staff we talked with were very complimentary about the training they had been provided with and all staff members confirmed that they had received training in the mandatory health and safety areas, such as moving and handling ,as well as areas such as positive dementia care. Training is well managed and the manager has a matrix in place to help him allocate resources effectively. Out of 36 staff members, 31 hold National Vocational Qualifications in care at level 2 or above. In addition, another two staff members are currently doing the training. This is a good achievement and exceeds the national target of 50 . Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The manager of the home monitors all aspects of the service and is able to identify and address areas that need to be developed. EVIDENCE: The home’s manager has worked closely with us since registration in November 2007. He has notified us about all the significant events that have taken place in the home and also provided us with a good deal of information as part of our inspection. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 24 Throughout the inspection the manager was co-operative and responded positively to requirements and recommendations we made as a result of our findings. People who responded to our written survey and those we spoke with during our visit spoke very highly of the manager, describing him as supportive and approachable. One staff member said “His door is always open and we know we can go to him with any concerns.’’ There are processes in place to help the manager monitor quality in all aspect of the service and these include regular satisfaction surveys and meetings with residents and their relatives. We found that many of the issues we identified as part of this inspection had previously been identified by the manager and he was in the process of taking steps to address them. There is a legal requirement that any home which is not managed on a day to day basis by the provider must be visited by the provider (or a representative) on a monthly basis. A report of the visit must be completed and provided to the home. At the time of our visit there were no reports available, although it was later confirmed that the reports were in the home but the registered manager was not aware of their whereabouts. We have made a requirement in respect of this matter. There is a health and safety policy in place which is supported by a number of separate policies and procedures, for example, fire safety, COSHH (control of substances hazardous to health) and infection control. Training records confirmed that all staff have carried out mandatory health and safety training, such as moving and handling and fire safety. During a tour we noted the presence of balconies on the first floor of the home. In addition, we were aware of the presence of kettles in people’s living accommodation. We were able to determine that there were risk assessments in place relating to the presence of balconies and the use of kettles. We strongly recommend that these risk assessments be kept under constant review. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 25 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 (1) & (2) Requirement Timescale for action 31/07/08 2 OP8 3 OP9 4 OP9 5 OP9 Residents’ care plans must contain all the relevant information about their individual needs and preferences so that staff are aware of the support they should provide. 13 (4) (c ) Risk assessments in relation to individual residents must be completed and relevant information transferred to their care plans so that carers have guidance in promoting people’s safety. 13 (2) Procedures must be followed to ensure that residents are given the correct medicines at the correct times, as receiving incorrect medicines could seriously affect residents’ health and wellbeing. 13 (2) Regular, recorded audits must be carried out to ensure residents receive their medicines as prescribed. 13 (2) Sufficient information must be provided to staff to ensure that they administer ‘as and when required’ medicines at the appropriate times. DS0000071338.V359731.R01.S.doc 31/07/08 31/05/08 31/07/08 30/06/08 Lady Elsie Finney House Home for Older People Version 5.2 Page 27 6 OP12 16 (2) (m) & (n) 7 8 OP27 OP33 18 (1) (a) 26 (5) (b) Residents must be provided with 30/06/08 regular opportunities to take part in activities that are in line with their individual needs and wishes. Staffing levels must be adequate 31/05/08 to meet the needs of residents at all times. A written report regarding each 31/07/08 monthly visit made o behalf of the provider must be provided to the registered manager and maintained within the home. Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 28 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 2 3 Refer to Standard OP1 OP15 OP15 Good Practice Recommendations The Service User Guide should be made available in a variety of formats to ensure equal access to the information provided within it. Menus should be reviewed and relevant professional advice sought to ensure they provide a nutritionally balanced diet for residents. Consideration should be given as to how residents who cannot access written information can be informed about food choices available to them on a daily basis, for example through pictorial menus. The complaints procedure should be provided in a variety of formats to ensure that people have equal access to the information. It is strongly recommended that consideration be given as to how residents can be enabled to move around the home more freely so they can benefit from the various communal spaces around the home. With regard to residents’ changing needs and the admission of new residents, environmental risk assessments should be kept under constant review, for example those relating to balconies on the first floor of the home and the provision of kettles in residents’ communal areas. 4 5 OP16 OP19 6 OP38 Lady Elsie Finney House Home for Older People DS0000071338.V359731.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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