Inspection on 16/01/06 for Ladybank

This inspection was carried out on 16th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Ladybank 17/09/08

Ladybank 26/09/06

Ladybank 20/09/05

Ladybank 25/01/05

Ladybank 03/08/04

Ladybank 18/11/03

Ladybank 04/09/03

Ladybank 24/03/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Ladybank 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA Lead Inspector Julie Willis Unannounced Inspection 16th January 2006 08:30 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 DS0000032156.V283976.R01.S.doc Version 5.1 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. DS0000032156.V283976.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ladybank Address 10a Ladybank Birch Hill Bracknell Berkshire RG12 7HA 01344 424642 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) ruth.hallidaybracknell-forest.gov.uk Bracknell Forest Borough Council Mrs Ruth Patricia Helen Halliday Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (19) of places DS0000032156.V283976.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 20th September 2005 Brief Description of the Service: Ladybank is a residential and intermediate care resource for people aged 65 years and over. The intermediate care resource the ‘Bridgewell Centre’ is registered to admit service users under the age of 65. Mimosa and Magnolia units are based within the Bridgewell Centre, which provides intermediate care services to 19 service users for a maximum period of 6 weeks. Staff allocated to this unit are employed by the primary care trust and work within NHS policies and procedures. The purpose of this unit is to provide services to promote independence and preventing inappropriate hospital admissions and re-admissions. Long term residential services are located within three units, Avondale, Dawn and Eversley. These units are designed to be homely consisting of bedrooms, open plan lounge, dining room and kitchenette. The home is situated close to South Hill Park, local shops and amenities are within a short walking distance. The home is owned and managed by Bracknell District Council, Social Services and Housing Department. DS0000032156.V283976.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday morning and early afternoon over a period of five and a quarter hours. The focus of this inspection was the older peoples home consisting of three main units. Avondale, Dawn and Eversley. The inspector did see and speak briefly to staff of the intermediate care unit but the outcome of this report deals solely with the rest of the home. The previous inspection carried out in September 2005 concentrated on the intermediate care units Magnolia and Mimosa. A tour of the home was undertaken in which the service users accommodation and communal space were visited. A number of care records and health and safety documents were examined. The inspector spoke at length to 8 of the service users plus others in small groups and 2 relatives that were visiting at the time of inspection. The inspector spoke to a number of staff whilst they were carrying out their duties and was assisted throughout by one of the homes Residential Care officers and the Homes Registered Manager. There were no outstanding requirements from the previous inspection. Three requirements and one recommendation arose from this inspection. What the service does well: What has improved since the last inspection? DS0000032156.V283976.R01.S.doc Version 5.1 Page 6 The last inspection focused on the Intermediate Care Centre. Since the last inspection the bath in Magnolia unit has been fitted with a hoist and the unit has been redecorated. A new Service Users Guide has been written for users of the Intermediate Care Service. Care plans have improved and medication records are accurately kept. The staff roster in this part of the home now provides the designation of staff. What they could do better: 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. DS0000032156.V283976.R01.S.doc Version 5.1 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 DS0000032156.V283976.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 All service users are assessed prior to admission to ensure that the staff of the home will be able to fully meet their needs. EVIDENCE: Examination of three of the service user care plans including the file for the most recent admission to the home evidenced that a member of management had carried out a pre-admission assessment. The assessment was carried out in the users home or in a hospital ward and appeared comprehensive and holistic in detail. Information was gathered from the user, their family, friends and advocates about their personal and healthcare needs as well as their social history and cultural needs. At the point of referral a copy of the Social Workers assessment had been provi8ded to the home, which included a health report from the users GP. This information gathered pre-admission provided essential information, and forms the basis of a care plan. DS0000032156.V283976.R01.S.doc Version 5.1 Page 9 From discussion with service users it was clear that they had been provided with information they needed to decide if they wanted to live in the home. They had been offered a trial visit to meet staff and other residents and had been shown around the home including the room they would later occupy. They confirmed that they had time to settle in before they made a decision to stay permanently. Several residents said that they had been admitted to the home following a stay in the adjoining ‘Bridgewell Centre’ where they had received rehabilitative services. All service users spoken with said that they were happy at the home felt safe and comfortable. DS0000032156.V283976.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The health and personal care needs of users were well met by a team of caring and attentive staff. Care was being provided in accordance with the individuals care plan and there was evidence of effective multi-disciplinary working. The system for the administration of medication is good with clear and comprehensive arrangements in place to ensure the safety of users. EVIDENCE: Examination of the care plans for 3 users evidenced that their health and personal care needs were being met effectively by the home. Service users are provided with access to health and social care professionals for advice and support when necessary and service users confirm that they regularly see their GP who may refer them to hospital for further treatment. Routine screening and preventative treatments are provided to all residents by the local GP’s surgery. The written records were satisfactorily documented and provided staff with sufficient information to enable them to offer the appropriate level of care. There is a need however, to ensure that daily contact sheets validate the content of care plans and that a review is carried out of the plan and accompanying risk assessments at regular intervals as several files examined DS0000032156.V283976.R01.S.doc Version 5.1 Page 11 were out of date. It would be helpful if a photograph of each user could be on file in the care plan as well as in the medication files. This would aid clarity for new staff and agency workers and would be helpful for identification purposes should the user go missing. The documentation of service users weight was not always completed effectively. The inspector was told that this omission was as a result of the users inability to stand on scales. It would be of benefit if scales could be provided that all users could use safely. Observation of care practice concluded that users were encouraged to remain as independent as possible by providing appropriate levels of support to maintain their privacy, dignity and independence. From examination of the medication administration system and discussion with staff it is clear that the home follows best practice guidance when administering drugs. The permanent staff have been trained in the administration of medication and have been assessed as competent by the homes manager. Medication is administered from labelled bottles and packets and storage systems are effective and disposal systems safe. Service users confirmed that staff were always kind and respectful and felt that they were treated with dignity at all times. Staff were observed to approach users with sensitivity and care and to offer support in a way that validated the users right to autonomy independence and choice. DS0000032156.V283976.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 There is a need to improve the range of leisure pursuits offered to users to ensure that users are kept both mentally and physically stimulated. The routines in the home are designed flexibly around the needs of users and enable them to express personal choice and autonomy in relation to their everyday lives. Service users are encouraged to maintain contact with the local community, their friends and relatives. The meals in the home are satisfactory offering users both choice and variety. Special dietary needs can be catered for effectively. EVIDENCE: From discussion with users and observation of staff interaction with users it is evident that the range of leisure activities offered to users could be improved. Service users said that some of the permanent workers were very good at arranging ad-hoc activities such as quizzes, but that agency and bank staff tended to be task focused and appeared to have little time to converse socially or to engage users in meaningful activities. Service users said that a number of agency staff preferred to rely on the television to occupy the residents. DS0000032156.V283976.R01.S.doc Version 5.1 Page 13 Observation of care practice and discussion with users evidenced that the routines of the home are flexible and meet the needs of users. Residents confirmed that they could get up and go to bed at a time of their choosing. They are offered appropriate choices at mealtimes and in relation to the activities of daily living. All bedrooms had been personalised by the occupant and residents confirmed that they had been encouraged to bring any personal possessions including pictures and small items of furniture to the home when they were admitted. Relatives confirmed that they could visit at any time and were offered appropriate hospitality during their visits. They confirmed that staff were always available to provide information about the health and welfare of users and felt they were kept up-to-date and informed. Relatives said that management were very approachable and “always had an open door” and “would make time” for relatives. The inspector had the opportunity to talk to the chef and to observe how the lunch and breakfast were being provided to residents. The majority of residents in two of the units preferred to sit around the dining tables and appeared to use this opportunity to talk with other residents and were clearly animated. In the third unit most residents preferred to sit in their armchairs and to eat their meals served onto cantilever tables. There was less conversation in this unit and more reliance on the television for stimulation. The Chef said that she had not had the opportunity to do food hygiene training since the commencement of employment and this should be prioritised for the employee in their personal training and development plan. The menus were varied and followed a rotated menu. It would be helpful if the hot drinks and supper menu could be added to the main menu to evidence that service users have snacks and drinks between tea time and breakfast the following morning. DS0000032156.V283976.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Service users are protected from abuse and exploitation by well-trained and competent staff that demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies EVIDENCE: The homes complaint system is robust. Examination of records indicated that only 3 complaints had been made to the home since the 1st April 2005. The records indicated that management had undertaken full investigations into the complaints and a satisfactory outcome had been provided to each complainant. Service users were highly complimentary about the ‘open style’ of management. They said that they felt confident in expressing their opinions and knew that they would be taken seriously. Relatives confirmed that they felt the home was “open & welcoming” to complaints and felt that they would be dealt with swiftly and efficiently. There was evidence in staff files that all staff receive training in the abuse of vulnerable adults as part of their formal induction and NVQ training in which it is a core module. Refresher training courses are also offered regularly to staff as part of an on-going training strategy. Service users confirm that they feel safe at the home and are well cared for by competent and caring staff. DS0000032156.V283976.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Standards of décor and furnishings in this home are satisfactory and offer residents a comfortable and homely place to live. The home was clean and hygienic throughout and staff have received training in infection control to protect the health and safety of users. EVIDENCE: A tour of the home evidenced that standards of décor were good, furnishings were in satisfactory condition and the carpets were clean and free from odour. Service users spend most of their day in communal areas, which are bright and cheerful. Meals are provided in the dining areas of each unit or at cantilever tables in the sitting rooms. The dining areas can accommodate all of the users in one sitting and were set with tablecloths, mats and vases of flowers. All bedrooms are personalised by the user to reflect their particular choice and interests. DS0000032156.V283976.R01.S.doc Version 5.1 Page 16 Service users were highly complimentary about the quality of cleaning in the home. They said that the domestic staff were always on hand to mop up spills and kept the toilets and bathrooms clean and fresh. Users said that their bedrooms were always kept pleasantly clean and tidy. Relatives confirmed that the home was always clean and odour free and staff were always on hand to keep the home in a clean and hygienic condition. DS0000032156.V283976.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Staff individually and collectively were able to demonstrate that they have the necessary skills and experience to effectively meet the needs of service users in their care. Staff recruitment procedures are robust and transparent and protect service users from harm. Staffing levels are sufficient to meet the needs of users of the service. EVIDENCE: Examination of the recruitment files for 4 employees indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of service users. Records were well kept and met the required standard. Staff appeared to have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with service users. Staff are offered opportunities to gain qualifications to further enhance their knowledge and skills such as National Vocational Qualifications at level 2 & 3. All staff are provided with refresher training at regular intervals, in core skills such as fire safety awareness, health & safety, first aid, manual handling and infection control to ensure service user safety. DS0000032156.V283976.R01.S.doc Version 5.1 Page 18 Permanent staff are trained and assessed to administer medication and were observed to carry out this task safely and effectively. There was evidence that new staff are provided with induction and foundation training to Sector Skills Council standard. All staff receive on-going support and are formally supervised at least six times a year. Service users said that the staff were “kind and caring” and “always had time” for the users. One resident said that at times staff seemed “very busy” but that the staff “were always cheerful and friendly even when rushed”. DS0000032156.V283976.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 38 The registered manager is qualified, competent and experienced to run the home for the benefit of residents. Service users live in a safe environment where risks to their safety are assessed, minimised and managed effectively EVIDENCE: The Homes Manager is widely experienced and has attained the NVQ level 4, Registered Managers Award to further enhance her knowledge and skills. The manager is supported by her team of caring and competent Residential Care Officers and an Assistant Unit Manager who cover the management shifts over a 24-hour period. The management structure appears to reflect the size and complexity of business currently undertaken. DS0000032156.V283976.R01.S.doc Version 5.1 Page 20 From discussion with staff it is clear that the Homes Manager demonstrates effective leadership skills and is always keen to support individual members of staffs personal and professional development. Staff confirmed that they have the opportunity to express their opinions openly and have regular staff meetings, which follow a shared agenda. These meetings, supervision sessions and staff handover times provide plenty of opportunity for the staff to feel included and involved in the way the service is delivered. Service users relatives are complimentary about the management of the home and feel that they are kept well informed of the residents health & welfare. They say that the office is always open and accessible and the managers always make time to speak with them. Examination of a number of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment is undertaken at appropriate intervals to maintain the home as a safe and risk free environment for users. Unnecessary risks to users are identified using a comprehensive risk assessment. As far as possible risks are reduced or eliminated by putting in place risk management procedures and strategies. Service users confirm that they feel safe, well cared for and happy. DS0000032156.V283976.R01.S.doc Version 5.1 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 DS0000032156.V283976.R01.S.doc Version 5.1 Page 22 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. 2. 3. Standard OP7 OP12 OP38 Regulation 15 (2) b 16 (2) m 18 (1) c (i) Requirement Ensure all care plans and risk assessments are reviewed monthly Ensure that service users are provided with a range of stimulating activities Ensure that the Assistant Chef is provided with basic Food Hygiene training Timescale for action 16/04/06 16/04/06 16/07/06 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 OP8 Good Practice Recommendations Consideration should be given to providing weighing scales that are easy and safe for all service users to use. DS0000032156.V283976.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000032156.V283976.R01.S.doc Version 5.1 Page 24 - 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. 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