Inspection on 20/09/05 for Ladybank

This inspection was carried out on 20th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ladybank 17/09/08

Ladybank 26/09/06

Ladybank 16/01/06

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 Debbie Willcox Unannounced Inspection 20th September 2005 10:40 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 Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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.Hallidayracknell-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) of places Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 42 OP but Branscombe Unit and Cedar Unit can accommodate up to 16 service users who may be Younger Adults for a maximum of 6 weeks. 4th September 2003 Date of last inspection 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. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a weekday and conducted by one inspector. The main focus of this inspection was on the care provided from the two intermediate care units ‘Mimosa and Magnolia’. The rest of the home (long term residential care services) was not inspected on this occasion. Time was spent during this inspection with the Intermediate Care Coordinator, staff and service users. A variety of documents relating to staff employment, medication, assessment and care planning were viewed. There is one outstanding requirement from the previous inspection. The bathroom within Magnolia unit is not currently in use, as it does not have provision of an assisted bathing hoist and has been deemed as unsafe for staff to use. This has resulted in only one bath available between the two units being available for 19 service users. What the service does well: What has improved since the last inspection? Rehabilitation services from ladybank have proved successful and have been expanding with an extension to the premises enabling an increase in the number of beds from 8 to 19. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 6 Recruitment of new staff has been ongoing with a now almost complete team of staff subject to clearance of fitness checks undertaken on new 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. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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 Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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): 1,3,4,6, Without each service user being able to access information specifically related to intermediate care services prior to admission this does not enable people to make informed choices and avoid the misconceptions already experienced regarding the level of care provided. EVIDENCE: Ladybank has a statement of purpose, which provides details relating to the care provided from the intermediate care units. It was evident from discussions with service users, relatives and observation that the unit does not currently provide to prospective service users a service user guide specific to these units prior to moving into the home. It was evident from discussions with the care coordinator and service users that there is confusion as to the level of care and services that will be provided. Service users felt they had not been prepared to know what to expect and a service users guide relating to intermediate care services would be helpful to both those using the service and other health care professionals seeking to access this service on behalf of others. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 9 Intermediate care services are sited from dedicated accommodation within two units. Staff are trained and qualified to provide specialist services including the provision of Occupational Therapists and Physiotherapists. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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, Service users can be assured that they will be treated with dignity and respect. Further work is needed to ensure that staff have clear written care plans with instructions in how best to meet the personal, health and social care needs of people accessing this service. EVIDENCE: Pre-admission assessment and care planning documents on 3 service user files were viewed at this inspection. Pre admission assessments are conducted prior to admission and found to be clear and well documented. Whilst assessment of need and risk assessment was clear, care plans contained limited information which would instruct staff and service users in actions planned for meeting the personal, health and social care needs of individuals. Care plans did not cover the list of criteria outlined within standard 3 of the National Minimum Standards. None of the files seen contained a rehabilitation plan, which would identify planned physiotherapy and occupational therapy input. Service users spoken with who had been assessed as needing physiotherapy said physio had been provided but they had not been informed of any planned frequency for this Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 11 service. One service user prior to admission had been informed that he would receive physiotherapy daily and he had found this not to be the case. Staff shortages due to sickness and holidays had restricted provision of this service. This a young, busy and expanding service, gaps in recording of care plans had been identified by senior staff and it is hoped that with new staff in place and greater delegation of responsibilities care planning records will improve. There was good evidence of GP support to the units. The medication storage and recording on both Intermediate care units was viewed at this inspection. There were signature gaps found on medication administration sheets on both units. It was not clear in these instances whether or not medication had been administered. Some signature boxes contained a tick rather than a signature and it was not clear what this signified. Service users are encouraged to maintain their independence in handling their own medication and their ability to do so is assessed and clearly recorded. Staff are competency assessed before undertaking the responsibility of medication administration. There was no evidence from discussions with staff that staff competency to administer medication is assessed on a regular basis. The care coordinator said this has been recognised as a need and will be planned in the future development of all staff. It was evident from discussions with service users that staff treat them with respect and dignity is upheld when assisting with personal care. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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, Assessment and planning to meet the social, cultural and recreational interests and needs of service users is needed. Service users entering this home can be assured that choices in relation to daily living including food provision will be respected and upheld. EVIDENCE: It was evident from discussions with service users and the care coordinator that there are no planned activities within the intermediate care units. Care plans seen did not evidence that hobbies and interests were assessed and planned for. The majority of service users spoken with said they were often bored and would like to see activities provided other than the television. Service users did say that if they wanted to be supported in going to the local shops staff would support them with this activity. Relatives spoken with said that they were made welcome by staff in the home and could visit without any time limitations placed on them. The inspector sat with a group of service users for the midday meal. It was observed that meals are served directly to service users by staff including gravy and sauces. Service users were not given the opportunity to serve themselves vegetables and sauces. Considering the aim of this unit is to promote independence for individuals and enable people to return home, more Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 13 could be done to promote choice and independence around meals, mealtimes and social activities. Service users spoken with all said that the quality of meals on the whole was good and confirmed that menus are provided with a daily choice and that staff would offer alternatives to the daily menu if required. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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): EVIDENCE: These standards were not assessed at this inspection. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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): 19,20,21,23,24,26 Service users do not have a sufficient number of bathrooms accessible for use. The units are clean, pleasant and hygienic and bedrooms suit the needs of those accessing this service. EVIDENCE: The home has a policy in place instructing staff in controlling the risk of infection. It was evident from staff meeting minutes, message books and notice boards of staff awareness of protocols in place to control the risk of infection and maintain cleanliness of the units. Redecoration of Mimosa unit has been undertaken since the last inspection as well as the corridor and bedrooms. Lighting to the corridor had been improved and was clearly beneficial. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 16 Magnolia unit lounge is in need of decoration as paint on walls and doors and skirting boards had become chipped and worn. There is an outstanding requirement for the bath on Magnolia unit to be made accessible. The inspector had been informed that this bathroom is not in use, as it was deemed not safe for staff to use, as it does not have the provision of an assisted bath hoist. There is only one bathroom available for 19 beds. The timescale set for meeting this requirement has lapsed and no request for an extension of the timescale has been made to the CSCI. It was noted that no risk assessment has been undertaken for the use of this bath. There was evidence of service users accessing the gardens provided to the home. Bedrooms were seen to be clean and comfortable. Adjustable beds had been provided for some service users. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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 Further work is needed to ensure that evidence is provided of recruitment checks undertaken on staff such as written references and CRB clearance as well as a training plan for each staff member outlining training attended and planned for. EVIDENCE: With the expansion of rehabilitation services provided from ladybank work has been ongoing in the recruitment of new staff. Subject to fitness checks on new staff the units have an almost complete staff team. Agency staff are currently being used to fill gaps in the rota. Staffing rotas do not indicate the designation of staff. The files of 2 staff were viewed at this inspection.1 file contained a photo of the employed staff member the other did not. Files contained interview assessment sheets, contracts and job descriptions. 1 file contained evidence of CRB and 2 written references the other did not. The inspector was informed that all checks are undertaken but not all files contained within the office have evidence of this. Staff are supported with training, which can be accessed via both the local authority and the PCT. Discussions with staff evidenced training in manual Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 18 handling, infection control, POVA. Staff files did not contain a staff training profile and so it was difficult to ascertain if all staff have been provided with all mandatory training as required. The unit does not have a minimum of 50 staff NVQ qualified. The care coordinator is looking to provide in future a hard copy on staff files of training already attended and training planned for. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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): 31,32,35,36, This is an innovative and developing service, which has experienced ongoing change. Further development is needed to ensure a system whereby staff are supported with regular planned and recorded supervision. EVIDENCE: Staff 1-1 formal supervision has not been provided with any regularity. This responsibility has fallen to the care coordinator at present and has proved difficult for one person to provide this level of support to all staff. It was recognised by the manager of the ‘Bridgewell Centre’ that staff delegation is needed to ensure that all staff are supported and provided with supervision as outlined in the National Minimum Standards. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 20 Discussions with staff and service users evidenced the approachability of and the positive leadership style of the care coordinator. Informal supervision is provided on a daily basis and the care coordinator has an open door approach to management. The records maintained of service users money held for safe keeping were viewed. Dual signatures are provided for each transaction. Receipts are provided including those for hairdressing and chiropody services. The unit has a system for recording an inventory of valuables belonging to service users but this is not always maintained. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 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 2 x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 3 2 x 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 3 2 x x Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP21 Regulation 23 Requirement The bathroom located within magnolia unit to be fitted with an assisted bath hoist or replaced with a bath that is accessible to all service users. THE ORIGINAL TIMESCALE FOR COMPLIANCE WAS 01/06/05 A risk assessment to be undertaken for the use of the bath located on magnolia unit and a copy sent to the CSCI. The registered person to provide to prospective service users a written guide to Intermediate Care Services containing all relevant information required within regulation 5 of the NMS. Magnolia lounge to be decorated. Medication administration charts to be signed by staff when medication has been administered. Care plans to detail actions to meet the personal, social and health care needs of service users as listed within standard 3 and 7 of the NMS. Staffing rota to indicate the designation of staff. DS0000032156.V250807.R01.S.doc Timescale for action 01/01/06 2 OP21 13(4)(a) 01/01/06 3 OP1 5 Schedule 1 01/01/06 4 5 OP19 OP9 23(d) 13 (2) 17 01/01/06 01/11/05 6 OP7 15 01/11/05 7 OP21 Schedule 4 01/11/05 Ladybank Version 5.0 Page 23 8 OP36 18 All staff to be provided with formal supervision at least 6 times per year. 01/11/05 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 15 Good Practice Recommendations Independence and choice to be further promoted at mealtimes by enabling service users to serve food independently from terrines provided on tables is assessed as able. Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 24 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 Ladybank DS0000032156.V250807.R01.S.doc Version 5.0 Page 25 - 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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