Inspection on 24/02/06 for Ladycross House Care Home

This inspection was carried out on 24th February 2006.

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

Other inspections for this house

Ladycross House Care Home 05/05/09

Ladycross House Care Home 17/10/06

Ladycross House Care Home 30/06/05

Ladycross House Care Home 23/03/05

Ladycross House Care Home 23/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Ladycross House Care Home Travers Road Sandiacre Nottingham NG10 5GF Lead Inspector Steve Smith Unannounced Inspection 24th February 2006 09:30 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 Ladycross House Care Home DS0000035743.V282304.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. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ladycross House Care Home Address Travers Road Sandiacre Nottingham NG10 5GF 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) 0115 9098400 0115 9098402 Not given Derbyshire County Council Vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Ladycross House Care Home provides personal care and accommodation for 35 Older People. The Home is owned by the Derbyshire County Council and is situated in the town of Sandiacre on the outskirts of Nottingham. It is within easy reach of the M1 motorway and the A52 to Derby and Nottingham. The Home provides ground floor accommodation in four wings, each with its own lounge and dining area. There is a separate communal room situated near to the main entrance. All bedrooms are single occupancy. There is separate bath, shower and toilet provision. The Home also has a separate smoking area. Ladycross House Care Home DS0000035743.V282304.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 in just under 6 hours. Discussion was held with the Acting Manager and some of the Home’s records were examined, and the public areas of the Home were examined. What the service does well: What has improved since the last inspection? All Residents in the Home had been supplied with a Residents Guide to the Home. The content of Residents’ files had been greatly improved. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 6 The record of medication administered to Residents had also been greatly improved. The plans that Residents had made, with their families, concerning their last days and funeral arrangements were now recorded within Residents plans of care. Residents were provided with a choice of meal at all mealtimes. The Registered Providers had addressed a number of required items concerning the maintenance of the Home. Staffing in the Home was now provided at above the minimum level required by legislation. What they could do better: The Registered Provider needed to up date the Home’s statement of purpose ensuring that it at least includes all of the data listed in Schedule 1 of the Care Homes Regulations. They also needed to ensure that Residents’ statement of terms and conditions of residency or contract were inline with that required by the Care Homes Regulations and Standard 2.2 of the National Minimum Standards. The Acting Manager needed to ensure that a full and accurate record was maintained of all meals provided within the Home. Some staff needed to be required to respect the privacy of all able Residents, by remembering to knock on Residents doors and wait to be invited in. Residents should be informed, in the Residents Guide to the Home, of Advocacy Services available in the surrounding district. The Registered Providers were recommended to provide training on dealing with physically aggressive Residents. Urgent and detailed work was needed to the roof of the Home. Bath hoists needed to be updated to ensure they could be locked into position. The staff call system needed to be reviewed to ensure that the most reliable one was in use in the Home. It was encouraged that the Registered Providers should review the amount of Residents savings held by the Home, limiting this to approximately £50.00. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 7 The Registered Providers needed to ensure that the unannounced ‘inspections’ of the Home took place at the required frequency and covered the required issues. Staff training was required by a number of staff in the Home. The Acting Manager was encouraged to provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. 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. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 8 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 Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 9 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): Standard 1 & 2. The statement of purpose did not provide Residents with complete information on the provision of services by the Home. EVIDENCE: This Standard was not inspected on this visit to the Home. However, the Acting Manager said that the Home’s statement of purpose had not been fully completed by providing all of the items that were found to be missing during the inspection of June 2005. To correct this, the Registered Providers needed to ensure that item number 13 in Schedule 1 was provided. This states that arrangements must be made to inform Residents and their relatives and friends of how to make contact, once the Resident has moved to the Home. This issue had been included in inspection reports since 2003. Similarly, the Acting Manager said that the statement of terms and conditions of residency or contract, issued by the Local Authority, had not been updated to include information for Residents on additional services to be paid for over Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 10 and above those included within the fee. This issue had also been included in inspection reports since 2003. Standard 6 does not apply to this Home. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 11 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): Standard 8 & 10. The Registered Providers need to provide full records to ensure that the health of Residents is well maintained at all times. EVIDENCE: Standard 8, Health Care, was not inspected on this visit to the Home. However, the Acting Manager said that the record of meals provided for Residents was incomplete. No record was kept of the meals provided on a Saturday or Sunday. This issue should have been addressed from the inspection report dated June 2005. Standard 10 was also not inspected during this visit. However, while reviewing the Requirements made during the inspection of June 2005 the Acting Manager said that some staff still did not knock and await the response of able Residents before entering Residents’ bedrooms. Ladycross House Care Home DS0000035743.V282304.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): Standard 14. The Registered Providers need to ensure that Residents are fully informed of all services available to them, in support of their placement at the Home. EVIDENCE: While reviewing the Recommendations of the inspection of June 2005 the Acting Manager said that she had not provided information in the Residents Guide on Advocacy Services available in the surrounding district. This information would provide Residents and their relatives with an independent person to advise on the care provided by the Home and the rights of the Resident. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 13 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): Standard 16 & 18. The protection policies and procedures provided by the Home meant that Residents were well protected. EVIDENCE: Good records were maintained of both verbal and written complaints. Understandably, there were more verbal complaints recorded than written ones, even though these were of a minor nature. The Acting Manager was commended for her positive way of dealing with this issue. The Acting Manager was able to provide an Adult Protection procedure that included a ‘Whistle Blowing’ policy. The Home also had copies of the Public Interest Disclosure Act of 1998 and of the Dept of Health’s policy called ‘No Secrets’. She also confirmed that the Home would follow up all allegations and incidents of abuse promptly and that all actions taken by staff would be recorded. The policies and practices laid down by the Local Authority ensured that all staff understood physical and verbal aggression by Residents. However, she commented that the Local Authority did not provide training on dealing with physically aggressive Residents. She said that there was a policy available to staff stating that they could not benefit from Residents wills. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 14 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): Standard 19, 22 & 24. The Registered Providers have not maintained the building and facilities provided to the required standard to meet the needs of Residents. EVIDENCE: The inspection of June 2005 required the Registered Providers to address a number of issues within the Home. However, some have not been addressed, and so are listed again for the Registered Providers urgent attention. The condition of the outside of the Home was commented upon, as considerable attention seemed to be needed to ensure that the Home was fit for all weathers. During this inspection it was learned that considerable work was planned for the outside of the Home, which should start in approximately August 2006. Similar Requirements had been made to the Registered Providers from 2003 onwards. Bath hoists provided throughout the Home needed updating to provide a system of being able to lock them into position to safeguard Residents. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 15 The Acting Manager said that this was to be attended to later this year. The Requirement is outstanding from April 2004. At the time of the last inspection the vast majority of the staff call monitors were found not to be working. Replacement monitors were provided within a reasonable period of time, but the Acting Manager said that the reliability of the whole staff call system was very suspect, leaving Residents at risk. The Registered Providers need to review the system, with the Acting Manager, and if appropriate consider providing a system from another company that is reliable and can be trusted by staff, but most particularly by the Residents. The last inspection report also required the Registered Providers and Acting Manager to provide comfortable seating for two people within all bedrooms. It was also pointed out that this could be discussed with each Resident, or their representative, and if the Resident was happy with just one seat in their room, this could be provided. However, this needed to be recording within each Resident’s file. At the time of this inspection the Acting Manager said that this not been addressed. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 16 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): Standard 27, 28 & 30. The Registered Providers were providing sufficient care staffing, when compared to the Residential Forum, to meet the assessed needs of Residents. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. This showed that during the two weeks beginning 6 and 13 February 2006, the Home was providing care staffing above that required by the Residential Forum for 26 Residents at the Medium Dependency level. This was judged to be more than sufficient staffing for the resident group staying in the Home. These figures were calculated without the Acting Manager’s working time included, as recommended by the Residential Forum. The Acting Manager was asked how many care staff had completed their NVQ level 2 qualification in Care, and she was able to say that 75 of all care staff had completed this course. This is a very positive position for the Home to be in. Staff induction and foundation training was provided for all new staff that came to work in the Home. The Manager also said that all care staff were provided with at least three paid days training a year. All staff also had an individual training and development assessment and profile. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 17 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): Standard 31, 33, 35 & 38. The Acting Manager was appropriately qualified, although the Registered Providers did not regularly inspected the Home, to ensure good standards were maintained for Residents. The Home met the Quality Assurance issues that ensured the Home was run on a sound footing. EVIDENCE: The Acting Manager was able to say that she had completed her training to NVQ level 4 in Management and Care. She was also able to say that she had undertaken training in First Aid, Financial Abuse, Food Legislation, Fire Legislation and Fire Training within the Home, during the past 12 months. The Manager was also an NVQ Assessor, which allows her to assess the development of the staff in the Home. The Acting Manager was asked to show the record of unannounced ‘inspections’ of the Home by representatives of the Registered Providers. The Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 18 only record of a satisfactory ‘inspection’ was found to date from February 2005. However, since then there was only evidence of questionnaires being asked of Residents by senior managers of the organisation, with the results being published. The Registered Providers need to ensure that the Home was ‘inspected’ on a monthly basis, as laid down in legislation and described in Regulation 26 (4) and (5). This issue had been outstanding in the Home since April 2004. The work undertaken by the Acting Manager to meet the Quality Assurance standard was examined. It was found that the Home had an annual development plan, and Residents had been surveyed and took part in Residents’ Meeting and Amenities Meetings. The Acting Manager said that staff would be able to demonstrate a commitment to lifelong learning for each Resident, and the views of family, friends and stakeholders, such as Doctors Nurses etc, were sort on how well the Home was achieving goals for Residents. A small amount of Residents money was kept in the Home for everyday expenditure. Records of these were examined. Money were appropriately stored and securely held. Records were kept, and a sample of these was examined, and found to be satisfactory. However, a number of Residents accounts amounted to over £100.00, even thought the Acting Manager said that the Home was authorised to only hold up to £50.00 per Resident. The training provided for staff was examined. This showed that the Registered Providers had ensured that all but one member of the care staff had received the three yearly training in Moving and Handling. Fire Safety training was also examined and it was found that all members of staff had received the required amount of training. All staff were qualified in Fire Aid, although two members of staff needed refresher training. Nearly all senior staff and night staff were qualified as First Aiders, although two senior staff still needed this qualification. The Acting Manager said that all catering staff and care staff were qualified with Food Hygiene certificates. However, the Acting Manager also said that no one in the Home had undertaken training in Infection Control In addition to the above statutory training, the Acting Manager said that staff in the Home had, during the previous 12 months, also undertaken training in Dementia Care, Loss and Bereavement, Sensory Impairment, Tissue Viability, Recording Policy, Care Planning and Protection from Abuse. All Residents have been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Home has complied with all necessary legislation, such as Health and Safety at Work Act 1974, and the Manual Handling legislation of 1992. Risk assessments had been carried out for all safe working practices in the Home, although the Acting Manager had not provided a written statement of Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 19 the policy, organisation and arrangements for maintaining those safe working practices. The Acting Manager ensured that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. She also had ensured that fire safety notices were posted in relevant places around the Home. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 20 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 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X 2 X X STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement The statement of purpose must meet with the criteria set by Schedule 1 of the Care Homes Regulations and NMS1, and must be personalised to the Home. (This issue should have been addressed from the inspection report of 2003) The statement of terms and conditions of residency/contract provided to Residents must meet the criteria set by Regulation 5 of the Care Homes Regulations and National Minimum Standard 2.2. (This issue should have been addressed from the inspection report of 2003) The Acting Manager must ensure that a full record is kept of all meals, including Saturdays and Sundays, provided for each Resident cared for in the Home, keeping the record for at least 3 years. (This issue should have been addressed from the inspection report of 29 June 2005) The Acting Manager must ensure that staff are aware of the need DS0000035743.V282304.R01.S.doc Timescale for action 1 OP1 4 21/04/06 2 OP2 5 21/04/06 3 OP8 17 & Sch 4 21/04/06 4 OP10 12 21/04/06 Ladycross House Care Home Version 5.1 Page 22 5 OP19 23 6 OP19 23 7 OP22 23 8 OP24 16 & 23 9 OP31 26 to knock and await a response from the Resident before entering bedrooms. The Acting Manager and care team need to decide which Residents this must apply to, given Residents differing abilities. The roof must be repaired. The woodwork on the outside of the premises must also be maintained in a good state of repair. (This issue is outstanding from the inspection report of 2003) Bath hoists must be replaced with units that lock into position. (This issue is outstanding from the inspection dated 23 April 2004) The Registered Providers must review the reliability of the staff call system, and if appropriate install a more reliable system. All single bedrooms must be provided with comfortable seating for two people. However, this could be discussed with each Resident, or their Representative, and comfortable seating for one person could be provided if they agreed, and if this was recorded within the Resident’s Care Plan. (This issue is outstanding from the inspection dated 29 June 2005) Monthly unannounced visits by the Registered Providers or designated representative, complying in full with Regulation 26, must take place in the Home. Documentary evidence of these visits must be kept at the home for use by Acting Manager and for inspection purposes. (This issue is outstanding from the inspection report dated 23 April 2004) DS0000035743.V282304.R01.S.doc 31/08/06 31/08/06 31/08/06 21/04/06 21/04/06 Ladycross House Care Home Version 5.1 Page 23 10 OP38 13 & 18 11 OP38 13 & 18 The member of staff, identified during the inspection, must receive training in Moving and Handling. The 2 members of the care staff, identified during the inspection, must receive training in First Aid. 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP14 OP18 OP35 OP38 OP38 OP38 No. 1 2 3 4 5 6 Good Practice Recommendations The Acting Manager should provide information in the Residents Guide about Advocacy Services available in the surrounding district. The Registered Providers are encouraged to provide training to care staff on dealing with physically aggressive Residents. The Registered Providers should review the amount of money held on Residents behalf, limiting the amount to approximately £50 per Resident. Sufficient senior members of staff should be trained as First Aiders to ensure that at least one First Aider can be on duty, on each shift, both day and night. The Registered Providers and Acting Manager should ensure that all necessary staff receive training in Infection Control. The Acting Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. Ladycross House Care Home DS0000035743.V282304.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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