CARE HOMES FOR OLDER PEOPLE
Lake House Lake Walk Adderbury Banbury OX17 3NG Lead Inspector
Carole Moore Unannounced 28th June 2005 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 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. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lake House Address Lake Walk Adderbury Banbury OX17 3NG 01295 811183 01295 811260 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of Saint John Care Trust Anna Hicks Care Home (CRH) 43 Category(ies) of Learning Disability over 65 years of age (LD(E)) registration, with number 3 of places Dementia - over 65 years of age (DE(E)) 18 Physical Disability over 65 years of age (PD(E)) 12 Old age, not falling within any other category (OP) 43 Past or present alcohol dependence over 65 years of age (A(E)) 3 Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: !: The total number of persons that maybe accommodated at any one time must not exceed 43. 2. Admittance of one named under age service user. Date of last inspection 2/11/04 Brief Description of the Service: Lake House is a purpose built residential home situated in the village of Adderbury,close to Banbury in Oxfordshire. Local shops and amenities are all within easy reach and the home is on a regular bus route between Banbury and Oxford. It is home to 43 older people, formerly a County Council home and now the responsibility of the Orders of St John Care Trust. The single storey accommadation provides individual rooms where residents are encouraged to decorate their rooms with personal possessions. The communal areas are pleasantly decorated and the lounge area accommodates a day centre for older people from the community in which residents may participate if they wish. The building is divided into five wings and accommadates the bedrooms. Each wing of the home has its own sitting and dining area. Three of the wings have there own small kitchen area. The home is set in attractive grounds with a courtyard in the centre of the building.
Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place on Tuesday 28th June 2005. The inspector was made to feel very welcome and was appreciative of the cooperation of all the staff that were on duty that day. The inspector toured the building looking at the communal areas and the five wings as well as individual bedrooms with the permission of the residents. A majority of the time was spent talking to residents and some family members and individual time was also spent talking to the staff who were on duty that day. Lake House has a new manager and time was spent in discussion with her about the improvements she intends to make to further enhance the quality of care to her residents. A minimum of records were inspected due to the complete reorganisation of the home’s record keeping and this will be an area that will be looked at in greater detail at the next inspection. The home have just appointed a new Head of Care to assist the manager in her task of implementing new systems. This post is currently temporary and time was spent talking to this new member of staff. The carer on one of the wings was observed carrying out the lunchtime medication round and time was spent talking to some residents over lunch. Feedback from some of the residents and relatives was really positive. “Care is wonderful”. “Nothing too much trouble.” “Residents are really well cared for.” What the service does well:
Lake House has a very homely atmosphere and this was backed up by residents who were clearly saying that everything was geared towards meeting their needs and that they were really happy with the care they received. All visitors to the home are made to feel welcome and can approach the manager with any worries. All residents spoken to were clearly happy with the choice of food on offer and that the food was well cooked and well presented. The manager and her staff are committed to providing the best care possible for the residents. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better:
The standard of cleanliness in some areas of the home needs attention. Relatives commented on this and they advised the inspector that they had actually cleaned their relative’s room themselves on occasions. Some residents were disappointed at the lack of activities and this is hoped to be rectified by the appointment of another activities coordinator. It has been acknowledged that record keeping needs improvement and new assessment records are being introduced to improve overall recording. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 7 It has been acknowledged that communication could be improved and this is an area that needs attention. The manager has started this process and is talking individually to all staff about hours of working so that changeovers can be smoother and communication between staff better. There are three areas, which the inspector has raised on a number of occasions. i.e. The bath in one wing to be upgraded so that residents can actually use it, lighting in the main lounge to be improved, provision of kitchen areas in two wings. It is understood that these changes have been approved by the order of St John Trust and are in the budget for 2005/2006. It is hoped that they will be completed in time for the next inspection. 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. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 standard(s) 1&5 Lake House provides good clear information and it is used by prospective residents to help them choose a home that is right for them. EVIDENCE: The information about lake house was seen at the entrance to the building. The brochures outlined what the home can and cannot provide and it was written in plain English and could be easily understood. Relatives spoken to described how they were made very welcome when they first visited the home, and were given all the relevant information to support their decision to choose a home for their relative. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 standard(s) 9&10 There is a safe system of medicine administration within the home that is supported by policies, procedures and training. Residents are treated with respect. EVIDENCE: All care staff are trained in giving medication and a carer on one wing was observed giving out the medication. The trolley was clean and orderly and notes on each resident’s medication was clear. The medicine room was checked in the presence of senior care leader and all was in order. Trolleys are now locked to the wall and the room is secure. A random selection of medication was checked including the controlled drugs against the medicines administration charts and this was found to be satisfactory. Several residents were spoken to and confirmed that they were treated with respect at all times. Staff were seen knocking on doors and being sensitive to resident’s needs.
Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 11 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 standard(s) 12,1314 &15. Residents are encouraged to maintain contact with family and friends and are assisted to exercise choice over their day. Every effort is made to ensure that residents enjoy their meals . There needs to be a range of activities that suit the needs of all residents. EVIDENCE: The home welcomes all visitors and there were many families visiting on the day of the inspection. Relatives confirmed that they were welcome any time and gave examples of special events where they had stayed for meals. The inspector discussed the home’s food arrangements with the cook and she explained the dietary arrangements and choices available. Birthdays are celebrated in a special way. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 12 Three meals a day are offered to residents and hot and cold drinks are available at any time. Residents spoken to praised the cooking and there were two choices on the day of the inspection, one hot and one cold dish. One member of the kitchen staff was undertaking her NVQ with an assessor. Currently there are only 6 hours provided for a member of staff to carry out activities with the residents. An extra post is to be provided as soon as the necessary recruitment checks have been completed. This should then provide an opportunity for more time to be spent with residents, finding out their preferences and interests and setting up one to one time with the residents. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 standard(s) 16&18 There is a clear complaints policy and residents are protected from abuse. EVIDENCE: The complaints policy was seen on the notice board and in resident’s guides. The procedure was also seen in the complaint log and it was clear how complaints are acted upon with their outcomes clearly identified. Residents and relatives said they were happy to raise any issues with the staff or manager and that concerns were acted upon promptly. Staff spoken to were clear about their responsibilities in relation to “whistle blowing” should they have any concerns and that this formed part of their ongoing training. The manager has attended training herself on the protection of vulnerable adults with Social Services and is clear on the procedures to follow. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 standard(s) 19,20,21,23,24&26 Residents live in a safe homely environment, where most of the areas are cleaned to a reasonably high standard. Some areas of the home need more thorough cleaning. Residents have personalised bedrooms and have the use of suitable toilet and washing facilities. One wing currently does not have the use of its own bathroom. Residents have safe access to all parts of the home and grounds. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 15 EVIDENCE: The order of St John is responsible for the programme of routine maintenance of the home and grounds. There are several areas, which need attention, and this has been agreed in their 2005/6 plans. Bathrooms and toilets are in close proximity to bedrooms apart from Heather wing, which does have two bathrooms, but residents use neither. This is due to one bathroom housing a parker bath, which residents do not like, and the other bathroom has poor accessibility for those residents less able. Residents have the use of call bells in any emergency or if assistance is required The inspector saw several bedrooms and they were individually styled with resident’s personal possessions and they were pleasantly decorated and homely. Residents spoken to were happy with their rooms but one relative was not happy with the current overall cleanliness of the bedroom. There were also some areas not as vigilantly cleaned as others. Paper towels were missing in two toilets and the standard of cleanliness not up to standard in one of the bathrooms. It would be helpful if the manager looks at the deployment of domestic staff ensuring adequate cover in all areas of the home. The laundry was clean and orderly but staff were unhappy with only having one washing machine and one dryer. I understand this is being addressed in the years financial planning. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28 &30 The home is staffed in accordance with the needs of the residents and the staff undergo the appropriate training to meet the overall needs of all residents. EVIDENCE: The staffing rotas were examined and showed that there were sufficient staff on duty that day. The manager and Head of care are available during the main body of the day. The manager is proposing a variety of changes to the staffing, which she is currently communicating to the staff. Some staff members are anxious about these changes, but to improve handovers and communication between staff and to further improve outcomes for the residents, these changes are necessary. Staff spoken to were clear on the training they have received and the manager has set up a training matrix in order for her to identify those staff who require their training to be updated as well as ongoing professional development. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,3236&38 The new manager has a clear development plan and vision for the home. All staff receive regular supervision. The health safety and welfare of residents is considered to be a high priority at lake House. EVIDENCE: The manager holds regular meetings and residents and their families or representatives are invited to attend. Relatives spoken to were appreciative of these meetings and welcomed the opportunity to discuss a variety of issues. The manager is also using it to discuss any changes that she will be implementing in order to enable residents and relatives to be part of the initial discussions. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 18 The manager is carrying out formal recorded supervision and this was confirmed in discussion with staff on the day of the inspection. Records of these supervision sessions were also seen. The staff training records showed that staff receive mandatory training in moving and handling and fire safety and the manager had initiated a fire drill prior to the inspection thus ensuring the safety of residents. Further records in relation to health and safety will be looked at during the next inspection. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 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 3 2 2 x 3 3 x 2 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 Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 x 3 Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? 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. Standard 12 21 Regulation 16 23 Requirement Service users are able to participate within an increased activity programme. The bathroom in Heather wing needs to be upgraded to allow those residents use of their own bathroom . Timescale for action Sept 2005. Sept 2005 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 20 26 27 Good Practice Recommendations It is recommended that the communal lighting in the main lounge is inproved.(this was recommended at the last inspection.) It is recommended that more thorough cleaning takes place in all areas of the home. It is recommended that the manager continues discussions with staff who are anxious over the changes to their working hours.This is crucial to providing better communication between staff and management and to improving the overall outcomes for the residents. Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 21 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park (South) Cowley, Oxford, OX4 2SU 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 Lake House H57_H08_S13156_Lake House_V236829_280605_Stage4.doc Version 1.30 Page 22 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
