CARE HOMES FOR OLDER PEOPLE
Lakeland View Nursing & Residential Home 220-224 Heysham Road Morecambe Lancashire LA3 1NL Lead Inspector
Mrs Christine Marshall Unannounced Inspection 15th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lakeland View Nursing & Residential Home DS0000006144.V286102.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. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lakeland View Nursing & Residential Home Address 220-224 Heysham Road Morecambe Lancashire LA3 1NL 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) 01524 410917 01524 410917 Mr Frank George Gregory Nicholls Ms Bernadette Ann Wallbank Care Home 33 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (33) of places Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 33 service users to include up to 33 service users in the category OP (Older persons over 65) and up to 10 service users in the category DE (Dementia) 17th November 2005 Date of last inspection Brief Description of the Service: Lakeland View is registered with the Commission for Social Care Inspection to provide nursing and residential care for up to 33 older people. This includes 10 places for people with Dementia. The home is located in the Heysham Road area of Morecambe, close to bus routes and shops. Lakeland View has three floors and there is a passenger lift in place. There are 25 single bedrooms of which 2 have en-suite facilities, and 4 double bedrooms. There are adequate toilets and bathrooms. Bedrooms and lounge areas are decorated and furnished to a basically satisfactory standard. There is a delegated smoking area for residents. There are four lounge areas and a conservatory area. One is a quiet lounge and three lounges have televisions. There is a Statement of Purpose, Service Users Guide and Information Pack that is given to all prospective residents; this is a set of written information that tells you about the care service that is offered and what the resident can expect if he or she decides to live at the home. The most recent inspection report is available in the reception area of the home.
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 5 At the time of this visit, (15/5/06) the information given to the Commission showed that the fees for care at the home were £452 per week, with added expenses for hairdressing, chiropody and newspapers. There is ample parking space for visiting professionals and relatives and a small garden area to the front of the building with a patio to the rear of the dining room. The home is owned by Mr Frank Nichols and the registered manager is Mrs Bernadette Wallbank. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit, which means that the manager, staff and residents did not know it was taking place until the inspector arrived. All of the people spoken to and who were able at the home said that they preferred to be called residents. The visit took place over a full day and was carried out by the home’s designated lead inspector Christine Marshall. The day was spent looking around the home, speaking to residents, relatives and staff and looking at administration records. All areas of the home were clean, hygienic and adequately furnished: The manager completed a pre-inspection questionnaire before this key inspection visit and comment cards were sent to the home for residents, relatives and visiting professionals to fill in, however few were returned. Those that were, showed that they were happy with the care at Lakeland View. The manager, nurses and care staff were spoken to and their responses are to be found in the body of this report. Everyone was very friendly, welcoming and co-operative throughout the visit. What the service does well:
Generally the comments from people living at Lakeland View, and their relatives, were very complimentary about the care provided, the owner, and the manager and staff. One resident said ‘’You certainly get looked after here.’’ Another resident said ‘’I get really good care, they (the staff) are lovely.’’ A visiting relative said “The care is very good, I stay for tea each day and am always welcomed.” All registered care homes are expected to keep a written record for every resident, which describes their needs and how the care that is given meets
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 7 these needs. These records are called care plans. A number of these were sampled and showed that a very good system is in place. All aspects of physical, psychological and social care are recorded and each care plan showed a very individual and personal approach to meeting care needs. There is equality of care throughout the home in that residents are able to take part in a number of activities both inside and outside of the home. The activities coordinator makes sure that all residents are provided with activities that are appropriate for their needs and wishes, taking into account the needs of the dementia residents and also those who were unable to take part in group activities because they were unable to come out of their beds: For those residents, a range of gentle activities had been developed for a oneto-one basis, such as hand massages, music and tasting and smelling sessions. The food at the home was extremely good and a number of residents said that they were more than happy with their meals. One resident said, “The food is always good, I have never had cause to complain.” Wine or soft drinks are offered before meals and there is full equality of care in that all residents (nursing and dementia) enjoy their meals together and more than adequate staff are available to assist the residents with their food. Staff training programmes are an important part of the home’s provision of care and this makes sure that the residents are looked after by qualified and competent staff. With the exception of two new starters, every carer in the home holds an NVQ in care at level 2 or above; as the National Minimum Standard for NVQ training is 50 , this figure is commendable. What has improved since the last inspection?
The manager of the home is now registered with the Commission for Social Care Inspection, which gives stability to the staff and residents. Residents and relatives said that they were very happy with the manager and that she was friendly and approachable. Supervision programmes for all of the staff are now in place and this makes sure that everyone who works at the home is working to a satisfactory standard and that any training support that is needed by staff is provided. A new extractor fan has been fitted in the kitchen to make sure that the temperature is kept to a reasonable level for the preparing and storing of food. Some bedrooms have been redecorated and the manager goes around the home every week to monitor the progress of the refurbishment programme.
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 8 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. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 9 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 Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 10 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): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Anyone who is considering entering Lakeland View is supplied with basic information to help them make that decision. The home also gathers enough information about that person to ensure that their needs can be met. This means that people can make their choices and receive the care they require. EVIDENCE: The home’s Statement of Purpose and Service Users Guide is a set of written information that tells you about the care service that is offered, who the manager and staff are, and what the resident can expect if he or she decides to live at the home. This needs to be reviewed and updated and so that prospective residents are given up to date information about the home’e categories of registration and the registered manager’s details. However, there is an excellent Residents Handbook that is given to all prospective and existing residents which is very
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 11 informative and easy to read in larger print; therefore although there is a small shortfall in the information in the Statement of Purpose, the quality outcome of these standards, remains good. The current information is available in the reception of the home. A number of staff said that knew about the Service Users Guide and Statement of Purpose, and some were able to briefly describe the provision of care that they were giving to the residents. Pre-amission assessments were looked at and were completed satisfactorily. A visiting relative said that they had been invloved in a pre-admission assessment with their spouse and the home. Contracts of care were also in place and signed by either the resident or their advocates. This means that residents know what to expect from the home and what is expected of them. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 12 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 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents health and social care needs are met and people are treated with dignity and respect at this home. Residents are supported and protected in their daily lives. EVIDENCE: Care plans were reviewed and were satisfactory, giving clear information about the care that was being given. Care staff said that they knew about the care plans and that these generally reflected the care that they gave to each person. One resident was able to say that they knew about their care plan and that they had signed it; other residents spoken to were unable to express their views, however one visiting relative said that they knew about a care plan for their spouse. Health care opportunities are offered to all residents and there are records of GP, chiropody and physiotherapy visits.
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 13 The medication system at the home has been changed and records were satisfactory. Policies and procedures have been ammended for the new system and a clinical waste agent is contracted for the disposal of unused medication. Trained nurses give out all medicines and general advice was given about updates from the Nursing & Midwifery Council on the administration of medications, and advice was also given about storing creams and medications in the fridge. The residents were treated with respect, privacy and dignity, and excellent interaction was noted between the staff and the residents. The home has an excellent death and dying policy and procedure, however it did not include procedures for taking care of personal effects after death. This was being added to the document so that there would be no misunderstandings about the responsibilities of the staff after a resident has died. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents throughout the home are fully supported so as to promote the quality of their daily lives. EVIDENCE: Equality and diversity are fully considered for all residents in their social needs assessments. There is a dedicated activities coordinator who plans activities in line with individual residents’ needs and wishes. Prior to a resident moving to the home, the coordinator is involved in their assessment and gains information about their likes and dislikes and previous pastimes and hobbies. The activities that were available on a regular basis included visiting musicians, regular residents’ meetings, quizzes and bingo. A number of relatives were involved in the bingo session during this visit and the manager said that they also contribute with prizes that can be won.
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 15 As well as activities within the home, efforts are made to ensure that residents who wish to, have the chance to go out on trips as often as possible; a trip to the zoo was being planned after residents’ requested this. There is complete equality of choice, table settings and mealtime routines for all of the residents at this home. Both nursing and dementia residents eat together, with excellent assistance from the staff. Wine or soft drinks are offered before the meal and the staff regularly asked whether everything was all right, helping discretely where needed. All the residents who were able and their relatives said that they were happy with the quality and variety of meals available at the home. They also said that there was always a choice available and that snacks were available throughout the day. The monthly menus show a very varied choice of food and after meetings with the residents, the sweet choices for lunch and tea were changed so that a light pudding was served after the main meal at lunch and a hot pudding served at the teatime meal. This suited the residents much better than a very big lunch menu. One resident preferred his main meal at tea-time and this was honoured. There were nutritional assessments in place for all of the residents and a variety of meals were served, such as soft, pureed and diabetic diets. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies, procedures and practice make sure that residents are supported and protected. EVIDENCE: There are policies and procedures in place for complaints, whistle-blowing and adult abuse issues, and staff said that they were aware of these. A small number of residents and one visiting relative confirmed that they knew about the complaints policy and had no complaints to offer. The complaints procedure for the home is displayed in the entrance and is included in the Residents Handbook. There has been one concern levelled against the home, which has been dealt with through their complaints procedure. A review of a particular procedure at the home has been done and consequently, this should avoid any further concerns being brought up. Training files showed that all staff have had abuse awareness training during induction. The manager said that she had identified that it would benefit the residents and staff if further formal abuse awareness training were given. She
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 17 is now planning full abuse awareness training for all staff and this would be done within three months. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 18 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, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are provided with a comfortable, clean and hygienic environment and bedrooms were personalised. This means that residents will feel at home with their belongings around them. EVIDENCE: The home was clean, warm and basically comfortable. In general, the home was maintained and furnished to a satisfactory standard. There were procedures in place to provide guidance for staff on how to reduce the risk of cross infection in the home. Staff said that they knew about this and each carried small bottles of antibacterial hand gel; there were also safety
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 19 dispensers of this throughout the home, including by the side of the signing in book. The glass in the windows of rooms 25, 28 and 29 must replaced because the existing glass is misted up due to broken seals. This has been highlighted in previous reports and must be addressed as a matter of urgency, so that the residents in these rooms can have a clear view from their window. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 20 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents care needs are met through good levels of staff, who have the appropriate qualifications and experience necessary for the delivery of a good care service. EVIDENCE: The list of staff on duty showed that there are good levels of carers and domestic staff on duty at the home. Discussions with the carers and the kitchen and domestic staff were very positive and showed that there is a good skill mix of people in place. With the exception of two new starters, 100 of the care staff have achieved the National Vocational Qualifications (NVQ) to at least level 2: This is commendable. The new starters are enrolled on training programmes to begin in September. The recruitment files showed that pre-employment checks are done before a person can start work at the home; however a small number of staff had not had a full Criminal Records Bureau (CRB) clearance and this has been due to difficulties the home’s registration status with the CRB, who have implemented new rules for registering bodies such as care homes. The manager addressed
Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 21 this immediately and arranged for these staff to continue to work under supervision until the CRB’s were cleared. But for this shortfall in standard 29, the quality outcome for these standards would have been good. There is a robust training program at the home and carers said that they had done all of the required training to make them competent and safe to look after the residents. All members of staff have been given first aid training. The manager said that through supervision, she had identified that although the staff have basic abuse awareness training on induction to the home, the quality of care would be enhanced if all staff undertook more in-depth abuse awareness training. She is arranging this as a matter of priority. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 22 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, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported by an experienced manager and there are quality systems in place to make sure that they are protected. EVIDENCE: The manager is experienced and is just in the process of completing the Registered Managers Award. The residents said that she was friendly and approachable and often seen around the home. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 23 The International Standards Organisation (ISO) quality monitoring system is in place and the manager undertakes regular quality surveys. A copy of their latest survey was sent to the CSCI prior to the inspection visit and showed a very good level of satisfaction with the home. There are regular staff and resident meetings and staff confirmed that they had meetings; minutes of these were seen. Records of residents personal monies that are kept at the home proved accurate and the monies correct. Staff suopervision programmes are in place and records of these were seen. Staff also confirmed that they had regular supervision. The manager was aware of the responsibilities of maintaining all health and safety certificates of service for fire, equipment, electric, gas and nurse call systems. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 24 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 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 25 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 Standard OP1OP4 Regulation 4&5 Requirement The home’s statement of purpose and service users guide must include up to date information about the registered categories of the home, and the registered manager’s details. The glass in the windows of rooms 25,28 & 29 must be replaced. All staff must have CRB clearance before working at the home. Timescale for action 30/06/06 2. 3 OP25 OP29 16 19 30/06/06 05/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP11 OP18 Good Practice Recommendations The death and dying policy and procedure should include guidelines for the care of personal effects after death. All staff should have formal abuse awareness training. Lakeland View Nursing & Residential Home DS0000006144.V286102.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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