CARE HOMES FOR OLDER PEOPLE
Lakeland View Nursing & Residential Home 220-224 Heysham Road Morecambe Lancashire LA3 1NL Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 17th November 2005 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.V262205.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. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 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 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.V262205.R01.S.doc Version 5.0 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) 5th July 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 conveniently located in the Heysham area of Morecambe, close to bus routes, shops and a number of amenities. Lakeland View has three floors and there is a passenger lift in place. There are four lounge areas and a conservatory area. One lounge has a television in and adjoins the conservatory sun lounge. 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 acting general manager is Mrs Bernadette Wallbank. Lakeland View Nursing & Residential Home DS0000006144.V262205.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 which meant that the owner, acting manager, staff and residents did not know it would be taking place until the inspector arrived. As the owner of the home was unavailable at the time of the visit, the inspector was assisted by the acting manager. In depth discussions took place about the running of the home and the inspector examined a number of documents. The inspector was also able to consult a number of residents, their relatives and staff members during the visit. As part of the inspection, a case tracking exercise was undertaken. This involved the inspector closely examining the care of selected residents from the point of their admission to the home. What the service does well:
Throughout the visit the inspector was able to consult a number of residents and their relatives. During these discussions those consulted were very complimentary about the care provided at the home and spoke highly of staff and managers. One resident said ‘’This place would take some beating, they really are very caring.’’ Another resident said ‘’I am so glad I found this place. They are really good here and Frank ‘(the owner)’ makes sure everything is as it should be.’’ A number of residents spoke about the owner of the home extremely positively. It was apparent from these discussions that the owner keeps in close contact with all the residents and each one consulted clearly had a very good relationship with him. This was also the case for relatives who spoke very highly of the owner and staff at the home. One relative said ‘They are so kind. You can talk to them about anything, they have always got time for you.’’ All registered care homes are expected to keep a written record for every resident which describes their needs and how the home intends to meet these needs. These records are called care plans. Whilst the inspector did not assess care plans during this visit as a specific area, during the case tracking exercise a number of residents’ care plans were viewed. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 6 These plans demonstrated that the home have very good systems in place to ensure that each resident’s care is planned in line with their individual needs and wishes. The needs of those residents who require emotional or behavioural support had been very well planned for. In addition, there were very good systems in place for observing individual residents and monitoring particular areas. For example, an observation chart was in place for one resident who had been found to cry on a regular basis. The resident was unable to verbalise what was upsetting her, so carers were recording each time she cried and what was happening around her at the time. This type of monitoring can be very useful to help identify patterns of a particular behaviour and potential triggers for it. Through discussions held during the visit, the inspector was able to determine that residents at Lakeland view are able to take part in a number of activities both inside and outside of the home. It was noted that an activities coordinator had recently been employed and his role was to ensure that all residents are provided with activities which are appropriate for their needs and wishes. The activities coordinator was very enthusiastic about his role and had some good ideas that he was hoping to implement, such as the planting of raised flower beds that residents could tend to without having to bend down. It was also pleasing to note that the activities coordinator had taken into account the needs of residents who were unable to take part in group activities, for instance, those who were unable to come out of their beds. For those residents in this situation and well enough, a range of gentle activities had been developed which they could carry out on a one-to-one basis, such as tasting and smelling sessions. Many of the residents consulted expressed satisfaction with the quality and variety of meals provided at the home. One resident said, ‘’The food here is always excellent and there is a good choice of what to eat.’’ When carrying out the case tracking exercise, the inspector examined the care of one gentleman with special dietary needs. His care plan confirmed that his dietary needs had been very well planned for. One resident who was consulted during the visit commented that only several months earlier, her father had been very underweight when he was admitted to Lakeland View. She said ‘’You could see him fill out straight away, as soon as he came here.‘’ She was very pleased with how well her father had been since his admission to the home and felt that his improvement was due to the good standard of care that he had received. Residents meetings take place on a regular basis and relatives are invited to these as well. In addition it was confirmed that several relatives often take part in activities with residents. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 7 It was apparent that staff and the owner of the home maintain very good relationships with families of residents and one relative commented that she felt the care they provided to her husband was to a certain extent, extended to her as well. It was also very pleasing to observe one visiting relative being invited to come to the home for his dinner on Christmas Day. Since the home’s last inspection in July 2005, a 100 figure for NVQ has been maintained. 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?
Since the last inspection of the home a number of areas have been redecorated and refurbished. The home are currently going through the process of re-varnishing all residents’ bedroom doors in line with previous recommendations. Following the last inspection of the home it was noted that systems for managing residents’ medication were much improved but a number of requirements and recommendations were made. During this visit it was confirmed that all these requirements and recommendations had been carried out. A daily check was being kept of the temperature of the medication room to ensure that drugs were being stored within recommended guidelines. New systems were in place to ensure that the medication room remains locked at all times, and only a senior member of staff now carries the keys. Residents’ medication administration records were checked and found to be well maintained and in good order. There were no errors or unexplained omissions noted. New systems were in place to ensure that any medication administration records which were altered or written by hand were checked and signed by two staff members. Since the last inspection new supervision procedures had been implemented. The new procedures mean that all carers have the opportunity to formally meet with a senior staff member on a monthly basis to discuss areas such as training and personal development. However, whilst it was confirmed that this supervision was now being provided regularly to carers, there was no evidence to confirm that qualified nursing staff and the acting manager were being provided with it. Since the last visit, the home had improved their COSHH (control of substances hazardous to health) procedures to ensure that any chemicals which were potentially hazardous were not accessible to residents. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 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.V262205.R01.S.doc Version 5.0 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.V262205.R01.S.doc Version 5.0 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): None of the above standards were assessed during this inspection. EVIDENCE: Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 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): 9. The home plans care in line with each resident’s individual needs and wishes. There are safe systems in place for the receipt, storage, administration and disposal of residents’ medication. EVIDENCE: At the home’s last inspection a full pharmacy audit was carried out. Whilst it was recognised that there had been a number of improvements in relation to medication procedures, a small number of requirements and recommendations were made. It was identified during this visit that all these had been addressed. Improved records were being kept particularly in relation to variable dose medications. In viewing residents’ medication administration records, no errors or unexplained omissions were noted. In addition, any handwritten instructions added to the records were being checked and signed by two staff members. In line with advice given at the last inspection, the home have now implemented a system to monitor the temperature of the room which medication is kept in, to ensure it is stored within recommended guidelines.
Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 12 Finally, systems had been much improved to ensure that the medication room is kept locked at all times and only accessible to senior staff members responsible for administrating medication. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 13 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 & 15. Residents at Lakeland View are regularly enabled to take part in activities that are appropriate and suitable for their needs. A varied and nutritious diet is provided at Lakeland View and the home plan well for any person with special dietary needs. EVIDENCE: As earlier stated the home now has a dedicated activities coordinator who plans activities in line with residents’ needs and wishes. The inspector consulted the activities coordinator who was very enthusiastic about his role and expressed some good ideas for new activities he is hoping to make available. He also confirmed that prior to a resident moving to the home, he would be involved in their assessment and gain information about their likes and dislikes and previous pastimes and hobbies. Currently, there are a number of activities available on a regular basis including visiting musicians, regular residents’ meetings, quizzes and bingo. It was also pleasing to note that a number of relatives were involved in providing residents’ activities. 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. During
Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 14 the visit it was noted that plans had been made for all residents to go out Christmas shopping. In viewing minutes of residents’ meetings, the inspector was also able to confirm that activities were discussed on a regular basis. During the meetings residents and their relatives were able to share any ideas about new activities and make any requests they had. All the residents who were consulted expressed satisfaction with the quality and variety of meals available at the home. Residents also confirmed that there was always a choice available and that snacks were available throughout the day. In viewing residents’ meeting minutes it was noted that one resident had recently requested more choice in the cheeses available within the home. It was very pleasing to note in further investigation, that following this meeting the home had arranged for several different types of cheese to be purchased to accommodate this resident’s request. In examining the care of one resident who required a soft diet, it was found that his needs had been well planned for. It was noted that there were risk assessments in place which determined that the gentleman would only be assisted to eat by a qualified staff member or senior carer. The inspector was also able to confirm that the home had kept in regular contact with the gentleman’s speech therapist who was providing ongoing advice in relation to swallowing. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 15 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): None of the above standards were assessed during this inspection. EVIDENCE: Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Residents at Lakeland View benefit from a good standard of accommodation. There are good systems in place to ensure that the home is kept clean and that the risk of cross infection is well managed. EVIDENCE: At the time of the unannounced visit, the inspector found the home to be clean, warm and comfortable. In general, the home is maintained and furnished to a good standard. There has recently been a programme of major refurbishment at the home which has resulted in improvements to the majority of areas. In line with previous recommendations made, the process of re-varnishing all residents’ bedroom doors is ongoing and due to be completed in the near future. The recommendation that glass in the windows of rooms 28 & 29 be replaced by clear glass remains outstanding. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 17 At the time of the inspection, plans to put up Christmas decorations had recently been made. It was pleasing to see that those residents who were unable to come out of their bedrooms due to poor health were to be provided with Christmas decorations in their rooms. The home has thorough procedures in place that provide guidance to staff in how to reduce the risk of cross infection in the home. Staff who were consulted demonstrated a good understanding of such procedures. It was noted that all staff, including admin staff and cleaners are provided with antibacterial gels to keep on them, so that they can keep their hands clean at all times. There is also a gel at the front door for visitors to use. The inspector viewed the care plan of one resident who had MRSA. There were very clear guidelines in place for carers in how to work safely with the resident. These guidelines had also been provided to catering and laundry staff. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 18 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): None of the above standards were assessed during this inspection. EVIDENCE: Lakeland View Nursing & Residential Home DS0000006144.V262205.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, 36 & 38. The health, safety and welfare of residents is closely monitored and protected. Systems within the home have improved to ensure that care staff receive regular supervision. However, qualified nurses and managers also need to be provided with supervision. EVIDENCE: Lakeland View had been without a registered manager for some time, but the current acting manager is now going through the process of registration. She has worked for the home for several years and is due to complete her Registered Managers Award in early 2006. Since the last inspection new supervision procedures have been implemented. Carers now have access to regular supervision during which they have the opportunity to discuss issues such as personal development, training and practice issues.
Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 20 The qualified nursing staff provide supervision for carers and those consulted demonstrated a good understanding of its benefits. Nurses consulted confirmed that they had received in house training in how to provide effective supervision and also confirmed that they had enough time to manage supervisions on a monthly basis. However, there are still no systems in place to ensure that nurses themselves and management staff have access to supervision. The inspector was able to find evidence that the home comply with relevant health and safety legislation. In viewing staff training records and through discussion, it was confirmed that staff have access to training in a number of areas related to health and safety such as moving and handling and first aid. It was also confirmed during this visit that procedures are now in place to ensure all potentially hazardous chemicals are kept put of the way of residents. Lakeland View Nursing & Residential Home DS0000006144.V262205.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 X X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 X 3 Lakeland View Nursing & Residential Home DS0000006144.V262205.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 OP36 Regulation 18 Requirement All staff must have formal supervision. Timescale for action 31/12/05 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. 2. Refer to Standard OP19 OP19 Good Practice Recommendations A number of bedroom doors are badly marked and should be re-varnished. The glass in the windows of room 28 & 29 should be replaced with clear glass so that residents have a better view. Lakeland View Nursing & Residential Home DS0000006144.V262205.R01.S.doc Version 5.0 Page 23 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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