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Inspection on 08/05/08 for Lakeland View Nursing & Residential Home

Also see our care home review for Lakeland View Nursing & Residential Home for more information

This inspection was carried out on 8th May 2008.

CSCI found this care home to be providing an Good service.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The atmosphere at the home is warm and friendly. Staff work hard to provide flexibility and choice regarding daily life, social activities and meals. Staff respond to the people living in the home with sensitivity and patience. Relatives who completed CSCI surveys were generally extremely positive about the care provided at Lakeland View. Comments included; " We are extremely pleased with the standard of care given to our relative. We visit every week and at different times and days and have always been well received and never had cause for concern." Lakeland View provides a good range of communal living space, with two main lounges, a conservatory, a small lounge where people can smoke and a large airy dining room. There are also two areas of hallway on the ground floor where seating is provided. This means that people can choose to join in activities or spend time in quieter parts of the home. The dining room is spacious, light and airy, with the tables attractively set. The mealtime observed was pleasant and calm, with staff talking to residents and no sense of anyone being hurried to finish. The staffing levels are very good. Domestic, maintenance, kitchen, administrative and laundry staff are employed, allowing the nursing and care staff to focus on the needs of residents. Staff have good training opportunities and nearly all of the care staff have gained an NVQ (National Vocational Qualification), meaning that care staff have had their work practices assessed and found to be good.

What has improved since the last inspection?

Regular checks of the medication records and the medication stocks now take place and help to minimise any mistakes. A refurbishment programme is underway. The second floor of the home and one of the lounges has been refurbished and redecorated and some windows have been replaced. Several relatives commented, via the CSCI surveys, that they were very pleased with these improvements. Staff have completed training regarding protection and abuse. This has strengthened the training programme at the home and means that staff know how to respond should any concern be raised.

What the care home could do better:

Risk assessments are in place for those people who need to use bed rails to prevent falling out of bed. These need to be strengthened and risk management plans put in place. These should include regular checks of the equipment, stress the importance of using protective covers on the rails and also incorporate regular reviews. The arrangements regarding medication could be improved. Two people checking handwritten records, a photograph of each resident held alongside their medication record, dating medication when it is opened and clearer guidance relating to medication prescribed to be administered as and when required would all help to improve the current system and minimise chances of errors. The refurbishment and redecoration programme must continue with attention being given to the bedrooms on the ground floor, which are in a poor state of decoration and also require new flooring. Generally the staffing arrangements are very good at Lakeland View. This area is let down by poor recruitment practices, which could pose risks to those living at the home. Staff must not commence duty until all the necessary checks have taken place.The supervision and appraisal system should be extended to include qualified nursing staff. This would give nursing staff opportunity to discuss their work practice; any training needs and receive feedback about their work performance. It is important that cleaning materials are securely stored as access to these could pose risks to some people living at the home.

CARE HOMES FOR OLDER PEOPLE Lakeland View Nursing & Residential Home 220-224 Heysham Road Morecambe Lancashire LA3 1NL Lead Inspector Lesley Plant Key Unannounced Inspection 8th May 2008 09:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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.V361656.R01.S.doc Version 5.2 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.V361656.R01.S.doc Version 5.2 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) 15th May 2006 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 is parking space and a small garden area to the front of the building, with a patio to the rear of the dining room. The home provides a range of communal living rooms including two main lounges, a small conservatory, a separate lounge for those people who smoke and a large airy dining room. 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 home is owned by Mr Frank Nichols and the registered manager is Mrs Bernadette Wallbank. The fees currently range from £366.00 to £530.50. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place during the course of one day and looked at all the key National Minimum Standards plus supervision arrangements for staff. At the time of this inspection there were 24 people resident at the home. Discussions took place with, the owner, the registered manager, four staff and a number of people living at the home. Records and documentation were viewed and a tour of the building was carried out. Time was also spent observing staff and those living at the home as they engaged in activities. CSCI questionnaires inviting feedback about Lakeland View were received from ten relatives and three people living at the home. Since the last key inspection in May 2006, a CSCI pharmacy inspector carried out an inspection of the medication arrangements of the home in August 2006 and an Annual Service Review took place in October 2007. Reports relating to these are held at the CSCI office and will be made available to enquirers on request. What the service does well: The atmosphere at the home is warm and friendly. Staff work hard to provide flexibility and choice regarding daily life, social activities and meals. Staff respond to the people living in the home with sensitivity and patience. Relatives who completed CSCI surveys were generally extremely positive about the care provided at Lakeland View. Comments included; “ We are extremely pleased with the standard of care given to our relative. We visit every week and at different times and days and have always been well received and never had cause for concern.” Lakeland View provides a good range of communal living space, with two main lounges, a conservatory, a small lounge where people can smoke and a large airy dining room. There are also two areas of hallway on the ground floor where seating is provided. This means that people can choose to join in activities or spend time in quieter parts of the home. The dining room is spacious, light and airy, with the tables attractively set. The mealtime observed was pleasant and calm, with staff talking to residents and no sense of anyone being hurried to finish. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 6 The staffing levels are very good. Domestic, maintenance, kitchen, administrative and laundry staff are employed, allowing the nursing and care staff to focus on the needs of residents. Staff have good training opportunities and nearly all of the care staff have gained an NVQ (National Vocational Qualification), meaning that care staff have had their work practices assessed and found to be good. What has improved since the last inspection? What they could do better: Risk assessments are in place for those people who need to use bed rails to prevent falling out of bed. These need to be strengthened and risk management plans put in place. These should include regular checks of the equipment, stress the importance of using protective covers on the rails and also incorporate regular reviews. The arrangements regarding medication could be improved. Two people checking handwritten records, a photograph of each resident held alongside their medication record, dating medication when it is opened and clearer guidance relating to medication prescribed to be administered as and when required would all help to improve the current system and minimise chances of errors. The refurbishment and redecoration programme must continue with attention being given to the bedrooms on the ground floor, which are in a poor state of decoration and also require new flooring. Generally the staffing arrangements are very good at Lakeland View. This area is let down by poor recruitment practices, which could pose risks to those living at the home. Staff must not commence duty until all the necessary checks have taken place. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 7 The supervision and appraisal system should be extended to include qualified nursing staff. This would give nursing staff opportunity to discuss their work practice; any training needs and receive feedback about their work performance. It is important that cleaning materials are securely stored as access to these could pose risks to some people living at 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. The summary of this inspection report can be made available in other formats on request. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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 Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. The assessment process helps to ensure that people are only admitted to Lakeland View if their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose, Service User Guide and Residents Handbook provide good information about the service provided at Lakeland View and these are made available to anyone interested in staying at the home. The pre admission arrangements were discussed with both the owner and the manager of the home and records were viewed. The manager of the home and one of the nursing staff usually carry out assessments. Social work assessments are also gained and these were viewed on files. The records for two people recently admitted to the home were viewed. Both contained thorough information regarding the needs of the individual Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 10 concerned. Assessment information includes medical needs, nutritional needs, tissue viability, mobility, hygiene, mental health and social needs. One person had previously lived out of the area and the usual assessment visits had not been able to take place. A social work assessment was available and a high level of observation had been put in place, to monitor the mental health of this person and build up more detailed information regarding any areas of need. Files also contain a personal history, usually completed by a relative and prospective residents and their relatives are invited to visit the home prior to admission in order to view the facilities and meet the residents and staff. The home provides some short term or respite care and records show that good pre admission information is also gathered, even if the individual is only staying for a few days. Lakeland View also provides a limited amount of day care, which is closely monitored to ensure that the needs of those living at the home are not compromised in any way, by having an additional person visit the home for just a few hours. Intermediate care is not provided at Lakeland View. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Health, personal and social care needs are met. Staff training and good practice promote the privacy and dignity of those living in the home. Medication practices could be improved to provide extra safeguards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for four people were viewed. Each area of support has a separate assessment and this includes nutrition, mental health, mobility and hygiene. A care plan is then written if an area of need is identified. Each person has a named nurse who takes responsibility for reviewing the care plans. The care plans viewed were all being regularly reviewed. Although the home provides nursing care, there is a good attention to the social and emotional needs of the people at the home. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 12 Risk assessments are in place for those people who need to use bed rails to prevent falling out of bed. These need to be strengthened and risk management plans put in place. These should include regular checks of the equipment, stress the importance of using protective covers on the rails and also incorporate regular reviews. A care plan and recording system had been set up for an individual recently admitted to the home who had a history of epilepsy. Although he had not had a seizure since being at the home, the support plan was in place. Support plans are in place regarding nighttime care needs. Individuals are involved in agreeing any checks or monitoring provided by night staff. Regular nighttime checks were in place for a person recently admitted to the home, who had not yet settled into his new environment. Relatives who completed CSCI surveys were generally extremely positive about the care provided at Lakeland View. Comments included; “ We are extremely pleased with the standard of care given to our relative. We visit every week and at different times and days and have always been well received and never had cause for concern.” Each person is weighed every month and more frequently if required, such as for any individual where weight loss had been identified. A record is kept of each person’s meals eaten. Each person also has a tissue viability assessment completed and a care plan is put in place if required. Observation charts were viewed in relation to one person who is being nursed in bed, following surgery. These charts include a record of fluid intake and a record of turning to prevent skin pressure areas. The home has developed close links with community mental health services. The appointed local community psychiatric nurse comes to the home each week, to liaise with staff, monitor the health of individuals and review any treatment programme as required. Records are kept of any health care appointments, such as GP visits and these were viewed on individual files. Individuals spoken to felt that their health care needs were being met. One person explained that the previous day she had felt unwell, that the nursing staff had given her the medication prescribed for such circumstances, that she was now feeling a lot better and that the staff and the owner had all been very kind to her. Medication is safely stored and administered by qualified nursing staff. A CSCI pharmacy inspector carried out an audit of the medication arrangements in August 2006 and the report to the home detailed the improvements, which needed to be made. Some improvements have been made, such as introducing Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 13 regular audits and checks, which now take place; however there are still shortfalls in this area. Most medication is provided by the pharmacy in a monitored dosage system, ready to be administered by nursing staff at the home. There are occasions when medication records have to be handwritten. It was seen that one handwritten record had not been signed and the amount of medication received had not been entered. Another handwritten medication record did not give the dosage of the medication received, just the name of the medication. It appeared that this was an oversight as the other handwritten records seen had been completed correctly. All hand written medication records should be checked and signed by two people and contain full details of the medication prescribed and the amount received. It is also recommended that a photograph of each person is kept with the medication records. Where appropriate individuals are supported to administer their own medication. Risk assessments and written disclaimers are in place. Guidance needs to be put in place regarding any medicines, which are prescribed to be given as and when required, giving details of under what circumstances the medication should be given. It is also good practice to sign any medication not in blister packs, when it is opened. This helps to provide and audit trail and also reduces the risk of medication being used past its expiry date. Privacy and dignity are addressed within the induction period and also within NVQ (National Vocational Qualification) programmes. During the inspection staff were observed responding patiently and sensitively to those living at the home. Two staff approached an individual to take her to have a dressing changed. They explained why they were doing this and where they were going. The lady was helped into a wheelchair and made comfortable. The footrests were adjusted and the lady was reassured regarding the whereabouts of her handbag. One of the staff guided her hand, in order that she could feel where her bag was. Both staff were very patient and reassuring in their responses. All bedrooms contain a safe where valuables or personal papers can be kept. Screening is available in the double bedrooms and is used to provide some privacy. People living at the home were smartly dressed. The ladies hair looked nice and clothing appeared to be well cared for. Staff clearly recognise the importance of appearance in helping individuals to maintain their dignity. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Social, recreational and nutritional needs are met, visitors are made welcome and autonomy and choice is supported. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives are encouraged to complete a personal history or profile, giving information about the individuals past, employment, skills, hobbies and interests. Details of hobbies and interests are recorded on case files. Staff also record any events or activities, such as receiving visitors or going on a trip out, which helps provide a picture of how people are spending their time. During the morning of this inspection visit a small group of people went out for a walk, with a member of staff in the morning. On returning to the home the inspector spoke to one of the group who said that he had enjoyed his stroll and also confirmed that he is often supported to have short walks outside of the home. The home is very close to the promenade and sea front, providing a pleasant and level place to walk. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 15 Staff supported people to play games in the afternoon. Six people sat outside and played dominoes, supported by a member of staff who worked hard to keep everyone engaged in the game. The atmosphere was warm and friendly, with people clearly enjoying the game, whilst sitting in the sunshine with a glass of beer. Another small group were supported to play board games and then skittles, in one of the lounges. One individual told the inspector that she had been asked if she wanted to go outside to play dominoes, but had declined, thinking it may prove too cold for her. A member of staff had then sat with her and played dominoes with her inside. People are encouraged to take part in a range of activities. Newspapers and magazines are regularly delivered. One person goes out by himself several days each week, using his bus pass, and clearly enjoys his independence. Activities are listed on a board in the dining room and include, bingo, board games, trips out and staff spending individual time with residents. A hairdresser visits each week, a mobile library each month and a chiropodist every six weeks. Ministers from local churches also visit and give communion. Several of the people spoken to said that they enjoyed the trips out, going for a drive in the country or for lunch out. A mini bus is hired on these occasions and a trip out was planned for the following week. A relative commented on a CSCI survey; “They arrange little birthday parties, a Christmas party and an Easter party and a barbecue in the summer. They have been taken to see shows at the theatre in Morecambe and when the weather is good they go for walks in their wheelchairs along the prom.” Other activities include clothes parties. A member of staff explained that a notice is always put up to let relatives know of such events and that relatives are encouraged to come and join in. Relatives who completed CSCI surveys confirmed that they are made welcome at the home. Comments included; “When we arrive to see ****, we always get a nice mug of tea and the staff are so kind and helpful.” Some of the people living at Lakeland View have a diagnosis of dementia, resulting in various degrees of cognitive impairment. Relatives usually take responsibility for financial affairs. Details of advocacy services are available. People are able to bring personal possessions into the home and so make their bedrooms homely. Individuals are supported to make choices about their lives and routines are kept to a minimum. On the day of this visit a number of people had chosen to eat their lunch outside and this was facilitated. During the visit the inspector had lunch at the home. Lunch is generally the main meal of the day, with a choice of two hot meals and also a good choice of deserts. The meals were well presented and clearly enjoyed by the people at the home. Staff were observed asking each person what they would like to eat and drink. Soft drinks and wine are available at mealtimes. Several residents Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 16 commented on the good food provided. Options are also available at teatime, such as sandwiches, soup and a snack meal choice. Three people require food to be blended and need support to eat. Staff provided this support with sensitivity and patience. Each person has a nutritional assessment, with a record kept on their file. The cook on duty explained the menus and also said that she was aware of peoples individual likes and dislikes, as well as any specific nutritional needs. The dining room is spacious, light and airy, with the tables attractively set. The mealtime was pleasant and calm, with staff talking to residents and no sense of anyone being hurried to finish. Staff work hard to provide flexibility and choice regarding daily life, social activities and meals. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Policies, procedures, good practice and staff training help to ensure that concerns are responded to and people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place, provided within the resident’s handbook and this gives a clear timeframe within which concerns would be responded to. No complaints have been received by the home or by CSCI since the last inspection. The staff spoken to were clear about the procedure to follow, should any concern be raised. Feedback from the relatives and people living at the home who completed CSCI surveys indicates that people know how to raise concerns and are satisfied that any such concern would be responded to. There are written policies addressing protection and vulnerability. All staff have attended training regarding abuse. This is also addressed within NVQ programmes. The owner confirmed that there had been no recent issues regarding safeguarding or protection. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. The home is generally well maintained, however some of the bedrooms on the ground floor do not provide an attractive place to stay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained. A programme of improvement is underway. The second floor of the home and one of the lounges has been refurbished and redecorated and some windows have been replaced. At the time of the inspection visit decorators were working on the first floor. The owner confirmed that this programme of redecoration was going to continue throughout the home. It is important that this takes place as some of the bedrooms on the ground floor are in a poor state of decoration and also require new flooring. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 19 Lakeland View provides a good range of communal living space, with two main lounges, a conservatory, a small lounge where people can smoke and a large airy dining room. There are also two areas of hallway on the ground floor where seating is provided. This means that people can choose to join in activities or spend time in quieter parts of the home. The weather on the day of this visit was warm and sunny and a number of people had chosen to sit outside on the patio area outside the dining room. Radiator covers are in place and each bedroom has a washbasin. There are two domestic staff on duty each day and the home appeared clean. Policies, staff training and good practice are in place regarding infection control. The laundry is sited in the basement and there are separate laundry staff on duty. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Good staffing levels, excellent opportunities for qualification training for care staff and a robust staff-training programme are in place. The lack of proper recruitment checks could pose risks to those living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this unannounced visit there were six staff on duty during the morning and five during the afternoon. This included a qualified nurse. The owner and the registered manager were also on duty. Three staff including a qualified nurse are on duty during the night. In addition there are also administrative, maintenance, kitchen, domestic and laundry staff on duty during the day. These staffing levels allow for some individual time to be spent with those living at the home and for regular activities to take place, as well as ensuring that the physical needs of people are met. There was also a young person from a local school on a work placement at the home, who was spending time talking to residents and giving out refreshments. All but two of the care staff have achieved NVQ level 2 and a number have also gained the level 3 award. The two remaining unqualified care staff have commenced the level 2 programme. To achieve such a high proportion of Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 21 qualified care staff is excellent and indicates that staff are skilled in their work roles. Recruitment records were viewed, including records relating to a member of staff in post for just two months. Records include a completed application form, references and health information. No CRB (Criminal Records Bureau) disclosure or POVA (Protection of Vulnerable Adults) check had been applied for. This could pose risks to the people living at the home. The minimum check required is the POVA check, but staff must then work under close supervision until the full CRB disclosure is received. Staff must not commence duty until all the necessary checks have taken place. A new system for the induction of new staff has recently been introduced. Two days are spent with the manager or a senior member of staff working through the induction to the home. The staff member is then given an induction workbook, with each section being signed by a senior staff member, when it is completed. This workbook addresses the agreed standards for care workers as endorsed by the national training organisation Skills for Care. Good records of staff training are maintained. Staff undertake regular training in key areas of health and safety, and have also attended training regarding dementia. More training is planned for the current year and this will include updated training in health and safety topics and training regarding challenging behaviour. The owner of the home is an experienced mental health professional and has provided a programme of in house training, which has covered, mental health, challenging behaviour, self-harm and the law in relation to mental health issues. This programme has been running in the evenings over a period of several weeks. The staff spoken to confirmed that a good programme of training is provided at Lakeland View. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. The home is well managed, with quality assurance systems in place. Staff training and good practice help to promote the health and safety of people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked at the home for over 3 years and is registered with the CSCI. Qualifications include NVQ level 4 and the Registered Managers Award. Records show that the registered manager has opportunity to update her knowledge and has also completed training regarding health and safety, protection of vulnerable adults and abuse. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 23 There are clear lines of accountability within the home, with the owner, the registered manager, qualified nursing staff and senior care staff having certain designated areas of responsibility. There were a number of systems in place to monitor whether the service was meeting people’s needs and expectations and to determine whether the service could be improved. The ISO (International Standards Organisation) external quality assurance system is in place, which is re certified annually. The home issues surveys annually to all stakeholders, including relatives and health and social care professionals with links to the home. The results of this survey are forwarded to the CSCI. Feedback from the last surveys distributed in January 2008 was generally extremely favourable and where areas for improvement had been suggested, the registered manager had looked into these. A number of internal audits take place, such as the checking of medication and the checking of money held on behalf of those living at the home. Staff meetings take place approximately three times a year and residents meetings take place most months. An individual who lives at the home chairs these meetings and minutes are kept. This resident confirmed that the meetings are useful, that individuals are free to raise any issues and that staff respond to any suggestions made, such as ideas for activities for the Easter period. There are also informal day-to-day opportunities for people living at the home to offer their opinion about the service provided. The owner is in regular daily attendance and several residents stated that he was very approachable and helpful. A safe is available in each bedroom, should anyone wish to keep their valuables with them. A number of people living at Lakeland View have some degree of cognitive impairment and are unable to manage their financial affairs. A relative or representative, such as a solicitor takes this responsibility. Records are kept of any expenditure, such as hairdressing and the relative or representative is then periodically billed for this amount. For some people a small amount of spending money is held in safe keeping by the home. A record of income and expenditure is kept and a receipt is issued to any relative who leaves spending money at the home. The records viewed appeared to be well maintained and the cash balance for one person was checked and was correct. The administrator checks all the records and the money held every month and records of these checks were viewed. Staff supervision records were not available, as these had been taken for auditing by a senior member of staff. The care staff spoken to confirmed that they have supervision meetings with a member of the nursing staff Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 24 approximately every 6 – 8 weeks. Records of annual appraisals were seen on the files of care staff. At present the nursing staff do not receive formal supervisions or annual appraisals, although the owner meets with the nursing staff regularly and provides informal supervision to these staff. It is recommended that the supervision and appraisal system should be extended to include qualified nursing staff. Training records show that most staff have undertaken training regarding health and safety topics including, infection control, first aid, food hygiene, moving and handling and fire prevention. There are also plans in place for staff to receive updated training as required. Records were seen of; fire equipment and alarms being tested, fire drills, hoist and lift maintenance, accidents and the checking of the gas boiler. All hot water outlets are thermostatically controlled. During the visit the domestic staff left cleaning products unattended for a short period of time and manager must address this, as access to these products could pose a risk to certain people living at the home. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 26 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 OP19 Regulation 23 Requirement All parts of the home must be reasonably furnished and decorated. Staff must not commence duty until all the necessary checks have taken place. (previous timescale of 07/08/06 not met) Cleaning products must be safely stored. Timescale for action 30/09/08 2. OP29 19 31/05/08 3. OP38 13 31/05/08 Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The risk assessment and risk management of bed rails should be strengthened to include the action to be taken to minimise risks. A photograph of each person should be kept with the medication records. All handwritten medication sheets should be checked and signed by two staff. There should be clear guidance regarding when medication, prescribed to be given as required, should be administered. Medicines not in the blister packs should be dated upon opening. 2. 3. 4. OP9 OP9 OP9 5. 6. OP36 The supervision and appraisal system should be extended to include qualified nursing staff. Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Regional Contact Team Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Lakeland View Nursing & Residential Home DS0000006144.V361656.R01.S.doc Version 5.2 Page 29 - 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. 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