Inspection on 18/01/06 for Lakenham Residential Home

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lakenham Residential Home 06/03/09

Lakenham Residential Home 04/02/09

Lakenham Residential Home 20/07/07

Lakenham Residential Home 12/07/06

Lakenham Residential Home 02/08/05

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

CARE HOMES FOR OLDER PEOPLE Lakenham Residential Home Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ Lead Inspector Andy Towse Unannounced Inspection 18th January 2006 12:55 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 Lakenham Residential Home DS0000062626.V279393.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. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lakenham Residential Home Address Lakenham Residential Home Lakenham Hill Northam Bideford Devon EX39 1JJ 01237 473847 01237 470790 cordelia.murphy@Hotmail.com 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) Mr Timothy Oliver Murphy Mrs Cordelia Wai-Yu Murphy, Mr Christopher Charles Hampton, Miss Siobhan Catriona Hampton Mrs Cordelia Wai-Yu Murphy Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Lakenham Residential Home is a care home registered for 28 beds, providing personal care for service users in the category of old age (OP). The building is a detached former residence of the Duchess of Manchester and is situated on a large corner plot in the Northam area of Bideford. The home is sited in extensive well-kept grounds and has glorious sea and coastal views. Accommodation is provided on four floors and the home is extremely spacious with several large communal, reception and meeting areas. The home also has a Chapel on the ground floor of the home. The majority of rooms are single and en-suite, although two shared rooms are available if required. The home is accessible to all areas via a large, modern passenger lift. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over a period of five hours. The information obtained in this report came from discussion with the registered manager and the proprietor, examination of policies, procedures and other records, including care plans and conversations with residents and members of staff. What the service does well: What has improved since the last inspection? The home has compiled a new contract for residents. This will be used for all newly admitted residents. At the last inspection it was recorded that medication storing was inadequate, with specific reference to topical creams being opened but not dated. At this inspection, topical creams, which were in use were seen to have been dated. Residents are aware of the complaints procedure as it is prominently displayed. It also includes appropriate timescales. The registered manager has obtained relevant training materials regarding the protection of vulnerable adults and is instituting training for all staff which should be completed by June 2006. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 6 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. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 7 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 Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 8 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): 2 Residents’ rights of residence are confirmed in new contracts. EVIDENCE: This Standard was not fully inspected. These standards were inspected more fully at the previous inspection at which time it was recommended that resident’s contracts were updated. Since that time new contracts have been produced and will be given to new residents so that they are fully aware of the conditions of their residence at the home and that these meet their expectations as well as defining their rights. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 9 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, 9 The core standards were all inspected during the inspection of 2nd. August 2006. The effectiveness of care plans could be improved by more resident involvement. Residents are safeguarded by more effective medication storage. EVIDENCE: These Standards were not fully inspected during this inspection. All residents at Lakenham have care plans. The care plans seen were the same format which had been in use by the previous owners. That all residents were not involved in the compilation of their care plans was shown by a resident who was unaware that she had a care plan. This was confirmed when she was shown her care plan and from discussion with the registered manager and members of staff. The new owners have been at Lakenham since April 2005 and the registered manager said that care plans were an area which she was aware needed developing and she was intending to do this. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 10 Discussion with staff and examination of care plans confirmed that they were regularly reviewed. The home has rewritten its medication procedure. At the last inspection it was felt that the procedures in place for storing medication were inadequate and there was specific reference to topical creams being opened but not dated. The wellbeing of residents is now safeguarded by a more effective system of recording. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 Residents spoken to exercised choice and control over their lives. EVIDENCE: The home employs a person who arranges activities within the home and in addition a member of staff has responsibilities for arranging activities. This offers residents the opportunity of having a more stimulating environment. During the inspection, the inspector saw a staff member finding time to spend with a resident to assist her in reading and finding out, with her about what was on television. Interaction between the staff on duty and residents was seen to be good. Residents confirmed that friends and relatives could visit at any time. Residents spoke positively about the food available at the home. Residents who are able have control of their finances. The registered manager gave the names of five residents who had control of their own finances. The home has a policy of allowing residents to bring in their own furniture and possessions. The registered manager said that in order to accommodate Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 12 residents who wished to bring in items of furniture, the home would store existing furniture. This was confirmed during conversations with residents in their bedrooms and by ornaments and personal effects seen in these rooms. Residents spoken to were not aware that they could access their personal records (Standard 7 re Care Plans) Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Some amending of the complaints procedure is required. The protection of residents will be more effective when all staff have received appropriate training. EVIDENCE: These Standards were more fully inspected during the inspection of 2nd. August 2005. At that time it was recommended that the complaints procedure be displayed in a prominent position in a large print for all to see. Since that inspection the complaints procedure has been placed in a prominent position. The complaints procedure includes timescales relating to responses and contact details relating to the CSCI and the Ombudsman. It however needs amending to include the right of any complainant to refer the complaint to the CSCI at any time during the procedure. This was discussed with the proprietor and registered manager who agreed to make the appropriate change to the procedure. At the previous inspection mention was made that staff at the home had not had up to date training in the protection of vulnerable adults. Since that date the registered manager has acquired copies of the ‘No Secrets’ training video and the ‘Alerter’s Guide’. She informed the inspector that she was in the process of ensuring that staff were aware of issues relating to the protection of vulnerable adults, through watching the video at home and then having issues relating to it discussed during supervision. Unfortunately most of the staff who had received this training had since left the home. The manager considered Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 14 that her schedule of individual training would ensure that by June 2006 all staff had seen the ‘No Secrets’ video and received supervision/training to complement this. In addition to this, many staff are on NVQ training which covers the protection of vulnerable adults, and the registered manager was made aware of such training being available through the Social Services Department. This would ensure that residents are better protected from the risk of harm or potential abuse. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 15 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): none The core standards were inspected during the inspection of 2nd. August 2005 at which time they were assessed as meeting the requirements of the National Minimum Standards. EVIDENCE: Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29, 30 To ensure the safety of residents staff should receive appropriate training. The contents of staff files did not demonstrate that this home operates a recruitment procedure which ensures the protection of residents. EVIDENCE: The registered manager produced a rota and went through the number of staff who had attained at least NVQ 2 qualifications. Fifteen care staff were listed of whom 8 had either NVQ 2 or NVQ 3 qualifications. The home therefore has attained the percentage of qualified staff expected in the National Minimum Standards. The files of three recently appointed staff were inspected. Whilst one by containing information, such as police checks and two written references, showed that residents had been protected, the remaining two files did not. In one instance there were no references on file and no police check, although all these were said to have been applied for. The remaining file did not contain a police check, but this was said to have been applied for. Several staff have recently left Lakenham and the home has been recruiting new staff. The manager said that although police checks had not been received, they had been applied for and to ensure the safety of residents, staff awaiting police checks did not work unsupervised. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 17 Lakenham does offer induction for new staff. This has however not been amended since the new owners took over responsibility for the home and therefore, is in part obsolete as it refers to staff and residents who are no longer at the home. This needs updating to make it relevant to new staff. New staff do receive a copy of the General Social Care council’s Code of Practice which outlines the standards expected of people working in the care sector. The registered manager said that the main focus of training with Lakenham related to NVQ training. At the time of this inspection there is no schedule for staff training. In order to ensure the safety of residents, the registered manager should introduce training relevant to the care of older adults. An example of this would be moving and handling training. Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 18 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, 38 The registered manager has experience and qualification relevant to her position. The home does not have an effective quality monitoring or quality assurance systems. Residents are protected by an effective recording of finances. Lakenham demonstrated that they had in place systems to protect the health and safety of residents and staff with the exception of gas safety. EVIDENCE: The registered manager has been managing homes for older adults for seven years. She has a Diploma in Management Studies which she attained in 1983, and is an NVQ assessor. She is a qualified enrolled nurse although at the time Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 19 of the inspection information as to whether this registration was current was not available. Although the home has not introduced quality assurance and quality monitoring systems. These would be useful to assist the home in obtaining the views of residents and other stakeholders and incorporating them into the business plan, thereby ensuring that the home is offering a service which meets the aspirations of its residents. The registered manager is not appointee for any resident. The majority of residents have relatives who assist with their finances. Where the home holds monies for residents, this is limited to personal allowances. Expenditure was seen to be receipted and confirmed by double signatures. The home has a safe. When valuables are held by the home on behalf of residents these items are appropriately receipted and, to further protect both staff and residents, this record is double signed. The home protects the health and safety of residents and staff by having COSHH policies, records showing that portable electrical appliances were checked regularly and that there was a monthly checking of the effective functioning of thermostatically controlled mixer valves. Staff had received fire training in January 2005 from a specialist in fire safety. The home has also replaced all existing fire extinguishers, and a risk assessment relating to fire safety was undertaken by the maintenance man and the fire safety officer. The safety of electrical installations was demonstrated by there being a valid NICEIC certificate. There is a contract for the servicing of hoists. The home however could not provide evidence to confirm the safety of gas appliances, which should be available in order to confirm that residents were safe. Staff should receive training which includes safe working practices (Standard 30) Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X X X X X X X x STAFFING Standard No Score 27 x 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 x x 1 Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? no 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 OP29 Regulation 19 Sched 2 Requirement Timescale for action 31/01/06 2 OP30 18 (1)(c) (i) 3 OP33 24 4 OP38 13 (4) (a) The registered person shall not employ a person to work at the care home unless he has proof of the person’s identity, including a recent photograph, the person’s current passport, documentary evidence of any relevant qualifications of the person, two written references. The registered person should 31/03/06 ensure that staff receive training appropriate to the work they perform. (In this instance statutory training such as moving and handling) The registered person shall 30/04/06 establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The registered person shall 28/02/06 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (This relates to the need to provide confirmation of the safety of gas appliances and installations within the home) Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 22 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 plan is drawn up with the involvement of the service user, recorded in a style accessible to the service user; agreed and signed by the service user whenever capable and/ or representative. The registered person ensures that written information is provided to all service users for referring a complaint to the CSCI at any stage, should the complainant wish to do so. 2 OP16 Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lakenham Residential Home DS0000062626.V279393.R01.S.doc Version 5.1 Page 24 - 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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