Inspection on 12/07/05 for Lakeside Residential Home

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lakeside Residential Home 11/07/06

Lakeside Residential Home 14/02/06

Lakeside Residential Home 09/02/05

Lakeside Residential Home 07/09/04

Lakeside Residential Home 17/02/04

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

CARE HOMES FOR OLDER PEOPLE Lakeside Residential Home Lakeside Ernesettle Green Plymouth PL5 2ST Lead Inspector Kim Fowler Announced 12th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lakeside Residential Home Address Lakeside, Ernesettle Green, Plymouth, Devon, PL5 2ST Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 66800 Plymouth City Council Linda Mary Tippett Care Home 29 Category(ies) of Dementia - over 65 years of age (29) registration, with number of places Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09/02/05 Brief Description of the Service: Lakeside is a care home that is registered for a maximum of 29 older people who have dementia. It is owned by Plymouth City Council and is a purpose built large detached property. The home is situated in a residential area of Plymouth and has pleasant views from the rear of the home across open countryside. Opposite the home has a Health centre that is currently under construction for the local GP practice.The home has stair lifts and a passenger lift to the upper floor has been installed. The home is on a bus route, and is within walking distance of local shops.The home has large communal areas, and has a fairly new porch and hall area. The bedrooms are compact and are all single rooms. None have en suite toilet facilities but all rooms are near to toilets and bathrooms.Activities are provided regularly at the home to encourage independence and stimulation and the home is fitted with aids and adaptations to enable the service users to remain as independent as possible. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 1/2 hours and was a planned Announced inspection. A full tour of the premises took place and staff and care records were inspected. The Registered Providers and 5 of the service users and 1 relative were spoken with during this inspection. The CSCI received 5 Relatives/Visitors comment cards and 5 Service users comment card. What the service does well: What has improved since the last inspection? 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. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1/2/3/4/5 Information provided in the homes Statement of Purpose and Service Users Guide assist service users and relatives to make an informed choice of a care home. EVIDENCE: The home has Statement of Purpose and Service Users Guide and evidence was seen of both these document being updated, and the Manager regularly audits both the Statement of Purpose and Service Users Guide to incorporate any changes in the home. Case tracking provided evidence that the service users have a contract that contains the terms and conditions of the home. If they are purchasing care privately then they receive a copy of their contract with the home. The Manager informed the inspector that either she of one of the deputy’s visit prospective service users in their home or hospital and will liaise with relatives and health and social care professionals to obtain relevant information prior to admission. Copies of the pre admission assessments were seen. The home avoids emergency admissions, and prospective service users are invited to visit the home before admission. The manager and 1 staff have attended a National Fall Advisor training course and the training certificates were seen for these. One staff member is now responsible for monitoring the number of falls and risk assessments are based on these charts recording all information on falls. The home has the use of an Occupational therapist to help complete the assessment paperwork and risk assessments. This is via the GP surgery and the home hold a surgery within the house every 2 weeks. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 8 The home will monitor and record any changes in behaviours. Around the home they have placed large signs to orientate people with dementia and also uses bright colours for important signs such as the toilet. The home has appropriate aids and adaptation. Service users are invited to visit the home prior to admission, and are welcome to have a trial stay. A planned admission is always encouraged, and visits can be an overnight stay or a tea visit. Relatives are encouraged to be involved in the move to the home. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 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 standard(s) 7/8/9/10/11 The home continues to provide excellent personal support for service users in the home. EVIDENCE: Evidence was seen by case tracking that care plans are updated every month. And these care plans contain all the elements required for this standard. The plans are holistic and comprehensive in detail. All care plans seen contain risk assessment and these are complete and comprehensive in detail. Were possible either the service user or their representatives sign the care plans. All service users are registered with the local GP practice and the manager informed the inspector that the home has an excellent working relationship with this practice. The GP will review service users medication every three months or sooner if required. The District nurses visit regularly, and all visits are recorded by the home. The home has information in care plans of visits by the continence and falls prevention advisory services. Service users weight is monitored, and all aspects of mental health are closely monitored, as evidenced in service users records. The new GP surgery when completed will have a x-ray and minor surgery department. At present none of the service users self medicate and the home has no controlled drugs. Medication is kept in a locked metal cabinet in a lockable office. Policies and procedures are in place for medication, and staff had Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 10 received appropriate training for the administration of medication. Records regarding the dispensing, receipts and returns of medication were found to be accurate on the day of inspection. Service users medication records contain a photograph of the service user, and the home uses a MDS system of dispensing medication. The home has a small fridge in which ointments etc are kept. The Assistant manager has overall responsibility for medication. One service user is an insulin controlled diabetic and the District Nurse call to administer this medication. The pharmacist visits every 6 months and information received from the manager indicates that the pharmacist, who carries out medication training for staff, does a full day comprehensive medication training for staff. The privacy and dignity of the service users were seen to be respected during the inspection and several service users spoken with agreed that this did take place. Also seen was staff knocking on doors before entering, and staff were seen to be respectful of dignity issues when assisting service users to the toilet. All service users have access to a telephone in private, and the home has a private medical examination room. Service users preferred use of address is recorded on their care plans. Family and friends are encouraged to visit and can be seen in private. Service users are encouraged to choose what they wear themselves. Bedroom doors have locks that can be overridden, and service users are offered a key. The manager informed the inspector that the home had one death this year and the service user stayed at the home. The GP and District Nurse were involved in their care and provided additional support. The homes policy and procedure on death was seen and this states that service users are able to stay at the home for as long as possible with support from the GP surgery. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12/13/14/15 Service users can be confident that the home will enable service users to make decisions about their own lives. EVIDENCE: The homes mealtimes are within a certain time but can be flexible when needed. Service users with dementia that confuse night and day are encouraged to sleep at night and be awake during the day, and this is done with gentle persuasion and exercise, but is not enforced. Service users can have meals in their room if they wish and they can also go to bed when they wish. The activities organised by the home are displayed on the homes notice board and if needed taxis are used to provide transport. At Christmas the home hired 3 mini buses to take service users out for a meal. One service user confirmed that the home has an exercise class and these are held to maximise mobility and help prevent falls. Service users are encouraged as much as possible to make choices, even if they need encouragement to choose appropriate clothes every day. It was evident during the inspection that the staff work with the service users to maximise choices and independence. Service users are encouraged to bring their possessions to the home, for which an inventory is taken. The service users spoken with during the inspection confirmed that they thought that the food was very good. There was also a good choice and plenty of food available. The homes menus were seen and these showed a variety of wholesome food is Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 12 offered. The home employs full time cooks. Menus are displayed daily in large writing on a chalkboard in the entrance hall. Choices of food are recorded. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16/17/18 Service users can be confident that their complaints or concerns will be listened to and acted upon. EVIDENCE: The homes complaints procedure was seen. The home has received one complaint seen the last inspection and this information was sent to the Commission. Evidence was seen that this complaint was dealt with the timescale given and the outcomes and action taken were recorded. This complaint was substantiated. Several service users stated that they felt they could go to the staff if they had any complaint or concerns. The manager informed the inspector that postal votes were sent to the home and staff went to see each service user individually to enable them to vote if they wished. No one wanted to go to the polling station. All staff has completed the Adult Protection training with the local adult protection co-ordinator. The Guidance book was seen in the home for all staff to access. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19/20/21/22/23/24/25/26 The home continues to maintain a suitable environment for its stated purpose. EVIDENCE: The new entrance hall has now been completed. A canopy is due to be fitted but there are some issues on when this is due to take place. During the inspection it was a very hot day and the entrance hall was very hot and sunny and the service users would benefit from this extra shade. The home has sufficient safe and comfortable living space for the service users. All the service users are able to access the gardens and all the communal facilities. All bathrooms due to be redecorated as recommendation from a previous inspection report will have this work commence soon. The home plan to install a wet room and another bathroom will an electric hoist put in place during this redecoration work. An occupational therapist has assessed the home and the report is available. Appropriate disability equipment is provided in the home, and these include a passenger lift, hoists, stair lifts, wheelchairs, and a call bell system that records when staff visits service users rooms. All rooms are single but one room has currently been converted into a double for a married couple. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 15 20 of the rooms remain undersize. To meet the needs of the service users many of the rooms do not have carpet fitted but do have appropriate flooring. Some bedroom carpets have been replaced, and rooms are being decorated. All bedrooms are lockable, and service users can bring their own furniture and belongings. All rooms are well lit, warm and well ventilated. Radiators are guarded, and hot water outlets are regulated. Window restrictors are fitted to upstairs windows. All pipe work has now been covered. The home has 2 sluice rooms available and from discussion with the manager one sluice not working has been out of action for all the 12 months it has been fitted. One room has an odour and the manager is aware of this and is in contact with the continence advisor to help deal with the problem. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27/28/29/30 Staff training is supported and promoted enabling service users to receive the best possible service. EVIDENCE: The home is now advertising 5 posts. The staff in the afternoon shift has been increased as required in the last inspection. The home now has 4 staff pm. 19 of the 21 staff has an NVQ level 2 or above. 2 staff files were seen and contained all the relevant paperwork. The home uses the recruitment procedure used by Plymouth City Council. The pre-inspection questionnaire seen during the inspection confirmed that all staff had complete CRB checks. The staff training and development plan were seen in individual staff files. One assistant manager is responsible for over seeing the training programme and the home uses Plymouth City Council own training department for training. And the manager has recently attended training to enable her to train the staff. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31/33/34/35/36/37/38 The Registered Manager of this home is very good and ensures that records are effectively maintained. The staff team are well trained and above all service users are happy and their needs are met. EVIDENCE: The Registered Manager has now completed her NVQ 4 in care and it was evident from discussion with the manager that she continues with her own personal development. The manager holds the Registered Managers award. The homes quality assurance system was seen and the response by the manager to completed questionnaire were seen and read. These responses were passed to service users and relatives and information is also included in the homes Newsletter that was also seen during this inspection. All finance and accounting procedure, including the business plan, come under Plymouth City Council. The registered manager met the accountant this week to discuss the budget and the manager is able to move money around at her discretion. Service users and their families are encouraged to control their own money for Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 18 as long as possible, and records evidenced that service users personal money was well managed and accurate. However, service users money must be kept individually in personal accounts in the service users name, and not in pooled suspense accounts. A meeting has been arranged to try to rectify this issue. The staff files seen contained supervision notes and the staff have a supervision agreement. The home has a comprehensive induction programme for new staff. Evidence was seen that all records seen during this inspection, including care plans and staff records, have been regularly updated. During induction all staff complete a moving and handling course. The homes fire log was seen indicating that the home carries out regular fire drills and training and the home has the fire safety appliances regularly maintained. The home has a qualified first aider on duty, and the accident book was seen to be up to date, and comprehensively completed. Fridge and freezer temperatures are taken daily. The home has a contract for the collection of clinical waste, and there is an infection control policy. The home has measures in place to control Legionella, and boilers and central heating systems are regularly serviced. The Manager has completed risk assessments on all safe working practice topics. Hoist and stair lift servicing records were seen. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 4 x 3 3 2 3 3 3 Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 35 Regulation 20 Requirement Service users money must not be pooled in a suspense account. Timescale for action 31st Decemeber 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 21 26 Good Practice Recommendations The home should carry out the redecoration work on the bathrooms as discussed. The homes sluice facility should be in working order. And the room with an odour should have the ordour removed. Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Lakeside Residential Home D52-D04 S30844 Lakeside Residential Home V224213 120705 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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