Inspection on 03/12/07 for Lakeside Residential Home

This inspection was carried out on 3rd December 2007.

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

Lakeside Residential Home 03/03/09

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Lakeside Residential Home Smithybridge Road Littleborough Lancashire OL15 0DB Lead Inspector Jenny Andrew Unannounced Inspection 3rd December 2007 08:20 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 Lakeside Residential Home DS0000070074.V355697.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. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lakeside Residential Home Address Smithybridge Road Littleborough Lancashire OL15 0DB 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) 01706 377766 01706 370347 Eldercare (Lancs) Limited ** Post Vacant *** Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of people who can be accommodated is 40. This is the first inspection since Eldercare became the owners of the home. Date of last inspection Brief Description of the Service: Lakeside is a purpose built care home for 40 older people. It is located on Smithybridge Rd, leading towards Hollingworth Lake (a popular country park). The home is on two floors, both of which are serviced by a passenger lift. The accommodation is predominately singe bedrooms (eight of which are en-suite), although a small number of double bedrooms are provided. There are adequate aids and adaptations provided, promoting the independence of residents. A car park is available to the rear of the home. A sitting-out area for residents is also provided to the rear of the home with level access for people using wheelchairs. Charges are dependent upon the type of room and prices range from £343.41 to £353.41, the higher rate being for larger rooms or those with en-suite toilets. Additional charges are made for private chiropody and hairdressing. The provider makes information about the service available upon request in the form of a Service User Guide/Statement of Purpose, which is given to new residents. As this inspection is the first since the new company took over, there was no previous inspection report available. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted nine hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of some of the staff were also looked at to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, the acting manager, eight residents, three care assistants, the cook, activity co-ordinator, housekeeper and four relatives were spoken with. In addition, the company’s visiting managing director and director of care services were also spoken to about the proposed plans and changes they were going to introduce. Before the inspection, comment cards were sent out to service users, staff and relatives/carers asking what they thought about the care at the home. None of the cards were returned to us. Discussion took place with the acting manager about how the comment cards had been distributed. Those for staff and relatives had been left in the home for people to help themselves to. It was suggested that, in the future, staff and relatives are given them personally and asked to complete and return them to us, so their views can be included in the report. The acting manager said staff had assisted residents to complete them and she had returned them to us. They had not been received at the time of writing this report. Before the inspection, we asked the acting manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager did not complete this in as much detail as we would have liked, as she did not address all the key standards. This was discussed during the visit. The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This was the first inspection of the home since the new owners, Eldercare, took over in September. They had started on a refurbishment programme and were going to re-decorate and re-furnish each bedroom, re-decorate communal areas and refurbish the bathrooms and toilets. The acting manager was also in the process of re-writing all the care plans so they were more person centred. She felt she was being given good support from the company’s management team. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Lakeside Residential Home DS0000070074.V355697.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 Lakeside Residential Home DS0000070074.V355697.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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming to live at the home to make sure their needs would be able to be met. Standard 6 was not assessed, as intermediate care is not offered at the home. EVIDENCE: A new statement of purpose/service user guide had been written, since the new company had taken over. However, no copies were available for anyone interested in coming into the home. The acting manager was able to run off copies of the document during the visit, as it was on the computer. This also meant that if someone needed to have a large print copy, their request could be accommodated. It was noted that the contract was not included in the copy document but was in place in each of the resident files checked. The manager now needs to ensure that this document forms part of the service user guide/ statement of purpose. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 10 The files for the two most recently admitted residents were checked as well as for someone who had been in the home for a longer period. All three contained detailed level 4 assessments that had been completed by care managers, as well as the home’s own pre-admission assessment document. The acting manager said she visited all residents before they were admitted, either at home or in hospital, so she could be sure that the home would be able to meet their needs. Residents were encouraged to come and look around the home before moving in, although this depended upon their state of health. One resident was spoken to who said, “I came in for respite but my family came to look around as I was not well enough”. A relative spoken to also said they had come to have a look around on behalf of their mother and had been impressed with the friendly attitude of the staff and the cleanliness and well decorated building. It was noted that several residents currently being accommodated, had some form of dementia but very few staff had done any dementia care training. It is strongly recommended that this shortfall is addressed. Lakeside Residential Home DS0000070074.V355697.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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care was being met by staff who were aware of their individual needs. EVIDENCE: Since the new company had taken over Lakeside in late September of this year, they had introduced a new care-planning format. The acting manager was just in the early stages of re-writing the care plans and had already completed three. She was not rushing this process as she wanted to make sure they were detailed and reflected the needs of each person. Three care plans were looked at for people with different needs, one plan being the new format. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 12 The new care plan, for someone currently on a respite stay, was more person centred and included more details about the person’s likes and dislikes and social care needs, as well as addressing in detail the health and personal care needs of the resident. This care plan also addressed the privacy/dignity needs of the person. Risk assessments were in place in respect of moving/handling, skin care (Waterlows), nutrition, independence and falls. The moving/handling assessment was completed but it was unclear how the outcome had been determined. The acting manager was also unsure about the process and she should now seek advice from her manager before completing any further new assessments. This person had been admitted into the home with pressure sores and the district nurse was visiting. The Waterlow assessment reflected this, showing high risk and the care plan identified what the staff were doing to reduce the risk. The Malnutrition Universal Screening Tool (MUST) was being used and this person had been assessed at high risk. Following her admission, she had been monitored for a short period of time in respect of her diet and fluid intake until the staff were happy that she was eating and drinking without any problems. The other two care plans, whilst not being the new format, were detailed and accurately reflected the needs of the residents. All required assessments were in place. Falls recorded on the file of one person, were checked against accident records and these had been completed. Due to the number of falls this person was having, a referral to the falls co-ordinator had been made, resulting in her visiting the home. A letter following her visit, confirmed the staff were doing everything they could to reduce the risk of her falling. Regular monthly reviews had not however, taken place between May and October 2007 and the key worker had now left the home, after having updated the care plan in November 2007. The manager said she would ensure this person was reallocated a new key worker. Two of the senior staff had been booked on a Rochdale Social Services care plan and record keeping course in February 2008. Following this, they would be expected to pass on their knowledge to the team. Where a resident was felt to be at risk due to their vulnerability, the good practice of including this within the care plan was noted. This had been discussed and agreed with the person’s family and this was evidenced from a letter on the care plan file. New sitting weighing scales had been bought and this meant that even those people who were frail or immobile could now be weighed. Evidence was seen of all residents being regularly weighed and their weight being transferred to their care plans. Where problems were identified in respect of weight loss, the dietician was consulted. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 13 Personal care records showed that residents had regular baths and showers although two residents said on occasions these were missed if the home was short staffed. One of the care staff also confirmed this did happen occasionally but people always got a good wash in the morning and evening. Since the new company had taken over, they had invested in new moving/handling equipment. The staff spoken to felt this had really improved the safety of both the residents and themselves. Observations were made of the stand aid being used by at least four people during the inspection. The staff reassured those people who were hesitant about using it and talked them through the process. Two of the residents said they were now used to this way of transferring and felt quite comfortable and happy using this new piece of equipment. The staff had also received training in the use of the stand aid. Care plans recorded GP, District Nurse and other professional healthcare involvement, together with the action taken as a result of the visit. Healthcare professionals were called as and when needed and this was evidenced during the visit. One resident was quite poorly, and after consultation with the GP, an ambulance was called. The time given for the ambulance to arrive was up to two hours and the senior on duty asked one of the care assistants to sit with the resident until the ambulance had arrived. She had liaised with the person’s relative who was to meet the ambulance at the hospital. Flu injections had been arranged for the people who wanted them. Continence needs were appropriately assessed and addressed through consultation with the Continence Nurse. Likewise, care plans showed that the dietician was consulted for advice in respect of individual residents. Residents said the home called their GP when they needed them and the services of opticians, chiropodist and audiologist were accessed either at the home or in the community, as and when necessary. The care plan files and other documents showed evidence of such visits. A visiting district nurse was spoken to during the visit. She confirmed the staff followed any instructions they were given. She said that when they identified pressure relief was needed, it was implemented and that re-positioning charts were used. She felt the overall care of people living at the home was generally satisfactory. She also said the staff were pleasant and the home was kept clean and free from malodours. All four relatives spoken to felt the health and personal care needs of the people they visited were well met. One relative said, “my mother is always dressed smartly and looks well cared for” and another relative said, “the staff give my mother excellent care and do a wonderful job”. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 14 We had received an anonymous complaint before the visit, in respect of some residents not wearing underwear. This was checked out and found in some instances to be the case. The reasons for this varied. Some residents said they chose not to wear some items of underwear and others said they should have vests or underskirts on but they thought they must be in the laundry or they were being washed. This was discussed with the acting manager and care plans were checked for evidence of residents specifically requesting not to wear underwear items. Care plans did not contain this information. It was agreed the acting manager would speak to key workers about checking with their residents what their wishes were in respect of underwear and that following discussion, this information would be recorded on their care plan. The acting manager said they had clothes parties at least three times a year when underwear was purchased on behalf of many of the residents. The Annual Quality Assurance Assessment confirmed that medication policies and procedures were in place. All the staff responsible for giving out medication had received training, although one senior was on training on the day of the visit. He had been giving out medication before his course and the acting manager was advised this must not happen in the future. One of the senior care assistants was responsible for the overseeing of the medication system and it was clear that she took her duties seriously. She had some concerns that some of the other seniors were not following her explicit instructions and she was to have a meeting with them to reinforce the correct practices in respect of booking in drugs and their return. Records checked during the visit were accurate and all medication had been recently returned to the pharmacy. The returns book had not, however, been signed by the person collecting the drugs and the senior said she had already contacted the pharmacy to ask them to return to sign the sheets. The home’s procedures were being followed in respect of the storage and administration of controlled drugs. The fridge was not working but the senior carer said a new one was already on order. Observations made throughout the visit, showed staff to be aware of the needs of the residents in respect of privacy and dignity. One resident waiting to go to hospital was dressed appropriately with a large blanket wrapped around her to keep her warm. A staff member was identified to sit with her until the ambulance arrived. Staff cut up food so that people would not struggle with their meals, they knocked on bedroom doors before entering and enquired discreetly as to whether people wanted to go to the toilet. One of the male care assistants was aware of the female residents who did not wish him to assist them with personal care tasks and fully respected their wishes. When using the stand aid, staff reassured the residents and talked them through the process. All the residents spoken with felt they were treated with respect by the staff. Four staff had been booked on the “Dignity in Care” Social Services Department training course in February and March 2008. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 15 One area in need of improvement was in respect of wheelchair maintenance and use of footplates. Four residents were observed in wheelchairs, either without footplates or with footplates not being used. One resident did not have a full arm piece on the wheelchair she was sitting in during breakfast. Some of the chairs were also in need of cleaning. It is a health and safety issue to use wheelchairs without footplates, unless there is medical reason for non-use. In such cases, the care plan should record this information. One resident said she was reliant on a wheelchair for her mobility but she did not have her own. The acting manager should refer people through their GP’s for a wheelchair assessment so they will have a chair, suited to their individual needs. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 16 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives. EVIDENCE: The more independent residents spoken to said they were able to make daily choices in respect of what time they went to bed, when to get up, what to eat, whether to use the lounge or their bedrooms and what to wear. Those people who were reliant upon staff for all their personal care needs were also satisfied with their daily routines. Observations made during the visit included residents being assisted to get up at varying times, having a cooked breakfast as late as 09.45 and being asked for their choice of lunch and tea. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 17 An activity worker was employed three days a week, in an afternoon and the feedback about her visits was very positive. Comments included, “I’ve really missed her whilst she’s been on holiday”, “I look forward to the games of bingo”, “she’s very good” and, “you don’t have to join in if you don’t want to”. The acting manager said they were looking to increase her visits to four a week so that more varied activities could be offered. Discussions were ongoing during the visit about including arts and crafts in the daily programme and the activity worker was arranging to go and buy the necessary materials so she could implement this into her programme. At the time of the visit, there was no written programme in place, although the worker was recording activities in a book. The visiting directors had already addressed this and asked that a programme be written showing daily activities as well as something special being held each month. A notice board was ready to be put up on the wall so the programme could be displayed. It was suggested that more reminiscence sessions would meet the needs of the mentally frail people and she said she would arrange these and contact the library for reminiscence packs. No trips out or outings had been held this year and feedback from residents indicated they would have enjoyed these. A 100th birthday party had recently been arranged by the staff, and an organist had been booked for the entertainment. The resident whose party it was said, “I enjoyed every minute of it”. Her relative was also spoken to and she said that the staff had put a lovely buffet on and that all the residents had really enjoyed the afternoon. Christmas entertainment had already been arranged with the organist and two school bands having been booked. A party was to be held for relatives and friends as well as for the residents. The staff spoken to said they tried to spend some time either on a one to one basis with the residents but that personal care duties left little time for this, especially when they were short staffed, which was quite regularly. The religious needs of the present resident group were thought to be being met with a Catholic representative calling to give communion on a regular basis. This was held in the conservatory so that it was more private. However, when asked about the needs of those people of other faiths, the manager was unsure as to whether they would like to see someone of their faith. She said she would check this out and ring a local vicar to see if visits could be arranged. Whilst residents could choose to handle their own finances, at the time of the inspection, the relatives were tending to have control in this area. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 18 Relatives spoken to said they were made to feel welcome by the staff and could visit at any time. They also said they were notified when their relative was ill or any changes to their condition were identified and evidence of this was observed during the visit. Relative meetings had also re-commenced. One relative said he had attended the first one since the home changed hands and had felt it had enabled him to have some say about the service. Feedback from residents was very positive about the meals they received. The following comments were made: “the food is very good”, “there’s always a choice”, “we get excellent meals”, “the food is very nice but sometimes repetitive”, “the cook is very good indeed”, “we always get nice food” and, “can’t grumble at all”. The four-weekly menus were seen to include a variety of meat, fish, fresh/frozen vegetables and fruit. For breakfast there were options of a cooked breakfast, fruit juices , toast and preserves and porridge. A choice of two meals were offered at lunch time together with dessert. Soup or a hot snack and a choice of sandwiches were available at teatime. On the day of the visit, the choice of meal at lunch time, was either pork steak, apple sauce, croquet potatoes, cabbage and mixed vegetables or shepherds pie and vegetables, followed by strawberry sponge and custard. The hot snack at tea was egg and chips followed by a a dessert. We sampled the pork steak and shepherds pie, both of which were extremely appetising. The meat was lovely and tender and several residents commented upon how much they had enjoyed it. The cook was knowledgeable about the likes and dislikes of the residents, having worked at the home for some time. At breakfast one resident had chosen egg on toast and the cook knew that she liked brown sauce with it. Another resident commented over breakfast how much she enjoyed kippers before coming to live at the home. The cook immediately offered to make her kippers for tea that night and another resident also took up this offer. Regular drinks were given out during the day and staff also asked people if they would like second cups of tea. As a result of a resident meeting held recently, when residents had asked for different meals to be served, the cook was in the process of trying out new food before changing the menus. She had decided to have taster afternoons when very small portions of new foods could be introduced. One of these sessions had taken place where pasta twists with bolognese sauce was sampled and she said this had gone down very well with some of the residents. These tasting sessions were to continue. Another suggestion that had been acted upon, as a result of feedback from the resident meeting, had been to include a more varied choice of fresh fruit both during the morning and afternoon. Also more home baked cakes were to be offered in the afternoon. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 19 Suppers were also well catered for. Residents were able to have toast, biscuits or sandwiches with a hot milky drink at 6.30pm and then when the night staff came on duty, they could have the option of supper at approximately 8.30pm. The special dietary needs of the residents were being met and the cook was aware of the differing needs of the residents with diabetes and those who required soft options or pureed meals. The dining room was cleaned after each meal and the tables were appropriately set. Those residents needing assistance with their food were given it sensitively. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 20 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents and their relatives were confident that their complaints would be listened to, taken seriously and acted upon, but poor recruitment practice could place residents at risk. EVIDENCE: A copy of the home’s complaints procedure was kept in each person’s bedroom and was also included in the statement of purpose/service user guide. One resident said she would feel able to speak to any of the staff if she had a complaint and another person said she would speak to the manager. The relatives spoken to said they had never had any complaints about the home but if they did they would feel able to raise them with the manager. The minutes of the relative meeting held in November were seen. These recorded that the acting manager had reinforced to them the home’s complaints procedure and this good practice is acknowledged. We had received an anonymous complaint at the beginning of November, which was investigated on this visit in respect of residents not always being dressed appropriately. The outcome of this is recorded under the health and personal care section of the report and was left for the acting manager to follow up. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 21 One complaint was logged in the home’s complaint book, from a relative, in respect of the person they visited sitting for long periods in a wheelchair. This was thoroughly investigated by the acting manager. She had held an immediate staff meeting and from reading the minutes, it was clear action had been taken to ensure this did not happen again. The Rochdale Inter-agency Protection of Vulnerable Adults (POVA) procedure was held at the home. Several of the staff had undertaken the days training course that Rochdale Social Services training department held and nine other places had been booked over the next three months. The manager was aware that all staff must have safeguarding training. Other staff had done the training as part of their NVQ level 2/3 training. The acting manager had undertaken a training course in 2004, but had not been on refresher training since. It is recommended she books herself on a course to make sure she is up to date with present practices. Shortfalls were identified in respect of staff starting work before all the right checks had been made but this is addressed in the staffing section below. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 22 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The standard of décor and cleanliness throughout the home was to a good standard and provided residents with a pleasant place in which to live. EVIDENCE: From walking around the building, it was evident that the home was clean, tidy and well maintained. From talking to the visiting directors of the company, it was evident they had plans in place to keep it well maintained and also to implement a refurbishment programme. A newly refurbished room was seen and it had been fitted out to a high standard. It had been redecorated, new matching curtains, carpet and bedding supplied together with new wardrobe, set of drawers and lockable bedside cabinet. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 23 The other bedrooms that were seen were all bright, airy and personalised with residents’ personal belongings, bringing a homely touch to their rooms. Privacy screens were provided in shared rooms. Bedroom doors were fitted with locks. The residents who were spoken with said they were more than satisfied with their bedrooms. A handyman was employed which ensured that minor work was attended to promptly. Whilst walking around the home, it was identified that the shower room was very cold, as was the ground floor bathroom. A wall heater in the bathroom was tested and found to be extremely noisy. Staff said they did not use it, as when it had been on for a while there was a burning smell. Plans were in the process of being made to upgrade bathrooms and toilets and possibly fit some more en-suite toilets. However, as these rooms were both in use, interim action must be taken to ensure they are effectively heated. An Environmental Health visit had taken place the week before this visit. The acting manager, due to her reporting an infectious illness, had instigated this. The advice of the officer had been followed and there was no longer a problem at the home. The officer had then completed a full inspection of the premises, but the home had not yet received the report. The acting manager said there had been no major concerns. The cook said they were going to send her a daily log to complete in respect of cleaning and other tasks. Appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. As previously highlighted, new moving/handling equipment had also been purchased. There was a choice of communal areas with a dining room, lounge and conservatory being provided. The premises were clean, free from malodour and liquid soap and paper towels were supplied in toilets and bathrooms, as well as in residents’ bedrooms. Staff said there was always a supply of protective gloves and aprons and they were seen to use these during the inspection. Good practice was seen in respect of staff changing from white to blue aprons before assisting with food and those spoken to were aware of the need to follow good hygiene practice. Adequate laundry facilities were provided and individual baskets supplied for each persons’ clothes. Feedback from residents was positive, with residents saying there were no problems with the laundry system. Two laundry assistants were employed who worked alternate weeks. Arrangements were in the process of being made for a key pad to be fitted to the laundry door as it had been identified this could be a health and safety hazard should residents enter it unaccompanied. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 24 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home was not always adequately staffed to meet the needs of the residents and poor recruitment practice could place residents at risk. EVIDENCE: Information contained on the Annual Quality Assurance Assessment (AQAA) showed that, with the exception of two staff, the remainder were all white British. This reflected the ethnicity of the residents currently living at Lakeside. There were two male care assistants, which meant that if the male residents wanted personal assistance from a carer of the same gender, this could be arranged. At the time of this inspection, there were 37 people living at Lakeside, although two people were presently in hospital. In addition, two day care clients were being accommodated. Inspection of rotas for the week of the inspection and for the previous week, showed that insufficient staff were provided to meet the needs of the residents. This was also confirmed by speaking to the staff on duty. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 25 Many of the people living at the home were very dependent and needed assistance with all personal care tasks. Also the majority of people needed two staff for moving/handling purposes. Some days there were only four staff on duty on the afternoon/evening shift, reducing to three staff coming on night duty at 20.00. It was also said to be fairly common for only four to be on shift at weekends. The acting manager said she was struggling to cover the rota due to sickness and staff having left. She said she had recently recruited two new care assistants and was about to send off for Criminal Record Bureau (CRB) checks, following which a Pova first check could be done so that they could start work under supervision, subject to a full CRB check being received. The staff spoken to were clearly committed to providing the best possible care to the people they looked after. However, one person said they had been working long hours, e.g., 12-hour shifts and covering extra hours when they were asked due to sickness and vacant posts and this had resulted in them becoming run down. During the visit, the acting manager got authorisation to contact an agency to provide some additional cover in order to be able to meet the needs of the residents for the rest of this week. The manager was aware of the cover needed to be able to adequately meet residents’ needs and she must now ensure that this cover is provided on all future rotas, including weekends. The rota for the following week was requested but it had not yet been written. Several staff identified they found this a real problem, as it hindered them in making personal arrangements when their rota was not available at least a week in advance. The manager should take steps to ensure this is rectified. Satisfactory arrangements were in place in respect of provision of ancillary staff. Feedback from residents and their relatives was very positive about the staff team and the care they provided. There were currently 21 care staff employed at the home. The AQAA recorded that of these, only five had attained their NVQ level 2 or level 3 qualification. This gave an overall percentage of 24 . An additional nine staff were recorded as presently undertaking NVQ level 2 training and when they have completed, this will bring the total of trained staff to 67 . The acting manager said she was ensuring that all new staff were enrolled on training courses as soon as possible. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 26 The staff personnel files had recently been re-formatted and during this process, the acting manager said she had identified that not all the correct employment checks, such as references and Criminal Record Bureau checks, had been done. She had taken maternity leave from the end of June and had only returned in September of this year. She had thought that in her absence, the former owner and the person acting as deputy would have ensured that all relevant checks were completed before employing staff. She had identified five staff in total who had been employed without the CRB’s being done and had sent completed CRB forms off. Pova first checks had already been applied for for two carers and the remainder were to be applied for the day following the inspection. Three care staff files were checked, two for carers who had been employed in July 2007 and one for a carer who had worked at the home for almost two years. The oldest file contained a completed application form, two references and evidence that a Criminal Record Bureau (CRB) check had been done. The other two files were incomplete, although both contained application forms. One did not contain any evidence of a Pova first or receipt of a satisfactory CRB check having been done, nor did it contain any references. The third file only contained one reference although a full CRB check was in place. Clearly, the standard of vetting and recruitment practices had drastically declined during the acting manager’s absence, which could have compromised the residents’ health and safety. In future, no staff must start work at the home until all the necessary checks have been done. One of the staff personnel files did not contain any evidence that induction training had been completed. Inspection of the files for the two most recently recruited staff showed that induction training provided was still the home’s own programme which did not meet the Skills for Care standards. The acting manager was asked about the induction training programme for Eldercare and printed off a copy that was similar to the one currently in use. It was basic and did not cover the Skills for Care units. Action must now be taken to implement a new induction training programme for all new staff that covers the Skills for Care units. This training, including all mandatory training, should be completed within the first 12 weeks of employment. Discussion took place with the acting manager about cross-referencing NVQ and other relevant training on the Skills for Care induction record when inducting new staff. This will avoid having to go over units that people have already completed as part of their NVQ training. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 27 The training matrix showed that since the new company took over, they have been prioritising mandatory training as this had been lacking with the previous home owner. The majority of the staff had done fire training and several had completed moving/handling. Further in-house moving/handling, food hygiene and infection control courses were planned over the next few weeks. The director of care services said the company liked to train up someone in each of their homes so they could be a moving/handling facilitator and this was planned at some future date. From discussions with the visiting directors, we were assured of their commitment to providing training to all the staff working at the home. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 28 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The service would benefit from an increase in management monitoring, reviewing and staff supervision, which would improve the outcomes for the people living and working at the home. EVIDENCE: The home had changed hands in September of this year and at that time there was no registered manager in post. The deputy manager was acting manager although she had been on maternity leave from July until early September of this year. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 29 As a result of her absence, many management tasks had been neglected. With the help and support of the organisation’s management team, the acting manager was starting to address the shortfalls. She said she now felt supported by them and was to receive training in respect of management tasks, including risk assessments and supervision. She was in the process of registering to undertake the Registered Manager’s Award (RMA). Whilst she had previously almost completed her NVQ level 4 in care, a funding misunderstanding with the previous owner had meant she was unable to complete the course. Having completed many of the units meant she would now be able to complete the RMA in a much shorter space of time. The visiting directors confirmed that by the New Year, they would have made a decision about appointing a new manager and would submit an application to register this person at that time. The acting manager had not yet implemented any of the new organisation’s quality initiatives, except for starting to give out health care professional feedback questionnaires. Questionnaires for relatives and residents had not yet been circulated. It was, however, acknowledged that it was early days, given the company only took over towards the end of September of this year. Staff supervision had very recently been started but only a minority of staff had yet had a one to one meeting. This was particularly worrying, given that many of the newer staff had been working unsupervised in the home without CRB checks having been done. Staff meetings had been re-started, as had resident and relative meetings and minutes of these were seen. Suggestions for improving the service had been made by both residents and relatives and these were being implemented. The menus were currently being reviewed and more fish and fruit had already been introduced. Arrangements had been made for more activities to be done on a daily basis and for more entertainment to be provided by the organist. A new hairdresser was also being organised. The acting manager should now spend time familiarising herself with the new quality assurance and monitoring policies and implement them within the home. The Annual Quality Assurance Assessment (AQAA) that the manager must now complete on an annual basis could also be a useful tool in the self monitoring process. If this form was used as a working document over the next 12 months and completed as and when improvements or future plans were agreed, it would be a comprehensive document when it was next due to be sent to the CSCI. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 30 Resident feedback indicated the acting manager with the residents on a day to day basis and did manager should be having some contact, so that residents are satisfied with the service they are opportunity of observing staff practice. did not have much contact not work on the floor. The she can assess whether the receiving and give her the The home did not act as appointee for any residents, although they managed personal monies handed to them by relatives for residents’ use. Records in relation to three residents’ monies were inspected and seen to be in order. Incomings, outgoings and running totals were clearly recorded and receipts held. Residents’ monies were held separately and securely. As highlighted in the staffing section above, the new company had already identified that the majority of the staff needed to complete their mandatory training and several in-house training courses had already been booked. The majority of the staff had done fire training and several had already completed moving/handling. From walking around the building, one health and safety hazard was noted. The water temperature of the hot water in one of the bathrooms was extremely hot and recorded 50°. Hot water temperatures should be set no higher than 43°C. The acting manager arranged for someone to come to the home to adjust the water temperature that evening. A senior was responsible for taking water temperature recordings and the last recordings had been done on 14 November 2007. These showed extremely high recordings in eight of the bedrooms. The water temperatures ranged from 48°C – 60°C which could easily scald a resident. The person testing the water temperatures and recording them had not alerted the acting manager to the high temperatures and this must be addressed. The acting manager said she would ensure the water temperatures were re-set so they would not exceed 43°C. The AQAA recorded that maintenance of equipment was up to date and observations showed that the building was well maintained. The manager said the new company had made arrangements for an external body to come and do a full health and safety assessment of the building. Random checks were made of the bath hoist servicing, fire extinguisher and electrical equipment testing and these were in order. When checking the fire book, it was noted that weekly fire alarm testing was not being done. As this is required by the Greater Manchester Fire Service, this shortfall must be addressed. Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 31 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? This is the first inspection since Eldercare purchased the home. 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 OP1 Regulation 5 Requirement The service user guide must contain a copy of the home’s terms and conditions of residence so that people will be able to read about them before deciding whether or not to come into the home. Staff must not use wheelchairs without footplates as this can place residents at risk of harm. Bathroom and shower rooms must be heated so that residents can enjoy a comfortable and relaxing bath. Staffing levels must be increased in order to meet the needs of the people currently living at the home. Staff must not be employed to work at the home until all the required checks have been undertaken in order to ensure the safety of the people living at Lakeside. Timescale for action 04/01/08 2 3 OP8 OP19 13(4)(c) 23(2)(p) 28/12/07 04/01/08 4 OP27 18(1)(a) 28/12/07 5 OP29 19 28/12/07 Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 33 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. 6 Standard OP30 Regulation 18(2) Requirement All new staff must receive induction training, which should meet the Skills for Care specification. This will ensure that staff are competent when looking after people in their care. A permanent manager must be appointed and application made to the CSCI for the person to become registered. A quality assurance and monitoring system must be implemented so that outcomes for the residents can be measured Hot water outlets in bathrooms, showers and wash hand basins must be set at 43 degrees centigrade so that residents will not scald themselves. In line with Greater Manchester Fire Service, the home must ensure that weekly testing of the fire alarm is undertaken so that residents will not be put at risk if there is a fire. Timescale for action 28/02/08 7 OP31 8 31/01/08 8 OP33 24 31/01/08 9 OP38 13(4)(a) 28/12/07 10 OP38 23(4)(c) 28/12/07 Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 34 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 OP3 OP8 Good Practice Recommendations As some people in the home have dementia, the staff should receive dementia awareness training so they will know how to look after the people in their care. Residents who are immobile and reliant upon wheelchairs should be referred to their GP, so that an assessment can be arranged in order for them to have their own wheelchair. The acting manager should arrange for key workers to check that their residents have sufficient underwear and ensure staff assist them to dress appropriately in a morning. Staffing rotas should be written at least one week in advance so that the manager can ensure she has the staff needed and to allow staff to make personal arrangements so they can cover their allocated shifts. The manager and senior staff should liaise more closely so that important health and safety information is shared. 3 OP10 4 OP27 5 OP31 Lakeside Residential Home DS0000070074.V355697.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000070074.V355697.R01.S.doc Version 5.2 Page 36 - 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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