CARE HOMES FOR OLDER PEOPLE
Lakeview House 88 Churchill Avenue Northampton Northants NN3 6PG Lead Inspector
Mrs Pat Harte Unannounced Inspection 20th October 2005 10:05 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 Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lakeview House Address 88 Churchill Avenue Northampton Northants NN3 6PG 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) 01604 678810 01604 642307 www.northampton.gov.uk Northamptonshire County Council Miss Michelle Kathy Mullen Care Home 41 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (41), of places Physical disability over 65 years of age (3) Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. No person falling within the OP category can be admitted where there are already 41 people of OP category already in the home. No person falling within the DE(E) category can be admitted where there are already 15 people of DE(E) category already in the home. No person falling within the PD(E) category can be admitted where there are already 3 people of PD(E) category already in the home. To be able to accommodate one named service user who has needs within the LD(E) category. Total number of service users in the home must not exceed 41 03/05/05 Statutory Inspection 20/07/05 Additional Monitoring Inspection on compliance with requirements. Date of last inspection Brief Description of the Service: Lakeview House is a residential care home providing personal care for up to 41 Elderly Residents, including 15 people with Dementia and 3 people with Physical Disabilities. The Home has a specific condition to provide care for 1 existing named Resident with Learning Disabilities. The Home is owned by Northamptonshire County Council. The Manager is Mrs. M. Mullen. The Home is situated in a residential suburb of Northampton adjacent to nearby shops. The Premises consist of a 2-storey building providing lounge/dinning and bedroom areas on both floors. The first floor is accessible by a lift. Single bedrooms are provided for all Residents. The Home provides permanent care only. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for Service Users and their views of the service provided. Inspection planning took one hour and consisted of a review of the last inspection and the additional inspection reports, requirements made and the Home’s service history including notifications and events. The primary method of inspection used was ‘case tracking’ which involved selecting three Residents and tracking the care they receive through review of their records, talking with them and the care staff. In addition five staff and nine Residents were spoken with and discussions were held with the Registered Manager. A partial tour of the premises took place, a selection of records was inspected and observations made on care practices. The Inspection took place during the late morning and afternoon over a period of five hours and was carried out on an unannounced basis What the service does well:
The Home has a committed staff group. Residents spoken with felt that their relationships with the Manager and staff were very good and that they were provided them with good care and support and valued and respected as individuals. Routines are relaxed and flexible and Residents confirmed that they are enabled to continue the routines they have followed through their lives. Staff ensure that Residents Health Care needs are closely monitored with prompt referral made to Medical Professionals where necessary. Meals are varied, well balanced, of good quality and nicely presented. Residents stated that they are given a good choice of options in the daily menu and account is taken of their likes and dislikes and special diets. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Achieve completion of the updating and development of all care plans.
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 7 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. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 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 Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 4 & 5 Prospective Residents are provided with information to enable them to make informed choice regarding their placement. The pre-admission assessment is thorough and effective in ensuring that the needs of people admitted to the home can be met. EVIDENCE: The admission process ensures that all prospective Residents are visited and assessed by staff from the Home to ensure their needs can be met. Individual records are kept for each of the Residents. The assessment documentation has been reviewed and adopts a holistic approach with specific and recognised assessment tools used to identify needs and risk. Residents and their Relatives have opportunities to visit the Home and are given written information on the services and facilities. Residents spoken with felt that staff were well briefed on their needs and the care to be provided.
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 10 Staff spoken with felt that they were provided with good information on their Residents needs, routines and wishes. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Care plans clearly documented Residents needs and provided a good level of instruction and guidance for staff on how the care was to be carried through including guidance on how Resident’s with Dementia are to be supported. The Home’s Medication system was safely managed. EVIDENCE: Care plan formats have been reviewed and approximately 50 of all existing care plans have been updated to the new format. The development of the remaining care plans is ongoing. Three Residents care plans were inspected. The plans were well developed and showed that a holistic approach has been undertaken. Staff commented that the revised care plans had given them a deeper understanding of their Resident’s needs and they welcomed the clear guidelines and instructions on how the care was to be carried through. Attention has been paid to ensuring that information is gathered on Life Histories for all Residents with specific attention given to those with Dementia.
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 12 Staff felt that this information had again enhanced their understanding of the Dementia care needs and had been invaluable in promoting good interaction and communication with their Residents. The Home has one unit dedicated to the care of Residents with Dementia with a second being developed. Dedicated staff are now assigned to the units to provide continuity and consistency of care and ongoing monitoring and supervision. Observations of care practice showed that staff were sensitive in their approach and provided their Residents with emotional support reassuring them and helping them to talk through and resolve any fears, anxieties and frustrations. The care plans showed that account is taken of Residents’ wishes in relation to their preferred routines and lifestyles. The plans detailed tasks that Residents’ could undertake for themselves showing that they were encouraged to maintain their independence and as much control over their lives as possible. Residents stated that they felt respected and valued as individuals. They confirmed that they were fully consulted and involved in the care planning process. Where possible Residents are asked to sign agreement to the care plans. Health care needs were clearly documented. Residents commented and records showed that staff responded quickly to any changes and made referrals to the appropriate Medical Professionals. Residents were enabled to see their General Practitioners quickly. Procedures were in place for the management of Medication. Storage was appropriate. The Medication records were well maintained and showed that all incoming medication was checked on receipt. The Administration records were in good order. Opening dates for items such as eye drops and creams are recorded to ensure these do not pass the expiry times. Stock control had been addressed with stocks substantially reduced. Records of all disposals through the contracted Pharmacist are maintained. Observations and Residents comments confirmed that Staff ensure the protection of Residents privacy and dignity when carrying through personal care. Records evidenced that the wishes of Residents had been sought concerning arrangements to be made after death. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Residents are enabled to maintain their independence as much as possible and exercise control and choice in the way they wish to lead their lives. The meals in the Home are good, offering choice and variety and catering for special dietary needs and individual likes and dislikes. EVIDENCE: Residents stated that routines were relaxed and flexible and that their preferences on rising and going to bed times were respected. They felt that they were free to decide on how and where they wished to spend their time and were encouraged and supported to maintain control over their lives. The Home has an open visiting policy. Residents confirmed that they were enabled to receive their visitors in private if they wished. Residents felt they were offered wide-ranging choice in meals and stated that staff were fully aware of their likes and dislikes and dietary requirements. They confirmed that the quality of the meals was good and that alternatives to the main menus were always available. Cooked breakfasts and hot food choices are available for the evening meal. The mid day meal was well presented and efficiently served. Quantities were adjusted according to Resident’s wishes and appetites. Residents were enabled
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 14 to take their meals in their rooms if they wished. Staff were on hand to assist them where necessary. Nutritional risk assessments are undertaken. Records showed that weight charts are maintained and carefully monitored. Food records of intake are maintained and food and fluid charts can be used where nutritional risks are identified. Records confirmed that referrals are made to Medical Professionals where the need for food supplements is identified. Attention has been paid to the provision of activities for Residents with Dementia. Weekly plans are developed for general activities such as cooking, games and reminiscence on both a group and individual basis. Records are maintained of Residents involvement in activities ensuring that they do not become isolated. The development of the activity programme for other Residents is on going. Residents felt that staff made time to support them in their individual interests and made time to sit and talk with them. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Systems are in place to protect Residents from abuse and to ensure that complaints are listened to and acted upon. EVIDENCE: Residents confirmed that they had been given the Home’s complaints procedure which is also displayed in the Home. They felt confident and able to raise any issues or concerns with staff. A complaints and “grumbles” record is maintained. The record showed that prompt attention is paid by both the Manager and staff group to investigating any issues raised and seeking a resolution to the satisfaction of the individuals concerned. Since the last Inspection two complaints have been made to the Commission on the care provided and treatment of the Residents concerned. In the first instance the complaint was referred back to the Manager to investigate under the Home’s own complaints procedure. The Commission was satisfied with the Home’s investigation and response and the complaints were not upheld. The second complaint, of a similar nature, has been referred for investigation through the County Council’s Complaints procedure and the investigation is on going. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 16 Robust procedures for the Protection of Vulnerable Adults are in place and regular refresher training is provided for staff on the reporting procedures. Staff demonstrated, through discussions, their full understanding of the procedures. Notifications are made to the Commission of any allegations made and records showed that referrals for investigation are made to the relevant Authorities. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Residents are provided with a safe, well-maintained and homely environment. EVIDENCE: The premises were in good order, clean, warm, comfortable and well maintained. The Home employs a Handyman and the maintenance record showed a prompt response to all areas reported for attention. Standards of domestic and hygiene maintenance were viewed as very good throughout the areas of the premises viewed. Residents stated that cleaning routines were carefully organised to ensure no disruption to their routines. Since the last Inspection one shower tray has been altered to provide safe and easy access for Residents with work ordered for the alteration of a second shower in the near future. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 18 Observations confirmed that specialist equipment such as moving and handling aids is provided. The doors to the rear service area and boiler room have been replaced enhancing security and safety. Fencing has been erected to provide safe and secure garden areas for the units dedicated to Residents with Dementia. Attention has also been paid to ensuring double handles on all fire exit doors and an alarm has been fitted to the service exit by the laundry. This substantially reduces the risk of Residents with Dementia being able to leave the Home unnoticed. The Manager has identified a potential risk from falls should Residents with Dementia access the stairwell, off Rosedale Unit, unnoticed. She has referred the matter to the County Council for remedial action to be taken. Residents confirmed their satisfaction with the facilities. They stated their rooms were comfortable and suitable for their needs. They are enabled to personalise the rooms and have their furnishings and belongings about them. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 19 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): 27, 28 & 30 Sufficient numbers of care staff are deployed to meet the needs of current Residents. EVIDENCE: The Home currently has seven vacancies. Discussions with Residents and staff confirmed that the deployment of five care staff to daytime shifts is sufficient to meet current needs. In addition there is at least one Supervisor on duty from 07.30 to 22.00 hours. Three care staff provide night cover. The Home also employs domestic, laundry, catering staff and a Handyman. The ancillary staff provision ensures that care staff are not diverted from their care duties. The revised deployment of dedicated care staff to the individual units ensures good levels of supervision and monitoring. Staff responded quickly to call bells and Residents requests for assistance. Residents spoken with said that the all the staff, including ancillary staff, were very kind, committed and caring and that relationships were very good. Staff demonstrated, through discussions, their commitment to the well-being of their residents and were seen to respond quickly to their Residents needs and to the call bells.
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 20 Staff files have been fully reviewed and updated to ensure the required information is maintained. The staff-training plan show induction, foundation and ongoing training in core and specialist areas is provided. The staff induction pack has been revised to correspond to the Sector Skills Council’s guidance. Induction for Agency staff is now carried through. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 21 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, 32, 33, 35, 36 & 38 The Management of the Home is effective and the home is run in the best interests of the Residents. The systems for the management of Residents monies and items held for safekeeping are safely maintained. EVIDENCE: The Manager has demonstrated her commitment to her responsibilities and has good oversight of the running of the Home. She has worked hard to develop systems, to address practice issues and comply with previous requirements. Staff spoken with felt that the Manager was easily accessible to them and was willing to discuss any issues, guide them in practice and offer support. They confirmed that systems for informal as well as formal supervision were in place. Recording systems for staff supervision have been developed and are reflective of the different roles and responsibilities.
Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 22 Residents felt the Manager was readily available to them. They commented that the Manager consulted with them and sought their individual views and opinions. Residents felt that they had trust and confidence in both the Manager and the staff group as a whole. The systems for safekeeping and management, where necessary, of Residents monies have been reviewed and the records were generally well maintained. The records are regularly audited to ensure accuracy with receipts maintained for items or services purchased on behalf of Residents. Residents’ signatures, where possible, confirmed their involvement in the systems. The Manager was reminded to ensure that two staff sign the records for transactions carried out on Residents’ behalf. She has agreed to address this area. The system for the safekeeping of Residents’ valuables has also been reviewed. Records were generally in good order although an oversight had occurred in the failure to record a Resident’s new bankbook number. The Manager agreed to address this area and implement a full receipting system for items deposited. Withdrawals from the safekeeping system were appropriately receipted. The staff-training plan showed that staff receive training and regular updates in Health and Safety areas such as movement and handling. There are systems for reporting and resolving any identified risks. The Home was safely maintained. Records showed that Fire safety has been reviewed and care is taken to test systems, provide instruction to staff and undertake fire drills at the frequencies advised by the Fire Officer. Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 23 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lakeview House DS0000035736.V260639.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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