Inspection on 08/08/08 for Lambspark Residential Home

This inspection was carried out on 8th August 2008.

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

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

Lambspark Residential Home 09/08/07

Lambspark Residential Home 23/05/06

Lambspark Residential Home 11/11/05

Lambspark Residential Home 10/05/05

Lambspark Residential Home 24/11/04

Lambspark Residential Home 19/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

CARE HOMES FOR OLDER PEOPLE Lambspark Residential Home 38 Merafield Road Plympton Plymouth Devon PL7 1TL Lead Inspector Megan Walker Key Unannounced Inspection 8th August 2008 11:30 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 Lambspark Residential Home DS0000003538.V367557.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. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lambspark Residential Home Address 38 Merafield Road Plympton Plymouth Devon PL7 1TL 01752 330470 01752 345126 lambspark@supanet.com Telephone number Fax number Email address Provider Web address Name of Registered Provider(s)/company (if applicable) Name of Registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Richard Wraighte Mrs Tracey Elizabeth Wraighte Care Home 36 Category(ies) of Dementia (36), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (36), Old age, not falling within any other category (36), Physical disability over 65 years of age (36) Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The following person may provide the following category of service only: Care home providing personal care only- Code PC to service users 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, aged 60 years and over on admission- Code OP Mental disorder, excluding learning disability or dementia, aged 60 years and over on admission- Code MD(E) Dementia aged 60 years and over on admission- Code DE 2. Physical disability, aged 60 years and over on admission- Code PD(E) The maximum number of service users who can be accommodated is 36. 9th August 2007 Date of last inspection Brief Description of the Service: Lambspark is Registered to provide residential accommodation and personal care, for up to 36 persons over the age of 60 who may also have a dementia, a mental disorder and/or a physical disability. The home does not provide intermediate care and it is not Registered to provide nursing care. Lambspark is a detached, three storey property situated in the residential area of Merafield in Plympton. The home has 2 double and 32 single bedrooms with en-suite facilities situated on three floors. A shaft lift provides access from the ground floor to the 1st and 2nd floors. The dining room is situated on the ground floor and has a lounge area attached. There is a small separate lounge with a conservatory attached available for use by people living in the home who wish to smoke. A large, non-smoking lounge is situated on the 1st floor. There is a call bell system throughout the home. The home has a garden with seating available and limited car parking is available in the grounds of the home. Weekly fees range from £315.00 to £540 and are according to assessment of Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 5 the person’s personal care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates, and escort for hospital/GP appointments. All charges’ information was provided to the CSCI in August 2008. Written information including information about additional charges, is available for people considering going to live at Lambspark and for those who are resident, A copy of the most recent CSCI inspection report is available. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced and took place over two visits on Friday 8th August 2008 between 11:30 and 18:00, and Tuesday 19th August 2008 between 14:30 and 19:00. This inspection included talking to people who live at the home and care staff working on the day shifts. Also, observation of interactions between the staff and the people using this service, a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The Registered Manager and the Registered Provider were present during the first day, and the Manager and the Registered Provider on the second day. They were able to provide relevant information such as the day-to-day routines as well as the management of the home. “Have Your Say About Lambspark” Care Home Surveys were sent out to people living in the home and to staff. None had been returned to the CSCI by the time this draft report was sent to the Registered Provider. In addition other information used to inform this inspection: • The Annual Quality Assurance Assessment (AQAA) completed by the Registered Provider. • The last Key Inspection report • The Annual Service Review • All other information relating to Lambspark received by the CSCI since the last inspection. Five requirements and six “good practice” recommendation were made as a consequence of this inspection. What the service does well: The Registered Manager and Provider are approachable and manage the home in a style that is positive and inclusive for everyone living there and staff working there. The staff are friendly. Lambspark is clean and hygienic. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Lambspark Residential Home DS0000003538.V367557.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 Lambspark Residential Home DS0000003538.V367557.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, 2, 3,4,5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The pre-assessment needs to be personalised to show that people’s diverse needs are identified, considered and planned for before they move to the home. EVIDENCE: Anyone considering moving in to Lambspark is offered an informal tour of the home and an opportunity to meet people using the service. Their family or friends may do this on their behalf. A copy of the home’s Statement of Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 10 Purpose (also called the home’s brochure) and scale of care fees are given to everyone moving into the care home. We looked a copy of this. It has recently been updated in consultation with people living at Lambspark and some families. The Registered Provider said that he would provide a copy of the last inspection report with the Statement of Purpose and any other information that would be useful for prospective residents when they visited the home. We inspected five care files. We found these had basic pre-assessments of care needs, completed by the Registered Manager. These did not reflect sufficient information to provide staff with a holistic view of the person. The Registered Provider told us that there have been cases where there has been a lack of information available so people have not been offered a place at Lambspark. He also wrote to us that only people whose care needs can be met at Lambspark are accepted, “…we do not simply take people for the sake of filling bed.“. People move into the home for a variety of reasons. They may have made a private arrangement, or the local authority may have referred them to the home via the Social Services Department. There was a generic letter on each file offering a place and confirming that the person’s assessed needs could be met at the home. Two people we spoke to told us that their families had found the care home for them. Lambspark Residential Home DS0000003538.V367557.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 adequate This judgement has been made using available evidence including a visit to this service. People living at Lambspark can be confident that their care needs will be set out in a plan of care however this does not guarantee they will at all times receive the care appropriate for them. EVIDENCE: We chose five people, both men and women, to look at their care files and care generally because they were, for example, people with more complex needs (such as health care needs), and/or people with changing needs. Each care file seen had a photograph of the person whose file it was. Each care file seen had an assessment of care needs. Four of the five care plans had been reviewed. Daily Records showed that any medical condition was monitored and recorded. There were no personal support plans to inform staff what action to take in the event, for example, if blood sugars were too high/low. In some cases the information recorded was sketchy, e.g. “All care given”. No social histories Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 12 were seen on the care file we looked at. There was little information about people’s preferred activites or their interests. At the time of this inspection the care staff were all women. The care plan did not show if people were consulted about their preference for a female or male carer. Although the care plans have improved since the last inspection, they were written about things to be done to the person. There was little evidence of “person-centred” care planning – that is, information to show that each person is treated with respect and dignity, choice is positively encouraged and self-esteem is promoted by every day routines and practices being adapted to suit individual people to improve their daily life so it is meaningful to her/him. The preferred name of the person was recorded within the initial referral sheet however this was not reflected within care planning. It is not clear how staff are made aware of the home’s philosophies regarding privacy and dignity. During our second visit the chiropodist was seeing people in one of the main lounges. The Registered Provider agreed to consider a more private area for this to take place. If the chiropodist did not wish to see people in their individual bedrooms he said there was a possibility that the hairdressing room could be made available for the chiropodist to use. There was no evidence to show if people living at the home and/or their families/advocates were included in care plans reviews or told about any changes to their care plan. On one file there was evidence that a review had necessiated changes to the care plan and the care plan was changed. However there was nothing on the care plan, for example, a date, or other indicator to show that the care plan had been updated. It was unclear about arrangements for hospital appointments. Information about escorts to hospital is in the Statement of Purpose. Although there is a charge for this it is not included under “Fees – what is not included”. Medication was seen kept in a lockable trolley tethered to a wall. Controlled medication was kept in a separate lockable box in another wall mounted cupboard. Medication was dispensed in colour-coded blister packs. Any medication that was dispensed separately was clearly marked with the person’s name. The medication records had a photograph of the person for whom the medication was intended. Allergies to other medications were recorded on the medication administration records. The Registered Manager said she would also consider recording any other allergies as a prompt for staff to check with the pharmacist for suitability of any new prescribed medication. At the time of this visit the kitchen ‘fridge’ was used to store medication requiring refrigeration such as eye drops. The Registered Manager was advised that all medication requiring a controlled temperature, in compliance with pharmaceutical guidelines for medication, should be kept in a separate lockable ‘fridge’. She was reminded that any prescribed creams and medications are to be used only for the person named on the prescription label. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 13 At the time of this visit one person was responsible for their own medication and had a lockable drawer in their bedroom. Someone else was responsible for their prescribed creams. Anyone new coming into the home would be assessed to see if they were able to manage their own medication and would be given a choice about this. Only senior staff handle and administer medication. Locks were provided so those people who wished to lock their room could do so. There was no evidence about the type and use of door locks for bedrooms to form part of individual care plans. When we toured the building we found that all the bedroom doors were unlocked. The door locks were ‘Yale’ type locks so required a ’master’ key to open them in the event of an emergency. The Registered Provider said that he would be replacing all Yale locks as part of an ongoing maintenance plan. The front door has a security keypad for entry and exit, therefore the staff are able to monitor who is coming into and leaving the building. Some bedrooms have patio doors thereby allowing the occupants of those rooms separate access to the grounds of the home. During this visit we observed that staff were respectful towards the people using this service. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who are independent find the lifestyle offered in the home matches their expectations and preferences and satisfies their interests and needs. People are supported to continue to enjoy familiar supportive relationships with family and friends. There is a limited choice of food with a selection of alternatives offered at mealtimes. EVIDENCE: Throughout both our visits people using this service were seen either in one of the communal areas or in their bedrooms. They told us they could come and go around the home as they wished. Everyone we spoke to was complimentary about her or his room. They told us that they were comfortable and most bedrooms we saw were personalised with the occupant’s own possessions arranged as each individual preferred. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 15 During this visit observation of interaction between the staff and the people living at the home saw the staff mainly assisting with daily living activities. Low staffing levels and the physical layout of the home contributed towards to the lack of activities, and very little opportunity for staff to engage in ‘chit-chat’ with the residents or encourage peer interaction either. There was no evidence of people being actively encouraged in their personal interests or hobbies and there was little information about this recorded on individual care plans. One person we spoke to told us that in her opinion the activities had tailed off. She suggested there were a few people who could use something such as card games or board games. People were encouraged to eat their meals in the dining room. One person said they would like to have more fruit and, in their opinion, chips were served too often. The three people we spoke to about their meals told us that the food was variable and there was no choice on Fridays. Inspection of the menu found this to be the case as the choice was either fish in batter or fish in sauce. We discussed all these issues with the Registered Provider who told us that he was reviewing the menu plans. Dietary needs are catered for, as are individual likes and dislikes. People can choose when they have their breakfast up to 10 oclock so that people are not arriving for breakfast just before lunchtime. The care staff are responsible for preparing teas although there is a cook for the main midday meal. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 16 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 good This judgement has been made using available evidence including a visit to this service. The people living at Lambspark and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected by the home’s policies and procedures, and by a robust recruitment process. EVIDENCE: Since the last inspection the CSCI has received one complaint about Lambspark that was passed to the Provider. This was resolved and was not upheld. The Registered Provider is very open and keen to resolve any issue before it becomes a full-blown complaint. The complaints procedure is included in the Statement of Purpose. The contact details for the CSCI needed to be updated and the Registered Provider was advised of this at the time of this visit. The training records showed that all the staff had received in-house training about the protection of vulnerable adults. We saw information confirming dates in the near future for some staff to attend training organised by the local Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 17 authority. This means that they will be competent in recognising any signs of abusive or neglectful behaviour. They will know how to take appropriate measures to prevent any harm coming to the people who use this service. We made a random selection of staff personnel files and found that all the required checks including police checks and references had been completed correctly. The people we spoke to during this visit were confident that they could talk to a member of staff or to the Registered Manager about any matters that bothered them. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Peoples’ private accommodation was comfortable and clean, however areas of the home were institutional rather than homely. Health and safety measures must also be attended to, to ensure that it is a safe home for people to live in. EVIDENCE: Lambspark is a large building covering three floors. It is a very light building due to lots of large windows. On the top floor, at the rear, is a spacious lounge with a picture window giving extensive views across Plympton towards Dartmoor. Some bedrooms also have similar views. The bedrooms on the ground floor each house a tilt and turn style door that allows access to the Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 19 grounds of the home. All bedrooms also have an en-suite toilet facility. On the middle floor there are two steps down to the bathroom. A chairlift has been fitted for those people who are unable to negotiate stairs easily. The bathroom has a seated shower and an over-basin shower. There is also a large wet room with a walk-in shower on the ground floor. At the time of this visit there was no bath to offer people a choice of a bath or a shower. The Registered Provider told us that there were plans to install another bathroom with a bath in the future. Most of the bedrooms were personalised with peoples own possessions around them. Some rooms however were spartan and had little evidence to show they were occupied. There was no risk assessments on individual care plans to support rooms being impersonal for e.g. safety reasons. Some of the en-suite doors were poorly fitted. Some bedrooms did not have fire door closures. The windows were restricted with small link chains. They did not look as if they were sufficiently robust to protect people from harm should they try to open a window. Because of the size of some of the windows, and because some could be confused as doors leading out on to a flat roof, we discussed with the Provider the suitability of this style of window restrictor. He agreed to look for more suitable British safety standard style restrictors with anti-tamper devices fitted to them. He also agreed to consult with the Health and Safety Executive (HSE). There is a small room at the rear of the home that is used as smoking lounge. The Registered Provider explained that there were plans to install a bigger extractor fan to ensure that the rest of the home remained free from the smell of cigarettes. This would also make the room more pleasant for those people who sat in there. The staff room was not lockable at the time of this visit. On the first day the door was held open with a wedge that the Registered Manager disposed of to prevent its use. On the second visit the same door was held open by a set of scales. Wedging doors open is a matter of serious concern because it puts people using this service, visitors to the home, and staff at risk should there be a fire at the home. Care plans, accident records, policies and procedures and staff personal belongings are all kept in this room. Some of this is confidential information that should be kept securely when not in use. The Registered Provider agreed that an automatic fire safety release device and a key-code pad would be fitted to this door. There is a garden at the rear of the home that is accessible via a ramp. It is enclosed and has a security lock on the gate. There is seating area out here for people to use. Access to the garden is restricted and anyone wishing to go outside has to ask a member of staff to escort them. We discussed with the Registered Provider and manager that the garden could be made more easily accessible for people living in the home, without the need for staff to escort them. This would mean they might enjoy the independence and freedom to Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 20 roam around indoors and outdoors. The Registered Provider was also willing to consider enhancing the internal environment so that corridors on each floor could be differentiated, and bedroom doors more individualised in style. This would enable anyone with a dementia to have a better awareness of where they were, and to find their way around the building. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Although the Registered Manager and Registered Provider are taking steps to ensure people receive a safe basic level of care, staffing arrangements are not robust enough to assure people that sufficient competent staff that can meet their existing and changing needs will look them after. EVIDENCE: In total the numbers of staff employed to work at Lambspark according to the staff rotas and the AQAA were four senior carers, thirteen care assistants, one cook, two domestic assistants, a laundress, a ‘handyman’, a manager and the Registered Manager (days and on call). The majority of the staff worked part time so it was unlikely anyone would exceed the European Working Time Directive of forty-eight hours, including overtime, in any seven day period. The staff work across four shifts 0800 to 1430; 1430 to 2130; and 2130 to 0800 (two waking night staff). Between 1630 and 2130 there is a teatime assistant. Over 80 of the care staff, at the time of this visit, had a minimum National Vocational Qualification (NVQ) in Social Care, Level 2. The home’s policy is that no senior carer would be under 21 years of age to ensure that they would be able to work towards a NVQ Level 3. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 22 The Registered Provider told us that there had been problems with recruitment of staff and at the time of this visit he was looking to recruit one more carer for the daytime and one more carer for night-time. He was also advertising for a weekend cook. At the time of this visit care staff were responsible for cooking meals at the weekend although occasionally the weekly cook would work overtime. The Registered Provider explained that shifts are covered by staff working overtime as he tries not to use agency staff. He felt that there was not a real need for the use of agency staff because the staff already working at the home were willing to cover shifts. We requested to see a selection of personnel files including the most recently appointed staff as well as people who had worked at the home for some time. On each of the four files we looked at in detail they all had an application form although one did not have dates of employment. They all had appropriate to references. Only one file did not have a police check, although they all had a POVA check (a check to ensure that people being employed to work in the care sector are not named on a list of people who are not allowed to work with vulnerable people). The manager checked and found that this was a CRB that had been applied for in April and had not yet come back. She therefore agreed to contact the CRB office about the delay. Two of the files did not have a photograph of the person. Three out of the four had a contract and conditions of employment. Prior to the beginning of August this year the induction for all new staff was basic. New carers would work with another carer shadowing and getting to know people until such time as the Registered Manager or manager felt confident that the person could work alone and unsupervised. Since the beginning of August the manager has been introducing a new induction course based on Skills for Care for all new staff. From the training records staff needed to update food hygiene, health and safety, and moving and handling. They had all recently had fire safety training and a short course on dementia care. Dates have recently been confirmed by the local authority for POVA training, and three staff will be attending this. Only senior staff are able to handle and administer medication. They have all had in-house training however this needs updating with an external pharmaceutical trainer. The manager was looking into this at the time of this visit. There was little evidence on the files we looked at to show that staff had any training specific to the needs or conditions of people living at the home, such as the aging process or conditions of old age, sensory impairment, diabetes, strokes, etc, to ensure they could meet peoples’ current or changing needs. The manager said that there were regular team meetings and she was endeavoring to provide supervision three monthly. Some team meetings are group supervision sessions to look at practical issues or in-house training. It was agreed at the time of this visit these would be recorded on individual staff Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 23 files as supervision. Also any informal practice supervision that many take place needed to be recorded. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 24 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. Lambspark has a management team who are committed to providing a good standard of care, but there is still a lack of attention to some health and safety matters that could place people at risk. EVIDENCE: The Registered Provider and Registered Manager are actively involved in the day-to-day running of the home and share responsibility for staffing and overseeing the provision of care with the manager. The Registered Manager described herself as being a hands-on person and said that she preferred to be working alongside the care assistants in providing care to the people living Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 25 at Lambspark. The manager has taken on more of the administrative tasks, including responsibility for staff training and personnel files. At the time of this visit there was a possibility she would be applying to become the Registered Manager. The Registered Provider acknowledged that may be the management of the home could be more transparent in sharing information and plans for the home. The Registered Provider, the Registered Manager, and the manager were all approachable. They were open to discussion and consideration of different points of view and ideas to provide positive outcomes for the people using this service. The CSCI has introduced a legal document called an Annual Quality Assurance Assessment (AQAA). This is an annual report sent to the CSCI by all service Providers with information about the provision and quality of their service, and how the people using the service are involved in deciding what and how the service is offered and provided. A completed AQAA was received by the CSCI, completed by the Registered Provider. The AQAA was a general overview of the service provided at Lambspark. It provided adequate evidence to support the statements written about the service and plans for improvements over the next twelve months. The Registered Provider was honest throughout the AQAA stating what the service does well and what could be better. The Registered Provider was very positive about the introduction of the AQAA. He wrote in the AQAA that he intended to use the CSCI AQAA as an ongoing assessment, monitoring and development tool for the business”. The Registered Provider has given out questionnaires to both people using the service and to families in order to seek feedback about the service provided at Lambspark. There is also a regular newsletter about the home. Action has been taken to implement changes where they have been identified, such as the use of photographs. The menu has also been revised and there are further plans to monitor peoples satisfaction or otherwise with the food they are served. People can choose to manage their own finances or their representative on their behalf. The requirement made at the last inspection about safekeeping of any money held on behalf of a resident by the home has been met. Inspection of the staff rota showed low staffing levels that would make it difficult for any new staff to work in a supervised capacity until all checks were complete and good. Also, as care staff are expected to carry out domestic tasks that take them away from caring for people using this service, the staff rota, the physical layout of the building, and what we observed on the two days of this visit, indicated that insufficient numbers of staff were on duty to guarantee residents’ safety and well-being. An assessment of potential risks in the environment such as not fitting fire safety door closures, and external patio doors used by residents, had not been completed. In the event of a fire, people using this service, staff and visitors to Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 26 the home were at risk due to the use of door wedges. It was unclear if the risk assessment highlighting fire safety covered the use of door guards, and knowing if someone had left the building via a patio door. It was agreed at the time of this visit that as well as checking electrical appliances were switched off and unplugged, another evening check would be to ensure that all the patio doors were securely locked overnight. The Registered Provider agreed to provide a security locking device for the staff room to ensure the security of any confidential information held in this room. He also agreed to consider changing all the current devices used to restrict the windows, so they would meet British safety standards’ compliance and to have anti-tamper devices fitted to them. All incidents that affect the health, safety and/or well being of people using this service are the reported to the CSCI as required by Regulation 37 of the Care Homes Regulations 2001. Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x 3 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the Registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Pre-admission assessment must be thorough and robust to include consideration of mental health diagnosis, medical assessment, and discussion with purchasers of services, in order to safeguard residents. Prescribed skin creams and any medication, such as paracetamol, that is prescribed to be given as required must only be used for those residents for whom they were intended. I.e. the person whose name is on the prescription label on the product. • Doors must not be wedged or held open with anything other than an automatic fire safety guard. Doors must not be blocked open with any other object, e.g. stool. If the risk assessment shows that the door of a room is preferred open, appropriate fire safety automatic door closures that comply with the Timescale for action 14/10/08 2 OP9 13(2) 19/08/08 3 OP19 23(4) 09/10/08 Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 29 home’s fire alarm system must be fitted. Action must be taken to minimise any other risks identified during the assessment of rooms for fire hazards. 4 OP27 18(1) The Registered Person must review the current staffing ratios for any risks it presents to people using this service, and take any action to minimise any identified risk for people using the service and for staff. The Registered Person must ensure that on duty at all times there is a sufficient and suitably qualified, competent and experienced skill mix of staff appropriate to meet the assessed needs of the residents at all times. The Registered Person must review the current staff deployment in the care home. Any identification of care staff undertaking too many different tasks during any one work period, and thereby compromising the care and safety of the people using the service, action must be taken to ensure this is minimised. 09/12/08 5 OP27 18(1a) Sch4 (6e) 09/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The assessment of each person using this service should be person-centred, with individual risk assessments. The DS0000003538.V367557.R01.S.doc Version 5.2 Page 30 Lambspark Residential Home 2 OP8 3 OP9 4 OP12 assessment of the resident should be kept under review and when it has been revised at any time necessary if there is a change of circumstances, this should be clearly indicated on the care plan. Risk assessments should reflect the care plan and ultimately provide preventative and restorative care for the person using this service. The Registered Person should ensure that all care plans are person-centred, identify individual care needs and methods of providing care and support for each person using this service. This should include personal support plans to inform staff what action to take in the event that someone’s health care needs change. The Registered Person should provide a lockable ‘fridge’ to ensure that all medicines are stored securely in accordance with the current pharmaceutical storage regulations to prevent unauthorised access so potentially leading to non-availability of medicines for people in the home. This includes any medicines that require refrigeration. People should have more stimulating activities available, which are linked to their needs, interests and capacities. The Registered Person should ensure that all care plans are person-centred so that each individual’s capacity for autonomy and choice is maximised. To improve the environment in the home the Registered Provider should consider providing visual clues to areas, review the current window restrictors to ensure they are ‘fit for purpose’. 5 6 OP14 OP19 OP38 Lambspark Residential Home DS0000003538.V367557.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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