CARE HOMES FOR OLDER PEOPLE
Lamel Beeches Nursing & Residential Home 105 Heslington Road York North Yorkshire YO10 5BH Lead Inspector
Anne Prankitt Unannounced Inspection 14th March 2006 10:00 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 Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lamel Beeches Nursing & Residential Home Address 105 Heslington Road York North Yorkshire YO10 5BH 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) 01904 416904 Joseph Rowntree Housing Trust Miss Joanne Marie King Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Age Range 60 years and over Date of last inspection 18th May 2005 Brief Description of the Service: Lamel Beeches offers nursing and personal care for up to 41 service users. It is part of The Joseph Rowntree Housing Trust. The home is situated in Heslington adjacent to The Retreat Hospital. The bedrooms at Lamel Beeches offer en suite facilities, and many look onto the garden. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection lasted for six hours. Three hours preparation took place beforehand. The registered manager was on annual leave, and the deputy manager, Giles Dearing, assisted in her absence. He was available for feedback at the close. During the course of the inspection, some care plans were looked at and some residents and staff were spoken with. Observations were also made with regard to the general activity during the course of the day. Additional records that were looked at included the accident book, duty rota, residents’ monies and health and safety records. All communal areas were inspected, plus a sample of bedroom areas. What the service does well:
The home provides pleasant surroundings which residents appreciate. There are a variety of areas in which residents may choose to sit, including a library. Residents’ care needs are written down within their care plans, which are updated regularly by staff so that current needs are recorded and understood. Specialist care plans are being drawn up for residents who have dementia, which explain in detail their individual needs. Staff enjoy working at the home, and residents said that they appreciate the care that they provide. Comments included ‘On the whole there are enough staff, who get on well together’. ‘My needs are met’. ‘I feel that I am in the right place’. One resident felt that the home was getting ‘better and better’. Residents are asked their opinion about how the home is run, and how things could be made better. Their views are taken seriously. This was evidenced on the day of the inspection. There are a number of varied activities in which residents are free to participate. The home is currently developing the activities available for those residents who may be more isolated. Residents are able to make choices about how they spend their time, and are not limited by the routine of the home. They are assisted to maintain their independence. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 6 Residents enjoy a varied menu, and have a choice at each mealtime. Comments included ‘The food is fantastic. There is fresh fruit all the time’. Staff understand that they must report matters of concern which affect the vulnerability of residents who live at the home. 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. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: The deputy manager confirmed that intermediate care is not provided at the home. Therefore this standard is not applicable. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Staff understand the needs of service users, the majority of which are recorded within the detailed plans of care. EVIDENCE: There were eleven service users at the time of the inspection who had been admitted by virtue of their nursing needs. The remaining thirty one service users had been admitted for personal care only. The district nurse team provides nursing intervention for those service users admitted for personal care only. Key workers are given responsibility for, and ensure that, care plans are updated on a monthly basis. Where possible, the plans had been signed by the service users. The care plans contained evidence that contact is made with outside professionals where required, and the General Practitioner and district nurse attend review meetings each fortnight. The needs of service users are reviewed, and review is completed by the appropriate professional where nursing needs develop. Risk assessments and care plans are developed where risk is identified by staff. The deputy manager stated that further work was being carried out whereby a life history album will be completed for service
Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 10 users. This will further enhance the information available to staff. Specialist care plans have been developed for those service users who have mental health needs associated with dementia. Those seen were detailed, and provided good information for staff. A dementia support group has been set up, and to which representatives from the university school of nursing lecturers attend. Consultation has taken place with the nutritionist, and additional nutritional risk assessments have been carried out. Details regarding specialist dietary needs for service users at risk have been passed on to the cook. It was discussed that some service users have swallowing difficulties. A suction machine was ordered on the day of the inspection, as this was not available at the home. Service users spoken with were satisfied that their needs were met, and comments included: ‘I feel that I am in the right place’, ‘My needs are met’. The deputy manager explained that, in order to minimise the chance of administration error, Temazepam is currently stored in the locked facilities provided for the storage of medication within service users’ rooms. Whilst the reason for this decision is understood, the home does need to comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This requires care homes offering nursing care to store this particular medication in a controlled drugs cupboard. The deputy manager has agreed to rectify this forthwith. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Service users are supported to make choices and maintain their independence. They benefit from a range of social activities, and steps are being taken to ensure that gaps in meeting the social needs of individuals are addressed. They benefit from a choice of menu which can cater for special dietary needs. EVIDENCE: A number of activities take place at the home six days out of seven, and which are organised by staff in the absence of an activities organiser. A volunteer service assists service users with computer activities. Activities include exercise classes, scrabble, classical concerts, prayer meetings, hairdresser and videos. There is also a library with a print viewer for service users with visual problems. Activities are planned and advertised. Those service users spoken with were generally satisfied with the activities on offer, although comments made included that for those who needed to stay in their room, or who have cognitive difficulties, the activities programme was more limited, being mainly based on group activities. The deputy manager stated that this issue has already been identified, and that, with the assistance of the mental health specialist nurse employed by the Trust, additional activities are being developed to meet the needs of these client groups. Links with The Retreat hospital allows access to the ‘Snoozelum’ for service users.
Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 12 Service users were happy that they were able to continue with their own preferred routine. They can remain in their own rooms, the doors to which have a letter box and door bell. Those who are able and wish to do so launder and iron their own clothing. Those bedrooms seen were individualised, and contained personal belongings. Rising and retiring times are flexible to meet the individual needs and wishes of service users. There is a four weekly menu in operation, with a choice available at each mealtime. Mealtimes are seen as a social occasion, and service users are encouraged to eat in the dining areas. However, they may eat in their own rooms should they prefer. Comments from service users included ‘The food is fantastic’. ‘There is fresh fruit available all the time’. The kitchen can cater for service users with particular dietary needs, such as diabetic, soft diets and those with nutritional issues, and the cook was able to explain who required enriched diets. Liquidised diets are now provided as moulded meals to improve the appearance. There is home baking available every day. There was a plentiful supply of fresh fruit and vegetables within the stores. The cook explained that each meal is presented individually, in order that it is correct for each specific service user. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The fact that staff understand that they must report matters of abuse assists in protecting service users from unnecessary risk. EVIDENCE: Staff are instructed about abuse during their induction. Those spoken with were clear with regard to their responsibilities for reporting their concerns about abuse, and the fact that they may not be in a position to ‘keep secrets’. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: None of the standards were assessed at this inspection. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 15 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 and 28 The needs of service users are met by a busy staff team who are offered an ongoing programme of training to assist them in the work that they do at the home. EVIDENCE: The home provides a core group of permanent staff. Agency staff are occasionally used where staff shortage occurs. On the day of the inspection, there was one trained nurse on duty, and seven carers. An additional carer had been provided in order to escort a service user to a hospital appointment. The deputy manager was supernumerary. Comments from service users included ‘On the whole there are enough staff, who get on well together’. ‘Staff are stretched sometimes, but my needs are met’. The mealtime observed was not rushed, and sufficient staff were available to assist service users where required, and throughout the course of the inspection, staff went about their duties quietly and inconspicuously. There is an active programme of NVQ training at the home. The manager holds the internal verifier award, one care staff is qualified as an NVQ assessor, and a nurse is currently also working towards the assessors award. Two staff have completed NVQ Level 3 in care, six have completed Level 2 in care, with a further five staff working towards completion of NVQ Level 2. Catering staff also undertake NVQ qualifications in catering. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 16 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): 33, 35 and 38 The management seeks, listens to and considers the views of service users, who are provided with feedback. Service users can be assured that personal monies safe kept by the home on their behalf will be handled appropriately. The introduction of the recording of bed rails checks and ensuring that hazardous chemicals are kept locked away will further improve the robust health and safety systems operated at the home. EVIDENCE: The quality of the service is assessed by the Trust. Questionnaires are sent out to service users about a specific topic on an annual basis. A team of volunteers assists service users where required. The results are summarised, and a report produced. Resident meetings are held on a three monthly basis. Issues
Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 17 brought up by service users are fed into the management meeting, and subsequent action to be taken fed back to service users. The deputy manager stated that there is an ‘open door’ policy in order that relatives are able to air their views. The home is also subject to an annual audit which is carried out by the management of another home within the Trust. Internal auditing, for example of the care plans and the medication system, is also undertaken. There are no service users for whom the home acts as appointee. Finances are mainly managed by family members where the service user is unable to manage their own affairs. The home can safe keep personal monies for service users. These are kept in secure facilities, and records kept could be reconciled with monies held. Where transactions are made on behalf of service users, receipts are kept, and two staff signatures are obtained. The administrator confirmed that a number of service users manage their own monies, and lockable facilities are provided for safe storage. Maintenance certificates seen evidenced that the home is kept maintained, and that the fire safety arrangements are kept up to date. Staff receive regular training in fire safety. The fixed wiring certificate is not kept on site, and the home arranged to have a copy sent to the commission. This has been received. Good records are kept within the kitchen of fridge and freezer temperatures. There was one firm that did not provide van delivery temperatures, and the administrator stated that this would be followed up. There were cakes and pureed foods kept in the freezers which were not date labelled. Whilst a risk assessment had been completed, there is currently no record kept that bed rails are checked on a regular basis to confirm that they are safe and fit for use. In three areas of the home, it was observed that hazardous chemicals were not kept locked away. Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 1 Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement In order to comply with the Misuse of Drugs Act (Safe Custody) Regulations 1973, Temazepam must be stored in a controlled drugs cupboard. As part of the risk assessment, staff must record that bed rails have been checked on a regular basis as confirmation that they are safe and fit for use. Hazardous chemicals must be kept locked away when not in use. Food stored within the fridge and freezer must be dated. Timescale for action 21/03/06 2 OP38 13 31/03/06 3 OP38 13 14/03/06 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 It is recommended that care plans are further developed to identify:
DS0000027969.V284212.R01.S.doc Version 5.1 Page 20 Lamel Beeches Nursing & Residential Home • • The social needs of service users, and how they can best be met The needs and wishes of service users upon dying and subsequent death Lamel Beeches Nursing & Residential Home DS0000027969.V284212.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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