Inspection on 15/05/07 for Lamel Beeches Nursing & Residential Home

This inspection was carried out on 15th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lamel Beeches Nursing &... 14/03/06

Lamel Beeches Nursing &... 25/11/04

Lamel Beeches Nursing &... 26/07/04

Lamel Beeches Nursing &... 09/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Lamel Beeches Nursing & Residential Home 105 Heslington Road York North Yorkshire YO10 5BH Lead Inspector Denise Rouse Key Unannounced Inspection 15th May 2007 10:25 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 DS0000027969.V335076.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. DS0000027969.V335076.R01.S.doc Version 5.2 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 DS0000027969.V335076.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 60 years and over Date of last inspection 14th March 2006 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. Fees ranged from £1928 per calendar month, upwards for single residential occupancy. Nursing fees ranged from £2687 for nursing per month; minus the registered nurse care contribution, on the day of the site visit. DS0000027969.V335076.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the homes file since its last inspection. • Information submitted by the registered provider in the pre inspection questionnaire • Surveys received from four service users, relatives, and one general practitioner. • An unannounced visit to the home, which lasted five hours, this included a full tour of the premises. Evidence gained by direct observation, talking with service users, staff and visitors. Inspection of records, including care profiles, medication administration records, staff files and some of the homes policies and procedures. What the service does well: What has improved since the last inspection? The storage of controlled medication had been improved to comply with legislation. Bed rails are checked monthly to ensure they remain safe for service users use. Hazardous chemicals are locked away and food in the fridge is dated to ensure service users health and safety is maintained. DS0000027969.V335076.R01.S.doc Version 5.2 Page 6 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. DS0000027969.V335076.R01.S.doc Version 5.2 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 DS0000027969.V335076.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 3 (6 not applicable) People who use the service experience good quality outcomes in this area. Service users are fully assessed prior to being admitted, this ensured their need could be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Prospective service users were fully assessed prior to being admitted to the home, this information formed the basis of the care plans etc. This ensured that their needs were known and could be met. They were invited to visit the home and if they wished stay for lunch, to help them to gain insight. Contracts were issued and all new residents had a statement of purpose and service user guide. This ensured service users made an informed decision about the home. One service user stated, “ I received enough written information and I was given a tour of the building”. And “ I brought a friend to see Lamel beeches before it was opened, I said I would like to live here and was told well you can”. DS0000027969.V335076.R01.S.doc Version 5.2 Page 9 The statement of purpose was inspected as part of a review of the registration certificate. It was brief and required further information to be added to meet the regulations. DS0000027969.V335076.R01.S.doc Version 5.2 Page 10 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): Standards 7 8 9 10 People who use the service experience good quality outcomes in this area. Service users receive health and personal care, however there were shortfalls relating to the documentation of this, and shortfalls in some medication systems. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Service users were seen being treated with dignity and respect by staff who addressed them by their preferred title and knocked on their bedroom doors prior to entering. This ensured service users privacy and dignity was respected. Surveys indicated service users always received the care and support they required. Comments received included “We elderly are reticent to ask for anything, at Lamel we ask and if possible, our request is always yes”. And “Staff are available when you need them bearing in mind they to need a break”. However one service user stated “ Sadly because of the pressures the staff have, and an ever changing case load, if you need to have attention you DS0000027969.V335076.R01.S.doc Version 5.2 Page 11 get it, perhaps not always in the timescale you would like, but I am amazed on the swift reaction to a problem”. Care plans and risk assessments were inspected for three nursing service users and one residential client. These had not all been reviewed monthly, this shortfall must be addressed, to ensure all service users continue to receive appropriate care and that this is fully recorded. The recording of health care professionals visits had not been continuously documented, however the nurse in charge assured the inspector that these visits had taken place. Service users verified that they received the health and personal care they required, however it was apparent from inspecting the documentation that this was not always thoroughly recorded. This issue must be addressed. The medication systems in operation within the home were inspected. Medications were stored securely in the service users own bedrooms. The medication administration records for the case tracked service users were inspected. These showed that some balances of stock and signatures by staff observing medication was being taken, was not always recorded. This shortfall must be addressed to ensure that this document gives a clear picture of the medications being taken by the service users, to ensure their health is maintained. Service users who self medicated were not formally assessed to ensure they were able to do so safely. This must be implemented to ensure service users health and safety is maintained. The treatment room was inspected, controlled medication was stored correctly and the balance checked was correct. One comment received from a service user was that “staff give very careful attention to the tremendous amount of drugs which they need to count and check, and they observe these are taken”. DS0000027969.V335076.R01.S.doc Version 5.2 Page 12 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): Standards 12 13 14 15 People who use the service experience good quality outcomes in this area. Service users social and dietary needs are well met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Service users were seen going out independently within the local community and were supported by the staff as required. There was an internal shop, which was open, and this provided a small array of products this was well used by residents. The administrator also took letters to the post office. Visiting at the home was open. There was a weekly schedule of activities advertised on two notice boards, one at a lowered height so that wheelchair users could access this information. Physical and social activities were arranged, and a trip to visit a past resident to Scarborough had been organised and was proving to be popular. Service users preferred activities were known, this ensured that their needs would be met. Comments received “ Activities include concerts, and several outings during the summer all are very well organized”. And “ I take part in activities if I wish”. DS0000027969.V335076.R01.S.doc Version 5.2 Page 13 All service users had a doorbell at the entrance of their bedroom and their own letterbox. The kitchen was inspected, cleaning; fridge, freezer temperatures and hot meat temperatures were taken and recorded daily. This ensured that food hygiene was maintained. However one small dry store had an area of damp on the ceiling and wall, tins and bread were moved to a different area this was to be reported to the estates department for attention. Also A small area of kitchen lino was missing underneath a fridge, this had been reported and was awaiting repair. A four-week seasonal menu was available, and was advertised upon notice boards throughout the home. Service users had a board in the dining area advising them of the lunch menu. The chef knew the service users special dietary needs and these were provided. There was fresh fruit available at lunchtime for the service users to take. Food looked appetizing and nutritious, the chef sated that service users who were nutritionally challenged were offered fortified food and food in between meals, to help them to maintain adequate nutrition. Staff assisted service users as required with patience and respect. Mealtimes were unhurried and were very much a social occasion. Comments received included “ It is my custom to comment on every meal, if it is excellent or not to my taste. The choice is good, the quality is good, and the fruit bowl is always available. Maybe the wheelchair residents would like the opportunity to choose and not be whisked to their rooms in preparation for staff meals”. And “ The meals are varied, well cooked and presented”. “ My only criticism is that we get far too much”. DS0000027969.V335076.R01.S.doc Version 5.2 Page 14 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): Standards 16 18 People who use the service experience good quality outcomes in this area. Service users can be assured that their concerns would be listened to and acted upon. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaints policy was inspected; it required changing to ensure that the Commission for Social Care Inspection title was correct. The complaint received was inspected, this was continuing to be dealt with; the outcome of this will be supplied to the Commission for Social Care Inspection. Service users indicated they knew who to speak to if they were not happy. “ I would speak to “The head of the home, who has an open door policy”. Another comment received was “ The head of the home is always ready to deal with any problems and there is a residents committee, two of which attend the regional management meeting”. “ I would go to the office, if that fails I would go to the representative on the committee, who comes in from time to time”. Service users were all assured that any issues raised would be dealt with appropriately. Staff were spoken with relating to action they may undertake if they suspected abuse had occurred. They were informed of the actions they should take. The policy relating to this was inspected and may need reviewing as it had not been reviewed for some time. This would ensure that the policy DS0000027969.V335076.R01.S.doc Version 5.2 Page 15 continued to reflect the current action that should be taken if an allegation of abuse was ever to be received. New staff had the relevant pre employment checks undertaken to ensure that they were suitable to work within the care industry. This helped to protect the service users. DS0000027969.V335076.R01.S.doc Version 5.2 Page 16 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): Standards 19 26 People who use the service experience good quality outcomes in this area. Service users live in a homely and well-maintained environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home was inspected; it was clean, tidy and well maintained. Disabled access was easily available throughout the home. The gardens were designed to be wheelchair friendly and were well kept. The lounge areas were well presented and there were quiet lounge areas, a computer lounge and a library for service users to use. Service users had access to their own laundry and this was popular with those who still wished to undertake their own laundry, and maintain their independence in this. Service users indicated that the home was always fresh and clean, however DS0000027969.V335076.R01.S.doc Version 5.2 Page 17 One comment received indicated, “ I have noticed a tremendous improvement. several en-suite bathroom extractor fans are out of action due to age but I guess repairs are in hand”. These issues should be looked at by management and the necessary action taken to maintain service users and staffs health and safety. The laundry was inspected and the cleaners storeroom all areas were maintained correctly. Hand wash facilities were available throughout the building; this helped to ensure that infection control measures were in place. DS0000027969.V335076.R01.S.doc Version 5.2 Page 18 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): Standards 27 28 29 30 People who use the service experience good quality outcomes in this area. Service users receive care from staff who are competent, however there was a shortfall relating to fire training. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has achieved over fifty percent of care staff who hold the national vocational qualification in care at level two or three. This ensures that the care given to service users is of a high standard. Staffing levels were well maintained. However nursing staff appeared to be under some pressure, due to the increasing dependency of some service users and the increase in numbers of nursing clients. This may have contributed to the care profiles not all being reviewed timely. The management must look at this and where possible put into place systems to ensure that the nursing staff have the quality time to undertake all their duties timely. Care staff had at one point been trained to undertake medications, however there was only one carer who was trained working in the home, which could undertake this for the residential clients. This should be looked at to see if this could be re introduced to the home. Nursing, and ancillary staff stated that they had access to plenty of training and were actively encouraged to undertake this. They all stated that this was DS0000027969.V335076.R01.S.doc Version 5.2 Page 19 an excellent home and a delightful place to work. Training recorded for four staff was inspected. These did not appear to be up to date with statutory training, more evidence was requested to be sent to the Commission for Social Care Inspection for perusal. Fire training was not occurring in line with the North Yorkshire Fire Service Regulations and this must be addressed to ensure that service users and staff health and safety is maintained. Uniforms for care and domestic staff were not worn, therefore giving the home an informal feel. Surveys indicated staff listen and act upon what the service user says. DS0000027969.V335076.R01.S.doc Version 5.2 Page 20 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): Standards 31 33 35 36 38 People who use the service experience good quality outcomes in this area. Service users live in a well managed home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The management of the home was unavailable on the day of the site visit. However the nurse in charge and administrator was able to assist the inspector. The manager and administrator had an open door policy, this ensured service users and staff could come and chat with them about any issues they may have. Service users and staff stated that the manager was approachable, and had an open door policy. A comment received indicated, “ Personally I cannot envisage living in a happier home, The staff go to great lengths to ensure our DS0000027969.V335076.R01.S.doc Version 5.2 Page 21 needs are met. We receive pleasant courtesy from the cleaners to the management”. Quality assurance systems were in place. Staff and residents meetings took place regularly and they were minuted. A manager from another home carried out a full audit once per year and a chef also undertook an internal audit of the kitchen. Action would be taken if shortfalls were found. The outcomes of these were shared with service users and staff. Yearly questionnaire were sent to service users and relatives. The outcome of this was publicised. Two residents were voted onto the management review committee and they attend the relevant meetings to give the residents perspective relating to the services provided within the home. This ensured service users were involved within the management of the home, and made their views known. Service users personal allowance balances were inspected and found to be correct. This ensured that they were protected from financial abuse. Upon inspecting staff files evidence was not contained of supervision and appraisals being undertaken. This information was held elsewhere. Management should ensure that staff receive this input to help and support staff to maintain the quality of the service, by giving them support and any further training required. Health and safety records were inspected. Fire training had been undertaken, however this must be provided for all staff in line with the North Yorkshire Fire & Rescue Services requirements. The manager must ensure training being provided complies with this. Training relating to manual handling had not been provided yearly to all staff. This must be undertaken to ensure service users and staffs health and safety is maintained. Service users requiring the use of bed rails were assessed and a risk assessment was in place. These bed rails were checked daily by staff, and quarterly by the maintenance man. The nurse call system had been inspected recently due to the system failing due to a recent overload of calls being received on one occasion. The manager has had the relevant company out to inspect the system and no fault was found. These checks must continue to be maintained, to ensure the safety of all service users requiring the use of bed rails. DS0000027969.V335076.R01.S.doc Version 5.2 Page 22 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 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 X X 3 X 3 2 X 2 DS0000027969.V335076.R01.S.doc Version 5.2 Page 23 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 OP1 Regulation Schedule 1 Requirement The statement of purpose should include all the information required, to ensure service users can make an informed choice about the service. Care plans and risk assessments for nursing clients must be reviewed monthly. Timescale for action 30/06/07 2 OP7 15 14/06/07 3 OP8 15 A record must be undertaken of 14/06/07 all health care professionals visits and any action to be taken. Medication balances must be recorded. Gaps in medication administration records for service users must be investigated. The medication administration chart must reflect medications taken. 30/06/07 4 OP9 13 (2) DS0000027969.V335076.R01.S.doc Version 5.2 Page 24 Assessment of service users who wish to self medicate must be undertaken and recorded to ensure they are safe. 5 OP15 23 (2) (b) The dry food storeroom must have the damp ceiling and wall attended to. And the floor lino under the fridge must be replaced. Management must audit the systems of work to ensure that the registered nurse in charge has adequate quality time to ensure care profiles are up to date. The manager must consult with North Yorkshire fire and rescue services, to be sure that fire training provided and its frequency is sufficient to safeguard people who use the service. Moving and handling training must be provided yearly for all staff. 8 OP38 23 The nurse call system must continue to be monitored to ensure that it can cope with the volume of calls received. 30/06/07 30/06/07 6 OP27 24 30/06/07 7 OP38 18 (1) (c) (i) 30/06/07 DS0000027969.V335076.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 Good Practice Recommendations The statement of purpose should contain all relevant information specified in Schedule 1. The management should review the giving of medications, to ensure the registered nurse is not placed under excessive pressure. The abuse policy should be reviewed to ensure that it is current and up to date. En-suite bathroom Fans should be checked to ensure they are in working order, and replaced where necessary. Staff should receive appraisals yearly and supervision six times per year. OP9 3 4 5 OP18 OP19 OP36 DS0000027969.V335076.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000027969.V335076.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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