CARE HOMES FOR OLDER PEOPLE
Lancaster Court 21 Lancaster Court Southport Merseyside PR8 2LF Lead Inspector
Daniel Hamilton Unannounced 27 September 2005
th 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 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. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Lancaster Court Address 21 Lancaster Court Southport Merseyside PR8 2LF 01704 569105 Telephone number Fax number Email 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 John Kershaw Mrs Kerry Norton Care Home 30 Category(ies) of Old age 30 registration, with number of places Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 30 OP Old age. 2. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection 14/03/05 Brief Description of the Service: Lancaster Court is a privately owned care home that is registered to provide residential care for 30 older persons. The home is owned by Mr John Kershaw and Mrs Joan Kershaw and managed on a day-to-day basis by the owners and Mrs Kerry Norton. It is pleasently situated in the residential area of Birkdale village, which lies within easy reach of Southport and all the amenities that the seaside town offers. Accommodation consists of 30 bedrooms, one of which has an ensuite facility, that are situated over four floors and are accessible by lift. There is a separate dining room and a large sitting room with various seating areas. The home is equipped with ramp access at the front entrance and additional ramp access is available to the rear garden areas. Garden furniture suitable for the service users resident is also available. The home has suitably adapted equipment to assist with the needs of the service users and a call bell system is in place throughout the home and in each bedroom. Car parking facilities are available at the front of the home. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 8 hours. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. There had been no cause for any visits to the home since the last routine inspection in March 2005. A partial tour of the premises took place and observations were made. A selection of care, staff and service records were also viewed. The owner, manager, 2 staff members, 1 relative and 9 of the 29 residents were spoken to during the visit and their views obtained of the home. Comment cards were also left in the home to enable people to feedback their views on the service provided. What the service does well:
Assessments of need were completed for new residents and an effective care plan system was in operation to ensure the care needs of residents were identified and planned for. All residents and relatives spoken with were satisfied with the overall service provided and complimented the care provided. Comments from residents included; “The care is first class. They respond to your needs immediately” and “The staff are very caring. It’s the next best thing to living at home.” A range of social activities were provided and residents received a variety of wholesome and nutritious meals. Feedback from residents included: “The food is very good. Meals are varied and alternatives are available” and “It’s like a hotel. The food is delicious and the care is great.” Although two complaints had been recorded since the last inspection, residents interviewed were sure that any complaints would be listed to. Comments included; “I am positive the staff would listen to me if I had a complaint” and “If I wanted to make a complaint, I am confident that they would deal with it to my satisfaction.” Residents spoken with complimented the staff team. The views of residents included: “The staff are really good, they are gems” and “The staff have a good sense of humour, but are kind and sensitive too”. Sufficient staff were on duty to meet the needs of residents. Safeguards were in place to protect the people living in the home from abuse and recruitment practice was robust. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 6 The home had a pleasant and relaxed atmosphere and the building was well maintained, clean and tidy. A resident reported; “The home is spotless and the staff are attentive to detail when cleaning.” 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.
Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 standard(s) 3 Assessments of need had been undertaken, to enable the home to identify the care needs of residents. EVIDENCE: Assessment documentation was viewed for three residents who had moved into the home since the last visit. The three assessments viewed covered a comprehensive range of needs / assessment criteria, with the exception of personal care and physical wellbeing. Although the owner / manager confirmed that assessments were completed prior to prospective residents moving into the home, this could not be verified as the form was not dated. Information gained from the assessment process had been used by the home to devise a plan of care for each resident. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 standard(s) 7, 9 and 10 Care plans had been completed, which detailed the needs and support requirements of residents. Some medication was being secondary dispensed by night staff. This practice has the potential to place staff and residents at risk. General care was provided in a sensitive and respectful manner, thus maintaining the privacy and dignity of residents. EVIDENCE: Three files were viewed for residents who had moved into the home since the last inspection. Each resident had a care plan that had been generated from an assessment of need. Care plans viewed detailed preferred routines, the health, personal and social care needs of residents and the support required from staff in response to identified needs. Risk issues, key points to be aware of and observe and objectives were also recorded. Care plans were kept under monthly review and had been signed by residents or their representatives. Supporting documentation including; risk assessments, social activities records; personal care and weight records; health care records and report sheets were also maintained. The home had a medication policy to provide guidance to staff. A staff specimen signature and initial checklist and resident identification system was
Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 10 available for verification purposes. Likewise, a risk assessment was in place for a resident who self-administered medication. Following a requirement at the last inspection, medication administration records had been correctly completed to include the date that medication was received into the home. Furthermore, the staff member responsible for the administration of medication during dinner was observed to sign the Medication Administration Record immediately after the medicine had been given in accordance with guidelines issued by the Royal Pharmaceutical Society of Great Britain. All medication checked during the inspection was stored and recorded correctly. However, a system was in place for night staff to dispense medication into medicine pots for staff to administer to residents the following day. This practice is not safe and is otherwise known as ‘secondary dispensing’. Residents interviewed were pleased with the standard of care provided and the general approach of staff. Comments included; “I am treated very well indeed. They look after you”; “The care is first class. They respond to your needs immediately”; “I like living here. The staff are very caring and it’s the next best thing to living at home” and “I am treated wonderfully and my dignity and privacy is always respected”. Staff spoken with demonstrated a good understanding of the residents’ care needs and how to treat residents in accordance with their individual wishes and preferences. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 standard(s) 12 and 15 A range of activities were organised, which offered variation and interest for the people living in the home. Choices of meals were not clear, however nutritious and wholesome meals were provided, which met the dietary needs of residents. EVIDENCE: Residents spoken with confirmed that they were able to organise their daily life and maintain preferred routines. Social activities were provided each week which included; coffee mornings, entertainers, musicians and keep fit sessions. A hairdresser also visited the home three times a week and arrangements were in place for residents to maintain contact with local church representatives, according to their religious beliefs / preferences. Posters were displayed in the dining area to advertise activities although a programme of activities was not in place. Overall, residents were satisfied with the range of activities provided. Comments included: “They have plenty of activities in the home. I particularly enjoy the musical entertainers, as I have an interest in classical music”; I participate in the keep fit sessions on a Wednesday, to increase my mobility” and “There is a range of entertainment to meet everyone’s interests.” Some residents interviewed reported that they would like more quizzes. The home had a four-week rolling menu, which was changed each month following consultation with residents. Menus viewed showed that a range of
Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 12 nutritious meals were provided however choices were not recorded. Residents were consulted each day about their choice of meals and this was recorded on a meal request form. Meals were served at set times however arrangements were flexible to accommodate individual needs. The home’s dining room was pleasantly furnished and equipped with tablecloths, condiments, flowers and napkins. Residents interviewed were satisfied with the choice and standard of food provided. Comments included: “The food is very good. Meals are varied and alternatives are available”; “The meals are appetising, nutritious and very satisfying”; “It’s like a hotel. The food is delicious and the care is great” and “The food is well cooked, wholesome and very nutritious.” Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 standard(s) 16 and 18 Complaints / concerns received by the home had been handled objectively and fairly and residents spoken with were sure that any complaints would be listened to and addressed. Safeguards were in place to sure a proper response to any suspicion or evidence of abuse. EVIDENCE: The home had a complaints procedure in place, a copy of which was made available to residents and / or their relatives in an information pack. The complaints register showed that two complaints had been received from one resident since the last inspection. Records showed that both complaints had been promptly investigated by the manager and had not been upheld. The outcomes of complaints were clearly recorded. Residents and relatives spoken to had no complaints about the home and were confident that if they had any issues, they would be handled appropriately. Comments from three residents included: “I have no complaints. I am sure they would listen to us if we had a complaint as they are attentive to our needs”; “If I wanted to make a complaint, I am confident they would deal with it to my satisfaction” and “I am positive the staff would listen to me if I had a complaint.” A range of policies and procedures had been developed by the home to protect residents from abuse. These included; Protection of Service User; Acceptance of Gifts; Whistleblowing and the Management of Service Users Money and Financial Affairs policies. A copy of the local authority Adult Protection Procedures for Vulnerable Adults was also in place. Staff spoken with had completed ‘Abuse Awareness’ training and understood the different types of abuse and their duty of care to protect the welfare of residents.
Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 standard(s) 19 and 26 The environment was suitable for the needs of the people living in the home and areas viewed were clean, homely, well maintained and safe. EVIDENCE: Areas viewed during the inspection were maintained to a good standard and were comfortable, homely and were free from obvious hazards. Hot water risk assessments had been completed, however a radiator guard had not been fitted to an accessible radiator in one room viewed. Since the last visit, the lounge carpet had been replaced, a bedroom had been refurbished and the front and side exterior of the building had been repainted. Daily and weekly checklists were undertaken by the manager to monitor a range of issues including; maintenance work, health and safety, fire equipment and the building. Repair, maintenance and refurbishment work was completed as required. The gardens were maintained to a very high standard by the home’s gardener who was observed to be tending to the gardens on the day of the visit. Infection control policies and procedures were in place to minimise and control the spread of infection. Hand washing facilities were equipped with paper
Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 15 towels and soap and protective clothing was available for staff use. Areas viewed were clean and tidy. Domestic staff were observed to be cleaning the home during the visit. One resident said; “The home is always kept clean and fresh” and another reported; “The home is spotless and the staff are attentive to detail when cleaning.” Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Sufficient numbers of staff were deployed to meet the needs of the people living in the home. The welfare of residents was protected via the home’s recruitment procedures and practice. EVIDENCE: Examination of staffing rotas and discussion with staff and residents confirmed that staffing levels had not changed since the last inspection. The manager continued to deploy a minimum of three staff during the day, with two waking night staff on duty through the night. The home employed a good skill mix of staff, to ensure the various needs of residents were met. Residents and staff spoken with were of the opinion that the home was adequately staffed to meet the needs of residents and residents spoke highly of the care provided. The views of four residents included; “There are always staff on hand when you need them”; “The staff are really good. They are gems”; “The staff have a good sense of humour, but are kind and sensitive too” and “The staff are very competent and appear to understand my needs.” A recruitment policy was in place. Since the last inspection only one member of staff had commenced employment at the home. Appropriate pre-employment checks were in place for the staff member, however some recruitment / employment records had not been fully completed. Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed None of the above standards were inspected. EVIDENCE: Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? 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 9 Regulation 13 (2) Requirement The practice of night staff preparing medication for the following day (secondary dispensing) must stop. Timescale for action 27/10/05 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 3 Good Practice Recommendations Assessments should be dated to provide evidence that they were completed prior to the admission of residents to the home. The assessment form should also be revised to include personal care and physical wellbeing. The home should consider introducing a programme of activities to include quizzes. The menus should be updated to record the daily choice of meals. All radiators that do not have low surface temperatures should be fitted with guards.. All recruitment / employment records should be completed in full 2. 3. 4. 5. 12 15 19 29 Lancaster Court 20050927 Lancaster Court X10015 UN Stage 4 S5332 V226395 F53.doc Version 1.30 Page 20 Commission for Social Care Inspection Burlington House, South Wing 2nd Floor, Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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