Inspection on 08/07/08 for Lancaster House

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Good 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

Lancaster House 05/07/07

Lancaster House 29/06/06

Lancaster House 04/08/05

Lancaster House 21/04/05

Lancaster House 07/02/05

Lancaster House 06/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lancaster House 2 Portal Avenue Watton Thetford Norfolk IP25 6HP Lead Inspector Brenda Pears Unannounced Inspection 8th July 2008 09:00 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 Lancaster House DS0000027327.V368034.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. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lancaster House Address 2 Portal Avenue Watton Thetford Norfolk IP25 6HP 01953 883501 P/F01953 883501 annette.howarth@lancasterhousecarehome.co.u k Mr Sarath Ekanayake Mrs Jeeva Ekanayake Mrs Annette Howarth Care Home 19 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) Category(ies) of Old age, not falling within any other category registration, with number (19) of places Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nineteen (19) Older People may be accommodated. Date of last inspection 5th July 2007 Brief Description of the Service: Lancaster House was originally built as officers quarters for the RAF and is situated near the entrance to the former barracks on the outskirts of the Breckland town of Watton. The barracks are no longer operational and have since become a private residential area. The house itself has been extended and adapted to provide residential care for a maximum of 19 older persons. The accommodation is all within single rooms. The 10 ground floor rooms all have en suite facilities. The upper floor is accessible by a stair lift and rooms in the older part of the house have wash-basins and share toilet facilities that are close by. The care home has a large and pleasantly appointed lounge dining room with 2 access points out into the rear garden. All the main doors into the house have ramped access. There is a private car park at the front of the building. Fees vary according to the needs of the individual, as a rough guide prices can range from around £350.00. A full breakdown of fees can be obtained direct from the home. A statement of purpose and a service user guide can be obtained from the home by post or by collecting a copy in person. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced inspection undertaken on the 8th July 20008 and started at 10.00am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment (AQAA). During the visit to the home we spoke to the manager, with members of staff and also with five residents. These methods and previous findings all inform the outcomes of this report. What the service does well: What has improved since the last inspection? Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 6 Choices are now available for meal times and residents are asked their preferences for the menu planning. Meals looked appetising and a hot or cold choice was available for lunch with salad and potatoes. A domestic member of staff has been employed, this means that care staff have more time to provide care and support. Redecoration has been completed in various areas of the home since the last inspection including in the kitchen and some resident’s rooms. 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. Lancaster House DS0000027327.V368034.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 Lancaster House DS0000027327.V368034.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager does assess the needs of any new client to make sure individuals can be fully supported before an agreement is undertaken. EVIDENCE: A full assessment is undertaken before support is agreed and appropriate staffing levels are provided. One resident confirmed that information and full discussions were carried out prior to agreements being completed. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans contain clear information that enables staff to meet individual needs, but not all sections were up to date. Medication is handled and stored correctly for the safety and well being of those living in the home. EVIDENCE: We looked at three care plans and these confirmed the information in the AQAA that stated that the care plans and risk assessments are regularly reviewed. The care plan format has detailed sections of information that shows both doctors and district nurses provide support and other healthcare services are accessed when necessary. One referral has been made for physiotherapy support as one resident is having difficulties with mobility. Pressure areas needing attention are recorded and the district nurse contacted to make sure these skin areas are dealt with before they become a problem. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 10 While healthcare needs are being met, staff do not always record information on the correct section of care plans. For instance, one person’s health had deteriorated and the doctor prescribed a soft diet. This was recorded on the daily report sheet but had not been transferred to the sheet containing the physical needs of the person. People wishing to deal with their own medication are supported to do this safely. Risk assessments are completed and the local pharmacy come in and discuss which is the best and easiest way to provide the medication. Another prescription was detailed on the outcomes for the GP visit but had not been written on the front sheet that shows the care required. Full information was seen when we looked at daily records. These contained detailed information about how the person had spent their day. When the accident book was checked, we found these details on the daily record and on the medical sheet when a health check had been necessary, showing that staff had clearly recorded all areas of this information. The medication trolley was found fixed to the wall and locked at this inspection. Records of the administration of medication were clearly completed, up to date and medication was in date and stored in an orderly way. The manager said that regular audits are carried out to make sure medication is stored and handled correctly. A check is also carried out regularly to make sure medication is in date and that the date of opening ins clearly written on the box. We saw that the temperatures of the medication fridge are taken and recorded regularly. Care plans show that people are regularly weighed and this is recorded on care plans, however, there are no chair scales available in the home for people who are unable to stand. There is not system in place for monitoring people who are less able and is only providing a service to a certain number of residents. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are supported to take part in a range of leisure activities and to maintain contact with family and friends. Clients are offered a variety of healthy meals that they have chosen. EVIDENCE: People living in the home told us that there are lots of regular visitors who are made welcome. We saw staff giving people time and not trying to rush them. A copy of the menu is on each dining table for information and people are asked daily what meal they would like. Some people did say that they could have a different meal and ‘we never leave the table hungry’. Staff asked if people wanted any more and if they had enough to eat. Not everyone comes into the dining room for meals; some meals are served in rooms when chosen. Almost all people have breakfast in their rooms and get dressed whenever they choose. Any special diets are catered for including diabetics and fish Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 12 allergies. A copy of the menu is also kept next to the visitor’s book to inform visitors and families and enable them to discuss this with people in the home. Residents have the opportunity to take Holy Communion in the home once a month and a vicar from the local church visits some residents, recognising the diverse spiritual needs of residents. The manager said that a person would be supported with any religious support they wished. The manager explained that information from residents and families has improved and regular comments are encouraged about the food on the menu. There is a monthly newsletter with information about coming events such as a clothes party and a strawberry tea. Family members and friends were involved with such events as a summer fete and a coach trip to Cromer with a summer fete planned for during August. We talked to some residents who said they had enjoyed trips outside the home. There are regular meetings with people in the home and the manager explained that a variety of trips have been taken such as one to the theatre and another to a show. There is a record of activities and who has participated. There is a system in place where staff give individual time to residents, however, this is not currently recorded on care plans. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 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. 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. Residents know who to complain to and feel they will be taken seriously, however, lost clothing is causing some people to be upset and annoyed. Procedures are in place, including staff training, to provide protection from abuse. EVIDENCE: We looked at the complaints records and saw one complaint that was received some months ago and as the manager was newly in post, the proprietor dealt with this. The manager said that these outcomes had been satisfactory and the home has a copy of correspondence. When talking to people living in the home, they did say that they feel comfortable talking to the manager or staff about any problems and that action is taken. During discussions people said that washing can often get lost, or they get the wrong clothing. They said ‘this can make me feel upset and angry’ and that ‘washing is clearly labelled and I do not see how things can get lost’. Staff had Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 14 tried to find the washing and some items were found in other rooms but some items are still missing. The manager explained that staff had been asked at staff meetings to make sure this does not happen but there was no record of lost clothing in the complaints folder. There was no record of any complaint regarding missing washing. This was discussed with the manager at this time. The home has a record of many thank you letters and cards that people have sent. We have not received any complaints about the service since the last inspection. There are robust practices used when dealing with money on behalf of a resident. All receipts are kept on file, social services and family members also provide support with money. There are regular copies of accounts for auditing and these are also sent to those people such as social services and family members. All staff have received training with regard to safeguarding adults and recognising abuse. Discussions with staff also confirm they are aware of safeguarding issues and what action to take. A selection of staff files were seen during the inspection and these show that appropriate checks are now carried out during the recruitment process. Discussions were undertaken with the manager about one personal reference that was obtained for one member of staff where good practice dictates that a professional reference is obtained where possible. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 15 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): 19,20,21,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does provide a safe, clean environment, however, communal and bathroom areas do not meet with current standards. EVIDENCE: The home welcomes all visitors and some people were relaxing in the lounge area while others were in their rooms. During the afternoon, some people were having their hair done by the hairdresser. The lounge offers seating in a variety of armchairs and is open plan to the dining area that currently has two tables. These two tables cannot accommodate all 19 residents at once and as some people choose to eat in their rooms, this is currently not a problem. However, the manager did not know how she would accommodate all residents should they wish to eat in the Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 16 dining area as there is not space for another table without taking some of the lounge space. This one lounge/dining room also means that staff duties and record storage is carried out in this area. Any activities have to be undertaken here too as does staff training, staff handover, record keeping. The hairdresser takes a great deal of this space, although there did not appear to be any objection. Those using this area to relax or having their hair done were happily chatting. When explaining routines around staff training and handover at change of staff shifts, the manager said that these obviously disturb residents and the television can distract and interrupt staff. This is obviously a difficult situation to manage and does not provide additional space for anyone not wishing to join in activities or to sit quietly. The only option available is for a person to go to their own room or to sit outside, which is not always possible depending on the weather. There is a small room off the lounge that is used by the manager but two people cannot sit in this room without the door being left open. This is how the inspector, staff and the manager had to occupy this space at this inspection. The home has one bath and one shower room. The assisted bath is old and grubby with a damaged surface. The bathroom itself is very drab, old and dim. The sink is coming away from the wall where the plaster is old and not keeping this secure. The toilet in the bathroom was leaking and the paper towel dispenser had no paper towels. The manager explained that the proprietor pays the bills and there has been no delivery of paper towels. The older part of the building has been repainted and redecoration of rooms is ongoing. A grab rail has been added at the front door area following a request from relatives and visitors. A gardener has been employed and new garden furniture has been purchased. The old wall tiles in the kitchen have now been replaced. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home have their needs met by a consistent staff team who are well trained and regularly supervised, providing stability and continuity of care. EVIDENCE: At the time of this inspection there were four care staff on duty with the manager and there were three care staff during the afternoon period and three night staff on duty. Staff were seen to be providing support in a calm manner and not rushing anyone and there was relaxed conversations and laughter between residents and staff. Since the last inspection a domestic person has been employed to deal with all cleaning in the home. We looked at three staff files that showed recruitment procedures that, in the main, were appropriate. Safety checks included CRB, two proofs of identification and references. However, not all references reflected good practice as one file had a personal reference, where a previous employer could have been contacted. This was discussed in depth with the manager. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 18 There is a programme of training in place that includes dealing with bereavement, food hygiene, manual handling, first aid, dementia awareness, protection of vulnerable adults, medical conditions and fire safety. Staff who spoke to us said that they receive adequate training that they feel relevant to meeting the needs of people in the home. Staff said that they had received a thorough induction and that ongoing training is provided and refreshed when needed. Five care staff have gained NVQ level two certificates, two staff have NVQ level three and four are just starting on NVQ level three. The manager does provide regular supervision sessions and staff said that they feel supported and do discuss personal development as well as the needs of residents. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is managed by a suitable person and is run in their best interests. EVIDENCE: The manager is a suitable person to be managing the home and has achieved a registered managers award and NVQ level 4. The manager operates an open door policy that means residents or staff are able to discuss any matters with her. This was confirmed through discussions with staff and residents carried out at this time. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 20 There is a record of up to date servicing certificates for electrical items (PAT), hoists and all fire extinguishers. The fire alarm has recently had a new part to make sure this is working correctly. A current insurance certificate is on display in the home, the hairdresser has her own insurance and her equipment is also fully tested for safety. Regular checks are undertaken and recorded for hot water temperatures, emergency lighting and on the emergency call system. There are written policies and procedures in place that cover areas including concerns and complaints, bullying, dealing with aggression and missing persons. As previously stated, appropriate systems are in place for dealing with any personal finances. The manager now gives out satisfaction surveys for the monitoring of quality assurance. These are sent out to families, GPs and sent to social services departments, to district nurses and handed out to any other visitors. There is an induction programme in place to provide staff with information that will assist them in their roles. Staff said that the manager does support them and that she always has time to listen to staff and residents. Staff who spoke to us said they enjoy working in the home and that they can always ask for training or support when needed. Discussions with staff confirm that there is an open management style and that they are able to talk to the manager anytime they need. One person said ‘I would not want to work in different home’. Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 21 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 1 X X X X 2 STAFFING Standard No Score 27 3 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 3 Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 22 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 OP21 Regulation 13.4 (a) 23 (2)(j) Requirement That the one bath in the home be replaced due to the poor condition of the surface and risk of cross infection. This requirement had a timescale of 01/11/07 that has not been met. Enforcement action is now being considered. 2. OP16 22.8 That all complaints are recorded along with investigation details and any actions taken to show that they have been satisfactorily dealt with. 04/08/08 Timescale for action 08/07/08 3. OP23 23 (2) (g) That an appropriate area is 30/09/08 identified for hairdressing to be undertaken, other than the communal area (lounge/dining room) to ensure residents leisure time is not disturbed. That every effort be made to provide appropriate areas for staff handover and staff training. To support privacy, dignity and confidentiality. DS0000027327.V368034.R01.S.doc 4. OP10 23 (1) (a) 2 (a) 30/09/08 Lancaster House Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lancaster House DS0000027327.V368034.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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