Inspection on 16/07/09 for Lancum House Care Home

This inspection was carried out on 16th July 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lancum House Care Home 24/07/07

Lancum House Care Home 12/07/06

Lancum House Care Home 03/02/06

Lancum House Care Home 26/07/05

Lancum House Care Home 06/12/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lancum House Care Home Bush Close Hardwick Road Wellingborough Northants NN8 3GL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Irene Miller     Date: 1 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Lancum House Care Home Hardwick Road Bush Close Wellingborough Northants NN8 3GL 01933445770 01933443404 Lancum.House@shaw-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare (de Montfort) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 0 43 dementia old age, not falling within any other category Additional conditions: 43 0 The maximum number of service users who can be accommodated is 43 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Lancum House is a purpose built residential care home for the elderly, formerly owned by the Northamptonshire County Council Social Services Department, and now owned by Shaw Healthcare. The accommodation for service users is set out on the ground floor. The first floor accommodates the managers office, and an area used for training Care Homes for Older People Page 4 of 28 Brief description of the care home and as a staff room. Service users rooms are divided into small individual areas called flats. Each flat has a small lounge and dining area, all bedrooms are single occupancy with ensuite facilities. There is a communal lounge area and a larger foyer area where service users frequently choose to sit. The home has a wide corridor that is called the street, where tables and chairs are placed for the service users use. The home is surrounded by pleasant gardens and is situated in a residential area close to the town centre and other local amenities. The home caters for elderly residents of both sexes with both physical and dementia related illness. The current fees are in the region of 450 pounds per week according to assessed needs. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of people using the service were sample checked which involved looking through written information on their care, such as their individual care plans (a care plan sets out how the home aims to meet the individual service users personal, Care Homes for Older People Page 6 of 28 health care, social and spiritual needs). We case tracked people during the visit which included looking at records of their care, asking them how they view the care provided at the home, observing care practice and talked with staff about the needs of people using the service. Records in relation to the homes management and administration systems, quality assurance, staffing recruitment and training, and general policies and procedures were viewed. Prior to this visit the Commission for Social Care Inspection sent out to the provider an Annual Quality Assurance Assessment (AQAA) this document allows the provider to supply us with information on how they view their own performance, and gives the opportunity for them to tell us what they do well, what they could do better and any plans for future improvements. The AQAA was returned to the Care Quality Commission CQC within the timescale set, and gave an insight into how the home is managed and quality assessed. Throughout the body of the report the term we is used to describe the Care Quality Commission (CQC) as a collective body. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 28 The building has been improved to provide a home that is clean, pleasantly decorated, homely and safe. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with sufficient information about the service to enable them to make an informed choice as to whether the home can meet their needs. Evidence: Information is available to people considering using the service and their families in the form of a statement of purpose and service user guide. A copy of the statement of purpose and service user guide and the most recent inspection report are available in the foyer. The statement of purpose and service user guide, are corporate documents with some information specific to Lancum House. Having this information available aids in assisting people considering using the service to make informed choices about their care. Within the care files viewed pre admission assessment had been carried out and relevant care plans were in place, in discussion with staff they demonstrated that they Care Homes for Older People Page 11 of 28 Evidence: were aware of the needs of people using the service. The AQAA details that each person who lives in the home are given their own copy of the service user guide. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medication systems are not being appropriately managed, which leaves people at risk of their health care needs are not fully being met. Evidence: We looked at a sample of care plans to see if there was sufficient information contained within to guide staff in the care that is needed for individuals. We found that generally there was sufficient information on the medical histories, care and support required for people using the service. There was records of assessment having been carried out on pressure area care, nutrition, manual handling, falls and mobility. Within the care plans the staff use body charts to record when people have sustained any injuries, or when unexplained marks to the body appear. Within one of the care plans there was records of five body charts having been completed which had identified areas of marking to the persons body such as, bruises, marks and scratches. Care Homes for Older People Page 13 of 28 Evidence: We found several of the body charts had differing dates recorded upon them. One chart recorded marks on the persons body found in February 2009 and the same chart contained several entries added in May and July 2009. The need for the body charts to provide a clear record of injuries was discussed with the area manager during the inspection, we asked what the procedures were for the completion of the body charts, and were informed that unless the an injury relates directly to the first entry on the chart, that a new chart should be commenced. Based upon the findings at the inspection there appeared to be some confusion as to the use of the body charts. The eating and drinking care plan for one person stated that in order for them to drink independently they required to use a two handled mug and required their foods to be cut up, we observed the person receiving their lunchtime meal, the staff were observed to provided support for the person in accordance with their care plan, with the exception of the two handled mug. However the person was observed to manage their drink using a conventional cup with no obvious problems. We sample checked the medication storage and Medication Administration Record charts (MAR) of two people using the service, one person had been prescribed ear drops to be administered daily, however upon checking the MAR chart for this person we found that on two consecutive days staff had not signed the MAR chart when this medication had been administered, therefore we were unable to establish whether the ear drops had been administered as prescribed. Lancum House use a monitored dosage system (MDS) which consists of medicines being supplied to the home by the pharmacy on a monthly basis. Each persons months supply of medication is placed by a pharmacist into individual separate compartments to ensure that the correct medicine and dose is given at the correct time. We checked the medication stock and administration records of a person prescribed medication to treat Parkinsons Disease. We found on the MAR chart there was an entry where a member of staff had recorded that two of the mid morning tablets were missing from the persons morning medication stock compartment. This member of staff had taken appropriate steps to ensure that the person received their medication as prescribed, and followed the correct procedure in recording and reporting the discrepancy. We checked the remaining medication stocks for this person, we found that two tablets were missing from both the morning and lunchtime compartments for the following weeks supply of medication. We brought these discrepancies to the attention of the Care Homes for Older People Page 14 of 28 Evidence: area manager during the inspection, who immediately set about rectifying the medication shortfalls. The area manager informed us that a full investigation would be carried out to find the root cause of the missing medication. As part of the planning for this inspection we looked at records of notifications received from the provider, it was noted that there had been several medication errors which had involved, medications being incorrectly administered, and omissions in the recording of medications. One of the notifications had been referred to the Northants Safeguarding Team and had resulted in action plans being put into place for two people to ensure that the medications were given as prescribed. At this inspection it was of particular concern that medications still continued to be poorly managed. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are treated as individuals and the care enables people to follow their personal interests and activities and lead their chosen lifestyle. Evidence: People spoken with during the inspection said they were happy with the care they receive at Lancum House, we found that care plans include peoples preferences in terms of individual and social activities. The staff were observed to treat people as individuals and ensure that people had opportunities to make informed choices. A small group of people were observed enjoying a game of dominoes within one of the group lounge/diners the atmosphere was relaxed and friendly. People were observed to receive assistance and support according to their needs and were observed to be enjoying the conversation as much as the actual activity. Visiting arrangements are flexible and visitors were observed to be welcomed by staff. Care Homes for Older People Page 16 of 28 Evidence: The Catering staff meet regularly with people using the service in order to hear their views and revise the menus to reflect peoples choices. On the day of the inspection the choices on offer for the lunchtime meal was Pork with Apple Sauce and Ham or Cheese Salad, we observed the lunch time meal being served and noted that it was hot, looked appetising and was well presented. Staff were observed to inform people of the meal choices on offer and accommodated their choice, people who required practical assistance to eat their meal were seen to be supported by staff and this was carried out with sensitivity and tact. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The policies and procedures in place safeguards people from abuse and neglect. Evidence: There is a complaints procedure, which is detailed in the statement of purpose and provides contacts within the service and also at a higher level within the company. The complaints procedure, the statement of purpose and service user guide was also available in the front entrance of the home. Since the last key inspection we received information raising concerns about staff recruitment practices and training this was referred to the provider to investigate under their own complaints procedure. At this inspection we spoke with the area manager about some of the recent complaints and safeguarding issues and looked at records of investigation relating to these. We found that there was evidence that the company is taking concerns seriously and acting on issues raised. Where concerns have been raised about staff practice, there is evidence that disciplinary action has been taken where appropriate, with regular supervision for staff and further training where necessary. Care Homes for Older People Page 18 of 28 Evidence: Training statistics show that staff had received training on safeguarding vulnerable adults as part of their induction training. Staff spoken with during the inspection demonstrated that they were aware of the type of events that would constitute abuse and of the safeguarding reporting procedures. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean, pleasant and safe. Evidence: Lancum House reopened in July 2008 following a period of extensive refurbishment , bedrooms viewed were clean and personalised. The communal areas viewed were clean and pleasantly decorated, the carpet within Redwell lounge was badly stained, the area manger confirmed that plans were in place to have this carpet replaced. Information received within the Annual Quality Assurance Assessment (AQAA) submitted in May 2009 detailed that health and safety checks are carried out as required by the homes maintenance man, and the The building company who carried out the refurbishment are responsible for keeping the grounds surrounding the home up to an acceptable standard. Areas identified within the AQAA where Lancum House feel they could do better was in making the lounges and communal areas more personalised and to expanding on the reminiscence themes within the communal areas of the Dementia units. Care Homes for Older People Page 20 of 28 Evidence: During the refurbishment, work had been carried out within the homes laundry, through the reorganising of the work space and the introduction of new laundry systems. Staff spoken with during the inspection, that work within the laundry area who said they were very pleased with their new working environment. Throughout the home we observed that information literature was on display to remind people about the importance of hand washing, and we observed that personal protective equipment (PPE) was available such as gloves and aprons. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff that are aware of their needs. Evidence: We looked at a sample of staff recruitment files and found that they contained sufficient evidence to demonstrate that pre employment checks are carried out, such as checks with the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults Register (POVA first) and written references obtained. All new staff undergo a four day induction programme with the company that covers the core training required for staff to commence work at the home, this includes moving and handling, food hygiene, fire awareness, and emergency procedures. In discussion with the area manager she confirmed that all new staff work a two week shadow shift alongside existing staff members. Information provided within the Annual Quality Assurance Assessment (AQAA) submitted in May 2009 details that staff only commence employment upon the home receiving, New staff are offered employment upon receipt of a satisfactory CRB & POVA check. Care Homes for Older People Page 22 of 28 Evidence: The staffing ratio consists of one team leader plus a senior support worker and seven support workers on both the early & late shifts, and at night there are five waking night staff on duty. Areas identified within the AQAA where the home feel they could do better are in, staff receiving induction training within the first six weeks of commencing employment., staff supervision to be further developed and staff meetings to be well attended. On the day of the inspection there was sufficient staff on duty to meet the needs of people using the service, one of the groups had an extra agency worker to support the staff due to the high level of need within this area of the home. Records of staff supervision viewed, evidenced that areas discussed in supervision include looking at the individual staffs skills and competencies and areas for self development. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality assurance systems in place ensure that people using the service are fully consulted. Evidence: The registered manager for Lancum House is also employed as the company project manager, she took on the post as an interim measure whilst the company advertised for a new manager. We were informed at the time of the inspection that interviews for a new manager at Lancum House had been successful, and that a new manager was to be appointed once all their pre employment checks had been carried out. On the day of the inspection the area manager was available at the home throughout the whole of the inspection. Care Homes for Older People Page 24 of 28 Evidence: The company carry out quarterly satisfaction surveys to seek the views of people using the service and their representatives, the results are published and displayed on the notice boards within the home. The Annual Quality assurance Assessment (AQAA) submitted to CQC in May 2009 details that at Lancum House they are constantly working towards a centre of excellence, with the aim of ensuring that the people Living at Lancum house are able to express their views, make choices individual to themselves. Monthly unannounced visits (under regulation 26 of the Care Standards Act 2001) take place by a representative of the company, and in addition annual external quality audits are carried out by the company quality team. Regular meetings take place with people using the service and minutes of these meetings are in display throughout the home. Systems are in place to record accidents and incidents both manually and electronically. As identified within the health and personal care section of this report the completion of the body charts needs to be reviewed. This is to ensure that the information entered provides the tool to identify the possible cause of injuries and put in place measures to reduce the number of injuries people sustain. As identified within the health and personal care section of this report, it was of concern that serious errors continue to take place in the homes medication systems. This has been a cause for concern by the safeguarding authorities, which has prompted safeguarding actions plans to be put into place for individuals. We sample checked money held on behalf of people using the service and found that there was written records of all financial transactions, with records of receipts. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Systems must be in place to ensure that staff adhere to the procedures, for the receipt, recording, storage, handling and administration of medication. This is to ensure that people using the service are protected by the homes policies and procedures for dealing with medicines. 22/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 The use of recording injuries on body charts should to be reviewed, to ensure that the information entered on the chart is clear and provides a audit tool, to identify the possible cause of injury, and the measures to be put in place to ensure peoples safety. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!