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Inspection on 09/06/05 for Landemere Residential Care Home

Also see our care home review for Landemere Residential Care Home for more information

This inspection was carried out on 9th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users feel that they are well cared for by supportive staff. Staff receive regular training to equip them with the knowledge and skills to perform their roles. Service users are supported to be able to live within the pleasant environment, many of them relatively independently. The facilities and private accommodation provided for service users are well maintained and there are systems in place to promote their safety and wellbeing. The management of this care home are accessible and responsive to service users needs and are committed to providing a personalised service.

What has improved since the last inspection?

Arrangements are in place to seek a reasonable and measured resolution to improving the air quality conditions in the conservatories, with consideration being given to the differing opinions of the service users who use these rooms. A trial of air conditioning units has been organised. Carpets are on order for the corridors in the home, the fitting of which should further enhance the environment. A formal staff supervision system has been initiated to provide reassurance that service users receive care from appropriately trained and supervised staff.

What the care home could do better:

The assessment and care planning documentation, whilst generally of a satisfactory standard needs further monitoring to ensure that staff are consistently providing documentary evidence of the regular review of assessment needs and of the associated individual care plans. There need to be periodic organised service user satisfaction surveys as part of the quality assurance and quality monitoring, which are then reported on in a format that is easily understood and made readily accessible to service users, including prospective service users. There is a commitment by management to the training of staff and there will be further reassurance of the comprehensiveness of this when infection control measures are included as a specific subject for covering within the on-going training programme.

CARE HOMES FOR OLDER PEOPLE Landmere Residential Care Home Inverary Close Off Grampion Way Derbyshire DE2 3JX Lead Inspector Andrew Bailey Unannounced 09 June 2005 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. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Landmere Residential Care Home Address Inverary Close, Off Grampion Way, Sinfin, Derbyshire, DE2 3JX 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) 01332 272007 Anchor Trust of Anchor Trust (Landmere) Mr Edward William Carey Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 February 2005 Brief Description of the Service: Landemere is a purpose built care home for older people and was built in 1991. The home provides accommodation for up to 40 service users. It is situated close to local amenities and to bus routes serving Derby city centre. The accommodation is on two floors, with access to the first floor via staircase or shaft lift. All rooms are single occupancy, with en-suite facilities. Each room has the benefit of refreshment facilities and is fitted with a small refrigerator. Services include personal laundry, meals, and personal care designed to meet individual needs. A range of leisure and social events are organised. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and the duration of the inspection was approximately 4.5 hours. A tour of the building took place. Discussions were held with eight service users and with six staff. There were no relatives available to speak with during the inspection. A number of records were examined, including care plans (as part of the case tracking process, which is used to facilitate assessment of the home from the service users perspective). An assessment was also made of progress by the registered persons to address requirements made at previous inspections of this service. What the service does well: What has improved since the last inspection? Arrangements are in place to seek a reasonable and measured resolution to improving the air quality conditions in the conservatories, with consideration being given to the differing opinions of the service users who use these rooms. A trial of air conditioning units has been organised. Carpets are on order for the corridors in the home, the fitting of which should further enhance the environment. A formal staff supervision system has been initiated to provide reassurance that service users receive care from appropriately trained and supervised staff. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.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 Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.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) 1, 2 & 3 Pre-admission procedures are in place to ensure that new service users are admitted on the basis of a full assessment of their needs. There is now greater assurance that these needs are undergoing regular review, although on-going monitoring of this is needed by the manager to ensure standards are met consistently. EVIDENCE: A new system of pre-admission documentation was on trial at the home, in order to further improve the process. Assessment information was recorded in all service user care plan files examined at this inspection. The assessments were comprehensive and formed the basis for the development of care plans. Additional information had been provided by other agencies involved in the admission arrangements, such as social services (where applicable). Steps had been taken since the last inspection to ensure more regular review of the assessment of need (previous requirement). However, some of the files examined were noted to be a couple of months since the last documented review, indicating that further monitoring of the process is needed. Notwithstanding this, the measures recently introduced give greater assurance Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 9 that the assessment needs of service users are being considered on a more frequent basis than previously. The Statement of Purpose and Service User Guide had been reviewed in January 2005, with no significant changes as a result. It was established that there were some references to National Care Standards Commission, rather than the Commission for Social Care Inspection and the manager agreed to ensure that this will be amended at the next review of these documents. Revised contracts (including terms and conditions) were receiving legal scrutiny by the organisation and it was proposed to issue these to all service users in the near future. This was taking place to ensure that the contracts were reflective of the service provided. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The documentary standards of care plan entries are generally satisfactory. Further monitoring by management should ensure that all plans are consistently reviewed within the required timescales. There are robust systems in place to promote the safe administration of medicines. Service users feel that staff maintain their privacy and dignity. EVIDENCE: As with the assessment of need there has been progress overall since the last inspection to see that the reviews of care plans (referred to as Lifestyle Agreements at this care home) take place regularly. The same files examined that had showed a two-month period since the last review of assessments (specifically risk assessments) also showed similar timeframes since the last review of the care plans that had been developed from assessments. However, there had been progress in addressing this problem (a requirement from the last inspection) and with increased monitoring this should be easily resolved. There was written evidence in care plan files examined to support that service users had been involved in the formulation of the care plans. Service users Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 11 also reported that they are consulted about care issues. This demonstrates a partnership in care between care staff and service users. A positive development is the imminent introduction of risk assessment with specific focus on the prevention of falls. Staff are currently being familiarised with the use of the associated documentation. This introduction should provide greater protection from falls for service users (rather than taking action when falls have already taken place). There had been regular audits of the medication system by the retail pharmacist (reports examined at inspection). This provides an external quality monitoring of the homes medication practices and supplements the home’s internal quality monitoring. All staff administering medication had received training from an outside agency. This provides further assurance that competent staff administer the medications. Service users spoken with confirmed that staff are respectful of privacy and dignity in their daily dealings with the service users. The staff induction programme in place at the home also covers this subject. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The social and leisure programme is well organised, providing stimulating and interesting opportunities for the service users. The meals are reported by service users to be of a satisfactory standard, with a choice available. EVIDENCE: There is an activities programme, with records of participation maintained in respect of each service user. A member of staff undertakes the main coordinating role for the social & leisure programme. Coffee mornings are held on Mondays and Fridays, entertainers visit the home and there are a range of in-house activities organised such as skittles and bingo. A summer fayre has been planned. Most of the service users spoken with were appreciative of the range of activities and events organised on their behalf. Open visiting is encouraged for visitors to the home and service users reported that their visitors are made welcome at any time. There was also confirmation from service users that the home is run along flexible lines, with an emphasis on personal choice for the service users. Therefore, service users are able to exercise as much control over their lives as possible. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 13 Many of the service users dine in the conservatory areas, which lead on to the central garden area of the home. Previous reports have identified that there can be problems with the air quality in the conservatory areas (too hot usually). The manager confirmed that a trial period is to be arranged involving the hire of air-conditioners, although some service users have expressed reservations about having the doors and windows closed (essential for airconditioners to function effectively). If the trial is not successful the manager is considering the installation of vents in the conservatories. Service users expressed general satisfaction about the quality of the catering service. The menus are changed regularly and the daily menu is displayed on notice boards throughout the home so that service users know in advance what the meal choices are. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 There is a complaints procedure in place, with evidence to support that any concerns are investigated and acted upon where appropriate. The systems in place and the training of staff promote the protection of service users from abuse and neglect. EVIDENCE: The complaints procedure is displayed in the home and contained within the written information available to service users and visitors. There is also a complaints book near to the entrance. Concerns entered into this book had clearly been followed up by management, providing reassurance that concerns are taken seriously and acted upon where necessary. There had been no recent adult protection issues. The manager is well informed about adult protection issues. He undertakes training with the care staff, not only in this home but also within other care homes within the company. The next training for staff on abuse issues was planned for June 2005 (training programme identified this). All reasonable precautions were being made to safeguard service users from abuse and neglect at this home. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 & 26 Service users live in a safe environment, which is kept in good order structurally and decoratively, with good standards of hygiene and cleanliness maintained. EVIDENCE: A tour of the building was undertaken during the inspection. The building is maintained to a good standard, which is visually pleasing to the service users and visitors, and also provides assurance that there is regard to the safety of the service users. One area for improvement is the need to replace corridor carpets, but this is being addressed and carpets have been placed on order. New furniture has also been ordered for the main lounge. The dining rooms have been recently redecorated, as have most of the bathrooms. There are pleasant garden areas for service users to access and the enclosed position further promotes the safety of the service users. Recent inspection by Environmental Health did not raise any issues of concern for service users. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 16 Staff had undertaken risk assessments in respect of service users who had elected to smoke. Anchor is in the process of reviewing the smoking policy for its’ care homes in the light of evidence that passive smoking can have a detrimental effect on others. The outcome of this organisational review is awaited. Service users expressed satisfaction with the standard of their rooms. The standard of cleanliness received particular praise and the laundry service was also complimented. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 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 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) 29 & 30 A cohesive and well-trained team of staff cares for service users. There is an established training programme to equip staff with the knowledge and skills to undertake their roles. The recruitment processes in place promote the protection of the service users. EVIDENCE: The majority (76 ) of care staff have either achieved (12 ) National Vocational Qualification (NVQ) Level 2 or are in the process of working towards completion of this qualification (64 ). Five of the eighteen care staff are currently working towards NVQ Level 3. This demonstrates that there is a commitment to ensuring that a competent and knowledgeable workforce cares for service users. A thorough recruitment process is adopted in respect of the appointment of staff, with regulatory checks made to further assure the safety of service users. A recruitment file for a newly recruited member of staff was examined at this inspection and supported that appropriate recruitment measures were in place. A copy of an induction programme was examined and this had been aligned with the Training Organisation for the Personal Social Services (TOPSS) induction standards. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 18 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) 31, 32, 33, 35 and 38 There is effective management of this care home and management is accessible and responsive to service users needs. The systems in place promote the protection of service users from health, safety and best interest perspectives. EVIDENCE: The manager has completed Registered Manager Award training and is thus able to demonstrate that appropriate training has been undertaken in order to manage the establishment. He has also undertaken training in the assessment of staff and this further enhances the training arrangements at the home. There is evidence that the home is run in an open and transparent manner, with records examined at this inspection that demonstrated the involvement and consultation with staff and service users. Minutes of meetings were made Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 19 available, with most meetings taking place on an 8-10 week frequency. A yearly programme of meetings had been scheduled with dates identified. Visits to the home in accordance with regulatory requirements had been made (Regulation 26) and these provide support that there is on-going monitoring of the quality of the service from the registered provider at a level of management not concerned with the day-to-day running of the home. This should provide an assessment of the service less prone to subjectivity than might be the case if self-assessment alone were relied upon. In addition, a national company tool is utilised by local management to undertake self-assessment. This complements the system referred to above. Whilst there is evidence of quality monitoring systems being employed, there has not been any recent survey of the service user opinion of the service. The manager has agreed to implement a satisfaction survey and to make the results available to service users in an appropriate format. Notwithstanding this, service users spoken with said that they felt able to raise issues with the management and it was evident that management was accessible to service users and responsive to identified issues. The system for the accounting of service users personal monies (only applicable to a small number of current service users) was examined at this inspection. A dual signature arrangement is employed, with the standard of the accounting providing an easily auditable system. Staff supervision was not examined in detail at this inspection, but it was established that a system had been commenced (this requirement was made following a previous inspection). Staff had received training in the majority of safe working practices, with training to be arranged to specifically cover the area of infection control. The manager confirmed that there had not been training that was specifically focussed on infection control issues. When this training is completed, there will be further assurance that satisfactory efforts are being made to promote the health, safety and welfare of service users, staff and other persons entering the premises. Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 20 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 3 3 2 x x N/A 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 x 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 2 x 3 x x 2 Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 21 yes 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 3 Regulation 14 (2) (a) Requirement The manager must ensure that the assessment of need is regularly reviewed. (Previous requirement - Progress had been made since the last inspection, but further monitoring by the manager is needed to ensure a consistently high standard is maintained) The manager must ensure that the service user plan is regularly reviewed. (Previous requirement - Progress had been made since the last inspection, but further monitoring by the manager is needed to ensure a consistently high standard is maintained) Surveys of service users views must be undertaken and a report of the results made available to service users and the Commission Training must be provided for staff on infection control measures Timescale for action 31 July 2005 2. 7 15 (2) (b) 31 July 2005 3. 33 24 (1,2,3) 30 Sept 2005 4. 38 13 (3) 30 Sept 2005 Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 22 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 Good Practice Recommendations Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection South Point Cardinal Square Nottingham Road Derby, DE1 3QT National Enquiry Line: 0845 015 0120 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 Landmere Residential Care Home C52 C02 S1991 Landmere V232064 090605 Stage 4.doc Version 1.30 Page 24 - 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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