Inspection on 02/08/05 for Landmere Care Home

This inspection was carried out on 2nd August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Landmere Care Home 23/08/08

Landmere Care Home 04/03/08

Landmere Care Home 12/09/07

Landmere Care Home 13/03/07

Landmere Care Home 03/05/06

Landmere Care Home 22/11/05

Landmere Care Home 08/03/05

Landmere Care Home 07/10/04

Landmere Care Home 25/03/04

Similar services:

Hunter`s Lodge

Lester Hall Apartments

Harvey House

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

CARE HOMES FOR OLDER PEOPLE Landmere Ruddington Lane Wilford Nottingham NG11 7DD Lead Inspector Mary OLoughlin Unannounced 2 August 2005 - 10:00am nd 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 C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Landmere Address Ruddington Lane Wilford Nottingham NG11 7DD 0115 945 5940 0115 982 7341 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) Lifestyle Care PLC vacant Care Home with Nursing Care - Private 70 Category(ies) of D(E) - Drug Dependence over 65 70 registration, with number DE - Dementia MD 10 of places MD - Mental Disorder 10 MD(E) - Mental Disorder over 65 70 Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The 10 or fewer sevice users who may be accommodated in categories MD & DE must be aged between 55 & 65 years. Date of last inspection 08/03/05 Brief Description of the Service: Landmere Care Home is a purpose built home divided into four units with a total of 70 places. The home provides nursing care for people over 65yrs with Mental Disorder, Dementia, past or present drug dependence. Ten places can accommodate people from 55yrs with a mental Disorder or Dementia. The home was registered with the Commission in 2002 and the registered provider is Lifestyle Care PLC. The home is situated in a residential area of Wilford, south of and on a bus route to the city of Nottingham. West Bridgford is close by and provides shops, library and leisure facilities. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted unannounced by two inspectors, Mary O’Loughlin and Steve Keeling over 3.5hrs. The main method of inspection was case tracking, this is looking at the records and care plans of the residents to ensure that their needs are assessed and met by the home. Residents were spoken with and all confirmed they were happy with the care they received. The manager and deputy manager assisted throughout the inspection. The home was clean and well maintained. There were some areas of malodour and the manager has identified ways in which this is controlled. The level of staff on duty was sufficient to meet the needs of the residents. What the service does well: What has improved since the last inspection? Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 6 All previous requirements from the last inspection have been met. There has been significant improvement in the management of nutritional needs of the residents ensuring that each individual is assessed and referred to specialist support if required. The manager has completed dependency analysis to ensure effective deployment of staff and safeguard people from harm. The accident records are audited and the manager has looked at ways that staff deployment can reduce the risk of accidents occurring which is good practice. What they could do better: The manager must ensure that at the point of admission people have a care plan in place that enables staff to meet the person’s needs and keep them safe. Where residents are assessed as requiring restraint a risk assessment must be undertaken and any restraint should only be used as a last resort to maintain the immediate safety of the resident and or others. The methods of using communal type toiletries that are held securely to prevent accidental injury should be reviewed. The manager must look at ways in which individuals can have their own personal toiletries, which could be stored safely within the lockable drawers in each bedroom or other safe storage. There should also be written records of how residents’ personal finances are managed to ensure that as circumstances change they can be referred as necessary to financial or legal advisers. If the home are managing a person’s personal allowance they should also ensure that a monthly review of what they may need such as clothing or other personal items is undertaken and purchased on their behalf. Please contact the provider for advice of actions taken in response to this Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 8 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 C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Prospective resident’s receive an appropriate assessment of their needs which ensures that the home are able to meet their needs prior to admission. Delayed production of care plans for new admissions may not ensure the resident receives appropriate care and support in the first days of admission and may put them at risk. EVIDENCE: The records of a recent admission were examined which contained a discharge summary provided by the NHS Mental Health Services. There was also evidence that prior to accepting the person into the home the manager had conducted an assessment of the person’s needs to ensure that the home was able to meet those needs. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 10 Although the person had been at the home for six days there was no care plan in place which addressed the immediate needs and ensure that staff would know how to care for him. Daily records did contain a summary of the most pertinent problems and staff were familiar with the person’s needs, it was also clear that action was being taken in response to changes in the person’s condition. However, if there is a lack of continuity with staff on duty this method of verbal communication and daily records may not safeguard the person from harm. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 11 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 The health and personal care of the residents is generally well documented providing staff with good instruction on which to base the care to be provided and ensure that residents receive appropriate care and are kept safe. The management of falls and the use of restraint do not always safeguard the resident from harm. EVIDENCE: The records of four residents were examined and found to contain comprehensive assessments of the person’s activities of daily living. Records were clear and provided staff with all the information on which to deliver care. Health care was well documented and appropriately managed. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 12 There was evidence of external support from specialists and annual reviews of medicines. Residents received visits from the chiropodist, ophthalmologist and dietician. Nutritional assessment and care planning was very well recorded and ensured that resident’s received monthly monitoring of their weight and daily dietary supplements when recommended. Each person has a monthly review of their tissue viability and appropriate intervention to prevent them developing pressure sores. Resident and relative are invited to be involved in care planning and when the care plan is agreed the resident or relative signs it. Falls risk assessment is in place. One resident had been assessed as requiring restraint in his armchair to prevent him from falling. There was a daily record of the implementation of this restraint but no risk assessment or multidisciplinary assessment had been undertaken to ensure this was the best practice with this individual. Mental health and behavioural problems were appropriately assessed and care plans were in place to ensure staff were informed of how to deal with potential problems. Medicines were recorded onto the home and appropriately stored and administered by trained nurses. Hand written medicine record sheets did not contain a signature and countersignature of the person writing up the medicine instructions which is best practice to ensure mistakes do not occur. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 13 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) EVIDENCE: These standards were not assessed at this inspection. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 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) 16There is a complaints procedure made available to all residents and relatives that ensures people know how to refer their complaints and what to do if they are unhappy with the home’s investigation. EVIDENCE: The Commission for Social Care Inspection has addressed two complaints against the home since the inspection of March 2005. The home responded appropriately to the investigations and took immediate action to address concerns. One referral has been made for Adult Protection agencies to investigate an allegation of abuse. The outcome of which was not upheld. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 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 - 25 The home provides a safe well-maintained environment for residents. EVIDENCE: The home was clean and warm with well-ventilated areas and access to external spaces for the residents. The home has a long-standing problem-controlling odour in certain areas. The carpets are cleaned on a rotational basis and there are Ozone machines in areas of malodour. The building complies with local fire and environmental services. External doors are kept locked and keypad devices secure internal areas to safeguard people who may be at risk of wandering. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 16 Generally the home is in good decorative order with a programme of routine maintenance and renewal in place. Chemicals are safely stored. Hot water is regulated at safe temperatures in the rooms of the residents case tracked, one main bathroom had hot water exceeding safe temperatures in the wash hand basin which may be a risk to the residents. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 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) 27 There are sufficient numbers of staff to meet the needs of the residents. EVIDENCE: The staff duty rota records what staff are on duty throughout the 24hr period. The numbers of staff on duty were compliant with the agreed minimum level. Trained staff are skilled in both Mental Illness and General Nursing. Staff deployment is directed according to the dependency levels of the residents. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 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) -35 Residents are safeguarded by the accounting and financial procedures at the home. EVIDENCE: The acting manager has applied to register with the Commission for Social Care Inspection. Resident’s finances are managed according to the provider’s policy. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 19 The provider, Lifestyle Care maintains a central account into which the resident’s monies are deposited and a summary of any interest on the deposited funds was evidenced during the inspection. All incoming and outgoing payments are recorded and receipts are held which safeguards residents from abuse. One resident had been referred to the Guardianship Office to ensure her financial affairs were appropriately managed. Generally information on who was managing or had power of attorney for each resident was not recorded within the person’s file which would be best practice and ensure that this area of need was regularly reviewed with referral to legal or financial representatives as required. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 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 x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 3 x x x x x 3 x STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 x x x Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 15 Requirement The registered person must ensure that folowing the preadmission assessment a care plan is drawn up with the prosective resident and representative that will address the immediate needs of the resident whilst the initial settling in period and assessment within the home is ongoing. The Registered Person must ensure that no service user is subject to physical restraint unless restraint is the only practical means of securing the welfare of that or any other service user and that these are exceptional circumstances. A clear description of physical intervention should be within the care plan and should reflect government guidance. It is essential that where the service user lacks the capacity to give consent to the care they receive, a wider consultation process will be necessary, including members of the multidisciplinary team, GP, Consultant, Community Nurse, Occupational Therapist, relatives C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Timescale for action 31st August 2005 2. 8 12 31st August 2005 Landmere Version 1.40 Page 22 and advocates. 3. 8 12 The Registered Person must 31st August ensure that the care provided is 2005 based on current good practice and reflects relevant specialist guidance. For service users at an increased risk of falling the home must involve Community Occupational therapists to ensure the care provided is appropriate to meet the needs and control the risk of injury. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 25 35 Good Practice Recommendations The registered person should ensure that hand written medicine instructions are signed by the person writing them and checked by a second person. The registered person should ensure that a risk assessment of the bathroom 150 is undertaken to assess the risk of how water temperatures. The registered person should record how the personal finances are managed and by whom. Landmere C53 C03 S26450 Landmere V241854 020805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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