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Inspection on 22/11/05 for Landmere Care Home

Also see our care home review for Landmere Care Home for more information

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

A warm and friendly atmosphere was prevalent throughout the home and staff were polite and helpful. Care plans in place were personalised, in depth and addressed service users complex needs.

What has improved since the last inspection?

The manager has contacted the falls assessment team and is awaiting an assessment of the home so individual service user assessments can take place. The relevant services and relatives are liaised with regards to the use of restraint. Restraint is only used in exceptional circumstances following consultation with relevant others to ensure best practice is maintained and service users are protected from abuse. Preadmission assessments are drawn up with prospective service users and relatives to ensure immediate needs are addressed during the initial settling in period and assessments within the home are ongoing.

What the care home could do better:

Further improvements are required with regards to ensuring appropriate risk assessments are in place with regards to the use of bedrails to fully protect service users. Evidence to substantiate that appropriate maintenance and servicing has taken place to ensure the health and safety of staff, relatives and service users is required. All staff employed are required to have the necessary documentation in place to fully protect service users. Further evidence is required to demonstrate staff are fully trained and competent to carry out their job role in order to fully meet service users needs.

CARE HOMES FOR OLDER PEOPLE Landmere Care Home Ruddington Lane Wilford Nottingham NG11 7DD Lead Inspector Karmon Hawley Unannounced Inspection 22nd November 2005 10:00 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 Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 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. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Landmere Care Home Address Ruddington Lane Wilford Nottingham NG11 7DD 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) 0115 9455940 0115 9827341 Lifestyle Care PLC Ms Yolanda Wasylko Care Home 70 Category(ies) of Past or present drug dependence over 65 years registration, with number of age (70), Dementia (10), Mental disorder, of places excluding learning disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (70) Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 10 or fewer service users who may be accomodated in categories MD and DE must be aged between 55 and 65 years. 2nd August 2005 Date of last inspection 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 Bridgeford is close by and provides shops, library and leisure facilities. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in one day and was performed by one inspector. The main method of inspection was case tracking, this is a method of sampling the records of five randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Due to the complex needs of service users conversation was not directly held, however the inspector observed staff in care practice and interaction so as to give the inspector an insight into the conditions and standards within the home. Staff demonstrated a caring atmosphere and that a good rapport was maintained with service users. The acting manager assisted in the inspection process and three members of staff were spoken with. Staff were knowledgeable and able to discuss the needs of service users and the core values and principles. The purpose of this inspection was to assess the remaining core standards and the requirements set at the previous inspection and therefore the report should be used in conjunction with the previous inspection report. What the service does well: What has improved since the last inspection? The manager has contacted the falls assessment team and is awaiting an assessment of the home so individual service user assessments can take place. The relevant services and relatives are liaised with regards to the use of restraint. Restraint is only used in exceptional circumstances following consultation with relevant others to ensure best practice is maintained and service users are protected from abuse. Preadmission assessments are drawn up with prospective service users and relatives to ensure immediate needs are addressed during the initial settling in Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 6 period and assessments within the home are ongoing. 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 Care Home DS0000026450.V267766.R01.S.doc Version 5.0 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 Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: Not assessed during this inspection. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10 Service users individual needs are set out in a plan of care ensuring needs are met, however this may be compromised due to a lack of information available in some risk assessments and reviews. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Service users undergo various assessments with regards to nutrition, incontinence, dependency, manual handling and the activities of daily living, information gained form the basis of the plan of care. Care plans in place were in depth, personalised and addressed complex needs. Reviews were evidence to take place however the frequency of these was not consistent between plans of care. In one file observed the care plan had not been reviewed for seven months. Risk assessments were in palace, however within one case file where the service user used bed rails there was no risk assessment in place with regards to this. There was evidence of observations taking place however one service user who was diabetic and it had been highlighted within her plan of care that her blood sugars were unstable due to refusing to take her medication there were no records of blood sugars since July 05. Daily running records were in depth and covered significant events. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 10 Staff are instructed on maintaining service users privacy and dignity during training, staff spoken with were able to substantiate this and were observed to do so in practice. There are no restrictions on visiting times and relatives are aware of the key codes so they may visit more easily. All consultations are carried out in private in the service users own room. Mail is given to relatives, as service users are unable to deal with this. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Service users are enabled to find a lifestyle that suits their need; they may maintain contact with family and relevant others as desired and exercise choice and control over their lives where able. Service users receive a wholesome and appealing diet in pleasing surroundings. EVIDENCE: Staff spoken with described a flexible routine based upon service users needs so as to offer optimum care. Service users are enabled to make choices as able with regards to how they spend their day and what time they get up and retire to bed. There is an activities coordinator employed who carries out activities on a group or one to one basis. There was evidence within plans of care that social assessments have taken place to enable this process and ensure that past experiences, likes and dislikes are taken into consideration. As no service user is able to handle their personal finances relatives act on their behalf, there is also a banking facility at the home should it be required. Although not used at present advocate would be used if necessary. Visitors are welcomed at any time during the day and these may be received in private should it be desired. There is a coffee morning held every week and there was evidence of visitors coming freely and being welcomed into the home throughout the inspection. The manager stated religious observance is facilitated within the home as required. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 12 A seasonal four weekly menu is in use, which reflected a wholesome, balanced and appealing diet. Although no specific choices are offered at the main meal it is made apparent that alternatives are available on request. Staff spoken with substantiated this and discussed the choices some service users make. Records within the kitchen were satisfactory with the exception of the temperature recording of fridge three which demonstrated that this has been running at a high temperature for a significant amount of time. The chef was able to discuss special diets and how these are accommodated. Staff were observed to assist service users during the main meal in an appropriate manner. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users are protected from abuse. EVIDENCE: Relevant policies and procedures are in place with regards to protecting vulnerable adults. All staff employed have undergone successful criminal records bureau checks and protection of vulnerable adults checks as required. Staff when spoken with were able to discuss these procedures in a satisfactory manner and the action they would take should they suspect abuse is occurring. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The home is clean pleasant and hygienic. EVIDENCE: There are ample domestic staff employed to maintain the cleanliness of the home. Staff when spoken with stated they had had instruction with regards to infection control and they were observed to wear protective clothing as required. Ample hand wash facilities were in place as was appropriate equipment and laundry facilities. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The number and skill mix of staff meets service users needs. Whilst there is evidence of staff training it is questionable as to whether staff are fully trained and competent to carry out their jobs and that service users are in safe hands at all times. Service users may be placed at a degree of risk due to the homes recruitment polices and practices. EVIDENCE: The duty rotas were observed and demonstrated that sufficient staff are employed and allocated to each unit in the home. Highlights where shifts need covering and where agency is used. Staff spoken with stated that there was enough staff employed however on occasion due to sickness numbers were low, however where possible this is covered with agency. Training records observed demonstrated that 4 staff are working towards their national vocational qualification (NVQ) level 2 and 1 member is working towards level three, there have been difficulties in the past with regards to providers, however this has now been addressed and further staff are to commence their NVQ. On commencing work staff undertake an induction and foundation course of which there was evidence within staff personnel files, this was at a recognised level. Five staff personnel files were observed, one file, a registered nurse did not have evidence available to demonstrate that the personal identification number was current. There were no photographs, copies of birth certificates or passports as proof of identity. These files contained a wealth of information with regards to disciplinary action if any and liaison with staff, this proved Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 16 difficult to find relevant information due to the shear amount of paper work in each file. Staff training records observed demonstrated that training is taking place however did not provide evidence to substantiate that staff have been trained in all mandatory areas, such as fire, manual handling, health and safety, first aid and food hygiene. The acting manager stated that arrangements are currently in hand with regards to further training in adult protection and dementia care. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 The home is run in the best interests of the service user and managed by a person who is of good character and able to discharge his responsibilities. The health safety and welfare of service users and staff is compromised due to the noted deficits. EVIDENCE: The acting manager has been working at the home for the past seven and a half years; one year as the acting manager. He is awaiting registration and is to complete his application. As a registered nurse in learning difficulties he has a wealth if experience and knowledge and remains up to date with mandatory and specific training. He is currently working towards the national vocational qualification registered managers award. Questionnaires are sent to relatives and service users if they are able to complete them, these are then sent to the head office where responses are collated, results are then passed back to the home manager so an action plan Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 18 may be prepared to address any concerns. Completed questionnaires were observed, generally results were satisfactory and of a positive nature. The manager has an annual development plan with regards to long-term improvements; this is due to be addressed in January of next year. Policies and procedures are updated as required to ensure best practice is maintained. Maintenance certificates with regards to the gas, mains electrics, clinical waste and lift servicing were not available for inspection, whereas certificates with regards to the chlorination of water tanks and the lifting hoists were available. The portable appliance testing was out of date. The maintenance man carries out routine maintenances and required checks within the home and there was evidence available to substantiate this. Accident records contained relevant information. Proof of identification was lacking in staff personnel files and a registered nurses professional identification number had not been checked as current since April 2004. Evidence of blood sugar monitoring was not available in one service users care plan. Also in one care plan where bed rails were in use there was no risk assessment in place with regards to entrapment. The fridge number three in the kitchen was noted to be running at a consistently high temperature. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X X X 1 Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 13(4,c) Requirement The registered person is required to ensure that appropriate risk assessments are in place with regards to the use of bedrails to fully protect service users. Ensure appropriate monitoring and recording takes place with regards to complex needs and To monitor fridge number three temperature and if consistently high to replace to ensure service user safety. All staff employed are required to have items as listed in schedule two in place. To provide evidence of the registered nurses professional identification number and to put practices into place to ensure these are checked on a regular basis to ensure they remain current. To provide evidence that staff are individually and collectively trained with the required knowledge and skill to carry put their job role. To provide evidence of maintenance and servicing check DS0000026450.V267766.R01.S.doc Timescale for action 23/12/05 2 3 OP7 OP15 12(1,a) 23(2,c) 30/11/05 23/12/05 4 5 OP29 OP29 Schedule 2 19(1) 18(3) 23/02/06 24/11/05 6 OP30 18(1,c,I) 23/02/06 7 OP38 23(2,c) 07/12/05 Landmere Care Home Version 5.0 Page 21 and forward to the commission. 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 OP7 Good Practice Recommendations To carry out service users reviews of plans of care on a monthly basis. Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Nottingham Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Landmere Care Home DS0000026450.V267766.R01.S.doc Version 5.0 Page 23 - 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. 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