Inspection on 04/03/08 for Landmere Care Home

This inspection was carried out on 4th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Landmere Care Home 23/08/08

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 02/08/05

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 Care Home Ruddington Lane Wilford Nottingham NG11 7DD Lead Inspector Karmon Hawley Unannounced Inspection 4th March 2008 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.V360596.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 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 945 5940 0115 982 7341 manager.landmere@lifestylecare.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Vacant 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.V360596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 10 or fewer service users who may be accommodated in categories MD and DE must be aged between 55 and 65 years. 12th September 2007 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. Due to recent changes in restrictions to ages within registration categories, the registration certificate is now incorrect following review and will be replaced by the CSCI. The provider remains responsible for reflecting the specific services available within the statement of purpose. 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. The range of fees is from £423:00 to £660.00; this does not include hairdressing, chiropody and toiletries. This information together with last inspection report is available upon request. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of the inspection undertaken by the Commission for Social Care Inspection is upon outcomes for service users, and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that require further development. This was an unannounced key inspection undertaken by one inspector, which took place over the course of two days. The main method of inspection used is called ‘case tracking’ which involves selecting four people who use the service and tracking the care they receive through checking their records and discussion with them, and observations of the care received and asking staff about their needs. Five people using the service and four members of staff were spoken with as part of the inspection. Other people who were not part of the case tracking were observed during a specialist observation, which focuses on outcomes for people using the service. Documents and medication policy and practice were examined as part of the inspection to gain evidence and form an opinion about the residents’ health and safety. A partial tour of the premises was undertaken which included communal areas, and a sample of bedrooms to ensure that the environment was pleasant, homely and safe. What the service does well: A warm and welcoming atmosphere was present on entering the home. Staff were observed to interact with people who use the service and their relatives in a professional and caring manner. People spoken with who use the service offered the following comments, ‘ I am very settled and comfortable here, the staff are very nice and look after me,’ and ‘I like it here, I can do as I wish, I often make my own decisions as to what I do with my time.’ There is a wide range of activites available for people to join in should they wish, and for those people who are less able, time is spent on a one to one basis carrying out stimulation work. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 6 The menu on offer is well balanced and appealing and all service users spoken with confirmed that food was good and plentiful. To enable people who use the service to maintain relevant contacts there are no restrictions imposed upon visiting. Staff continue to undertake training in all compulsory areas and were able to discuss peoples needs to a good standard. What has improved since the last inspection? The statement of purpose has been updated to ensure that all the necessary information is available that someone may need to make a decision about whether to move into the home. Records in regards to monitoring peoples behaviour, weight and pressure area care are in place thus ensuring that peoples needs are monitored and met. Plans of care are developed and reviewed in consultation with relevant others thus ensuring that people are appropriately involved and their needs are met. The deputy manager and nurse in charge are currently assessing all people using the service in regards to their ability to self medicate, therefore promoting their rights and choices. Additional methods have been employed to enable people using the service to continue to practice their religious beliefs, a private area is available should a person wish to use this for prayer. The complaints procedure has been improved and all concerns and complaints are recorded and investigated appropriately to ensure that these are resolved. The acting manager has readdressed staffing levels to ensure that sufficient staff are available to meet peoples needs and to ensure that staff are not working alone and are therefore protected. Additional work has taken place in regards to ensuring that all staff have Criminal Record Bureau checks (a police check to see if an individual has a police caution or criminal record) in place, thus ensuring that people using the service are further protected from unsuitable people being employed. The acting manager has submitted an application to become the registered manager to ensure that the home is run and managed by a person who is fit to be in charge. All records were available for inspection, thus ensuring that the Commission was able to carry out its work in monitoring the service. To protect and safeguard service users’ welfare, notification is now sent to the Commission when people are admitted to hospital. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 8 be made available in other formats on request. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 9 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.V360596.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who move into the home are assured that they will have the necessary information available to them to make an informed decision. People who move into the home will be assured that their needs will be assessed and that these can be met on entering the home. The service does not offer intermediate care. EVIDENCE: The service’s statement of purpose has now been updated to ensure that anyone who may decide to move in to the home has all the necessary information that they will need to make an informed choice. This is available to visitors and is on display in the main entrance of the home. Before admission to the home, the acting manager or a registered nurse visits people within the community to carry out a preadmission assessment to ensure that the staff can meet the needs of this person. There was evidence of the preadmission assessment taking place within those care files examined. A Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 11 member of staff spoken with outlined the arrangements that take place before someone is admitted to the home to ensure that all the necessary equipment is in place to enable their needs to be met. The service does not offer intermediate care. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Despite plans of care being in place these are not always followed in working practices, which results in peoples needs not being fully met. The current restrictive practice of using lap belts does not support people in ensuring that they are safe from the risk of entrapment and protected from potential abuse. Although staff demonstrated a good understanding in regard to ensuring that dignity is upheld when speaking with them, working practices do not always ensure that this happens. EVIDENCE: To enable people’s needs to be assessed and a plan of care devised people using the service undergo various assessments such as nutritional needs, manual handling and skin care. Plans of care in place addressed people’s personal preferences, however were mainly task focused, there was evidence available to demonstrate that service users where able or their relatives had been involved in the care planning procedure. Plans of care were in place for peoples identified needs, however there was evidence obtained during the observational period that showed that these were not always followed in Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 13 practice. For instance in regard to the use of lap restraints, brief risk assessments were in place, which stated that people using these devices must be checked on an hourly basis and this logged on an observational chart. However during the observation that took place over a two hour period, two people who had lap belts in place had not been checked, one persons was noted to be very loose with a gap of approximately 30 cm, leaving them at risk of entrapment should they slip in their chair. On asking for the observation sheets, there were none available, as these had not been completed. Following this the nurse in charge adjusted the lap belt in question to ensure the person was safe. During the tour of the home another person who had a lap belt in place was seen to have slipped down in their chair, the lap belt had prevented them from falling on the floor, however this person had not been supported to move back up the chair despite a member of staff being in the room. Plans of care also did not fully address a person’s capacity to consent in regards to the use of lap belts and restraint. There was no evidence that this use of restraint had been fully discussed with the person or their relatives or alternative measures tried before this option decided upon. Staff were not spoken with about this issue until the following day, on speaking with them they confirmed that the deputy manager had reinforced the policy with them all that morning in regard to the use of lap belts and the observations that must be made, therefore each member of staff was able to discuss these issues. When looking at the observation charts these had since been completed, however in regard to the actual checks, it simply stated which room the person was in. Plans of care also stated that people are to have individual activity programmes in place, there was a lack of evidence available to demonstrate that this takes place, which is further discussed in standard 12. To ensure that health needs are met records for monitoring weight, challenging behaviour and turning service users were maintained up to date. All service users spoken with said that they were happy with the level of care that they received and that they felt that their needs were met. Staff spoken with were able to discuss service users individual needs and the level of support that they required in meeting their needs. There was evidence in plans of care of those people using the service to show that the necessary equipment that they needed had been made available and this was verified on a partial tour of the home also. There was also evidence of people accessing relevant services such as the general practitioner, opticians and dentist as required. One person using the service spoken with said that they could see the doctor if they needed to. The medication practices and procedures were observed. Four peoples prescriptions were checked against the medication record, these corresponded ensuring that people using the service were receiving the correct medication. On observing the fridge temperatures there were of a number of gaps in the recording of these, also room temperatures where medication is stored had Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 14 not been checked to ensure that all medication is stored at the correct temperatures, thus maintaining its working properties. Staff had begun to complete a number of risk assessments in regard to people using the service to ascertain if they would be able to manage their own medication, thus working towards complying with the requirement set at the previous visit. Each person’s room has a doorknocker to ensure that people knock on their doors before they enter. Staff were observed to knock on service users doors before they went in. Staff spoken with were able to discuss the issues in regard to ensuring that a persons privacy and dignity is upheld, for instance ensuring that personal care is offered according to their wishes and religious beliefs. However during the observation one person was observed to raise from their seat and their trousers fell down, as they were too big, they were assisted by a member of staff to remedy this; however it occurred again, once more in the quiet room and once in the dining room before the trousers were changed to prevent his happening again. As this was not remedied at the first instance and it subsequently happened again this detracted from ensuring that the person’s dignity was upheld. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are enabled to partake in activites should they wish, however further consideration to those less able would enhance their quality of life. Attention to the way in which staff assist people to eat their meals is needed to ensure that peoples dignity is upheld at all times. EVIDENCE: Activites staff are available to assist people using the service to join in activites should they wish. A range of activites are provided such as arts and crafts, reminiscence, music, gentle keep fit seasonal work and reading to people using the service. A large activites room is available for people to use should they wish and there is an outside seating area that people can enjoy. During the visit three people were seen to enjoy making Easter egg decorations, the staff member assisting them worked at each person’s own pace and enabled them to complete the parts that they were able. During this time those people participating in activites were seen to be in a state of wellbeing, thus enhancing the quality of their life. The people who had not or had been unable to join in the activites at this time spent the observation time mainly asleep or unengaged in anything or with anybody, the only time they appeared to be aware of their surroundings was when they were assisted by staff to eat or Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 16 drink. This was discussed with the activites coordinator who stated that time is still given to those people who are unable to join in activites and things such as hand massage and time spent talking to them or listening to music is spent, this was stated within their plans of care, however there was no further evidence within the running records to state that these had taken place. Two people living at the home spoken with said ‘I enjoy the activites here, I am not that good but I always join in, I am hoping to have a hand massage today, they are very good,’ and ‘there are activites to join in if I want to, I do sometimes but not all the time.’ During the observational period it was seen that with the exception of the time spent offering activites to people using the service, the majority of time staff spent with people was mainly attending to tasks, such as offering drinks and assisting people to go to the bathroom. In the case of one person observed the only attention afforded to them during the observational period of two hours was to assist them to have a drink and for another person to have a drink, to move a limb to make them more comfortable and to assist them to eat their lunch, no other interaction took place. There were several episodes of poor interaction where staff either spoke over people or spoke to them in a commanding manner indicating the tasks they were to perform, this detracts from the persons sense of wellbeing and dignity. The activites coordinator is also developing contacts within the local community and has been trying to organise religious input for those people who want this. Staff spoken with said that should anyone wish to go out to church they would be supported to do so, however there is no one who wants to do this at the moment, which is why the activites coordinator is trying to get some services in house. To enable those service users who are less able to partake in their religious needs, compact disc music and services have been obtained for them to listen to. Should a person wish to pray all the staff members spoken with said that this would be facilitated and a private room made available for them to use during this time. To ensure that people maintain contacts that are important to them, there are no restrictions imposed upon visitors and to ensure ease of movement throughout the home they have access to any codes required. Several visitors were seen throughout the visit to enter the home and converse in an easy manner with staff. Staff spoken with discussed how they support those people who wish to maintain personal relationships and stated that it would not make a difference if a relationships was between a couple of the same sex, in all instances respect and privacy would be offered. Two people using the service said, ‘ I am very happy here, my family visit, not often but at least they come,’ and ‘my visitors are always made welcome.’ A wholesome and appealing menu is on offer with choices available at each mealtime. People using the service said, ‘food is good here and I get enough to eat,’ and ‘there are choices at each meal if you do not like something.’ On Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 17 the first day of the visit the lunchtime meal looked appealing and people were seen to enjoy their meal. For those people who needed assistance this was given in a discreet manner. However in one instance a member of staff assisting one person, kept saying in a commanding voice, ‘open,’ ‘open,’ each time they were delivering a spoon of food, this detracted from maintaining the persons dignity. All meal times are now protected (staff are not allowed to take breaks during this time) to ensure that sufficient staff are available to assist people using the service as they need. The lunchtime meal on the first day of the visit was at a relaxed pace due to this arrangement and people could eat their lunch when they were ready for it. Special diets are also catered for. Staff were able to discuss how arrangements have been made and family have been liaised with in regard to peoples religious dietary needs. Three people using the service spoken with all stated that food was at a good standard, plentiful and choices were available. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are assured that their complaints or concerns will be listened to and resolved appropriately. Staff have an understanding of monitoring poor practice and concerns are investigated appropriately. EVIDENCE: The service has received four complaints since the previous inspection, all of which had been logged, investigated appropriately and resolved, thus demonstrating compliance with the requirement set at the previous visit. The complaints procedure is on show in the main entrance hall to ensure that relatives are aware of how to complain should they feel the need to. The acting manager also holds surgeries where relatives may spend time with her to discuss any concerns should they arise; there was evidence in the meeting folder to show that some relatives had used this service. Staff spoken with were able to discuss how they would deal with a complaint should one be received. One service user spoken with said that they felt comfortable with staff and they would be able to tell them if they were unhappy about anything, they said, ‘I can talk with the staff if I am unhappy about anything. I wouldn’t want to be anywhere else.’ Eighty six percent of staff have undertaken training in the protection of vulnerable adults. All staff members spoken with were able to discuss relevant issues in regard to this and their responsibilities in reporting poor or unsafe practice to ensure that people using the service are protected. There are Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 19 currently two safeguarding issues under investigating, one in regard to a fall that a person using the service sustained and another in regard to a member of staff. There was evidence available to demonstrate that the acting manager was fully involved with the investigation and was working with the safeguarding adults team. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service live in a well-maintained environment, which is clean and comfortable, however they may be placed at a degree of risk should a fire break out due to the practice of propping open fire doors. EVIDENCE: There was evidence of ongoing maintenance taking place within the home to ensure that people using the service live in a comfortable and well-maintained environment. The maintenance person was working at the home on the day of the visit and there were positive comments noted within service users meeting minutes about the work that had taken place. The downstairs units have all been redecorated and new furnishings purchased, offering people a more comfortable environment. There are also paintings on the wall, which aid reminiscence and tactile boards (boards which contain everyday objects such as materials, zips and door knobs that people can touch and feel). The key coded pads have been removed from the main communal room doors, however throughout the visit it was observed that these had been propped Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 21 open when people were using or accessing these rooms, thus presenting a risk to people should a fire break out. This was discussed with the deputy manager who removed these immediately. The maintenance person showed us that a quote had been obtained in November of last year to obtain self-closing devices. One person using the service spoken with said, ‘there is plenty of room here and I am comfortable.’ Sufficient domestic staff were seen throughout the visit and the home was clean and tidy in all areas. One person using the service said that staff help them to keep their room clean and tidy. Staff spoken with said that sufficient equipment such as gloves and aprons were available as needed to ensure that effective infection control procedures were maintained. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The increase in staffing numbers has enabled more quality time to be spent with people using the service. Although staff undertake compulsory training and attend supervision sessions, as staff do not always follow good practice it is questionable whether both the training and supervision of staff is effective. EVIDENCE: The acting manager has undertaken additional work to reassess the dependencies of people using the service; she has considered the layout of the building, the staffing levels and their deployment to ensure that sufficient staff are available to meet peoples needs. The staff duty rota seen was a true reflection of the amount of staff in duty on the day of the visit. All staff spoken with stated that the staffing levels had increased and that they felt that people were now more settled as additional staff were available to tend to their needs. They also stated that this had increased staff morale, which in turn has had a positive effect on people using the service. Throughout the visit staff were observed to be in prominent positions throughout the home. Two people using the service stated that they felt they there were enough staff available to meet their needs, and offered the following statements, ‘staff help me to the toilet, they are always there when I need them,’ and ‘I can have my independence and staff offer encouragement and support when I need it.’ Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 23 To ensure that staff are aware of their roles and responsibilities they undergo an induction, which covers all the information they need to know at the start of their employment. There was evidence of staff undertaking inductions within staff files observed. One member of staff spoken with said that they were on their induction at the moment and they felt very supported by the staff and that they had been made welcome to the team. To ensure that staff have a wide range of knowledge and skills in caring for the people who use the service, eight members staff have undertaken the National Vocational Qualification (a nationally recognised work and theory based qualification) level 2 in care and 3 are working towards this qualification. Three members of staff have also completed level 3 and one is working towards this qualification. Two members of staff spoken with said that they had undertaken this training, which they felt had been extremely beneficial to them. Six staff files were observed to see if they contained all the necessary documentation required by law to ensure that service user are protected from unsuitable people being employed. Five files contained all the required documentation and there was evidence that additional work had taken placed since the previous inspection to gain a number of Criminal Record Bureau Checks (a police check to see if an individual has a police caution or criminal record) for those staff members who did not have one on file. However during this process one member of staff had not completed their application, resulting in them being employed without this check in place. The deputy manager immediately contacted this person and they were removed from the duty rota for the foreseeable future until a satisfactory check had been received. In light of this a proportionate approach was taken in respect of the requirement set at the previous inspection and enforcement action was not considered at this time, however should this breach reoccur this will be reconsidered. Staff training in a number of areas such as manual handling, dementia care, fire training and health and safety continues to take place to ensure that staff have the necessary skills to meet peoples needs. However during the observation period there was evidence that staff were not always following good practice, such as propping open fire doors and not carrying out the observations required when people are using lap belts. Staff spoken with all stated that they felt supported in their training needs and that training was at a good standard. There was evidence of staff undertaking supervisions with senior staff members to monitor their work performance. Staff spoken with stated that they felt that these sessions were beneficial to them. One person using the service stated that they felt that staff were well trained as they knew how to look after them. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although quality assurance monitoring takes place it would be beneficial if views and opinions are sought from people who use the service and their relatives to enhance this process. Although relevant checks and training take place in regard to health and safety working practices then compromises this, which leaves people using the service at risk. EVIDENCE: The acting manager is in the process of going through the necessary procedures to become the registered manager if successful. All staff members spoken with said that the home had improved greatly in many areas over the last months and that they felt the management team supported them and that they were approachable. The administrator has been promoted to the deputy manager to support the manager in her job role. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 25 To promote a quality service an ongoing quality assurance auditing system takes place. This includes audits in all areas of the home such as the environment, care planning, medication and accidents that have occurred. Actions plans are then devised to address any areas of concern. As yet surveys have not been sent to service users or their relatives so their views have not been obtained in this way, however regular meetings for people using the service and their relatives are held, minutes of these meetings were seen and it was evident that both are given the opportunity to express their views and opinions. One comment made during the latest meeting was ‘I am glad we are all good friends, I like it here and couldn’t think of anything I would like to change.’ Regular staff meeting also take place, the minutes showing that issues such as the standards of care provided and training are discussed. One staff member spoken with said that a staff meeting had taken place, however they were unsure when the next one would be. Due to the current needs of people living in the home no one looks after their own money, therefore there is a safekeeping facility available. Four service users personal allowances were observed. Each account was kept separately and accurate records were available, demonstrating that finances are protected. Receipts were available for all transactions. The number of staff who may access these are restricted to senior staff, however should a person using the service require access this is always available. All the required documentation was available for inspection, demonstrating compliance with the requirement set at the previous visit. The acting manager ensures that the Commission for Social Care Inspection is informed of all events where a person has been admitted to hospital, thus ensuring that adequate monitoring of the service can take place. To show that relevant maintaince and servicing had taken place on equipment within the home, the hoist, lift and gas certificates were observed, these had all been serviced accordingly. Regular fire and emergency light testing was taking place and staff had attended fire safety training and fire drills to ensure that people were protected from the risk of fire within the home, however this was then compromised due to the practice of propping open fire doors in the communal areas. . Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 26 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 3 2 Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1) 15(1) Requirement Ensure that staff are fully aware of people’s plans of care and that these are carried to ensure that the individual needs of people using the service are met. Where restrictive practices or equipment such as lap belts are being used there must be evidence that an assessment has taken place to deem that this method is the only practicable means of securing the welfare of an individual and there are no other options available. Where restrictive practices or equipment such as lap belts are being used, appropriate care plans must be in place, to maintain service users safety and prevent potential abuse. To prevent potential abuse where practicable consent to care plans and the use of any restrictive equipment or practices should be sought from service users or their representatives. It must be ensured that people’s DS0000026450.V360596.R01.S.doc Timescale for action 04/05/08 2 OP8 13(7) 04/05/08 3 OP8 15(1) 04/05/08 4 OP8 15(1) 04/05/08 5 OP10 OP15 12(4,a) 20/04/08 Page 28 Landmere Care Home Version 5.2 privacy and dignity are maintained at all times; • ensuring that people are not in a state of undress, • that people using lap belts are sat comfortably at all times; and • people are assisted to eat their meals in a dignified manner. 6 OP9 12(3) Further evidence is required to demonstrate that assessments to promote independence and choice, in regard to people’s capacity to self-medicate have been completed. Due to work that has taken place, this requirement has been repeated, however evidence of compliance is now required. To ensure that service users are protected appropriate records of the date and reference number of staff criminal record bureau checks should be made available for inspection. Due to work that has taken place, this requirement has been repeated, however evidence of compliance is now required. Provide evidence that the auditing system used by the service demonstrates that staff continue to carryout good practice once they have received necessary training. Further develop the quality assurance systems to ensure that people who live in the home and their relatives have the opportunity to express their views and opinions, which will be fully considered. • Consult with the Fire authority regarding keeping doors open, whilst complying with Fire safety DS0000026450.V360596.R01.S.doc 30/04/08 7 OP29 19(1)(b) 04/05/08 8 OP33 18(1,c) 04/06/08 9 OP33 24(3) 04/05/08 10 OP19 23 (4,a) 08/05/08 Landmere Care Home Version 5.2 Page 29 • • regulations to keep people living at the service safe. Implement practice recommended by the Fire authority without delay. Cease practice of propping open doors. 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 OP9 Good Practice Recommendations Maintain systems to record and monitor the temperature where medication is stored to ensure that this remains effective and service users are welfare is maintained. Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Landmere Care Home DS0000026450.V360596.R01.S.doc Version 5.2 Page 31 - 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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