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Inspection on 24/04/08 for Lands House Care Home

Also see our care home review for Lands House Care Home for more information

This inspection was carried out on 24th April 2008.

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

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

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

What the care home does well

Lands House has a relaxed welcoming atmosphere; people living at the home and visiting relatives and friends confirmed this is always the case. Some form of activity takes place most afternoons with a wide choice available for the people using the service to participate in if they choose to do so. The activities are recorded. It is clear that staff work as a team to meet the physical, personal and emotional needs of people who live at the home. The meals provided are of a very high standard. People said that the food is first class. The acting manager and staff are committed to providing a high level of care to people and to keeping clear and detailed records of the care provided.The acting manager told us that she has an excellent team of people, qualified nurses, care workers and ancillary staff who she knows are committed to providing a good service to people who live at the home, at all times. The home has a committed acting manager who takes her role very seriously and heads up a professional nursing service.

What has improved since the last inspection?

There is a programme of National Vocational Training (NVQ) training in the home and records show that the home now has in excess of 50% of care staff that have completed or enrolled on level 2 or 3. Or its equivalent. A programme of refurbishment and re-decoration of the home is on target, all of the communal rooms and many private areas have been brought up to standard, some are yet to be completed. The provider advises that the external paintwork is to be completed this year and a decision will be taken when estimates are all in. There are firm plans to build a new care home in the grounds of Lands House. The plans being to then convert the existing premises into independent living units. The outside courtyard has been re-surfaced so that people can sit out in comfort and safety in the warmer weather. Some bedroom light cord switches are not within reach from bed. This is difficult to change in a building of this complexity however, there is a programme to provide touch lamps for everyone, which is on the way to completion. This will give everyone control of lighting in their bedrooms Concertina doors have been provided to all en-suites where previously curtains were fitted. In one shared bedroom the occupants declined this and prefer the curtain, their wishes have been met. Staff duty records are now accurate.

CARE HOMES FOR OLDER PEOPLE Lands House Care Home New Hey Road Rastrick Brighouse West Yorkshire HD6 3QG Lead Inspector Mavis Pickard Key Unannounced Inspection 24th April 2008 11:00 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 Lands House Care Home DS0000060872.V363019.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. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lands House Care Home Address New Hey Road Rastrick Brighouse West Yorkshire HD6 3QG 01484 716633 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) Mrs Georgina Copley Vacant post Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2007 Brief Description of the Service: Lands House, which is registered to provide nursing and personal care for up to 30 older people, is a spacious detached property situated on New Hey Road in Rastrick with easy access to the town centres of Halifax, Brighouse and Huddersfield. Local community facilities are nearby. The property is generally well maintained provides accommodation in single and double rooms. Safe and accessible garden areas with seating are available for the service users to enjoy, especially in the summer months. The weekly charges at the home range from £339 to £470:50 with a £5:00 top up and additional charges made for personal toiletries, newspapers, hairdressing and podiatry. Lands House Care Home DS0000060872.V363019.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 1 Star Adequate. This means the people who use this service experience adequate quality outcomes. As part of this key inspection, a visit to the home took place. Whilst at the home, key documents such as care assessments, care plans, risk assessments, daily records and the home’s policies were looked at. We had a tour of the home and some people who live at the home showed us their private accommodation. We spoke with 6 people who live at the home and with visitors. We spoke with the acting manager, the cook, the laundry person and the maintenance person. We also spoke informally with other staff on duty. Staff were very welcoming and were seen to be going about their roles in a relaxed way. We noticed in particular that staff spoke with people in a respectful and friendly way. People we spoke to told us that “it’s a happy place to live” “ the staff are lovely” “ I’ve only been her a week but I feel comfortable and safe ” “I can do as I want” and that “staff are here to help me if I need it” What the service does well: Lands House has a relaxed welcoming atmosphere; people living at the home and visiting relatives and friends confirmed this is always the case. Some form of activity takes place most afternoons with a wide choice available for the people using the service to participate in if they choose to do so. The activities are recorded. It is clear that staff work as a team to meet the physical, personal and emotional needs of people who live at the home. The meals provided are of a very high standard. People said that the food is first class. The acting manager and staff are committed to providing a high level of care to people and to keeping clear and detailed records of the care provided. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 6 The acting manager told us that she has an excellent team of people, qualified nurses, care workers and ancillary staff who she knows are committed to providing a good service to people who live at the home, at all times. The home has a committed acting manager who takes her role very seriously and heads up a professional nursing service. What has improved since the last inspection? What they could do better: The service provider must take steps to ensure that service has a registered manager. The acting manager must take advice from ‘Skills for Care’ to see if her current management qualification meets current requirements. If this is not the case she should take steps to enrol on a suitable NVQ level 4 management course. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 7 The provider should ensure that the person in day-to-day control of the home has sufficient supernumerary hours[additional to hours as the only nurse on duty] to meet administration and management responsibilities. It remains the case that some private accommodation requires re-decoration and re-furbishment. The room commonly used for respite care should be redecorated when it is vacated and before anyone else is admitted into it. 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 be made available in other formats on request. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are assessed before moving into the home and they are provided with written information about the services and facilities provided. EVIDENCE: The home has a clear detailed Statement of Purpose and service user guide that contains up to date information about the facilities provided, by the home. This means that people have sufficient information about the home before making a decision to move in. The acting manager and/or a social worker assesses all people before they move into the home, to ensure that people’s needs can be met. People are Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 10 encouraged to visit the home meet the staff and other people living in the home before they make a decision to move in. People spoken with said that it was the comfort and friendliness of the staff that helped them make a decision to move in. All people have a contract which states the terms and conditions. People spoken with said that they knew what to expect of the home before they moved in. A relative said that she was given clear and detailed information about the service and facilities before her relative moved in and that she is satisfied that the home gives a good service. The home does provide respite care but not intermediate care. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are met and care plans clearly show how their support is to be given. EVIDENCE: Care plans show that the needs of people are being met. Plans contain up to date assessments of needs and how the care is being delivered. The assessments include details of nutritional requirements, falls risk assessments, tissue viability and skin care and medical information. A daily record is kept which clearly shows how people have spent their time and any significant events. People living at the home spoken to during the visit confirmed that their personal and health care needs are met. Comment cards sent to people who Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 12 live at the home have yet to be returned, however we spoke with several people who told us that “the staff are lovely and help me with everything” A person who lives at the home told us that their partner who also lives at the home is “being well looked after, I could not give them the care that they are now receiving”,“This takes a load of my shoulders”. Both people said that although they would rather be in their own home, Lands House is a comfortable happy place to live. The home’s medication is securely and appropriately stored. There is always at least 1 qualified nurse on duty who is responsible for the medication. The medication systems used by the home means that people using the service are given their medication safely. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People choose how to spend their time and join in activities provided in the home. The meals provided are good and mealtimes are a relaxed social occasion. EVIDENCE: Activities takes place daily, usually in the afternoon when things are quieter and staff are generally free to help. There is an activities calendar posted in the entrance hall. The acting manager told us that they keep to the calendar and that recently the home has raised money to buy new activity items as the ‘old’ ones had been used so much they needed replacing. The current activities advertised include reminiscence therapy, ball games, gentle exercise, videos, arts and crafts, bingo, baking, songs of praise and Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 14 board games. In addition to activities provided within the home, regular outings take place. People spoken with said that they join in and enjoy it and that there is always something going on after dinner. People living in the home confirmed that they can choose when to get up and go to bed and that they can take their meals especially breakfast in their room if they wish. People said that they can spend their time where they want and with whom they want. We saw that the two dining rooms and two sitting rooms were being well used, as was the hallway. Some people preferred to stay in their private rooms, one person told us that they liked solitude to read their newspaper and do the crossword in the morning and will use the sitting rooms later. Visitors spoken to at the time of the visit said they were always made welcome when they visit the home, and are kept informed of any issues concerning their relative. There were several visitors in the home when we visited, all were complimentary about the home, the manager and staff saying,“ They are always around to help”, “Nothing’s too much trouble” Menus showed that the people living at the home receive varied and nutritionally balanced meals. The main meal of the day is served at lunchtime, we asked if a choice is made available. The cook said that she understands what people like and that although there is no set choice she would always provide anyone with an alternative should they not like what is provided. A note is kept of any changes to the set menu. Breakfast menus showed that there is a large choice that includes a cooked breakfast everyday, many people take this option, other breakfast items include sandwiches, cereals, toast or a combination of all. People who live at the home and visitors said that people are very well fed. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are protected by the policies, procedures and practices in the home. EVIDENCE: People living at the home and relatives spoken with said that they are confident that people are safe and protected. People said that they know who to talk with if they were unhappy about anything. A relative said that they would know what to do but had not seen the home’s complaints policy. The home has a complaints policy and details about it are on the notice board. The acting manager knows what to do if she should be concerned that there is any form of abuse suspected, she said staff would come to her or to the provider who also works in the home. When asked the acting manager was sure that she would alert social services and any named social worker for any resident who may be at risk of any type of abuse. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 16 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, 23, 24, 25 and 26 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is in the process of refurbishment but it remains that some people’s private accommodation remains unacceptable. EVIDENCE: There are 2 passenger lifts. This enables people who live there and visitors to access all areas of the building. The property is generally well maintained and all communal areas are nicely decorated and are bright and clean. The entrance to the home is welcoming and pleasant. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 17 The home was seen to be clean and hygienic throughout. There are wellmaintained, safe and attractive garden areas, which are enjoyed by the people living at the home in the warm weather. Some bedrooms have been recently re-decorated and the maintenance person who gave us a tour of the home said that the process is well underway and that when a room becomes vacant the room will be redecorated and refurbished. In some shared room the en-suite facility had curtains for privacy as an outward or inward opening door would take too much room. People living in the rooms were consulted and all but the people in one room agreed to have concertina door that close with a magnet. The people who declined have a curtain, which remains their choice. Pull cords to the light switches in some of the bedrooms are out of reach from people when they are in bed. This is difficult to resolve as the configuration of the rooms has changed over time and re-siting ‘lazy-daisy’ switches is not straightforward. However where this is a problem the provider is providing touch activated bedside lamps so that people can have control over the light in their room. People living at the home are encouraged to personalise their rooms and there was evidence of personal possessions in all of the bedrooms we visited. Bathrooms seen were bright and fresh, some are wheel in shower facilities for less mobile people. Comments made by relatives: “The bedrooms are all different shapes and sizes and some residents get a better environment than others. My mother’s room is very small and we cannot put two chairs in it comfortably. We have to have ‘our visits’ in the communal rooms. We visited several rooms that require to be brought up to a reasonable standard of decoration including one used for respite care. Consideration should be given to the redecoration and refurbished of this room before it’s relet. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 18 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 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient suitably qualified staff meets people’s needs and people are protected by the home’s recruitment policy. EVIDENCE: There is always a minimum of 1 Registered Nurse on duty supported by a team of carers. The staff rotas seen were detailed and accurate, they showed the level of qualified, unqualified and ancillary staff on duty for each day and week. People spoken with and relatives confirmed that there was always plenty of staff around, we observed staff going about their duties and noted that people did not have to wait for attention. The day seemed busy but staff appeared to be able to give time to individuals not only to the task in hand. The staff were meeting the needs of the people living at the home in a sensitive manner and promoting dignity and independence. People spoken to confirmed that this was always the case. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 19 Comments made by relatives or people who live at the home included, “There is always someone available.” “There is always someone to talk to”. “All staff are always there to listen, I am happy living in the home”. A relative spoken with said that staff seemed to have the skills necessary to look after older more frail people. We saw that care staff were caring about their role, checking with trained staff about things they needed to and making sure that they were providing care in an appropriate way. There is a programme of National Vocational Qualifications (NVQ) with all staff being required to undertake their level 2 award. The home now has in excess of 50 of staff who have an NVQ at level 2 and some who are undertaking level 3. A high proportion of staff are undertaking training equivalent to NVQ level 2 or 3 in a range of care related issues these include health and safety training, understanding MRSA, tissue viability and skin care, catheter care, dementia care in elderly clients and falls risk. The home has a training schedule to show where training is taking place, has been completed or where there are gaps. This level of training for care workers will ensure that a high standard and consistent quality of care is given to the people living at the home. The home operates a safe recruitment procedure application forms are always completed two written references received and a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosure are required prior to commencing employment. This means that people are protected. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36 and 38 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a well-run and adequately managed service. People’s health and welfare are protected by the home’s health and safety practices. EVIDENCE: The acting manager is experienced and competent to run the home, she is a Registered General Nurse and has been in post since June 2007. She has not as yet applied for registration as manager of the service. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 21 Although the acting manager has a management qualification gained from a time when she worked in a general hospital, she has not yet sought advice that her qualification meets the current management requirements needed to manage in a care home setting. The provider has yet to put forward acting manager for registration with the Commission for Social Care Inspection [CSCI.] It is clear however that the acting manager and the proprietor who is also a registered nurse work together as a team and provide strong leadership. The service has clear policies and procedures for handling finances, which means that people’s personal finances are held safely. There are detailed health and safety policies and procedures in place. All staff receives mandatory training in health and safety and safe working practices. Risk assessments are in place, which ensure the health and safety of the people living and working in the home are protected. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 22 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 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 2 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 23 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 OP31 Regulation 9(2)(b)(i) Requirement The acting manager must ensure that their management qualification meets with current requirements. If this is not the case they must take steps to gain appropriate management training. The person managing the care home must apply for registration with the Commission as a matter of urgency. Timescale for action 30/06/08 2 OP31 The Care Standards Act 2000 Part 2 11(1) 30/06/08 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 OP24 Good Practice Recommendations Consideration should be made to the re-decoration and where necessary re-furbishment of any bedrooms where this has not been undertaken, before these rooms are relet. Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Lands House Care Home DS0000060872.V363019.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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