Inspection on 23/10/08 for Lanercost House

This inspection was carried out on 23rd October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lanercost House 03/07/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lanercost House Berkley Grange Carlisle Cumbria CA2 7PW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Jinks     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Lanercost House Berkley Grange Carlisle Cumbria CA2 7PW 01228595138 01228597227 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 82 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only: Care home with nursing: Code N, to people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical disability Code PD The maximum number of people who can be accommodated is 82 Date of last inspection Brief description of the care home Lanercost House was previously operated by Westminster Healthcare, and was taken over by Barchester Healthcare in February 2007. Lanercost is a purpose built care home, all on the ground floor, providing nursing care and accommodation for up to 82 people in the categories of old age, dementia and physical disability. The home is divided into units, each with its own lounges, dining rooms and bathrooms. There are 74 single and 4 twin bedrooms, all with ensuite facilities. There is ample outdoor space including parking and a secure garden. The home produces an information brochure and welcome pack that details all the services offered. Care Homes for Older People Page 4 of 33 0 0 3 Over 65 39 43 0 Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this service was undertaken over several months. We considered information from a variety of sources, including the Annual Service review, which we carried out in July 2008. A pharmacist inspector had carried out a random visit to the home in September 2008 and this information was also taken into account. This inspection included a visit to the home by myself, another inspector and the pharmacist inspector. We spoke to the manager, some of the staff, a number of people who live at the home and some of their relatives. This helped us to understand some of their experiences and views of the service. We also looked at a selection of records that the manager is required to keep at the home. The manager had completed a self assessment called an Annual Quality Assurance Assessment (AQAA) in May 2008. We also used this information to help verify aspects of the inspection. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 33 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care needs assessments are not consistently completed or detailed. This means that people may be living in a home which cannot meet their needs and expectations appropriately. Evidence: The manager said that prior to admission to the home, people are given information about the home and the services it can provide. People thinking of moving into Lanercost are able to visit the home and spend the day there if they wish. By reading the information and visiting the home, people are helped to decide whether the home will be suitable and able to meet their needs. The manager told us that transport can be provided for people who may have difficulties getting to the home. Some of the people we spoke to during our visit to the home said that their relatives had been able to visit the home on their behalf. We looked at a selection of care and admission records of some of the people that use Care Homes for Older People Page 11 of 33 Evidence: this service. We saw some evidence of care needs assessments being undertaken. It is difficult to assess whether they had been carried out prior to the persons admission as most of them have not been dated or signed by the assessor. In some cases further information regarding health and social care needs has been obtained from social workers or from hospital discharge notes. The information recorded on the assessment forms is not always consistently detailed. This lack of information means that some care or support requirements of people moving into the home may not always be properly considered. It also indicates that consideration of staff skills, ability and experience may not always be taken into account during the admission assessment process. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service do not have detailed plans of their health and social care needs or plans of how their needs will be met. These shortfalls mean that people may not always receive the support they need. Evidence: The manager told us that care plans are completed at the time a person is admitted to the home. She told us that total care assessments are completed to show the level of care each person needs. An element of risk assessment is included in the care plans together with other assessments such as nutritional needs, continence, pressure care and tissue viability. The manager also told us that the home uses a person centred approach to assessment and care planning. We looked at a selection of care plans and assessments during our visit to the home. The records do not demonstrate that care plans are developed in a person centred way. Important information is missing from them because of poorly completed admission assessments. We found that someone had been identified as needing care during the night, but there is no care plan detailing these needs or of the action staff should take to ensure their needs are met. Care Homes for Older People Page 13 of 33 Evidence: Where people have been identified as needing assistance with their nutrition there are no detailed plans or instructions for staff to follow. Where advice has been sought from a dietician, some instructions are recorded but care plans are not updated to reflect these changes and records show that the catering manager is not always told of any special nutritional requests. Some of the instructions ask for peoples weight or nutritional intake to be monitored, but this is not done with any consistency and records provide minimal details where kept. Risk assessments contain only brief amounts of information and instructions for staff to follow. They are not always completed at the time of admission to the home nor are they always maintained in an up to date and accurate manner. Some people living at the home are susceptible to falls or may demonstrate behaviour that challenges at times. There are no clear and detailed instructions for staff to follow. This means that people living at the home or staff working at the home may be placed at risk of harm or injury. Daily notes and other records indicate that people living at Lanercost do have access to health care professionals such as chiropodist, doctors, dieticians, community nurses and physiotherapists. We spoke to some of the people that live at Lanercost and made observations of some care and support practices. We found that the quality of the service can be variable. The people we spoke to said that most staff are kind and helpful and attended to them as soon as they could. We were also told that sometimes residents have to insist that staff attend to certain areas of their care needs. One person told us that they were sometimes worried about using their nurse call bell, despite the fact that they are immobile without assistance. They told us that staff could be off hand and say they will do things when they are less busy. Not everyone living at the home is able to be so assertive or make their needs known. We observed a very serious incident of poor practice, which placed both the resident and the member of staff at risk from harm or injury. This incident also did not promote the ethos of respecting the individuals privacy and dignity. We checked a sample of medicines and found they usually added up showing they had been given correctly. We found some minor discrepancies such as medicines being out of stock and occasional gaps in the records, which we discussed with the manager and advised her to look at in more detail. We looked at the times medicines were given and Care Homes for Older People Page 14 of 33 Evidence: found improvements in the records and when they were given. Giving medicines at the right time helps to make sure they work correctly. We looked at a sample of care plans and records and found some general improvements about how when required medicines were to be given. However, we found information missing in several care plans that meant some medicines might not be given correctly. One person did not have a care plan about how their seizures were to be managed and three other people were prescribed medicines for agitation but there was no information about how and when they were to be given. Lack of clear guidance for when required medicines can result in them being given to people incorrectly. We highlighted this issue at the last inspection but this had not been properly addressed. We looked at how staff were using a fluid thickening medicine to make it safe for people with swallowing difficulties to have drinks. We talked to care staff and checked the care plans of three people. Staff had some knowledge about how to use it and one said a speech therapist had given her some guidance. However, the care plans for these people did not have information about how much thickener to use, which could lead to staff making drinks of the wrong consistency that could result in people choking. The manager told us that the dietician did not provide any instructions and there is no evidence to confirm that further advice has been sought by the home. We checked how controlled drugs (medicines that can be misused) were stored and recorded. Records of handling were accurate and suitable secure storage arrangements were in place to make sure they are not mishandled. We looked at how medicines were stored and found the arrangements to be clean, tidy and secure. New fridges for storing medicines that required cold storage had been obtained and these were regularly checked to make sure they were at the right temperature so that medicines are not spoilt. We looked at how medicines were checked and audited. The manager said that since the last inspection regular informal checks of the records and stock were now carried out and we saw some evidence of this on the current records. The manager also said that two detailed medicines audits were soon to be carried out and that records would be made of their findings. Since our last visit the manager had carried out competency assessments for handling medicines on all nursing staff and we saw the paperwork to support this. The manager also said all nursing staff were to attend in house medicines handling training sessions within the next month. Efficient recorded checks of the medicines, competency checks on staff and regular training help to make sure staff have the necessary skills to handle medicines safely. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are provided with the opportunity to participate in a variety of activities. This helps to promote a stimulating lifestyle and promote independence. Evidence: The manager told us about the activities and routine of daily life at Lanercost and she has identified areas where improvements could still be made regarding activities. She told us that care staff are beginning to take a more active role and sees that enabling residents to have at least ten minutes of quality one to one time each day, as an improvement to the service. The manager also told us that residents meetings take place but some of the people we spoke to were not aware of these meetings. The staff on Priory Unit were busy with many of the residents taking part in craft activities. We also observed a relaxing situation in one of the lounge areas on this unit. Residents were sat quietly listening to some relaxing music whilst one member of staff was giving the ladies manicures. One person told us that there had been a visit to the home from the mini Zoo, which they had enjoyed. Records showed that some people are able to choose whether to take part in activities such as games, cards, dominoes and bingo. The home organises trips out and has access to its own minibus. Care Homes for Older People Page 16 of 33 Evidence: People are able to have their own televisions and radios in their rooms and some people choose to have their own newspapers and magazines delivered to the home. People told us that the food is generally very good and that there are always choices, they are aware of the daily menus and we saw samples of these posted around the home. The kitchen has been assessed as excellent for its food safety and hygiene standards by the local council. We saw the serving of the lunchtime meal in one of the dining rooms and staff were on hand to help people if they needed it. Residents may take their meals in their own room or in one of the dining areas as they please. People were offered hot drinks at various times throughout the day and had access to cold drinks in their own rooms. We saw some evidence of nutritional plans. These are generally poorly completed. They do not provide sufficient details to ensure that people always receive suitable nutrition, appropriate support or monitoring. There are a number of communal lounges and dining areas in the home where residents may sit and relax or meet their visitors. There are televisions and music centres in some of these areas for residents to use if they wish. The television in one of the communal lounges on Warwick unit is rather small and does not present with a good clear picture. One resident was watching this but had to be quite close to the screen. We noted that there are plenty of visitors to the home at all different times of the day. Visitors are greeted in a friendly manner and there are a variety of comfortable communal areas where residents may receive their visitors, they are also able to see them in their own room if they wish. One visitor we spoke to told us they think the home is ace. The home has a friendly and welcoming atmosphere and they think it is the best move they made to bring mum in here. They thought that she gets good care. Care Homes for Older People Page 17 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are not consistently protected from, harm injury or abuse. Evidence: There is a complaint process in place at the home. This is included in the information given to people and their relatives when they move into Lanercost. People living at the home told us that they know who to speak to if they have any concerns or complaints. However, not all of them are confident that the matter would be dealt with effectively. Where complaints have been received and recorded, there is evidence to confirm that the manager does try to address them properly. Records of the complaint, investigation and the outcome are kept. Staff at the home receive training in the protection of vulnerable adults (prevention of abuse). The manager has undertaken training so that she can train staff in this subject. She is able to demonstrate her knowledge in adult protection procedures and knows when incidents must be reported to social workers and other outside agencies, although this is not always done with consistency. The recruitment process in place at the home also helps to ensure that people using this service are supported by suitable staff. The references and registration status of prospective staff are checked, as well as Criminal Records (CRB) and protection of vulnerable adults (POVA) registers. There are some shortfalls, which do compromise the health, safety and well-being of people using this service. The manager does not always notify us of reportable events Care Homes for Older People Page 18 of 33 Evidence: and there are gaps in the pre-admission assessments and care planning stages. Care Homes for Older People Page 19 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service generally live in a warm and comfortable environment. There are some areas that need attention to help reduce the risks of harm, injury or cross infection. Evidence: As part of the assessment of this service we looked at the condition and general standard of the environment at the home. People living at Lanercost have their own rooms with en-suite facilities and access to shared bathrooms, toilets and showers. They are able to personalise their own rooms to their own taste with ornaments, pictures, televisions and small items of furniture. We met a married couple who are resident at the home. Arrangements have been made so that they can share a bedroom and have use of another room, which they use as their sitting room. Their sitting room has patio doors with access to one of the enclosed communal garden areas. Residents rooms are generally well decorated and maintained to a high standard. The manager told us that the bedrooms are usually redecorated prior to a new resident moving in. Some of the communal areas, although still very pleasant and clean, are showing signs of wear and tear. The manager told us that there are plans to update and refresh the home, with some of the areas being redecorated before Christmas 2008. The home is equipped with aids and adaptations to help people access facilities as Care Homes for Older People Page 20 of 33 Evidence: independently as possible and there are handrails throughout the home. Where people need special beds, mattresses or other equipment this is generally available or obtained. Most of the communal bath and shower rooms are being used for storage. They are very cluttered with hoists, wheelchairs and other items of mobility equipment. The staff told us that the rooms are in use and that they have to move the equipment out before they can use them for their intended purpose. We noted that the emergency call bells in these areas are tied up off the floor and would not be accessible to a person who may have fallen on the floor. Some of the fixtures and fittings in toilets, bathrooms and shower rooms are in a poor condition and need replacing. For example, toilet seats, toilet raiser seats, mirrors and external bath panels are corroded or damaged and pose a risk to the control of infection and safety. We found that some of the bathrooms were not particularly warm, although staff confirmed that they are in use. Where we pointed this out to staff, they did turn on radiators. The home employs domestic assistants and generally the home is clean, tidy and odour free. We did detect some odours in the entrance area to the Priory Unit and in one of the nearby bathrooms. We asked staff about the bathroom and they confirmed that it had just been used by a resident. We checked this room later in the day but the odour remained. We also noted that the room was full of handling equipment and some personal items belonging to staff. We discussed this with the manager as needing attention. We also visited the laundry area. Staff there told us that they are provided with protective clothing and have special laundry bags for use with particularly soiled laundry. These measures help prevent the spread of any infection. They told us that they have received training in health and safety matters, COSHH, fire safety and infection control. The laundry is kept clean, tidy and well organised. It is arranged so that soiled laundry arrives at one place and goes out at the other side. We saw that personal items belonging to residents were nicely laundered, clean, pressed and neatly folded or placed on coat hangers. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are usually satisfied with the care and support they receive. There are some shortfalls in the service, which means that people sometimes receive unpredictable or inconsistent care and support. Evidence: We looked at a selection of staff records during our visit to this service and spoke with some of the staff that were on duty. They told us that they are provided with training to help them with their job. Some told us that they had received training in health and safety, COSHH, fire prevention and evacuation, infection control and manual handling. One member of staff mentioned that they had received training in working with people who may demonstrate behaviour that challenges and adult protection, another thought that they had received this training. The manager told us that over two thirds of the staff have gained or are working towards obtaining, a national vocational award (NVQ). We asked the manager for a selection of records relating to staff training. The information records that staff are provided with adult protection training, fire training, manual handling, food safety and some induction training. Some of the qualified nursing staff have undertaken specialist training in stoma care, use of syringe drivers, venepuncture and safe handling of medicines. We did not see any evidence of specialist training for staff in subjects such as dementia care or dealing with challenging behaviour being provided. The records given to us by the manager do not Care Homes for Older People Page 22 of 33 Evidence: record the duration of the training or who the training provider was. This makes it difficult to assess whether induction training always takes place for new staff and whether it meets the recommended requirements. From the information available, it is unclear whether staff receive at least the recommended three days annual training. The staff recruitment records demonstrate that there is a robust process in place. Prospective staff complete application forms, attend interviews and references are obtained. Criminal record bureau checks (CRB) and POVA checks are obtained prior to staff commencing work at the home. The registration status is checked for people who are qualified nurses. These checks help to make sure that people using this service are protected from people who may not be suitable to work in care settings. Although a large number of staff have left the home over the last eighteen months, there generally appeared to be a sufficient number of staff on duty during the time of our visit. We did observe an unsafe situation where only one member of staff was carrying out a task that should have been done by two staff. This placed both the resident and the member of staff at risk from injury. Some of the staff told us that they had on occasions to work long shifts, sometimes more than twelve hours long, due to staff shortages. Some of the people that use this service told us that they have to wait for attention from staff and whilst some are good and helpful there are others who they say they have to argue with. Staff sometimes tell them they will do things when they are less busy and occasionally tell residents that it is not their job or they havent got time. We discussed these concerns with the manager during our visit as they need to be attended to quickly. Care Homes for Older People Page 23 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not always run in the best interests of the people that live there. Their health, safety and welfare is not always promoted or protected. Evidence: The manager at the home is experienced and qualified in managing care services. She is a Registered Mental Nurse and has obtained the Registered Managers Award. She is supported in her duties by two heads of units and a full time administrator. We found that the manager does not ensure that comprehensive care needs assessments are made prior to people moving into the home. The records we looked at show that some people are admitted to a home that cannot meet their needs. There are gaps in risk assessment processes and staff do not consistently work to any instructions that may be recorded in care plans or risk assessments. We noticed that there are numerous items of toiletries left in communal bathrooms, indicating that these may be used communally. This practice does not promote dignity, rights or choices. It also presents the home with a risk to the continued health and safety of Care Homes for Older People Page 24 of 33 Evidence: some of the residents that live there. Some of the risk assessments identify that some residents may not recognise these items as toiletries and may try to ingest them. In addition to these toiletries we saw large amounts of prescribed creams and ointments (some without lids on), kept insecurely in residents bedrooms.This places people living and working at Lanercost House at risk from harm or injury. The manager told us that staff receive supervision in their work and that this is an area where improvements have been made. We looked at staff supervision records. The records we were shown by the manager were very sparse. There is some evidence to show that some staff annual appraisals have taken place and some of the staff we spoke to confirmed this. There are some records relating to group clinical supervision, but again very few and very little information is recorded. The manager told us that this type of supervision has only recently commenced. We saw two very brief records of what may have been individual staff supervision with care assistants. The manager confirmed that this type of supervision has not really got started. The staff we spoke to were very vague about supervision. They told us that more time was needed for supervision and one person told us that they would go to the manager or a trained colleague (nurse) if they had a problem. The lack of staff supervision means that staff employed at the home may not always follow good practice guidelines or work to the policies and procedures of the organisation. This potentially places both the staff and residents at risk of harm or injury. We looked at the accident book kept at the home. Records indicate that accidents and incidents are recorded at the time of their occurrence. We found some incidents that have not been reported to us, as required or to the social work team where appropriate. We also looked at a sample of other records kept at the home. They appeared to be up to date with fire equipment checks, fire risk assessments and staff fire training being carried out frequently. The manager told us that there are contracts in place to ensure that equipment and central heating systems are maintained and serviced annually. Care Homes for Older People Page 25 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 9 13(2) When necessary, information 12/10/2008 on how medicines should be used should form part of an individuals care plan to make sure they are given to people correctly. Care Homes for Older People Page 26 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 You must ensure that 12/12/2008 accurate and up to date care needs assessments are obtained prior to admitting a person to the home. Undertaking comprehensive care needs assessments and obtaining care and support details helps to make sure that the home and staff are able to meet the needs, requirements and expectations of people considering moving into the home. 2 7 15 You must make sure that 31/12/2008 people living at the home have an individual and detailed plan of their health, social care and support needs. The plans must include details of their needs and the actions that staff will take to ensure those needs will be met appropriately. You must make sure that staff are Care Homes for Older People Page 27 of 33 aware of these care plans and know what is required by each individual. Care plans help to ensure that all the care and support required by people who use this service is being provided and that the outcomes identified are being met appropriately. 3 9 13 When necessary, information on how medicines should be used must form part of an individuals care plan to make sure they are given to people correctly. Previous timescale of 12/10/08 not met. Medication must always be given as the doctor intended. Clear information and guidance for staff helps to ensure that people using this service are not placed at risk of harm. 4 10 12 You must ensure that people 12/12/2008 using this service are treated with respect and dignity at all times. Individualised procedures must be included in care plans and risk assessments to help ensure staff treat people with respect at all times. People using this service have a right to be treated courteously and with respect and dignity. 12/12/2008 Care Homes for Older People Page 28 of 33 5 15 17 You must ensure that clear 12/12/2008 and accurate records are maintained relating to people using this service in respect of their nutritional requirements. Where special therapeutic diets are prescribed you must obtain and record detailed instructions of their use. This will help make sure that people using this service receive a nutritious and suitable diet. It will also help ensure that people are not at risk of poor nutrition and are protected from harm or injury. 6 19 23 You must make sure that all areas of the home provide a safe environment for people to live and work in. You must make sure that corridors and bathrooms in particular, are accessible and are free from hazards and obstacles. This will make sure that people are safe from the risks of suffering trips, falls or injuries. 12/12/2008 7 27 18 You must make sure that there is a sufficient number of experienced and competent staff on duty at all times. This will help ensure that the needs of people using this service are met in a safe and timely manner. 12/12/2008 Care Homes for Older People Page 29 of 33 8 31 12 You must ensure that the 12/12/2008 registered manager is aware of their responsibilities and accountability in relation to the day to day running of the home. You must make sure that the care, health and welfare of the people that use this service is monitored, promoted and protected at all times. The home must operate within its stated purpose, aims and objectives and in the best interests of the people who use this service. 9 36 18 Staff employed at the home must be supervised and have their care practices monitored on a regular basis. Staff supervision helps to monitor their performance in their job role as well as helping to identify any training and development needs. Supervision forms part of the monitoring and performance of the service and should help to develop and improve the service provided. 12/12/2008 10 37 17 You must ensure that records required by regulation for the protection of people that use this service and for the effective running of the business are maintained, up to date and accurate. 31/12/2008 Care Homes for Older People Page 30 of 33 Accurate and up to date records help to maintain and protect the rights and best interests of people using this service. 11 38 37 You must ensure that the Commission is notified of any events that adversley affect the well-being or safety of people using this service. You are required by law to inform CSCI of such events. This information helps to inform the judgements made by CSCI about the service. Additionally, you should use this information as part of your quality monitoring system to help identify areas for improvement. 12/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Consideration should be given to replacing some of the television equipment in the communal areas of the home to ensure there is adequate reception of programmes and subtitles. This will improve the quality of viewing for people who may have hearing or visual impairments. You should consider reviewing the complaints process with the people that use this service, their relatives and staff who work at the home. This will help make sure that people know who to raise concerns with and improve confidence that their concerns will be listened to and acted upon properly and in a timely manner. You should make sure that people using this service have access to nurse call bells at all times. This will help to make sure that people using this service can summon the help 2 16 3 22 Care Homes for Older People Page 31 of 33 and assistance of staff quickly, when necessary. 4 30 You should make sure that all staff employed at the home receive appropriate training in accordance with the aims and objectives of the home and to meet the changing needs of people living at the home. There should be a comprehensive staff training and development plan to help ensure that people using this service receive a high quality service from well supported and trained staff. Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. 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