Inspection on 03/07/07 for Lanercost House

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lanercost House 23/10/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lanercost House Berkley Grange Carlisle Cumbria CA2 7PW Lead Inspector Jenny Donnelly Unannounced Inspection 3rd July 2007 09:30 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 Lanercost House DS0000069272.V345119.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. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lanercost House Address Berkley Grange Carlisle Cumbria CA2 7PW 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) 01228 595138 01228 597227 Barchester Healthcare Homes Ltd Ms Mildred Grace Broome Care Home 82 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (43), of places Physical disability (3) Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 27 November 2006 Brief Description of the Service: 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. The weekly fees at the time of this inspection ranged from £389.00 to £700.00. Fees are set according to the persons care needs and the standard of bedroom occupied. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on 3rd July 2007 between 09.30am and 5pm. The inspection comprised of talking to people who live in the home, visitors and staff. A tour of the premises and inspection of care, medication and staffing records was also undertaken. A second inspector attended for part of the day, and spent two hours in the Priory unit lounge watching how staff worked with people suffering from dementia. In the weeks leading up to this visit, the manager supplied written information to the inspector, and survey forms were sent out to a random selection of people. Three surveys were received from professional visitors to the home, 14 from relatives, and 8 from people living in the home and 9 from staff. Information gathered in these surveys is included in this report. What the service does well: What has improved since the last inspection? Since the last inspection improvements have been made to the staff supervision system, to ensure that regular meaningful supervision takes place. The Statement of Purpose and Welcome Pack have been updated. Joint working with the community Tissue Viability Nurse has been set up to improve skin care. And some new activities equipment had been purchased to provide people with a greater choice. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 6 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 be made available in other formats on request. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensures that people are well informed about this service, and confirms that peoples’ care needs can be managed before they are offered a place. EVIDENCE: Barchester Healthcare has produced a Statement of Purpose and Service User guide in the form of a colour brochure pack and a welcome pack. The welcome pack is individual to each person, and includes the name of his or her keyworker, as well as general information about daily life in the home. People are welcome to visit the home to look around and meet the staff. Preadmission assessments are thorough and detailed enough to ensure that people’s care needs can be met at Lanercost prior to them being offered a place. There is evidence of good liaison with other health professionals and social workers during this admission process, especially where people have complex needs. Funding arrangements are clear and people receive copies of Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 9 their contracts, which show the level of fees and states who is responsible for payment. People receive annual letters advising them of fee reviews. The home does not provide an intermediate care facility. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. People were receiving a good standard of health and personal care, which enhanced their general health and well being. EVIDENCE: Each person has an individual care plan in place, and these were kept up to date through frequent reviews. The plans contained risk assessments, detailed personal and health care needs, and a “life history” which detailed significant events in the person’s life and things that remained important to them. These were completed with the help of relatives. The care plans on Priory unit were particularly good in this respect. There was evidence of good liaison with other health professionals including doctors, chiropodist and optician. The home employed a physiotherapist and a physiotherapy assistant to work with people to improve mobility and advice staff on safe handling and good positioning. The staff work jointly with the local NHS tissue viability nurse, to ensure wound care treatment is up to standard. Survey forms from visiting professionals to the home stated; Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 11 • • • “Clients healthcare needs are met effectively and relevant information is always available” “The service treats clients with dignity and respect and have been skilled at managing some difficult behaviour while ensuring dignity is maintained” “Staff know individuals well…my instructions are always acted on” The management of medicines was sound, and where possible people were assisted to manage their own medicines within in a risk assessment framework. The time spent watching people and staff in the Priory unit showed that staff worked well with people, chatting in a kindly manner, attending quickly to anyone in distress and using a variety of distraction methods to keep people engaged in some purposeful activity. Staff were seen to treat people with dignity and respect throughout the home. Surveys received from people living in the home stated; • “I am well looked after here, staff are prompt when I ring the buzzer, my dressings are changed on time”. This was echoed by comments received on the day that “we get all the help we need”, and “everything is done for us”. Surveys and comments received from relatives stated; • “Staff have no awareness of peoples past life” • “Care provided is probably the best in the district” • “I always see staff around helping residents, if my (relative) needs anything, staff are never too far away” • “If health becomes out of normal, the doctor is called and I am informed” • “They treat people as individuals and try to understand specific needs” During the inspection, people looked well cared for, with tidy hair, clean nails and wearing nicely laundered clothes and appropriate footwear. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. People experienced a variety of activities and entertainment, and had good access to visitors and voluntary organisations. The provision of meals was good and took into account peoples wishes. EVIDENCE: The home had good contacts within the local community and made visitors very welcome. There were volunteer visitors from the Alzheimer’s society who spent time with those people in the Priory unit who would not normally have visitors. The home also had links with the Care Aware advocacy service, which offers independent advice on a range of subjects. There had been a finance information evening recently, attended by a number of relatives. There were visiting ministers of different faiths who provided group or individual services. There were two activity organisers who between them provided an appropriate range of group and individual activities. Some new activities equipment had been purchased to extend the range of choice. There were musical instruments, large board games, reminiscence games and a new Snoozelum (light, sound and smell therapy). People especially liked the large parachute Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 13 used in groups for bouncing soft toys and balls in the air. This activity along with others was designed to incorporate gentle exercise. The home has it’s own minibus and there were two outings each week in the bus for about 5 people and their staff. Activities were seen taking place in small groups throughout the day, these were nail care, jigsaws, conversation, newspaper discussions and letter writing. One person played a harmonica for a time, which other people obviously enjoyed. Two relatives survey forms stated more activities and entertainment were needed, one said the home provided good stimulation, and the people who live in the home said they were satisfied with the activities on offer. People living in the home praised the provision of meals, saying; “the meals are very good” and, “food is excellent”, although one person “would like more choices on the menu”. Lunch was observed and the dining tables were nicely set with glasses, napkins and condiments. People could eat in their bedroom if they chose. There was a choice of two main meals on the menu and orders were taken one day in advance. Some people had chosen alternatives to the menu such as omelettes, jacket potatoes and sandwiches, and these had been provided. There was evidence that special diets were appropriately managed and the chef had taken advice from the dietician where necessary. Soft and pureed diets were nicely presented, and people were quietly given sufficient help to eat their food as needed. The menus were discussed at residents meetings, where people were able to make comments and suggestions. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 were enabled to raise concerns and complaints and know these would be addressed. Staff were knowledgeable about safeguarding people in their care, and people felt safe and secure. EVIDENCE: The home had a complaints procedure on display, and a personal copy had been issued to each person on admission. The manager kept a copy of any complaints received and a copy of the action she took in response to the complaint and the outcome of any investigation. Records showed that minor complaints were also managed in this way. Details of complaints had been forwarded to CSCI for information. One visitor stated she had previously made complaint to the manager about a number of issues, and said these had now been corrected. There was evidence that complaints had been responded to appropriately and managed in a constructive manner. All grades of staff had received training in safeguarding people (abuse) and were aware of their responsibilities in this area. Care staff and domestics were able to talk confidently about their role in protecting people and were knowledgeable about the process for reporting any concerns. People said they felt safe living at Lanercost and knew how to raise any concerns, stating; “I have no complaints, but I would tell nurses and know they will sort it out.” Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Lanercost provides a very clean and comfortable environment for people to live in, with the facilities and equipment needed to meet their needs. EVIDENCE: Lanercost House is a purpose built care home all on one level, and is divided into two distinct areas. Sycamore and Lowther, which are the elderly frail nursing units, and Priory which is a secure unit caring for people with dementia. The home has 74 single bedrooms and 4 twin bedrooms, all with ensuite facilities. There are 10 spacious assisted bath/shower rooms, and 6 comfortable day rooms. The standard of accommodation, décor and furnishings throughout the home is extremely good. Heating and lighting arrangements were also good. Many people had personalised their bedrooms with possessions from home, and had a private telephone line. The home is well equipped with hoists, slings and Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 16 other equipment to assist people with mobility. Some people have their own individual specialist equipment, such as wheelchairs, special mattresses and seating arrangements. There was access to pleasant outdoor areas, and a safe enclosed garden. Some bedrooms had patio doors to the outside. The standard of hygiene in the home was very good indeed, everywhere was clean and fresh with no bad odours. Domestic staff worked to a set routine, clearly took a pride in their work, and were knowledgeable about how to prevent infection in accordance with Barchester procedures. People said, “it’s always very clean here”, and survey forms stated; • “There should be hand wash by the entrance for visitors” • “The cleanliness and general environment is very good” • “They have fairly good equipment and new hospital beds” People said the provision of the laundry service was good, and their clothes were laundered with care and promptly returned. There is continuous maintenance to attend to any problems that arise. A lot of thought and effort had been put into Priory unit to make it suitable for people with dementia. The corridors were colour coded for ease of recognition and decorated with tactile objects, including fabrics. There was an exploration chest with brightly coloured knobs, for people to open drawers and find everyday objects to handle. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 excellent. This judgement has been made using available evidence including a visit to this service. A professional, competent and very caring staff team support people living in the home. EVIDENCE: One the day of this inspection the home was staffed with 4 registered nurses and 13 care staff. In addition were the manager, catering, domestic, activities, and administrative and maintenance staff. The staff were divided with nine on Priory unit and eight between Sycamore and Lowther. There were 79 people in the home with two new people booked to arrive, leaving just one vacancy. Staffing levels were in line with expectations and people were seen to be getting plenty of attention. The nurses organised their units with professionalism and allocated care staff to specific duties on a daily basis in accordance with peoples’ individual needs for that day. Out of 25 surveys (excluding staff surveys), two stated that the home needed more staff and three commented on some staff not speaking good English. Other people commented; • “They provide a high level of carers and qualified nurses, in numbers and ability” • “Staff have always been here when I needed them” • “Staff are prompt when I ring the buzzer, I don’t have to wait”. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 18 Staff had excellent opportunities to access training through Barchester Healthcare and a wide range of subjects had been covered already this year including; care of hearing aids, dementia, mental capacity act, fluid balance charts, Parkinson’s disease, pressure ulcers and skin care. A four-day Memory Lane training course was being run on the day of the visit. This was for all grades of staff, to help them better understand how to work with people with dementia. Staff present at this training, said it had been “excellent” and they were really confident it would help them provide a better service to people. 82 of the care staff had an NVQ (National Vocational Qualification) in care, which is excellent. Staff said there was lots of good training, lots of opportunities, and good teamwork here. Staff were seen to work positively with people, demonstrating patience, respect and kindness. The surveys from visiting professionals to the home said, • “Staff have been very willing to develop necessary skills and follow guidance from professionals to increase their knowledge and skill base” • “Staff have the right attitude and ethos, they are responsive to individuals and do not exclude” Relatives commented that, • “Staff are friendly and helpful, my (relative) could not be in better hands” • “Core staff change little and carry out what is required” • “Staff tend to my husbands needs with care and patience” Staff files demonstrated that the home operated sound recruitment procedures that safeguarded people from having unsuitable persons working in the care home. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 19 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, 34, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People benefit from sound and consistent management, which provides good leadership and vision whilst taking their views and wishes into account. EVIDENCE: The registered manager, Millie Broome, is a Registered Mental Nurse who has completed the Registered Managers’ Award. She has been in post for a number of years and was previously the head of care on Priory unit. Barchester Healthcare provides a comprehensive set of policies and procedures for the home to operate by, and the manager receives regular support and supervision from the company. There is sound financial and forward planning. People who live in the home, visitors and staff are enabled to voice their opinions about the way the home is run, through meetings, satisfaction Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 20 surveys and informal discussion. The manager was seen to spend a lot of time on the units talking with people and checking that everything was in order, and she frequently eats with people in the dining room. One person said, “Millie is always here to explain things”. Staff said they felt well supported and were able to make suggestions and requests, both informally and through formal staff meetings. Recorded staff appraisals and supervision were now taking place regularly. The company operates a thorough quality assurance system, comprising of audits of all areas of the service and six monthly customer satisfaction surveys. Audits cover care planning, care delivery, medicines, skin care, nutrition and accidents. All staff had received health and safety training at appropriate intervals, including fire safety, safe moving and handling of people and equipment, food hygiene, infection control and the new smoking laws. All mandatory training like this, is booked in advance and due dates are marked against each individual staff member. The manager provided information to demonstrate that all services and equipment in the home had received regular checks and services by competent people to ensure everything was in good safe working order. Barchester Healthcare had recently contracted an external company to undertake health and safety audits of all its’ care homes, in which Lanercost scored very highly. Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 3 4 3 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 3 X 3 3 3 Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 Lanercost House DS0000069272.V345119.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!