CARE HOMES FOR OLDER PEOPLE
Lansglade 14 Lansdowne Road Bedford Bedfordshire MK40 2BU Lead Inspector
Leonorah Milton Unannounced Inspection 10th January 2006 14.45 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 Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 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. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lansglade Address 14 Lansdowne Road Bedford Bedfordshire MK40 2BU 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) 01234 356988 01234 359194 Lansglade Homes Limited Ms Vivien Lockwood Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31), of places Physical disability over 65 years of age (31) Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th August 2005 Brief Description of the Service: Lansglade House was a large double fronted Victorian building that had been sympathetically converted to provide comfortable accommodation. The directors of the company had changed in 2004. Their influence had resulted an improvement in the under pinning documentation of the service. Mrs Vivian Lockwood had effectively managed the home for a number of years. The home was situated in a pleasant residential area of Bedford within close proximity to the towns amenities including local bus services and national coach and rail networks. The service was registered to provide for thirty-one older people who may also have physical disabilities and/or dementia. The condition for physical disabilities was not necessary as the home could accommodate those with the frailties associated with old age under the category for old age (OP). The accommodation was arranged over three floors with the communal sitting and dining areas on the ground floor. The bedrooms were located on each of the three floors. Bathrooms and toilet facilities were located for convenient access throughout the building. The upper floors could be accessed by a shaft lift. Twenty-five single bedrooms were provided and four double rooms. Eleven single rooms and one double room had ensuite toilet and washbasin facilities. The remaining rooms were fitted with washbasins. The home was well decorated and maintained. A well maintained garden with garden furniture was located to the rear of the property. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focused the core standards not assessed at that visit. During this inspection the arrangements for the care of two service users was assessed. Their case files were reviewed and conversations took place with both service users to obtain their opinion of their lifestyle in the home. The manager was present in the home throughout the inspection and a proprietor attended for the latter part of the visit. Both were present for the feedback as the conclusion of the inspection. It is recommended that this report be read in conjunction with the report of the inspection carried out in August 2005 for a complete overview of the standard of the operation between these dates. What the service does well:
Service users were well cared for in an environment and atmosphere that was conducive to their welfare. Personnel on duty were observed to treat the service users with friendliness and respect. Areas of the home seen at this inspection were well maintained, clean and orderly. There was a particular emphasis in creating a homely appearance and atmosphere. As had been identified at previous inspections, Lansglade was a well staffed and managed home that provided a good standard of care. Records indicated that more than fifty percent of the care team had achieved NVQ qualifications in care and that others were either working towards this award or scheduled to commence in the near future. Ancillary personnel had also achieved NVQ qualifications in their chosen field. Service users who contributed to the inspection were complimentary about the personnel in the home, the manager being described as approachable, kind and helpful and members of the care team as very nice and that “nothing was too much trouble for them”. Appreciation was also expressed for the service provided by the domestic, catering and maintenance team. Service users confirmed that they were satisfied with the daily routines in the home although one felt that meal times could be a little rushed when staff had
Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 6 other tasks to carry out. The other person was satisfied with the arrangements for mealtimes. Both stated that the provision for their meals was satisfactory and that they enjoyed their food. Records and conversations with service users indicated that they had been informed about the operation of the home through the service user guide that was available in their bedrooms and via service user meetings and questionnaires. Both felt confident that action would be taken on any concerns they might have about their stay in the home. What has improved since the last inspection? 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. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 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 Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 EVIDENCE: The manager stated that the home did not provide an intermediate care service. Beds for respite care were occasionally available. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Written care plans were in the main satisfactory place and provided guidance for personnel in relation to service users’ individual needs and how these were to be met. Satisfactory arrangements were in place for the safe storage and administration of medicines. EVIDENCE: The case files for two service users were assessed. They contained care assessments and plans that were based on the details specified in Standard 3 and provided a thorough guide to needs and how these would be met. There were records of monthly reviews. The manager was advised where significant and permanent changes to needs had been identified, as was illustrated by the review that showed that a service user’s ulcerated legs had healed, the central plan of care must be adjusted to reflect this change. Similarly, plans must indicate if service users have a high level of anxiety and show an assessment of nutritional needs, where there is a need of such assessment and monitoring. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 10 Medicines were stored securely in an office. A lockable, purpose made trolley was used for storage and for transporting medicines around the home. The records for the administration of medication showed that these had been properly maintained. One showed that the frequent updates from a clinic in relation to the anti-coagulant therapy undertaken by a service user had been changed as necessary to ensure that staff gave the correct dosage. The manager stated that a there were no Controlled Drugs in use in the home at this inspection but that she had introduced a bound book, with numbered pages throughout to ensure that any future records of the use of Controlled Drugs conformed to safe practice requirements. Records indicated that personnel with the responsibility for handling medicines had received training in safe practice from a local pharmacist. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Satisfactory arrangements were in place to meet current service users’ nutritional needs. EVIDENCE: Menus indicated that a variety of nutritional meals was available to service users. Meals served at the inspection were in accordance with the advertised menu. The evening meal was observed. Service users had a variety of choices of a light meal of soup and sandwiches or a more substantial choice of bacon and egg. Fruit was available to service users but its provision was more controlled than previously to ensure that all had the opportunity to have fruit on a daily basis and that others did not use the fruit bowl as a replacement for more balanced meals. Service users confirmed that they could take breakfast in their rooms or with others in the dining room. One felt that members of staff were anxious to clear away breakfast dishes and that at other meals she felt hurried because staff wished to serve puddings before the first course had finished. She also stated that she would like a cup of tea after lunch as well as at the allotted afternoon teatime. The manager explained that this person was quite anxious
Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 12 and made frequent reference to some aspects of the home because of her anxieties. This was not fully borne out by her records. Neither care plan seen at this inspection contained a nutritional needs assessment. The manager explained that this would be undertaken where a need to do was indicated. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not reviewed as they were assessed as met at the previous inspection. EVIDENCE: Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Satisfactory arrangements were in a place to maintain the hygiene of the home and to protect service users from the spread of infection. EVIDENCE: Satisfactory written procedures were seen at this inspection to show that guidance was in place for personnel in relation to safety and hygiene issues. Training records seen also showed that staff had received instruction and training in relation to infection control and food hygiene. The home used a safe system for the laundering of contaminated linen. Satisfactory procedures were in place for the disposal of used continence materials and for safe handling of such items. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Staff had been encouraged to undertake training to achieve qualifications in care and other aspects of work to ensure that a skilled and knowledgeable team cared for service users. EVIDENCE: Records indicated that twelve of the nineteen care staff held qualifications in care at NVQ 2. Four had also achieved an NVQ award at level 3. One member of staff was working towards the NVQ2 award and four others were scheduled to commence in the near future. Two cooks held NVQ awards in cooking skills. One domestic assistant, responsible for the cleaning of the home had achieved an NVQ in her field. Another was working towards this award. Training records on the whole indicated that personnel had been provided with statutory and other relevant training to enable them to perform well. This had included the maintenance person who had undertaken a Fire Warden’s course and in the testing of electrical equipment to enable him to take on the responsibility for the monitoring of electrical equipment (PAT testing) and fire safety checks and evacuation practice. Training had been achieved through external providers and via an administrator who oversaw the training arrangements and also provided some aspects of training. To qualify as such the administrator had undertaken training to deliver guidance in safe manual handling techniques.
Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,37,38 Satisfactory arrangements were in place to protect service users from risks to their safety. There was a risk that the lack of record keeping in relation to cheques cashed on behalf of a service user could lead to confusion about amounts handed over. Service users had been given opportunities to express their opinions about the service. EVIDENCE: The home had adopted comprehensive risk assessment and safety management strategies from a professional provider to ensure that safety matters were well managed and monitored in the home. The last review of risk assessments had been held in November 2005. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 17 The actual underpinning procedures in relation to safety were also comprehensive. However those in relation to other aspects of the operation of the home were a little outdated. The manager explained that these were being reviewed under a quality monitoring audit to ensure that the procedural manual conformed to current good practice guidelines. Records indicated that meetings with service users had taken place on June and October of this year. The June meeting had taken place to review service users’ questionnaires as part of a quality audit process. Examples of the service users’ responses were seen and showed a positive feedback about the operation of the service. The manager explained that another such exercise was underway. Questionnaires had been sent out. The year planner showed that a date had been set to meet with service users to review their responses to the questionnaires. The manager explained that a service user’s chequebook was held in the home’s safe and that cheques were cashed for her within the home. There were no records for these arrangements, which put the home as well as the service user at risk if misunderstandings or mistakes were to occur. The manager was advised that records of transactions and valuables held on behalf of service users must be maintained for the best interests of the service user and the home. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 2 x 2 3 Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1)(a) 15(2)(b) Requirement Care plans must be updated to show significant changes of need, record an assessment of nutritional needs where necessary and where service users have high levels of anxiety. Records must be maintained of cheques that are cashed in house for a service user. A receipt must be introduced to show that the service user or her representative has signed for the monies handed over. A record must be maintained of all valuables held in safe keeping for service users. This must include cheque-books or similar. Timescale for action 31/03/06 2 OP35 17(2) Sch.4.9 31/01/06 3 OP37 17(2) Sch 4.9 31/01/06 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 Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 20 1. OP33 2 OP15 It is recommended that service users be reassured about aspects of the service where their anxiety has given rise to a misperception about an aspect of the service. In this instance this refers to the routines for mealtimes. Introduce the serving of tea immediately after lunch for those service users who have expressed a wish for this. Lansglade DS0000014925.V275938.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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