CARE HOMES FOR OLDER PEOPLE
Lansglade 14 Lansdowne Road Bedford MK40 2BU Lead Inspector
Leonorah Milton Unannounced 12 August 2005
th 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 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 I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Lansglade Address 14 Lansdowne Road Bedford MK40 2BU Telephone number Fax number Email 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 Ltd Ms Vivien Lockwood Care Home 31 Category(ies) of PD(E) Physical disability over 65 years - 31 registration, with number OP Old age - 31 of places DE(E) Dementia over 65 years - 31 Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09.12.04 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 town’s amenities including local bus services and national coach and rail networks.The home was registered to provide for thirty-one older people who may also have physical disabilities and/or dementia. The condition for physical disabilitiues was not necessary as the home could accomodate those with the frailties associated with old age under thecategory 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 I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 4.20 hours. The manager was present to assist throughout. The methods of inspection included a review of the case files for three service users and an assessment of their private accommodation and that for communal use. Conversations took place with two of these service users, one other and also with a frequent visitor to the home. Discussions took place with the manager, the deputy and a care assistant. Sundry other documents were reviewed in the main lounge of the home where it was also possible to observe the day-to-day arrangements and activities in this room where the majority of service users were seated. The inspection identified that the home had continued to provide a quality service. The one requirement from the previous inspection had been met. There were no requirements arising from the aspects of the service that were reviewed at this inspection. What the service does well:
The home had a welcoming and friendly atmosphere that was indicative of the service provided at Lansglade House. The majority of the staff team had worked at the home for sometime and were well acquainted with individual service user’s needs and the home’s operational systems. Members of the team had been supported by management through individual one to one meetings with a supervisor and team meetings that were specific to the roles of the various components of the team. The manager was described as supportive and fair. Training records indicated that the team had received training to enable them to understand and carry out their duties effectively. It was evident that members of the team took a pride in this well presented and operated home. Their commitment to the service had resulted in a good standard of care and high customer satisfaction levels. Service users similarly were able to voice their opinions and had been provided with opportunities to meet with the owners who visited the home on a weekly basis. A visitor to the home spoke in positive terms about the care of her relative. She visited the home often and stated that her welcome, the standard of care, environmental standards and information provided to her about her relative’s progress were of unvarying high standards. Service users were also complimentary about the service and the kindness of members of the team.
Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 6 One service user stated that she would rather be in her own home but raised no complaints about her treatment in the home. The arrangements to meet service users’ recreational and spiritual needs had continued to be of a good standard and identified that the home had established links with the local community. Records indicated that the home had appropriately referred service users to professionals for their healthcare needs. This had included a situation where a service user was found to have suffered adverse effects from overmedication prior to admission to the home. It was evident that the intervention of the home in this instance had resulted in an improvement in the service user’s overall well being. 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 I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 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 standard(s) 1,3,4. Service users had sufficient written information to make an informed choice about moving into the home. EVIDENCE: A comprehensive statement of purpose that outlined arrangements as specified by this standard provided a clear and user-friendly guide to the service provision was displayed in each bedroom seen at this inspection. The manager explained that copies were available to prospective service users on request. Assessments of need for those admitted after the introduction of the National Minimum Standards (NMS) in 2002 had incorporated the details specified by the NMS. Observation of practice, conversations with service users, a visitor and members of staff and an assessment of records identified that the team had the skills to meet service users’ assessed needs. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 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 standard(s) 7,8,10. There were satisfactory arrangements to properly care for service users. EVIDENCE: Written care planning arrangements provided a systematic guide to meeting care needs based on an updated assessment of needs. The information in the documents had been personalized to demonstrate individual abilities, needs and preferences in most instances. A record had been maintained to indicate a monthly review of care needs and updates to care plans as needs had changed. Service users who contributed to this inspection confirmed that all who worked in the home had treated them with kindness and respect. No unmet needs were reported. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12,13,14. The daily routines and activities in the home had been developed for the benefit of service users. EVIDENCE: The arrangements for the service users’ daily lifestyle took account of individual preference and were based on good practice guidelines. As with other inspections service users were positive about the provision of activities; regular organised activities such as bingo, music and movement and scrabble sessions. There was also a programme of external entertainment, sing-a-longs and themed parties. Recent events had included a trip attended by thirteen service users to a local museum. Arrangements to meet spiritual needs were evidenced by notices about services and meetings in relation to three local churches. It was noted that a service user who liked readings from the bible had been matched with a key worker with similar likes and who had provided one to one support for the service user that was sensitive to this particular need. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 16,17,18 Appropriate arrangements were in place to enable service users or their representatives to complain and for the protection of service users from abuse. EVIDENCE: Previous inspections had identified that the home’s written complaints and protection procedures were satisfactory. Records seen at this inspection showed that there had been appropriate action taken about a complaint about the home’s invoicing system. Records also showed that the home had registered service users for postal votes. The home had taken appropriate action to protect a service user. Recent events in the home identified that the home had liaised with the Local Authority to ensure that a service user’s rights to choose to remain in the home were upheld when there had been interventions from outside the home to override the service user’s rights to choice and to protection from abuse. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 19,20,21,23,24,25. Service users lived in clean, safe, well-maintained environment. EVIDENCE: The building had been converted to meet the requirements of the environmental health services and fire safety requirements. The layout of the building was suitable for its purpose and gave appropriate access to the upper floors for disabled persons via a shaft lift. The maintenance programme had ensured that the home remained in good decorative order. The appearance of the home was homely and comfortable. Bedrooms seen at this inspection showed that service users had been provided with comfortable private accommodation that had been personalized with their own possessions. Views from a few of these were a little restricted but this was compensated by the spacious and well appointed communal lounges. Toilets and bathing facilities were located within close proximity to the bedrooms seen at this inspection. Suitable adaptations had been made to these facilities to meet the needs of those who had mobility problems.
Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30. Staffing arrangements were sufficient to meet service users’ assessed needs. EVIDENCE: Records indicated that sufficient care staff had been on duty throughout the day and night to meet service users’ assessed needs. It was noted that sufficient ancillary personnel, administrative, maintenance, catering, cleaning, and laundry had been deployed so that the care staff team had been able to concentrate on their care related tasks. Training had been provided for personnel in various aspects of their role. This had included ancillary personnel, some of whom had achieved National Vocational Qualifications in their chosen field. Assessment of personnel files for those recently appointed showed that appropriate recruitment checks had been carried out to ensure that they were of the right calibre to work with vulnerable people. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37. The home had been effectively managed so that service users had received a service that was appropriate to their needs. EVIDENCE: The manager held the Advanced Certificate in Care Management and was responsible for the management of the staff to deliver the care. An administrator took responsibility for some aspects of the administration and record keeping. It had been noted at this and at previous inspections that the manager, with support from the proprietors, had reviewed the operational systems of the home to ensure that they met legal requirements and the National Minimum Standards. She had also supported members of staff through informal contact and more formal supervision and meetings. The result had been the development and retention of an established team, who understood the purpose of the home, their own responsibilities and the standards to achieve.
Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 15 Whilst the business and financial plan for the development of the service was not assessed, the proprietors’ reinvestment in the home was evident from the upkeep of its fabric and furnishings and the provision of training. Their personal commitment to the home was also noted from their frequent visits to the home, and the support they had provided for the manager. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x 3 3 x Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 17 No Are there any outstanding requirements from the last inspection? 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 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. 1. Refer to Standard 18 Good Practice Recommendations It is recommended that the home sets up protocols with the Local Family Protection Team in the event that a service users family attempts to remove her from the home against her wishes. Lansglade I51 S14925 Lansglade V222389 120805 Stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection 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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