CARE HOMES FOR OLDER PEOPLE
Lansglade 14 Lansdowne Road Bedford Bedfordshire MK40 2BU Lead Inspector
Katrina Derbyshire Unannounced Inspection 23rd April 2007 09:45 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.V334051.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. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 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 lansgladehomes@btconnect.com 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.V334051.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th May 2006 Brief Description of the Service: Lansglade House is a large double fronted Victorian building that has been sympathetically converted to provide comfortable accommodation. The home is 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. Accommodation is arranged over three floors with the communal sitting and dining areas on the ground floor. The bedrooms are located on each of the three floors. Bathrooms and toilet facilities are located for convenient access throughout the building. The upper floors can be accessed by a shaft lift. A copy of the homes statement of purpose and service user guide are available in the front hall. A copy of the most recent inspection report is displayed in the entrance of the home and is available to prospective people who may wish to move into the home. Samantha Warner, Senior care assistant at the home provided the following information on charges in April 2007. The fees for this home vary from £450.00 per week, to £470.00 plus per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing, barber services and newspapers. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 23rd April 2007. During the inspection several areas of the home were visited and the inspector spent time with many of the people who live at the home in the communal areas. The care of three people was examined by looking at their records and interviewing them and staff who look after them. The views of people living at the home and their relatives were also received through 18 returned comment cards and their feedback has been used alongside information from the home, through written evidence in the form of a pre inspection questionnaire to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
People living at this home feel that the staff are friendly and kind. One person said,” l came here 8 months ago and was feeling nervous but they made me feel at home”, another person said, “ the staff are just wonderful, they really are”. People feel supported and they feel at ease talking to the staff at the home, with many describing them as providing them with the support that they need in their day to day lives. Many relatives of people living here feel that they can still be involved in their care and support. One person said, “my mum looked at loads of homes before picking this one, we visit everyday and they always discuss things with us it was important that we stay involved”. Another relative said, “The home is very well run, the staff are first class and are always very helpful, as a family we are very satisfied”. So people living at the home and families also feel that staff support them in maintaining relationships that are important to them. When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 6 make sure for example, that they receive at least two references and carry out a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with vulnerable people. This had been done, all staff before being allowed to work had these checks made about them. What has improved since the last inspection? What they could do better:
To make sure people are treated in a respectful way at all times, the way some staff write needs to change. Staff make written entries on what is called ‘daily notes’ about everyone who lives at the home. These entries describe for example what has happened during the day to that person. Some staff need to change the way they describe things in these records, they must change because some write in a way that is based on their opinion, not on what they may have seen or fact. One example was within the records of one person a staff member had written, ‘very abusive and rude’. This is the staff members opinion, they need to write about what they see, not what they think. Staff also need to make sure that they record the temperature each day of the fridge that it is used to hold medication. This is important, as certain medicines must be stored at a certain temperature. Staff had only done this once in the
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 7 past 5 months, so there was no way of knowing if the fridge had been kept at a safe temperature. 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. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Pre admission assessments and information on the home is sufficient to ensure people can make an informed choice as to whether to move into the home or not. EVIDENCE: The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. All 18 comment cards returned to the Commission for Social Care Inspection from people using the service indicated that they felt they had been given enough information, before they decided to move into the home. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 10 Assessment documentation was in place for people that had moved into the home recently. This showed that the social, psychological and physical needs of the person had been looked at to ensure staff would know if they had the skills and experience to meet their needs. Management through discussion confirmed that an assessment of someone’s needs was always undertaken prior to their admission. Intermediate care is not provided at the home. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Staff are good at supporting people to access health care support so that their health needs are met. EVIDENCE: At this visit a District Nurse was seen to be visiting people at the home, this was to provide assistance with dressings and support someone who needed help with management of their diabetes. A General Practitioner later on also was seen to visit someone; the staff had contacted him, as the person needed their help due to deterioration in their overall well being. Records seen within the care files examined showed documents from health care practitioners, for example a dietician to demonstrate that access was gained when a person required it. All 18 returned comment cards indicated that people at the home felt they received the medical support that they needed.
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 12 Medication stocks were examined alongside the records relating to this area. The medication administration records showed current balances and contained initials of staff when medication had been given. Staff and training records confirmed that training had been undertaken in safe administration. The stock maintained in the home was sufficient to provide for the current 28-day administering period. However the recording of the fridge temperature had not been taking place, it had been undertaken once in February 2007 and prior to this August 2006. Care plans were seen to be of a mixed standard. The managers overseeing the home at this time advised that this was because they were in the process of revising all care plans, but had not yet completed all of them. The plans that had been changed obtained sufficient information to guide staff in how they should support the person. However those not yet revised were not clear and this was acknowledged by the management at the home. Staff when questioned were able to describe the needs of the people living at the home, although some had a greater understanding than others. The daily records examined contained some entries by some staff that were not appropriate. They described the person as ‘rude’ for example, rather than describing the action or behaviour of the person and a requirement is made relating to this. People living at the home felt that their privacy was maintained. Everyone spoken with said that staff knocked on their doors before entering and that they used their preferred term of address. Privacy screens were in place within the shared rooms. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at this home feel that arrangements in place for activities are good and meet their social needs. EVIDENCE: Several people spoke of the activities available to them in the home and one person commented “ l like it when l get my hair done”. Information supplied by the home through the pre inspection questionnaire to the Commission for Social Care Inspection showed that activities arranged in the home included outings to museums, garden centres and the pub, church services and visiting entertainers and singers. The Bedfordshire library service also visits the home and church services are held. Several people during this inspection were seen to receive visitors. A family member of one person said “ l have no complaints, they look after my wife very well”. Everyone spoken to confirmed they were able to receive visitors when they wished and many would chose to see them in the privacy of their
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 14 own rooms. Entries were also seen within residents records that demonstrated that the staff at the home would contact the nominated next of kin if there had been a change in their well being, one example of this was following an accident and the contact details had been recorded by the staff member. Options available to people in maintaining control, independence and choices in their lives included, choice of meals, voting, choice of clothing, access to a complaints procedure and access to community healthcare support. People living at the home and records confirmed that the choices associated with people’s daily lives were available to them whilst living there. The views of the people living at the home received through return comment cards to the Commission for Social Care Inspection regarding the catering, was in the main complimentary. At this visit a choice was available of the main course and starters of soup and a sweet was also available, the options reflected the information detailed on the menu board that had recently been introduced at the home. Protein, carbohydrates and vegetables were noted to be offered daily providing a balanced diet. In addition staff were observed in the morning offering tea or coffee, cheese and biscuits and later on sherry or fresh orange juice. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Systems in place at this home for receiving and investigating complaints is good so people are assured that their concerns will be acted upon. EVIDENCE: Records supplied by the home to the Commission for Social Care Inspection show that staff had undertaken training in the protection of vulnerable adults. On interviewing staff they demonstrated a sufficient level of knowledge on the types of abuse including physical and psychological. In addition the homes procedure in this area was examined, it’s reflected the local guidance. The management had sought a copy of the local protocols and these were seen. The management and staff at the home did demonstrate through discussion an understanding of the need to refer any allegation or suspected abuse. Complaints received at this service had been kept alongside documents to show the investigation carried out, response and any recommendations made following the investigation. 15 of the 18 returned comment cards indicated that they knew who to speak to if they were unhappy. Within the homes statement of purpose there was details on how you could complain and to whom. Staff
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 16 when interviewed gave satisfactory responses on their responsibilities if they were to receive a complaint and this matched the guidance within the homes own procedure. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 17 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 & 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The standard of cleanliness in this home is of a good standard and provides a pleasant environment for people to live in. EVIDENCE: The premise is a converted three-storey house. Accommodation available is across two floors at this time. The furnishings, fittings and décor in these areas is of a good standard. The assessment of these standards was noted to be as stated at the previous inspection. People living at the home who were seen commented that the environment was pleasant and felt that the home catered well for their needs in this area. The rear/side garden area provides space to
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 18 sit out in the warmer months. Individual rooms contained personal items of the person to assist in creating a homely atmosphere. All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner and clinical waste contracts are in place. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 19 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 & 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The training arrangements for staff are sufficient with staff demonstrating a clear understanding of their role. EVIDENCE: The induction and training of staff was recorded in the individual records of all employees. Staff through interviewing confirmed that they had undertaken a variety of courses these included health and safety, moving and handling and national vocational qualifications in care. Several of the people living at the home made positive comments on the skills of the staff team, one person said “they always seem to know what they are doing”. The homes recruitment policy and procedures as previously assessed are clear and comprehensive, documents submitted by the home to the Commission for Social Care Inspection show that no change has taken place to these policies. References are taken prior to staffs’ commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Certificates of qualifications are present within staff files.
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 20 Senior support workers, care assistants, catering and housekeeping staff are employed at the home . The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this time. Residents confirmed that staff were available to help and assist them when they need help. Training records examined that were supplied by the home show that staff had undertaken statutory training, including moving and handling, fire safety and food hygiene. In addition staff confirmed that they had attended a variety of courses including dementia awareness. People living at the home who were spoken with felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Staff were questioned on the individual needs of some of the people who live at the home, through this they demonstrated a good level of understanding of the needs of the person. One staff member had a very good level of knowledge relating to one person, and was able to describe their individual likes, dislikes, family history and the level of care and support needed. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 & 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and safety in the home is managed well and reduces the risk of accidents to people at the home. EVIDENCE: The Registered Manager had been off work for over 5 months at the time of this visit. The owners had arranged for interim management arrangements to be in place during this time. Two other Home Managers employed by the company were providing day-to-day support and were available for on call support. Staff reported that they found this to be sufficient to provide them with the support and guidance that they needed. During this period changes
Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 22 had taken place, including the revision of care plans, increased choice at mealtimes and individualised care to people living at the home. Documentary evidence was seen that showed that the home had undertaken a survey to gain the views of people living at the home and their representatives. Where areas had been raised the staff at the home had taken action to remedy this and make improvements for example the laundering of clothes. No monies are managed on behalf of any person living at the home. Health and safety records maintained by the home show that safety checks are carried out to ensure equipment in the home is kept in good working order. Copies of the most recent inspections undertaken by the fire service and environmental health were seen and evidence was also seen that work had been undertaken in response to any recommendations made. Where staff were seen to assist people in moving during this visit, the transfer was noted to follow safe practice for both the person and staff. In addition staff training records and staff themselves confirmed that they receive regular health and safety training one example was fire safety. Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 24 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) 1415(1) Requirement Care plans and daily records must contain sufficient information to show the support needed by the person, and must only contain accounts of observation not the opinion of staff. This is to ensure people receive continuity of care and records about them are written in a respectful way. The fridge used to store medication must have its temperature recorded daily. This will show if medication is being stored at a safe temperature. Timescale for action 31/07/07 2. OP9 13(2) 30/06/07 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.V334051.R01.S.doc Version 5.2 Page 25 Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Lansglade DS0000014925.V334051.R01.S.doc Version 5.2 Page 27 - 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!
