Inspection on 24/04/07 for Lapal House & Lodge

This inspection was carried out on 24th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Lapal House & Lodge 19/01/06

Lapal House & Lodge 11/07/05

Lapal House & Lodge 18/02/05

Lapal House & Lodge 23/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Lapal House & Lodge Lapal Lane South Halesowen West Midlands B62 OES Lead Inspector Mrs Cathy Moore Key Unannounced Inspection 24th April 2007 07:20 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 Lapal House & Lodge DS0000024965.V330359.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. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lapal House & Lodge Address Lapal Lane South Halesowen West Midlands B62 OES 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) 0121 503 0326 0121 550 1562 Mr Anthony Billingham Mrs Pamela Billingham Mrs Michelle Upperdine Care Home 41 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (35), of places Physical disability over 65 years of age (5) Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Lapal House & Lodge is located in an attractive area of Halesowen. Although it is not far from the A456 from Birmingham to Kidderminster, it can only be accessed via a minor road. A link to the M5 motorway is nearby. The home is set in acres of land, giving picturesque views from most windows. There is a farm to the rear. Service users who have bedrooms at the back of the home have the benefit of views of the farm and surrounding countryside. All the grounds are maintained to a high standard. The home is operated in two sections, the House and The Lodge. There is a registered Manager who has overall responsibility for the two areas. There are lift facilities in The House and a stair lift in The Lodge. There are separate dining and lounge facilities in both areas. The home operates a no-smoking policy for service users. Weekly fees at time of receiving pre-inspection questionnaire £382-£600. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced key inspection on one day between 07.20 and 17.20 hours. Prior to the inspection questionnaires were sent to the manager and service users’/ relatives for completion to gain views about the service from a range of people. Nine service user and three relative questionnaires were completed and returned, information from these will be referenced in the body of this report. I carried out the inspection mostly in the reception area in order for observations to be made about the service given and staff involvement with the service users’. I spoke to five’ service users’ one relative and four staff during the day, two of these were night staff. The manager was involved in the inspection throughout the day, the owner also took part at times. I looked at the premises, which included; the lounges, dining rooms, four bedrooms, two bathrooms, ground floor toilet, laundry, kitchen and garden. I looked at medication systems and safety and records concerning for example; recruitment, training, assessment of service users’, meals, care planning and activities. What the service does well: The home has a robust management team in place, which is effective and sound. The manager is very clear of her role and responsibilities. The owner of this home also has a number of other homes’ which allows support and information sharing regarding best practice with other staff and managers. The owners of the home take an active interest in the running of the home and are available at all times to give help and support. The home has a stable staff group, a number have been employed for some considerable time. Staff, were extremely friendly and helpful. I saw and heard interactions and exchanges between staff and service users’ which were positive. Staff being, very polite and supportive to service users’. Staff I observed and spoke to were very motivated and proud of the home and their achievements in terms of care provided to service users’. The home is set in large, attractive, grounds which, are well maintained. All staff, receive regular one to one supervision. The home has a high staff NVQ attainment level. All night staff have achieved NVQ level 2 or above. Internally the home is of a good standard concerning carpets, décor and furnishings. The homes’ atmosphere is positive, warm, welcoming and friendly. Visiting times are open and flexible. Relatives and visitors can if they wish with some notice, order a meal and eat at the home. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 6 The home employs an activities person three days a week and has it’s own transport to enable service users’ to go out on trips and outings. Food offered is of a very good standard. It gives a wide range of choice to service users’, is attractive and nourishing. Comments received from relative questionnaires included the following; They provide a caring, friendly environment that the residents feel safe and looked after, also an inventive and positive attitude. Everything that my mother requires. Everything that is necessary for the comfort and well being of my mother. One service user who was asked what the home does well told me; “ Watch over you so carefully, very accommodating”. One staff member said; If I left Lapal House I would not work in another care home as the high standards would not be the same anywhere else”. A visiting professional told me that he thought that the home was ‘ excellent’. What has improved since the last inspection? What they could do better: Better systems for care planning and service user record keeping would enhance the effectiveness in terms of easy, quick access to records. Some minor amendments to medication management will further increase medication safety. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 7 More attention to infection control in the home will maintain the good past history of virtual non- spread of infection within the home. Comments received from relative questionnaires included the following; Only by maintaining present standards. As far as I am concerned my mother is cared for very well. I think that the home is perfectly satisfactory. One service user who was asked in what ways the home could improve, said positively; “ Nothing really”. 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. Lapal House & Lodge DS0000024965.V330359.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 Lapal House & Lodge DS0000024965.V330359.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): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Time and effort is spent making admissions to the home personal and well managed. Prospective service users’ and their families are treated as individuals and with respect and dignity for the life changing decisions they need to make. EVIDENCE: Nine of nine completed service user questionnaires received confirmed that they have been issued with a terms and conditions or contract which is positive as this document gives them information about their rights as a service user accommodated in the home. However, when looking at the contracts on individual service user files I saw that the fee rate detailed was not accurate. These terms and conditions had been issued in 2005, yet the fee rate had not been updated for the financial year 2006/2007 which may confuse some service users’ about the cost of their placement. I informed the manager of Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 10 this shortfall who instructed the secretary to amend the fee rates as soon as possible. When I entered the home I saw that information about the home including, the last inspection report was available for all to read. During the inspection I saw one relative had come to look around the home to possibly place a relative. When I looked at service user files I saw that a record of assessment of need for each had been written. Three of three completed relative questionnaires confirmed that ‘they received enough information about the home so that they could decide that the home would be right’. This evidence shows that the home has in place good pre- admission and assessment of need processes in place to enable all parties to make a decision about the suitability of the home before admission. One service user told me; “ I was here before, for short stays and have decided to come in for good”. Lapal House & Lodge DS0000024965.V330359.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ have access to healthcare services. Staff make sure that service users who are fit and well are encouraged to be as independent as possible. The home understands the need to comply with safe medication management processes attention was paid when the few shortfalls concerning medications were discussed. EVIDENCE: I case tracked four service users and saw that a care plan was in place for each. However, not all needs had been fully documented in these for example; one service user had been admitted after the death of her husband but there was no mention of the care she may need concerning this. Similarly, the care plan for one service user who was very ill was fairly basic and needed to be added to. I saw the care plan for another service user who has confusion but apart from personal hygiene there was little mentioned about the input she may need concerning this confusion. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 12 There was evidence of a monthly key worker review and six monthly reviews for each service user which is positive, as that means some attention is being paid to any changing needs, however, if all needs are not included in care plans they cannot be reviewed. I found the process of case tracking difficult as records were held in many different places. For example; some care plans are held in the filing cabinet, professional visits are recorded on a sheet and kept on the office shelf, old records are not being filled to ensure only needed information is available and key worker information is kept in another file. I discussed this with the manager and explained that if staff needed information in a hurry for an emergency it may take them more time than needed to find required records. She agreed and said that the system was mainly due to lack of space. She and her staff discussed ways to ensure processes and systems are bettered. When I looked at service user records I saw information to confirm that access to healthcare services is maintained for service users which is good as that means they have regular check ups for instance from the dentist and optician. A staff member confirmed this further saying;“ The dentist and chiropodist come in”. During the inspection I saw a nurse come to treat one service user. The doctor also came. He confirmed that, he comes to do a surgery in the home every week. He also confirmed that staff, have always followed any instructions he gives which means that the medical needs of the service users are being met. I saw records to prove that assessment processes are in place for tissue viability, nutrition and falls risk assessment which means that the home tries to make sure that any risks are identified and risk to service users are managed or reduced. Generally, medication systems are managed well in that staff have received training and that no more stock than is needed is held. That medication is stored in a locked trolley secured to a wall. That photos of each service user are attached to their medication record to ensure that medication is given to the right person. That controlled medications are recorded and are securely stored. That medication received into the home and disposed of is recorded accurately and that staff signatures were only lacking for one day out of six weeks records. One, senior staff member has been given the responsibility to oversee medication management. From conversation with this staff member it was clear that she enjoyed this responsibility and was very keen to ensure that medication is handled safely to reduce risk to service users’. I did highlight a number of issues that need to be addressed to increase safety as follows; whilst it is positive that those service users’ who want to can keep their own medication present risk assessment methods do not confirm that a detailed assessment has been undertaken to judge whether or not individuals are safe to do so. I saw that Alendronic acid had been prescribed for two service users. Strict instructions need to be applied to the administration of this medication, unfortunately these instructions were not detailed on the service users medication record meaning that staff would not know what to do. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 13 I read records that told me that one service user last year had been reluctant to take her antibiotics. I voiced my concern to the manager when I read in the service users notes 9/12/06 ‘ taken antibiotic in her tea’. As there was no evidence that the administration for this antibiotic in this way had been approved by the doctor or pharmacist, this method could have placed this service user at risk. The manager tracked records back and confirmed that the staff member involved; “No longer worked at the home”, and agreed the process she had followed was not correct and would ensure that it was not repeated in the future. That staff promote privacy, dignity and independence which makes service users feel valued and respected is evidenced in many ways as follows; I saw the nurse who came to treat a service user take him into his bedroom to ensure his privacy. One service user told me; “ The staff are very good, they show me respect”. I saw that toilet doors had working locks and that staff shut doors when toilets are in use. I heard staff calling service users by their preferred names. Another service user said; “ I like company but I also like to spend time alone in my room watching TV, they let me do that”. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Central to the homes aims and objectives is the promotion of service user rights to live a meaningful life. Service users are offered a healthy, well balanced diet. There are choices for every meal and the dining areas are extremely attractive, but relaxed. EVIDENCE: That the home offers flexible routines and a stimulating environment is evidenced in many ways. I saw that breakfast times are flexible in that some service users’ had their breakfast early, others had their breakfast at 9.30. I heard staff asking service users’ what they wanted to do and when. On many occasions during the day I saw one service user walking around the home and up and down the stairs she told me; “ I like walking and exercise”. Another service user told me; “ We can come and go as we want, I get up when I want and go to bed when I want”. Service users are fortunate in that the home has it’s own transport which means they can access the local and wider community on a regular basis. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 15 The home employs an activities co-ordinator who provides structured activities three times a week. One service user told me “ we make things”. Another said; “They are taking me to the Severn Valley railway next week”. A staff member told me; “ They do lots of things, craft work, go out and celebrate for things like Easter”. I saw photos on the wall in the dining room area of a recent party to celebrate a service user’s 100th birthday. There was a beautiful cake and the press came and took a photo. Records showed me that service users’ are asked about their religious needs on admission and it is determined whether or not they wished to carry on practising. One service user told me that her she liked to follow her Roman Catholic religion. She said; “ I have communion”. The manager confirmed that the home meets religious needs by ensuring regular input from religious bodies in the community. One staff member said; Preachers and others come to the home often”. The home has an open, flexible visiting policy and actively encourages service users’ to maintain contact with family and friends. Visitors can be received in the lounges or service users’ bedrooms to meet their preferences. One service user told me; “ My daughter and grandchildren visit often”. A visitor told me; “My parents or sister visit a lot. Someone comes everyday. We are all made to feel welcome”. The owner told me that some service users’ have difficulty in getting out. So a table has been laid in the small lounge to allow visitors to come and have a meal with their relative if they wish. All service users’ are encouraged to bring into the home personal belongings to make their rooms feel ‘homely’. I saw a letter on file for one new service user to confirm that the home informs the local council that they are living at the home to ensure that they are able to vote. The home is split into two, the Lodge and the main house. Each side has its own dining room. The dining room in the main house especially is very impressive. The tables are nicely laid with cloths, mats and serviettes. The carpet and furniture, fixtures, curtains and fittings are all of a very good standard. The overall appearance is of a first class restaurant however, it does retain a homely, relaxed atmosphere. The cook is well experienced and qualified. She is very pleasant and accommodating, clearly keen to meet the dietary needs of all of the service users’. This was confirmed by one service user who said; “I’m very fussy about food but they always accommodate me”. I observed some of the breakfast time. Service users’ could have what they wanted. I heard the cooking asking each one what they would like. Set menus are in place which shows that service users are offered a very good standard of food. Menus cover four meals a day with choices for each. Food that I saw during the day was attractively presented and plentiful. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 16 Food stocks in the kitchen were also plentiful with brand names and plenty of fresh fruit and vegetables. The cook told me, “ I order what we need and what the service users’ want, I am never constricted in terms of budget”. Some service users’ made comments about the food as follows; “ They feed you well”. “ Breakfast was lovely”. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows service users’ to express their views and concerns. Service users’ and others involved with the service say that they are happy with the service provision and that they feel safe and supported. EVIDENCE: The Commission has not received any complaints about this home. The home has not received any complaints. A complaints procedure was on display on the wall in the main entrance hall to inform everyone how to make a complaint. Three of three completed relative questionnaires confirmed that they know how to make a complaint. Eight of the nine completed service user questionnaires confirmed that they know how to make a complaint, one answered no to this question. There have been no allegations or incidents of abuse. Staff and management confirmed separately that there have been no incidents of abuse and no incidents have occurred between residents. The majority of staff have received abuse awareness training, however; there was no evidence to suggest that this training mentioned Social Services procedures which are the ones that should be actioned if an incident or allegation of abuse were to occur. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 18 The manager was not aware of the Adult Protection manager for the local Social Services department or of the quick reference flow chart that should be available to staff to inform them of who to contact if a concern came to light, which could have caused a reporting delay. This was quickly rectified by the time the inspection ended. One staff member told me; “ I have got no concerns. There have been no incidents and we are all familiar with procedures and policies such as the Whistle blowing policy”. I asked a number of service users’ and a relative if they had ever seen anything concerning. All said “No”. That, “There was no shouting from staff or anything else”. All staff spoken to, including management, confirmed that there have been no incidents between service users’ which means that the home strives to protect, it’s service users’. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 19 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): 19,24,26. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home provides a physical environment which is of a very good standard and is appropriate to the needs of the service users’ who live there. The attractive, well maintained environment provides specialist aids and equipment to meet the needs of the people who live there. The home is very pleasant with it’s high quality furnishings and new carpets. It has large attractive grounds which service users’ enjoy, especially in the spring and summer months . EVIDENCE: Nearby is farm land with sheep and other animals. Nearby views that can be seen from many bedrooms are beautiful. The home is set in acres of attractive land and well maintained gardens. A number of service users’ whom I spoke with told me how much they enjoy the gardens, especially in the spring and summer months. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 20 The home is a large, traditional type detached building which has been altered and extended over past years to its present form. The home is very well maintained, spacious and bright. The owner employs a full time decorator for his group of homes’ a handyperson is also employed which allows an on-going maintenance programme. The surroundings, fittings and furnishings make it feel like a top class hotel, yet it retains a positive, relaxed, homely atmosphere. Recently new carpets have been fitted throughout which are of a good quality and are attractive. They make the home feel bright and spacious. Furniture and fittings throughout are of a very good quality. Staff and service users alike are very proud of the quality of the homes environment. I looked at four bedrooms, and found these to be well maintained, comfortable and homely. Service users’ have all brought some of their own personal belongings into the home to personalise their rooms. I spoke with one service user in her bedroom. This bedroom was of a very good size, with nice views over farmland. It was furnished to a good standard and was provided with very attractive bedding. Like the others I saw safety had been taken into consideration in that the radiator had been guarded. The service user told me; “ The room is very nice, there is nothing else I want in here”. Another service user told me; “ I really like my bedroom, it has got a balcony”. Infection control processes need some ‘fine tuning’. The laundry floor has gaps in places and would benefit from being replaced in the near future. I saw material towels in two bathrooms which could present as an infection transmitter if a number of different people touched them. The manager arranged for these to be removed during the inspection. I did not see hand wash signs in all toilets and bathrooms to remind service users’ to wash their hands as a good infection control measure. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has staff at all times to support the needs of the service users’ and has a proactive training programme. The service has a well-developed recruitment procedure that has the needs of the service users’ at its core. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is highly selective, with the recruitment of the right person for the job being more important to the filling of a vacancy. EVIDENCE: The home provides four to five carers during waking hours and three wakeful night staff. The home has a strict access criteria concerning admissions for new service users’ for example; people must be mobile and not have any behaviour which may challenge the service. The manager told me; “ We have to be very careful with new admissions, we have to think of any implications for people who already live here. I am never pressured into filling empty beds by the owner we all know that we have to meet the needs of new people and the needs of the people already here. Obviously if service users’ deteriorate once here we like to let them stay, with support from the doctor and nurses, I mean it’s their home”. As a consequence, dependency levels are relatively low. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 22 For example: all service users’ that I saw were independently mobile although a number used walking sticks or zimmer frames. I asked service users’ staff and a visitor if staffing levels were sufficient noone told me that they were not. I got the following answers; “ Yes, we have enough staff. The home runs well”. “ Yes there are enough staff, most service users’ are mobile and there are no challenging behaviours”. “ Staff ok, enough”. The staff I observed and spoke to were very pleasant and friendly. They all knew each service user well. One thing I did pick up was the motivation and positive attitude of staff. When they spoke with service users’ they were friendly and polite. I saw them giving service user’ choices. I saw service users approach them comfortably with questions and requests. Service users’ told me; “ Staff are good”. “Very good”. The staff are very good, they show me respect”. Three of three relative questionnaires received confirmed that ‘ The staff have the right skills and experience’. Pre inspection questionnaire stated that twenty two of the thirty one care staff have achieved NVQ level 2 which is well over 60 of the whole care staff team. This demonstrates that staff have had the required training and because of this service users are in ‘safe hands’. I randomly checked five staff files and was pleased to see that all of the required checks had been carried out before they were allowed to commence work at the home. One thing I did note was, medical conditions detailed on one staff members health declaration form. There was no evidence to suggest that a risk assessment had been carried out by management to reduce any risk to this person concerning these conditions as should have been. I saw that staff have in-house induction and that the home has recently implemented formal induction processes for new staff, to enhance their knowledge and basic skills. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36,38. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. There are processes in place for monitoring practices, staff receive regular, formal supervision and working practices are safe. EVIDENCE: The manager has been employed by the home since she left school. She has worked her way up and has earned her present role of registered manager. She is qualified, she has achieved her ‘ Registered Managers Award’. The manager is clear about her role and responsibilities and remains focussed and motivated. I saw on many occasions during the day staff, relatives and Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 24 service users’ approaching her, asking her questions and being confident to do so. Staff told me; “ She knows what she has to do”. “ We are well supported and trained”. I saw records to prove that the home has in place many methods to monitor care and practices. They showed me a system that has recently been introduced as a ‘ self assessment tool’ which covers all functioning of the home including, the National Minimum Standards for Older People. I saw minutes of staff meetings and completed questionnaires for staff, service users’ and relatives. I also saw that regular service user meetings are held minutes were available dated; 22 September 06, 15 December 06 and 1 Feb 07 proving that processes are in place to gain service users’ views about the home and for them to have the opportunity to discuss the functioning of the home. I was interested to learn that a number of staff have recently received ‘ Effective Customer Care’ training. The manager told me; “ It is important as we are not only here for the service users’ but callers to the home and very much for relatives, who at times need a lot of support”. The owner visits the home almost on a daily basis. The manager said; “ I am well supported and feel very happy to ask when I need advice”. Processes are in place for the safe keeping of service user money. Records and receipts are retained and records made. Unfortunately, two monies were not accurate against balances. One was 2p over the other when tracked back was due to a recording error. I saw evidence to prove that the manager regularly audits the money and it is held securely. I did inform the manager that the money would be better safeguarded and those who deal with it if two signatures verified each transaction rather than one. I was very impressed when I viewed staff files to see written evidence of regular supervision and appraisals. That all staff receive regular supervision was confirmed by both night staff who I was fortunate to meet. This means that staff, are receiving regular direction about working practices and other important feedback about the work that they do. I looked at health and safety records and service certificates for equipment these were all in order. I saw the following service certificates ; Gas landlords safety certificate 8/06, five year fixed electrical wiring test 30/03/04, lift service 12/4/07, and fire alarm service 8/2/07. The kitchen had recently been inspected by Environmental Health and things highlighted have since been addressed. I looked at staff training files and saw that training has been received in all areas such as; fire safety, moving and handling and first aid. A training matrix is, in place for planned future training. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 25 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 4 x x x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 4 x 3 Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Timescale for action 01/05/07 2 OP9 13(2) 3 OP9 13(2) Medication must not be put in drinks or disguised in any way without consent from a doctor or consultant the service user/ relative and the pharmacist. Clear instructions must be 01/05/07 included for the administration of medication such as Alendronic Acid. All medication bottles and 01/05/07 packets must be date labelled when opened to enable effective auditing. Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 27 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. 2 Refer to Standard OP2 OP7 Good Practice Recommendations Service user terms and condition / contract documents should be updated every year to reflect the correct fee. Care plans and records should be better organised to ensure that all are together for easy quick access and that they are signed by service users’ and relatives to show they are in agreement with what is written. Care plans must be expanded to ensure that all service user needs are included in detail for example; behaviour, bereavement. Where staff hand write medication records two staff should sign to confirm that information being transferred is correct. The laundry floor should be replaced to ensure that there are no gaps in which bacteria can grow. Where staff have confirmed on their health declaration that they have a health diagnosis then this should be explored and risk assessed to reduce risk. 3 4 5 6 OP7 OP9 OP26 OP29 Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Lapal House & Lodge DS0000024965.V330359.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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