Inspection on 24/02/06 for Lashbrook House

This inspection was carried out on 24th February 2006.

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

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

Other inspections for this house

Lashbrook House 01/12/06

Lashbrook House 04/11/05

Lashbrook House 15/03/05

Lashbrook House 16/09/04

Lashbrook House 10/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Lashbrook House Mill Road Shiplake Henley-on-Thames Oxfordshire RG9 3LP Lead Inspector Annette Miller Unannounced Inspection 24th February 2006 11:00 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 Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lashbrook House Address Mill Road Shiplake Henley-on-Thames Oxfordshire RG9 3LP 01189 401770 01189 404342 lashbrookhouse@majesticare.co.uk 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) Majestic Number One Limited Suresh Gogna Care Home 46 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (46) of places Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. Maximum of 30 persons with nursing needs. Date of last inspection 4th November 2005 Brief Description of the Service: Lashbrook House is situated in an attractive part of Oxfordshire near the river Thames and there is a railway station in the nearby village of Shiplake, as well as a post office and shop. The home is set in extensive grounds with views across open countryside. The home is registered to provide residential and nursing care for up to 46 service users aged 60 years and over. Registered nurses are on duty 24 hours a day. There are 30 single bedrooms and one double room on the ground floor, as well as two lounges, a dining room and a reception area. The first floor has 12 single bedrooms, one double room and also a lounge/diner. Most bedrooms have en-suite facilities of a toilet and washbasin. The five bedrooms without these facilities are provided with a washbasin situated within the room. Recreational and social activities are provided. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by one inspector from 11am to 6pm. A tour of the building took place and documents were examined. A discussion was held individually with two relatives and one resident to obtain their views of the home. The registered manager was on duty and was present throughout the inspection. The inspector was made to feel welcome by all staff and appreciated their cooperation. In order to gain an overview of the standards inspected during 2005/6 it is recommended that the previous report dated 4th November 2005 is read in conjunction with this report. What the service does well: What has improved since the last inspection? The home’s contract of residence has been revised to include information about how money provided by the NHS for nursing care is paid to residents. Two bedrooms have been redecorated and the programme of replacing bedroom carpets continues. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected at this inspection. EVIDENCE: Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 and 10 Medication records need to be improved to ensure that medication is safely administered. The care team has a good understanding about the importance of maintaining the privacy and dignity of residents, indicating that residents’ rights in these matters are upheld. EVIDENCE: All residents have their own medication administration record chart with details of the doctor’s instructions. A selection of charts were checked and it was noted that some instructions had been amended, possibly as a result of a nurse taking a verbal message from a doctor, but this was not clear and could not be checked as the changes were not signed or dated. The manager should ensure that records are signed and dated and also that when a verbal order from a GP for changes to a medication is received, written confirmation of the change is requested by fax, or by other means, whenever possible. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 10 Two medication charts had a list of handwritten instructions with most entries not dated or signed. One list was made from the instructions printed on medication containers brought in by a new resident. This is potentially unsafe because residents might not bring in all their medication, or bring in medication no longer prescribed. The manager should ensure that a list of current medication is obtained from the appropriate doctor for all new residents before they are admitted. The second chart was completed by a nurse who had copied medication instructions from a previous chart. All transcriptions should be referenced back to the original prescription, or a list of medications supplied by a doctor, and not the previous chart. A nurse shows when a medication has been given by writing his/her initials in the appropriate space on the medication chart. It is good practice to keep a signature list with initials on the medication file to enable initials to be easily identified in the event of a query arising about the administration of any medication. There was a list at the front of the medication file, but it was incomplete and out of date. Medication storage facilities, including controlled drugs, were checked and found to be satisfactory. The company has provided the home with good medication policies and procedures (last reviewed May 2004). However, there were medication documents from other sources that were out of date and these should be destroyed. Several medication records were loose because the file holes were ripped, which could result in records being lost. It is recommended that nurses responsible for administering medication receive an update in the administration of medications and record keeping, taking into account the guidance issued by the Nursing and Midwifery Council: ●Guidelines for the administration of medicines (August 2004) ●Guidelines for records and record keeping (January 2005). The inspector checked the temperature of the medication fridge and found it was 9.8ºC, whereas the daily recordings taken by staff showed the temperature to be below 8ºC at all times. The manager arranged for the fridge temperature to be checked after the inspection and stated that, although the temperature was found to be within the approved temperature limits when it was tested, she had arranged for a new fridge to be purchased. Members of staff have a good level of knowledge about the importance of respecting residents’ privacy and dignity, which is developed during induction and on further training updates arranged by the company. The inspector saw staff knock on bedroom doors and wait before entering. On admission residents are asked for their preferred term of address to ensure that they are treated with respect. There is provision for phone calls to be taken in private. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents’ choices are respected and acted upon by staff. EVIDENCE: Residents handle their personal finances and affairs for as long as they can, but when no longer able to do so this responsibility is passed to the person’s next-of-kin, or representative. Residents are encouraged to bring in personal possessions for their rooms and evidence of this was seen during the inspection. Information about the Age Concern advocacy service was available in reception. Residents are encouraged by the nursing staff to become involved in planning their care and can request to see their care plans whenever they wish. Two relatives were spoken to during the inspection and they each thought the home provided good care and that staff were friendly and helpful. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There are good systems in place to protect residents from abuse. EVIDENCE: The manager confirmed that she had attended training on the protection of vulnerable adults provided by the Oxfordshire adult protection officer. The home has a copy of the Oxfordshire multi-agency guidelines on the protection of vulnerable adults that sets out the local guidance in relation to how any concerns or allegations of abuse are investigated in Oxfordshire. The company arranges training for staff on the protection of vulnerable adults and the next training session is planned for April 2006. The home’s recruitment procedures include checking new staff against the vulnerable adults list held at the Department of Health to ensure that new employees are not listed as unsuitable to work with vulnerable people. The home has policies on the protection of vulnerable adults that are discussed with staff during induction training. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21 The standard of the environment within this home is good providing residents with an attractive and homely place to live. EVIDENCE: There is a programme of routine maintenance to ensure that the building is maintained to the company’s own high standards. A maintenance person is employed to carry out day-to-day maintenance, with outside contractors brought in as and when needed. Two bedrooms have been redecorated since the last inspection and the carpet replacement programme continues, with new carpets now fitted to 25 of the 44 bedrooms. The home is set in rural surroundings and many of the rooms have lovely views across open countryside. The gardens are well kept and provide pleasant outdoor facilities for residents and their visitors to enjoy. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 14 The Oxfordshire Fire Service and Environmental Health carry out periodic visits to ensure that good standards are maintained in each agency’s area of responsibility. The majority of bedrooms have en-suite facilities comprising washbasin and toilet. However, there are only three bathrooms with adapted baths suitable for residents unable to get in and out of a bath independently – two on the ground floor and one on the first floor. This number is low for a home providing care for up to 46 residents. There are a further three bathrooms, but they do not have assisted baths and the manager said these baths are not used because residents are unable to use them; she could not recall when they were last used. The company has previously indicated that these baths will be replaced as part of a planned programme of work, but the manager was unaware when this work was due to start. The manager reported that some difficulties were experienced as a result of this situation, explaining that staff overcame them as best they could by planning the times of baths carefully and offering baths throughout the day and evening as staff time permitted. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30 The number of carers with a National Vocational Qualification in Care has not yet reached the required minimum ratio of 50 , but good progress is being made towards achieving this ratio. All grades of staff attend a wide range of training to ensure that they are qualified and competent to undertake their work. EVIDENCE: 47 of care staff have achieved NVQ Level 2 in Care (or equivalent). Five carers are currently on this training and the home should soon exceed the minimum required ratio of 50 trained members of care staff employed within the home. Most of the required recruitment information and checks were found in the three staff files randomly selected for inspection. Omissions related to health declarations not being completed by two staff and gaps in employment not being checked for two staff during interview. This information must be obtained for all employees prior to appointment. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 16 There is a thorough and comprehensive induction programme that is based on the nationally approved Skills for Care induction course. Workbooks are issued to new workers to complete and the person supervising new staff members signs the workbook when each element of learning has been satisfactorily completed. Training records provided evidence of the wide range of training opportunities available and also showed that staff attendance was good. Certificates provided further evidence of staff attendance. The company is commended for its commitment to staff training and development. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 38 The home is well managed and there is good leadership, guidance and direction to staff. This results in good practices that promote and safeguard the health, safety and welfare of the people using the home. EVIDENCE: The company has good systems in place to measure success in meeting the home’s aims and objectives. For example, the manager sends out a questionnaire to all new residents approximately 4-6 weeks after admission to establish their level of satisfaction. The manager reported that prompt action was taken to deal with any matter raised as a concern. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 18 The company requires the manager to audit the standard of services on a regular basis and to provide evidence to the company for the conclusions drawn. The quality assurance and quality monitoring systems do not include obtaining the views of health care professionals who visit the home and obtaining this feedback should be considered. Residents’ meetings are held regularly and these also provide opportunities for residents and their relatives to express their views. The manager reported that the last meeting was particularly well attended for a talk by a community psychiatric nurse about the effects of dementia on people and their families. There are good systems in place for looking after residents’ pocket money when residents can no longer do this themselves. The income and expenditure accounts for two residents were checked and were found to be correct. The home has a written procedure for managing residents’ money and a copy was made available for the purposes of inspection. The inspector discussed health and safety issues with the manager and was satisfied that the procedures in place to monitor residents’ safety were thorough and well managed. Fire safety training records showed that staff attended the required amount of training during the previous year. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 2 X X X X X STAFFING Standard No Score 27 X 28 2 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 20 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 The manager must ensure that a record of a doctor’s verbal message for changes to an existing medication are dated and signed by the nurse who recorded the message. The manager must not employ a person to work at the care home unless all the information required by Schedule 2 of the Care Home Regulations 2001 is obtained. Timescale for action 24/02/06 2 OP29 19(1) 24/02/06 Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 21 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 OP9 Good Practice Recommendations ● Obtain a list of medication from a resident’s doctor prior to the person being admitted. ●When a verbal order from a GP for changes to a medication is received, written confirmation of the change should be requested by fax, or by other means, whenever possible. ● When it is necessary for nursing staff to start a new medication chart that is not supplied by the pharmacist, medication instructions should be copied from the original prescription, or from a list supplied by a doctor, and not the previous chart. Transcriptions should be dated and signed. ●Keep on file an up-to-date list of the names of staff responsible for administering medication, together with initials. ●Remove out of date information from medication files promptly. ●Keep medication files in good order to ensure that individual documents are held securely. ●Nurses responsible for administering medication should receive a medication training update, taking into account the guidance published by the Nursing and Midwifery Council: Guidelines for the administration of medicines (August 2004); Guidelines for records and record keeping (January 2005). Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 22 2 OP16 3 4 OP21 OP33 The registered person should review the home’s complaints procedure to ensure that the information provided is up-to-date and accurate. (Recommendation from the last inspection on 4th November 2005.) Increase the number of assisted baths. Obtain formal feedback on a regular basis from health and social care professionals involved with the home about the standard of care and services provided. Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 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 Lashbrook House DS0000027161.V285026.R02.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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