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Inspection on 11/08/08 for Lathbury Manor Residential Home For The Elderly

Also see our care home review for Lathbury Manor Residential Home For The Elderly for more information

This inspection was carried out on 11th August 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff team are well established and have a good overall knowledge of the service users needs. The home operates a named key worker system that clearly identifies which staff are expected to provide care in specific areas of the home. The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. Care staff are understanding and supportive to people who have dementia and the atmosphere is relaxed and accommodating to individual needs. There is a range of activities available to residents who are encouraged and supported to take part in these and remain in contact with their families and friends. The standard of food is good and there is a choice of main meal. Staff support seen at meal times is sensitive and discreet. The complaints policies and procedures work well and residents and their families feel that any concerns that they have are addressed promptly. Residents live in a homely environment which is the home is clean and tidy. The staffing levels and training undertaken by staff are good. Most staff are undertaking National Vocational Qualifications in Care and a number of staff have undertaken dementia care courses to give them the knowledge and skills they need to support people with dementia. The home is well managed by a stable experienced management team. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose.

What has improved since the last inspection?

A fire risk assessment has been completed and the recommendations from the previous inspection, by the fire authority, have been implemented. Care plans and risk assessments are being reviewed regularly. The use of Tippex correction fluid and scribbled over entries in care plans has now stopped. Staff`s practice in the administration and recording of medication has improved and no issues or concerns were identified. Weaknesses identified in the home`s recruitment procedure at the previous inspection have now been addressed.Two staff members check residents` money coming in and going out of their accounts and receipts are maintained for all transactions. The radiator in the lounge has been covered. Handwritten entries recorded on Medication Administration Records are checked, signed and dated by two staff members. The practice of staff standing up to feed residents has now ceased.

What the care home could do better:

Care plans must set out in detail the actions that need to be taken by care staff. The incidence of pressure sores, their treatment and outcome must be recorded, in detail, in the service users individual plan and reviewed on a continuing basis There must be a detailed protocol in place for the management of epilepsy, that provides informative guidelines for the staff on how the condition and needs should be managed and met. The identified repairs must be made to the home. These must include repairs to the kitchen cupboards, drawers and worktops, the laundry and the bathroom ceiling. The home must implement an effective quality assurance system is in place based on seeking the views of service users, relatives or other represntatives. Staff must complete and remain up to date with core mandatory training. This must include, infection control, fire training, moving and handling and basic food hygiene training. The fire alarm system must be tested on a weekly basis and this must be recorded.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Mulligan     Date: 1 1 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX 01908615245 Telephone number: Fax number: Email address: Provider web address: broadwaylathbury@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Gillian Elaine Broadway,Mr Edward Nigel Broadway Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: 1 person with a physical disability 6 people over 65 with dementia This home is registered for 23 older people with up to 5 people with a learning disability, Date of last inspection Brief description of the care home Lathbury Manor is an attractive old house with listed building status. It is conveniently situated on a main road to Northampton, just north of Newport Pagnell. There is a Care Homes for Older People Page 4 of 31 Over 65 0 0 11 0 6 5 0 1 Brief description of the care home landscaped garden and car parking to the rear of the property. Residents bedrooms and the communal rooms of the house have been comfortably furnished and pleasantly decorated. The home is registered to provide care for twenty-three residents. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. The inspection officer was Barbara Mulligan. The registered manager is Gillian Broadway. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some people who use the service, examination of some of Care Homes for Older People Page 6 of 31 the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the care home does well: What has improved since the last inspection? A fire risk assessment has been completed and the recommendations from the previous inspection, by the fire authority, have been implemented. Care plans and risk assessments are being reviewed regularly. The use of Tippex correction fluid and scribbled over entries in care plans has now stopped. Staffs practice in the administration and recording of medication has improved and no issues or concerns were identified. Weaknesses identified in the homes recruitment procedure at the previous inspection have now been addressed. Care Homes for Older People Page 8 of 31 Two staff members check residents money coming in and going out of their accounts and receipts are maintained for all transactions. The radiator in the lounge has been covered. Handwritten entries recorded on Medication Administration Records are checked, signed and dated by two staff members. The practice of staff standing up to feed residents has now ceased. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using 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 homes Statement of purpose and Service Users guide provide service users with details of the services and the home provide. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and are given an opportunity to visit the home beforehand to ensure it meets their needs. The home does not admit service users for intermediate care so this standard was not assessed during the inspection. Evidence: The Service Users Guide and the Statement of Purpose have recently been updated and the inspector looked at these.They are detailed and easy to read. However it is unsure if these are available in any other language or format. The registered manager said that in conjunction with these documents, potential Care Homes for Older People Page 11 of 31 Evidence: service users will receive an information pack.Together this provides potential service users with the information they need to make an informed choice whether they wish to live in the home. The inspector observed the assessment documentation for four service users, including those most recently admitted to the home. Four files looked at contained an assessment tool that consisted of a tick list. There was very little room to record findings and was not comprehensive. The registered manager said she found this tool wasnt suitable and the home has since reviewed this. A new assessment tool has been produced and this was used for the newest admission to the home. The admission documentation seen is fully completed, detailed and demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. All assessments seen are signed and dated. One person spoken to during the inspection confirmed that they had opportunity to visit the home before moving in and were supplied with enough information to help them make a decision about moving in. Unfortunately other people spoken to were unable to remember.Several service users have lived in the home for almost 10 years. Encouragement has been given to personalising bedrooms to help people settle in. The home does not admit service users for intermediate care so this standard was not assessed during the inspection. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care is delivered in a way that promotes respect and dignity, however care plans need guidelines in place that detail the action staff must take, to meet the assessed needs of service users and ensure that staff’s good practice is reflected and people’s health and wellbeing is promoted and protected. Medication is well managed, ensuring that service users receive the medicines they require as prescribed. Evidence: The care of four people using the service was case tracked and their care plans were examined. Recording in many care plans lack specific details about how to meet the needs of service users. For example several entries in care plans record, 2 carers to assist with personal care and needs help with baths and assistance with personal care and assistance with mobility and personal care required. In another file looked at there is a sheet regarding personal care and this tells the carer what the service user can do and what they cant do. However there is a post it note on this sheet that says this information needs to be updated. There is a short term care plan in place Care Homes for Older People Page 13 of 31 Evidence: but this lacks detail and does not provide sufficient guidelines for staff to meet the service users needs. In the care plan for the newest admission, under the heading of social skills it has been left blank and under the heading under of personal hygiene it states to prompt X to wash hands and face when possible. There is no information about bathing, showering or grooming. These are vague statements and must contain further details so staff can meet the assessed needs of the service users. A requirement is issued for improvement in this area. l A requirement was issued at the previous inspection for care plans to be reviewed monthly. The inspector observed that care plans are being reviewed on a monthly basis. A further requirement was issued for the use of tippex correction fluid and scribbled over entries recorded in care plans be ceased. It is pleasing to see that this has been complied with. Risk assessments show that there are a small number of service users with a pressure sore. These were examined by the inspector. One risk assessment records carers to check pressure area daily and pressure relieving equipment in place. However this does not tell the staff what to look for or who to report it to. In the daily notes for one person it records on the 05/08/08 pressure sore open on bottom but the pressure area risk assessment last reviewed on the 19/06/08 assesses this person as at low risk. This is conflicting information and has the potential to prevent staff working from current information. There is no detailed plan of care for people with pressure sores that provides details of skin preparations used, how often a person needs to be turned, pressure relieving equipment used and fluid and dietary intake. This will be a requirement of the report. Following the previous inspection a requirement was issued for moving and handling risk assessments and tissue viability risk assessments to be kept under review. This has been completed but the risk assessments for pressure area care need to be reviewed more frequently where a service user has a pressure sore. During the previous inspection it was identified that one particular service user suffered with epilepsy. However, there was no action plan in place outlining how the individual’s needs should be met. This was looked at by the inspector who was unable to find any appropriate guidelines in place for the management of epilepsy. A chart to record seizures was seen and this shows that some seizures last for over fifteen minutes which could potentially put the service users at risk. Specialist advice is needed to review this persons epilepsy and the senior carer made an appointment with the service users GP on the day of the visit. A detailed protocol must be in place for the individual with epilepsy, that provides informative guidelines for the staff on how the condition and needs should be managed and met. A requirement is issued for improvement in this area. Care Homes for Older People Page 14 of 31 Evidence: Following the previous inspection a requirement was issued for staff to administer medication in accordance with the British Pharmaceutical Guidelines. The home supports service users to receive the medication that they need by assisting with with their medication. There were no service users who were able to self medicate at the time of the visit. Medicine records looked at are accurate with no omissions and photographs are used for identification. At the time of the inspection there were no controlled drugs in use, however there are systems in place if this is necessary. There is evidence in the staff training records that demonstrate staff expected to administer medicines have undertaken training in the safe handling of medicines. The home uses a local chemist to supply and deliver the homes medication and the home uses a monitored dosage system. There were no out of date medications held in the service users home with a returns procedure in place. Where a service user is prescribed as needed medicine the care plans or instructions in medication charts should detail why and when this is to be given and this is strongly recommneded. Medication procedures are robust and ensure people get their medicines as prescribed by their doctors. Preferred terms of address are identified at the initial assessment and the inspector saw evidence of this in care plans. The homes induction programme includes training regarding privacy and dignity. The Statement of Purpose and Service Users Guide include information about maintaining the privacy of service user’s. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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. An appropriate range and variety of activities are on offer to service user, however, recording of peoples interests and social care needs should be improved. The presentation and standard of food is good and meets the nutritional needs of people who use the service, however the presentation of liquidised foods needs to be improved. Evidence: Care plans show some individual routines of daily living. These include rising and retiring times. The initial assessment does not always identify the social care needs of service users and these are not always reflected within the care plans. For example, in one care plan looked at it records, X likes drawing but there is no further information. Another entry reads enjoys going for walks but there is no further information to inform the carer where she likes to walk, how far, can she take a walk on her own or does she need to be escorted. Care plans should identify the interests and the social care needs of service users and must detail how these needs will be met. This is strongly recommended. Although the information in care plans does not adequately inform carers about peoples interests and social social care needs the home has a varied and busy programme of activities available for people using the Care Homes for Older People Page 16 of 31 Evidence: service. This includes a weekly exercises class, a healthy music session, quizzes, gardening and cookery sessions. The home is visited by various musical entertainers an aromatherapist and reflexologist, and a production group visits the home three or four times a year. One service user has a sensory impairment a volunteer from the RNIB visits on a weekly basis to take the service user for a walk. Service users are able to receive visitors in the privacy of their own rooms, and are able to choose whom they see and do not see. There are no restrictions on visiting, and this is documented in the Service Users Guide. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. Service users are offered three meals a day. The menu is rotated on a four weekly cycle and examination of the menus show that meals are varied, nutritious and there is a choice of main meal and sweet. The inspector joined service users for lunch. This was relaxed, unrushed and well organised. Most meals were attractively presented. However it was observed that liquidised meals for two people had all portions liquidised together resulting in a brown mass of liquidised food, and these were served in a bowl. When this practice was questioned, the registered manager said that one service user preferred her meal this way. This must be recorded in the care plan. However she was unsure why the other individual had received their meal like this. It is strongly recommended that when liquidised meals are provided, each portion should be liquidised separately to provide the service user with a selection of colours, tastes and textures. The inspector was told that service users can take their meals in their rooms if they wish. The home offers drinks and snacks throughout the day in accordance with needs of the service users. The nutritional needs of service users are assessed and there is good detailed evidence of regular monitoring in all care plans seen. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using 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 home has an effective complaints procedure to ensure that people who use the service or their representatives are listened to and there are policies and procedures in place to protect service users harm. Evidence: The home has a complaints procedure, which is accessible to service users and their representatives. There is a copy of the complaints procedure in each service users bedroom. This is also included in the Service Users Guide and Statement of Purpose. A record of all complaints is maintained, and this was viewed. The last complaint was received on the 12/07/ 2007. This had been dealt with within the stated timescales and is well recorded. The Commission has received two complaints about this service since the previous inspection. The home uses the Milton Keynes Safeguarding policy and an organisational policy in conjunction with this. There are guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. Training records show that most staff have received training about Adult Abuse, however there remains six staff that need to undertake this and two staff who last completed this training in 2004 and this needs to be updated. The registered manager does not act as appointee for any service users. There are systems in place to look after small amounts of personal allowance or for the Care Homes for Older People Page 18 of 31 Evidence: safekeeping of service users valuables. The Commission has received details of one safeguarding referral regarding this home. This was looked at by the inspector and was seen to have been dealt with appropriately and is well recorded. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is adequate, providing people who use the service with an attractive and homely place to live. However, prompt attention is required to repairs in the home to ensure the home remains a safe and homely place to live. Evidence: Lathbury Manor is an attractive old house, with listed building status which has retained many of its original features. It is set in one acre of grounds in the small village of Lathbury. The home is registered to accommodate 23 residents. There is car parking to the rear of the property. The home has a redecoration and refurbishment programme in place. At the time of the visit the homes three lounges were being redecorated with new chairs and carpets. There are many personal touches around the home such as flowers, pictures, books and mirrors. The dining room is bright and spacious and suitable for its purpose. The kitchen area requires some repairs. There is a small worktop island in the middle of the kitchen. The work top has worn down to the wood below and must be replaced. Care Homes for Older People Page 20 of 31 Evidence: There are several drawers and cupboards in the kitchen that are broken and need to be repaired. At the previous inspection undertaken in February 2006 the laundry area was part of the homes refurbishment planned programmed. However work has not commenced in this area yet. The laundry area is small and was cluttered with mops and buckets. The floor finishing is not impermeable and the floor and walls are not readily cleanable. This must be addressed. The ceiling in one bathroom, on the first floor, has peeling paint and vast damp patches. The registered manager said this was because a flood occurred on the floor above. This must be rectified. A requirement is issued for all identified repairs to be completed. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using 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 who use the service benefit from a staff team who are adequately trained and sufficient in numbers to support service users with personal care. The home has a recruitment procedure that is robust and ensures the safety and protection of service users in the home. Evidence: The home’s staff rota demonstrates that there are adequate numbers of staff on duty at all times to ensure the needs of the service users can be met. However the inspector was told that staff are expected to undertake the entire laundry for the home which often takes them away from their role as carers for lengthy periods. This is an area that the registered manager may wish to review. The home are making good progress with NVQ training. In additionto the registered manager there are nineteen care staff. Two staff are NVQ Internal Verifiers, three staff are NVQ assessors, two staff have completed NVQ level 3 and one staff member was undertaking this, and a further seven staff have competed NVQ level 2 and a further two staff who are training to achieve this. During the previous inspection weaknesses were identified in the homes recruitment practices and a requirement was issued for improvement in this area. The inspector Care Homes for Older People Page 22 of 31 Evidence: examined four staff files including those new to the service. These were in good order and all files looked at contain the necessary documentation as detailed in schedule 2. There is evidence that all staff CRB checks and two references have been obtained. There is an induction programme in place to ensure that new staff members are familiarised with the organisation and their roles and responsibilities. New staff are given a mentor to help them complete their induction and all staff receive a welcome pack. Following one month a review is held to see how the new staff member is progressing. This is repeated again after three months. The induction includes all core training and any further specialist training deemed necessary. Examples of specialist training include communication, continence, care planning, challenging behavior and dementia training. Staff confirmed that there are regular staff meetings. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. There are several areas of the homes health and safety procedures and quality assurance systems that need to be improved to ensure the service users health, safety and welfare are protected and promoted. Evidence: Lathbury Manor is owned and managed by Mr and Mrs Broadway. Mrs Broadway is the registered manager. They live on the top floor of the home. The registered manger has completed her Registered Managers Award and further training includes Catheter Care, a three day Safeguarding Vulnerable Adults course, Diabetes Training and first aid. There are clear lines of accountability within the home. The home has a care standards quality audit in place. However this has not yet been been completed. The registered manager said that the home gains feedback from Care Homes for Older People Page 24 of 31 Evidence: people who use the service by one to one discussions. There are special carer roles and they undertake this. However this is not recorded anywhere. The home does not send out service satisfaction questionnaires to service users or their relatives or representatives. A requirement is issued for improvement in this area. Following the previous inspection a requirement was issued for two staff members to check residents money coming in and going out of their accounts. The registered manager said that this was now being completed and receipts are maintained for each financial transaction. Staff supervision is being carried out on a regular basis and the inspector observed records for this. Many of the supervision sessions are supervised practice. Staff spoken to confirmed that they have regular supervision. Following the previous inspection two requirements were issued for 1) hot water temperatures in areas of the building to be checked and recorded monthly. Records should be maintained for inspection purposes, and 2) for the radiator in the lounge to be covered. It is pleasing to see that these requirements have been complied with. Records were seen for fire safety. There is a fire risk assessment in place dated 09/01/2008. The last visit undertaken by Milton Keynes and Bucks Fire Authority undertaken on 09/01/2008 identified that the home needed to test the fire alarm on a weekly basis. These records were examined and show that the fire alarm was tested twice in February, twice in March, four times in April, twice in May, once in June, twice in July and four times in August. A requirement is issued for improvement in this area. Training records show that six staff need to complete fire training and several staff need to update fire training as one was last undertaken in 2003, three staff in 2004, one staff in 2005 and another staff member in 2006. This must be completed for all staff on an annual basis and will be a requirement of the report. Training records show that some staff need to complete or update core training. This includes moving and handling training, basic food hygiene training and infection control training. This will be a requirement of the report. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for PAT testing dated May 2008, electrical installation 2005 and Gas Appliances 03/01/2008. There is no Legionella risk assessment. The registered manager said that following a visit by the Environmental Health Department on 19/10/2004 the home was advised that they only needed to clean the shower heads. This is being recorded in the home. COSHH sheets are up to date and accurate. Care Homes for Older People Page 25 of 31 Evidence: Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person is 30/10/2008 required to ensure that the incidence of pressure sores, their treatment and outcome are recorded, in detail, in the service users individual plan and reviewed on a continuing basis. To ensure the promotion of tissue viability and prevention of pressure sores is maintained. 2 8 12 The registered person is required to ensure that a detailed protocol is in place for the individual with epilepsy, that provides informative guidelines for the staff on how the condition and needs should be managed and met. 30/10/2008 To ensure the health and welfare of service users is promoted and protected. Care Homes for Older People Page 28 of 31 3 19 23 The registered person is required to ensure that all repairs to the premises, identified in the report, are completed. To ensure service users live in a safe, well-maintained environment. 28/02/2009 4 33 24 The registered person is required to ensure an effective quality assurance and quality monitoring system is implemented, based on seeking the views of people who use the service. To ensure the home is run in the best interests of service users. 30/01/2009 5 38 18 The registered person is required to ensure that all core training is completred and updated by all staff. To ensure staff are trained and competent to do the job. 28/02/2009 6 38 18 The registered person is required to ensure that all staff recieve upto date fire taining. To ensure the safety of service users and staff is promoted and protected. 30/12/2008 7 38 23 The registered person is required to ensure that the fire alarm system is tested on a weekly basis, and records are maintained for this l 30/09/2008 Care Homes for Older People Page 29 of 31 To ensure the safety of service users and staff is protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 10 It is strongly recommmeded that where a service user is prescribed as needed medicine, the care plans or instructions in medication charts detail why and when this is to be given. It is strongly recommended that the interests and social care needs of service users be identified and recorded in care plans. This should detail how these needs are to be met. It is strongly recommended that liquidised meals are blended separately to provide the service user with different tastes, textures and colours. 2 12 3 15 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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