CARE HOMES FOR OLDER PEOPLE
Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX Lead Inspector
Sue Smith Unannounced Inspection 20th December 2006 09:30 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 Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.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. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX Address 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) 01908 615245 Mr Edward Nigel Broadway Mrs Gillian Elaine Broadway Mrs Gillian Elaine Broadway Care Home 23 Category(ies) of Dementia (6), Learning disability (5), Old age, registration, with number not falling within any other category (11), of places Physical disability (1) Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. This home is registered for 23 older people with up to 5 people with a learning disability, 6 people over 65 with dementia 1 person with a physical disability Date of last inspection 23rd February 2006 Brief Description of the Service: 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 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. The current fees are £454.50 per week. There are additional costs for such things and newspapers, magazines, hairdressing and toiletries. This information was provided by the home on the 20th November 2006. The homes Service User Guide and Statement of Purpose are made available to potential service users and families with additional copies held in the home. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first key inspection of the service since the implementation of IBL2 (Inspecting for Better Lives). The inspection was undertaken on the 20th December 2006 by Sue Smith (Regulatory Inspector). The Proprietor who is also the Manager of the home was available throughout the inspection. The Inspector used a triangulated methodology to complete this inspection, pre-inspection information and documentation was used in the planning process to ensure hypothesis were formulated to support the inspector to explore issues of concern and verify practice and service provision. During the inspection a variety of documentation was assessed, which included Careplans, Risk Assessments, Monitoring tools, Medication procedures, Rota’s, Recruitment files and Training records. The Inspector for Case Tracking purposes identified three Service Users. In addition the Inspector met with three other Service Users to gain their views on care provision. All Service Users spoken with at the time of inspection were happy with the service provided and were complimentary of the Manager and her team. Feedback was received from relevant professionals prior to this inspection, the general comments were positive with noted ongoing improvements in the service provided. The Inspector would like to thank the Manager, Service Users and Staff for their hospitality and the support given to complete the inspection process. What the service does well:
No service user moves into the home without having his/her needs assessed, and has been assured these will be met. The service users all have individual plans of care, which are reflective of the service users personal preferences when implementing care. Service users make decisions about their lives with assistance as needed, their personal choices are now reflected in the Careplan.
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 6 The home has robust medication policies and procedures, which aim to protect service users. The lifestyle in the home suits the service users preferences, cultural, religious and recreational needs. Service users maintain contact with family/friends/representatives and the local community as they wish. Visitors are welcomed at the home. Service users receive a wholesome, appealing and balanced diet in pleasing surroundings. Service users and significant others are confident their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse by the current policies and procedures, which includes training for staff. The home is well maintained thus ensuring that residents live in a comfortable and safe environment. The needs of service users are met by a suitably trained and skilled staff team with sufficient numbers of staff employed to meet the needs of service users. The home has an effective recruitment procedure, which is reflective of all security checks such as CRB disclosures and two references for each potential employee. Service users live in a home that is run and managed by a suitably qualified and experienced manager who ensures the home is run in the best interest of the service users. The home operates health and safety systems, which ensure the protection of service users and staff. There is a friendly and relaxed philosophy at the home with service users satisfied with the support they are offered. Observations throughout this inspection were of a knowledgeable and professional staff team who undertake their duties in a sensitive and respective manner. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
The home continues to provide a safe and professional service to its service users. The home has received two recommendations to support professional practice as a result of this inspection. The home purchases height adjustable beds for their more frail service users, this has helped the home to manage its manual handling systems, however it is recommended that the home ensures its risk assessments are undertaken at more regular intervals. This will provide the home with a plan to provide sufficient numbers of height adjustable beds as required to support the changing needs of service users and staff. The home provides a good standard of meals throughout the day, alternative meals are available should they be requested by the service user, unfortunately these are not reflected on the daily menu board or the homes menu sheets. It is recommended these be added to the menu to ensure all service users are aware of these options.
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 8 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. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 9 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 Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 10 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes a pre-admission assessment for all potential service users to ensure the home are able to meet their holistic needs. EVIDENCE: The home ensures all service users have a pre-admission assessment prior to admission to the home. The assessment is undertaken with information provided by outside agencies and includes a visit to the service user or family members to obtain a wider picture of the care needs of the individual. There are no restrictions on admission based on gender, cultural/religious beliefs or ethnicity. The only restrictions in place are aggressive behaviours, as the staff are not qualified to manage service users with this specific care need. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.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. Individual plans of care are in place, which are reflective of the Service Users needs, with care implemented in a manner preferred by Service Users. The home has medication procedures in place, which are reflective of current guidance, thus protecting service users. The home provides a good standard of care and support, maintaining the privacy and dignity of the Service Users. EVIDENCE: The home has recently implemented changes to the Careplan format to ensure the needs of service users are accurately recorded with an outline of how they prefer care to be implemented. The Careplans are reflective of review and the
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 12 changing needs of service users are reflected in the Careplan. A pen picture of the service user is available in all Careplans, which provides the staff with a history of the service user this supports staff to maintain a holistic approach to care implementation. The detail found in the Careplans was of a good standard with all Careplans found to be easy to read and informative. Necessary risk assessments are in place, which support service users to maintain their levels of independence in a safe and supported manner. All risk assessments are subject to review with the dates of review and actions taken reflected. The home operates a robust medication procedure, which is reflective of current guidance. There is a clear audit trail for the receipt and return of all medications. All medication is stored in appropriately locked facilities. The MAR (Medication Administration Records) are well maintained, however there were two gaps evident on the day of inspection, this was discussed with the Manager who will address the issue with Senior staff. Generally the MAR sheets were maintained to a high standard, therefore no other action from the Commission is required. The standard of care and support delivered at the home is of an excellent standard, service users spoken with on the day of inspection were complimentary of the staff team and believed they met their needs in a sensitive and professional manner. Observations on the day of inspection were of a friendly and relaxed atmosphere. Staff are knowledgeable of the individual needs of service users and treat them at all times with respect. Care is implemented in a manner that maintains the dignity of service users. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities offered at the home are suitable, flexible and enjoyable; ensuring the social needs of Service Users is met. There are no restrictions in place on visiting enabling Service Users to maintain their family links and friendships. Meals offered at the home are nutritious and appealing, ensuring the needs of Service Users is met. EVIDENCE: The home offers a range of activities, which meet the needs of service users. These range from regular exercise sessions to support mobility and general wellbeing to sing along sessions and quizzes. At the time of inspection the seasonal activities were taking place with a wonderful carol singing session facilitated from a local community group, which included mulled wine and
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 14 mince pies. Those service users able to participate were greatly enjoying this visit and were supported to join the occasion. There is a well-stocked library section at the home with a variety of books available for service users to enjoy. Service users spoken with at the time of inspection felt there were sufficient activities to stimulate them throughout the day. The Manager has created a ‘family friendly’ atmosphere at Lathbury Manor; there are no restrictions on visiting times with all families and friends welcomed at the home. One visitor spoken with was complimentary of the support he receives from the home; he feels welcomed by the home and is supported to maintain some of the care needs for his wife. The meals offered at the home are of a high standard with no complaints received from service users as to the quality of the menus. The home does provide an alternative menu if there should be anything offered which is not to a service users liking. Service users are aware they can request this option, however this is not reflected on the daily menu in the dining area or the homes copy of the menus. A recommendation is made for alternative main meals to be reflected on the menu board and the homes copy of the menu to ensure service users are aware of the choices available. There are sufficient snacks and drinks provided throughout the day to meet the needs of the service users. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates a complaints procedure, which is reflective of current guidance and timescales for action, thus ensuring Service Users, and significant others are able to raise their concerns appropriately. The home follows the local authority Protection of Vulnerable Adults Policy and its reporting systems to ensure the ongoing protection of Service Users. EVIDENCE: The home has a complaints procedure in place, which is reflective of timescales for action. There has been one complaint received since the last inspection, which was satisfactorily addressed by the Manager. All complaints are held in a complaints file, which contains a copy of the original complaint and any investigation notes and correspondence pertaining to the complaint. Action is taken in response to substantiated complaints within reasonable timescales. The home is using the Milton Keynes Inter Agency Protection of Vulnerable Adults Policy and its reporting procedures to ensure the ongoing protection of the service users. Training is in place and staff have a clear understanding of
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 16 the reporting systems at the home. There have been no POVA (Protection of Vulnerable Adults) issues at the home since the last inspection. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and well-maintained environment for Service Users to enjoy. EVIDENCE: Lathbury Manor as the name suggests is an older listed building which has retained a number of its original features. It is a pleasant and homely environment with a high standard of furnishings and fittings provided for the enjoyment of the service users. There is sufficient communal space provided with a large main lounge and two smaller lounges provided.
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 18 Bedrooms are well presented with furnishings and fitting provided that are of a high quality as well as meeting the needs of the service users. Adjustable beds have been provided for the more frail service users, which supports the manual handling systems at the home. It is recommended that the home ensures its risk assessments are undertaken at more regular intervals to provide the home with a plan to provide sufficient numbers of these beds as required to support the changing needs of service users and staff. The Commission are satisfied at this time sufficient numbers of these beds have been provided. The home is maintained to a high standard with a dedicated maintenance team available to ensure any repairs are implemented in a timely fashion. There were no outstanding maintenance issues at the time of inspection that would affect the health and safety of the service users. The replacement of the lounge radiator cover has been undertaken as required in the last inspection report. The home is cleaned to a high standard and is free from offensive odours. The home has implemented infection control measures with suitable laundry systems in place to ensure there is no outstanding soiled or dirty laundry left in the home. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of suitably qualified and experienced staff to meet the needs of Service Users. The home operates a robust recruitment system, which ensures all relevant security checks are put in place prior to a start date, thus ensuring the ongoing protection of Service Users. The home provides ongoing training to support the staff to meet the needs of the Service Users. EVIDENCE: The Manager is proactive in ensuring the staff team receive a full programme of training, which will support their professional development and maintain the standards of care in the home. There is a strong commitment to supporting staff to achieve their NVQ qualifications in care with support offered by the Manager to achieve this certificate. The Manager is constantly seeking relevant and informative courses for staff to attend. An Alzheimer’s society approved course recently attended by the Manager has been inspirational and
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 20 plans are in place to implement changes to how the home manages service users with dementia type illnesses. Due to the teaching background of the Manager a high number of courses are facilitated in the home or at Park House (also owned by the Proprietors) this has enabled the home to ensure all necessary mandatory courses and update sessions are implemented within appropriate timescales. The home operates a robust recruitment procedure, which is reflective of all security checks taking place. Six recruitment files of recently employed staff were inspected with all maintained to a high standard and reflective of current guidance. The home are currently undertaking interviews for developing senior staff for the Deputy Managers role, a set of questions has been devised to support this process and it is hoped the role will be successfully filled from this process. There is presently sufficient numbers of suitably skilled and experienced staff to support the home to meet the needs of the service users. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A suitably qualified and experienced Manager is managing the home ensuring the home is run in the best interest of Service Users. The home operates a full quality audit system, which supports them to make improvements, which will enhance the lives of service users. The home ensures it follows current health and safety guidance with an audit system in place to ensure the ongoing protection of Service Users. EVIDENCE:
Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 22 The home is managed by a proactive manager who ensures a homely and supportive environment for service users is maintained. Staff report finding her approachable and supportive. The proprietor has implemented a thorough quality audit system which includes obtaining the views of Service Users and significant others, the audit system breaks the home into three areas – Residents, Staff and Household, the system is outcome focused with planning documents open to inspection. The quality audit system is in line with the national minimum standards for older people, and is reflective of a quarterly monitoring document as well as an annual audit of the home. This system of audit is implemented in both of the homes owned by the Proprietors, which has helped ensure future planning for the Organisation is maintained. The home has a thorough health and safety monitoring system in place; checks are undertaken with audit notes attached to ensure a rotating programme of checking is implemented monthly. In addition the home has implemented an annual planner which ensures all areas to be checked are planned in advance taking into consideration the seasons and necessity to further check some areas more often than others. All Health and Safety risk assessments were found to be up-to-date and reflective of the needs of the home. The home had a recent health and safety inspection conducted by the Environmental Health Department in line with the ‘BACKS 2006’ campaign. Two requirements were made as a result of this inspection with both actioned by the home. The home ensures there is always a member of staff on duty who holds a current First Aid certificate. Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations A recommendation is made for alternative main meals to be reflected on the menu board and homes copy of the menu to ensure service users are aware of the choices available. It is recommended that the home ensures its height adjustable bed risk assessments are undertaken at more regular intervals. This will provide the home with a plan to provide sufficient numbers of height adjustable beds as required to support the changing needs of service users and staff. 2 OP24 Lathbury Manor Residential Home For The Elderly DS0000015061.V304762.R01.S.doc Version 5.2 Page 25 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: 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
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