Inspection on 23/02/06 for Lathbury Manor Residential Home For The Elderly

This inspection was carried out on 23rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Lathbury Manor Residential Home... 11/08/08

Lathbury Manor Residential Home... 20/12/06

Lathbury Manor Residential Home... 19/10/05

Lathbury Manor Residential Home... 11/03/05

Lathbury Manor Residential Home... 19/10/04

Lathbury Manor Residential Home... 18/03/04

Similar services:

The Maypole Nursing Centre

The Briars

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

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

CARE HOMES FOR OLDER PEOPLE Lathbury Manor Residential Home For The Elderly Lathbury Nr Newport Pagnell Bucks MK16 8JX Lead Inspector Joan Browne Unannounced Inspection 23rd February 2006 10:00 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 DS0000015061.V284018.R01.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. DS0000015061.V284018.R01.S.doc Version 5.1 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) DS0000015061.V284018.R01.S.doc Version 5.1 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 19th October 2005 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. DS0000015061.V284018.R01.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 that took place on 23rd February 2006 between 10.00 am and 14.30 pm. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector). The inspection consisted of discussions with residents and staff, examination of care records and documentation and a tour of the communal areas. The recommendations from the previous inspection were discussed. Feedback on the findings of the inspection was discussed with the manager and the deputy manager. What the service does well: What has improved since the last inspection? What they could do better: Care plans, moving and handling and tissue viability assessments need to be reviewed regularly. Tippex correction fluid and scribbled over entries in care plans must cease. Staff’s practice in the administration and recording of DS0000015061.V284018.R01.S.doc Version 5.1 Page 6 medication need to be improved. Weaknesses identified in the home’s recruitment procedure need to be addressed. Two staff members need to check residents’ money coming in and going out of their accounts. Arrangements need to be put in place to ensure that the radiator in the lounge is covered. Residents suffering with tissue damage need to have a high protein and fat diet to assist with the healing process. Handwritten entries recorded on MAR sheets need to be checked, signed and dated by two staff members. Residents and relatives need to be made aware of how to access the services of an advocate if required. Information relating to residents’ treatments need to be recorded discretely. The unacceptable practice of staff standing up to feed residents should cease. The practice of disposing of waste food in a plastic container needs to be reviewed. 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. DS0000015061.V284018.R01.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 DS0000015061.V284018.R01.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): Standard 3 was assessed at the previous inspection. EVIDENCE: DS0000015061.V284018.R01.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): 7, 8 & 9 Care plans were in place however, further improvement is needed in the recording of detailed information to ensure that residents’ needs are fully met. Arrangements were in place to meet residents’ health care needs. However, more detailed information is needed to ensure that staff’s good practice is reflected and inter-relate with individuals’ care plans. Weaknesses identified in the administration and recording of medication has the potential to put residents at risk. EVIDENCE: Four care plans were examined. It is acknowledged that the format in place was clear and easy to follow. However, plans did not always fully describe the number of staff members needed to assist individuals with personal care also the level of encouragement, assistance and prompting they required. Such detail information would enable a new member of staff to work effectively with residents. It was noted in one particular resident’s care plan that there was only one action plan in place to meet the individual’s personal care and incontinence needs. It was evident that there were two separate needs that required more DS0000015061.V284018.R01.S.doc Version 5.1 Page 10 detailed action planning in how the individual’s personal care needs and incontinence needs should be met. It is acknowledged that there was an entry in the daily log for the 14 February 2006 that commented on the individual’s mood. Example, ‘good mood spent the morning listening to music.’ It was evident that care plans, moving and handling risk assessments and tissue viability assessments were not being reviewed monthly. However, some good information was recorded in them. It is being made a requirement that care plans and assessments be reviewed regularly. It is further recommended that residents suffering with tissue damage should have a high protein and high fat content diet in place to assist with the healing process. Tippex correction fluid and scribbled out entries were noted on some care plans information sheets. This practice must cease. Staff should be advised where there are lots of changes or amendments occurring a new sheet should be written. It is acknowledged that individuals’ dietary likes and dislikes and their preferred term of address and wishes relating to death and funeral arrangements were recorded in the care plans. Behavioural/emotional charts were in place for some individuals. However, they were not kept under review. Improvement in individual’s behaviour should be clearly recorded. It was noted 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 discussed with the manager who agreed to discuss the resident’s condition with the general practitioner. Residents being nursed in bed were supported by a turning chart. However, more detail is needed to reflect staff’s described practice and this must interrelate with the care plan. The medication administration record (MAR) sheets were examined. Inconsistencies in staff recording practice were noted. For example, handwritten entries recorded on MARS were not checked, signed and dated by a second staff member. When antibiotic treatments were completed the person making the entry was not dating and signing the entry. As a good practice it is recommended that the person making the entry should record a short statement. Example, course completed and date and sign the entry. Staff were not using the appropriate codes to denote the reason why medication was not administered. As a result gaps were noted on MARS. It was noted on the MAR sheet for a particular resident that staff were not following the instructions of the prescriber. The instructions recorded on the MAR sheet was that the following tablets: Amisulpride 100mg and Zolpidem 10mg should be administered once daily. However, staff appeared to be DS0000015061.V284018.R01.S.doc Version 5.1 Page 11 administering them twice daily. This was discussed with the senior who was confident that the tablets were being administered once daily. Staff need to read the instructions on MAR sheets carefully. It is further recommended that protocols be developed for residents on antiepilepsy medication and those suffering from diabetes and are on medication to control it. DS0000015061.V284018.R01.S.doc Version 5.1 Page 12 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 & 15 The home needs to promote the services of an advocate this would ensure that residents are allowed to exercise choice and control over their lives. An appropriate range and variety of meals were on offer to residents. However, the practice in place of staff standing up to feed residents needs to be reviewed to ensure that residents have a pleasant dining experience. EVIDENCE: None of the residents were using the services of the advocate. There was no information promoting the use of advocates displayed in the home. It is recommended that residents and their relatives are made aware of how to access this information should they wish to use the services of an advocate. It was noted that there was a white board in the office with information relating to treatments that were being provided to some residents. This information could be perceived as a breach of confidentiality and a breach in the Data Protection Act 1998. It is being made a recommendation that information is written more discretely to protect confidentiality and to avoid any breaches in the Data Protection Act 1998. DS0000015061.V284018.R01.S.doc Version 5.1 Page 13 Lunch was observed, which consisted of the following choices: Sausages, roast chicken, roast potatoes, broccoli, leaks and peas. There were a variety of fresh fruits and a chocolate sponge pudding with custard for dessert. The food was tasty and was well presented. Tables were covered with tablecloths and the appropriate cutlery, serviettes and condiments were available. Staff assisted those service users who needed assistance with feeding. However, staff members did not sit down to perform this task. It is recommended that this unacceptable practice be reviewed. It was noted that waste food was disposed in a plastic container. Although the container was left in the corridor it still appeared institutionalised. It is recommended that the practice be reviewed. DS0000015061.V284018.R01.S.doc Version 5.1 Page 14 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 Staff spoken to were aware of how abuse may manifest itself. This should ensure that residents are protected from abuse. EVIDENCE: The home has a whistle blowing policy and a protection of vulnerable adult policy in place. Staff have undertaken training in adult protection awareness. They are aware of their responsibilities should they have any suspicion or evidence that residents were being abused or neglected. DS0000015061.V284018.R01.S.doc Version 5.1 Page 15 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, 24 & 26 The home is well maintained thus ensuring that residents live in a comfortable and safe environment. EVIDENCE: The home is a listed building, which has retained many of its original features. The location and layout of the home is suitable for the collective needs of residents. It is well maintained and there is a redecoration and refurbishment programme in place. The replacement of the floor covering in the laundry room and the remedying of the flaking paintwork in the corridor near the bathroom are part of the home’s continuing refurbishment planned programmed. The fire services department recently inspected the building and no requirements were made. Bedrooms were personalised with personal possessions that reflected the individual characters of residents. There were two shared bedrooms with appropriate screening provided to ensure privacy. DS0000015061.V284018.R01.S.doc Version 5.1 Page 16 On the day of the inspection the home was clean, hygienic and free from offensive odours. Laundry and hand washing facilities were provided taking into consideration infection control measures. Washing machines with the appropriate programming ability to meet disinfection standards were in place. DS0000015061.V284018.R01.S.doc Version 5.1 Page 17 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 The home is working to ensure that 50 of the staff team achieve NVQ 2 qualification, which should ensure that residents are in safe hands at all, times. There were some inconsistencies in the vetting of staff working in the home, which has the potential to put residents at risk. EVIDENCE: The manager submitted information to the Commission to confirm that 18 of the 20 carers employed in the home are in the process of gaining NVQ qualification at level 2 or have completed it. It was noted that six staff have completed NVQ at level 2. One member of staff is an internal verifier and another is an assessor. The personnel files for four most recently appointed members of staff were examined. POVA first checks and enhanced Criminal Record Bureau (CRB) clearances were obtained for individuals. However, weaknesses in the home’s recruitment procedure were noted. For example, there was only one reference obtained for one individual. Not all references obtained were from individuals’ most recent employers. The status of some referees was unclear. Recent photographs for individuals were not in place. There were no copies of letters of offer of appointment, or statements of terms and condition. The manager has since confirmed that all staff have been issued with contracts. However, these are held in a separate filing cabinet. Detailed interview notes were not DS0000015061.V284018.R01.S.doc Version 5.1 Page 18 available. A requirement is being made to ensure that weaknesses identified in the home’s recruitment procedure are addressed. DS0000015061.V284018.R01.S.doc Version 5.1 Page 19 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): 35 & 38 Arrangements need to be put in place to ensure that good record keeping safeguards residents’ financial interests. Shortfalls in records pertaining to health and safety may put residents at risk. EVIDENCE: The home keeps a small amount of money handed in by relatives for residents’ personal use such as, toiletries and personal clothing. There were written records of transaction maintained. However, some weaknesses in the maintaining of records were noted. For example, there was only one staff member’s signature evident on individual’s record sheets. The transaction records for two residents were checked. It was noted on one sheet that the balance did not tally with money held. It is required that two members of staff must check monies coming in and going out of individuals’ account. Regular monitoring of money held in residents’ account should take place. DS0000015061.V284018.R01.S.doc Version 5.1 Page 20 There was evidence in place that the fire panel is checked weekly and regular fire drills take place. A list of staff’s names who attended fire drills was recorded. The fire extinguishers were serviced on 9 December 2005. There was an up to date hardwiring certificate of the building in place dated 14 March 2004. An up to date portable appliance testing (PAT) for electrical equipment used in the home was in place. There was evidence that the portable hoists were serviced on the 7 December 2005. The building fire risk assessment was updated on the 24 October 2005. The responsible individual stated that the lift is serviced four times yearly. However, the most recent service record that was available was dated 29 May 2005. There were no records maintained for hot water temperatures. It is required that hot water temperature records are maintained. It is acknowledged that restrictor valves have been fitted on hot water taps in residents’ bedrooms, bathroom and toilet facilities. During a tour of the building it was noted that a radiator in one of the lounges was not covered. A bedroom door was wedged open. A requirement is being made to have a cover fitted to the radiator. The appropriate door holding devices or dor-gards must be used to keep bedroom doors open. There was evidence that the oil boilers were recently refurbished in December 2005. It was noted that a mobile hoist was stored in the front entrance of the building, also flat pack bedroom furniture. A requirement is being made to ensure that a risk assessment is put in place as it poses a safety risk. A blue chemical solution was left on a trolley. Staff are reminded of their responsibility to ensure that COSHH solutions are secured safely and an appropriate risk assessment is in place. It was noted that there was a gate leading down to the basement, which posed a potential hazard. It is strongly recommended that a risk assessment be put in place. DS0000015061.V284018.R01.S.doc Version 5.1 Page 21 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 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 X X 2 DS0000015061.V284018.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2)(b) 13(4)(c) Requirement The registered manager must ensure that care plans are reviewed monthly. Moving and handling risk assessments and tissue viability risk assessments need to be kept under review. The registered manager must ensure that the use of tippex correction fluid and scribbled over entries recorded in care plans be ceased. The registered manager must ensure that staff administer medication in accordance with the British Pharmaceutical Guidelines. The registered manager must ensure that weaknesses identified in the home’s recruitment procedure are addressed. The registered manager must ensure that two staff members check residents’ money coming in and going out of their accounts. The registered manager must ensure that hot water temperatures in areas of the DS0000015061.V284018.R01.S.doc Timescale for action 30/04/06 2 OP7 10(1) 31/03/06 3 OP9 13(2) 30/04/06 4 OP29 19(1) Schedule 2 10(1) 31/03/06 5 OP35 23/02/06 6 OP38 13(4)(a) 31/03/06 Version 5.1 Page 23 7 OP38 13(4)(a) building are checked and recorded monthly. Records should be maintained for inspection purposes. The registered manager must make arrangements to ensure that the radiator in the lounge is covered. 30/04/06 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 OP7 Good Practice Recommendations It is recommended that the registered manager should ensure that residents suffering from pressure ulcers have a high protein and fat diet to assist with the healing process. It is recommended that the registered manager should ensure that handwritten entries recorded on MARS should be checked, signed and dated by two staff members. It is recommended that the registered manager should ensure that when antibiotic treatment has been completed. The person making the entry should date and sign the entry. It is recommended that the registered manager should ensure that residents and relatives are made aware of how to access the services of an advocate if required. It is recommended that the registered manager should ensure that information relating to residents’ treatment is recorded discretely on the white board in the office. It is recommended that the registered manager should ensure that the unacceptable practice of staff standing up to feed residents be ceased. It is recommended that the registered manager should review the practice of disposing of waste food in a plastic container. It is recommended that the registered manager should develop risk assessments for the following: storage of furniture, and the hoist in the front hall. The use of COSHH solutions and the gate leading to the basement. 2 3 OP9 OP9 4 5 6 7 8 OP14 OP14 OP15 OP15 OP38 DS0000015061.V284018.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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. 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