Inspection on 01/07/08 for Lea Green Court

This inspection was carried out on 1st July 2008.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lea Green Court 25/06/09

Lea Green Court 23/02/09

Lea Green Court 29/10/08

Lea Green Court 17/07/07

Lea Green Court 10/07/06

Lea Green Court 24/10/05

Lea Green Court 13/06/05

Lea Green Court 23/09/04

Lea Green Court 10/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Lea Green Court Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW Lead Inspector Elaine Charlton Key Unannounced Inspection 1st July 2008 08:30 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 Lea Green Court DS0000000401.V367518.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. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lea Green Court Address Kenton Road Gosforth Newcastle Upon Tyne NE3 3UW 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) 0191 285 1720 0191 2851960 lea_green.court@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd Manager post vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user is under 65 years of age, category DE. No further admissions are permitted in this category without the prior agreement of CSCI. 17th July 2007 Date of last inspection Brief Description of the Service: Lea Green Court is a care home that provides nursing care for older people with enduring mental health problems. Care in the home is provided by Registered Mental Nurses supported by care staff. The home is owned and managed by Four Seasons Healthcare Limited a large provider of care services to vulnerable client groups. The home is situated in Gosforth on the outskirts of Newcastle upon Tyne close to local shops and good public transport links. There are 45 single bedrooms located at ground or first floor levels, and there is a passenger lift to help people who may have difficulty with stairs. Most bedrooms have en-suite facilities, those that don’t have a wash hand basin and are close to bathroom, toilet and shower facilities. On each floor there are separate lounge and dining room areas, and a number of toilets and bathrooms. The home also has its own kitchen and laundry facilities. Fees in the home are between £421 - £616 per week. They are dependent on they type of service provided and whether the placement is privately funded or not. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star; this means that the people who use this service experience adequate quality outcomes. An unannounced visit was made on the 1 July 2008. A total of eight hours were spent in the home. The manager was present throughout the day. Before the visit we looked at: Information we have received since the last visit on 17 July 2007; How the home has dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The provider’s view of how well they care for people; The views of people who use the service, their relatives, staff and other professionals who visit the service. During the visit we: Talked with people who live in the home, staff, visitors and the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; Looked around the building/parts of the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit; Sent “Have your say” questionnaires for residents, who were able, to complete; Sent “Have your say” questionnaires to the home for relatives, healthcare professionals and staff to complete. We told the manager what we found. She showed an immediate commitment to identifying and putting in place change where necessary. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 7 The new manager co-operated throughout the inspection and displayed commitment and an open and honest approach to work that needs to be done. A beautiful, safe, garden area has been created so that people living in the home can spend time outside on their own or with relatives and staff. What they could do better: Ensure that care plans accurately reflect people’s assessment of need, are consistently completed, evaluated and kept up to date. Improve the quality of care plan evaluation recordings so that the care people are receiving is properly documented. Provide staff with guidance on the management of aggression and distraction techniques to help keep people safe and comfortable. Look at the number of staff who are helping people when they leave the dining room after meals so that outbursts and/or attempts to leave the building can be diffused. Expand the range of activities and social opportunities that people can choose from to provide them with stimulation and enjoyable events. Ensure that complaints are recorded in line with company policy and procedures. Continue to carry out the recently established programme of staff supervision and support, making sure it meets the minimum level of six sessions per year. About what the service could do better relatives said: “My mother would prefer help with dressing and personal care by female staff she does not like male staff to touch her body”. “Some staff attitudes need to be toned to a kinder approach to residents who can all be trying but need a bit of TLC”. “Activities, social care, more support to meet individual needs, food and get the basics in place”. “By paying attention to helping residents more by way of activities/entertainment instead of just been left sitting around for next cup of tea/biscuit/other meals”. “Do their best with current staffing levels but I have never seen any one to one interaction with my relative who is admittedly unlikely to respond too much now.” “Not enough staff to provide one to one care and attention.” Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 8 On a staff questionnaire we were told: “Staffing levels are based on minimum numbers and never on the dependency levels of residents. Therefore there are never sufficient staff to do any ‘extras’ with residents ie., taking them out”. 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. Lea Green Court DS0000000401.V367518.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 Lea Green Court DS0000000401.V367518.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): Standards 3 and 6. People who use the service experience good quality outcomes in this area. People are given good information to help them decide about moving into the home. Their need and wishes are fully assessed so that everyone is sure they can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Full professional assessments from local authority or hospital based staff were seen in residents’ files. This means that the diverse needs of people who may be admitted to the home are known and everyone can be sure these needs can be met. The company also has its own Dependency Assessment Rating Tool (DART) that is completed as part of the home’s assessment of its ability to meet the needs of people who may want to move into the home. The majority of DART Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 11 assessments seen had only been ‘scored’. No extra information had been added. Staff carrying out assessments had signed and dated the front sheet of the DART. Monthly evaluations had been completed but only the scores had been recorded there were no additional comments about changes in need that may have been identified. Additional assessments are carried out and recorded using recognised assessment tools to see what level of support people living in the home might need with pressure areas, continence, nutrition and any deteriorating mental health. The records for a lady admitted to the home in November last year as a privately funded resident were seen. Her needs had been properly assessed and nicely recorded. A relative said: “I feel there could not be a better place for my mother to be. This is because of the caring, loving, mature staff. I cannot praise them highly enough”. The home does not provide intermediate care. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. People living in the home are asked how they wish their personal care to be provided and by whom, but care plans sometimes do not include all the information staff might need. Residents are supported and helped to see health care professionals when they need and routines are in place for the safe administration of medication. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Two healthcare professionals who sent back questionnaires told us that staff always or usually seek advice and act upon it to improve residents’ healthcare needs. They said the amount of attention paid to privacy and dignity can vary between staff members. They also said, “It is sometimes difficult to assess needs of a patient but they always refer to us appropriately”. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 13 The relatives of people living in the home who sent back questionnaires told us that they always or usually got enough information and were always kept up to date with important issues. We were also told that the home usually meets peoples’ needs. In each of the files we looked at we found blank hospital admission forms. We discussed this with the manager who told us these are kept in individual files so that staff have easy access to them if someone needs to be admitted to hospital. The member of staff is expected to complete and copy the form so that there is a record of the information that has been sent to the hospital with the resident. A range of care plans have been completed for each person living in the home but these do not follow a person centred approach to care planning. These include care plans for the promotion of continence, diabetes, social isolation, aggression and agitation, nutrition and dehydration, and personal hygiene. Care plans do not always reflect the information and/or needs recorded in the assessment. Examples of this were: • • • • • • For a lady whose assessment included information about her having a sensitive back, there was no mention of this in her personal care plan or about how this sensitivity should be managed. Care plans to support the management of aggression do not give staff clear guidance about what they should do and how, and do not include guidance on distraction techniques that may work for the individual. One care plan for a resident said that they needed the assistance of one carer, whilst another about ‘allegations’ said ‘resident to have two carers present for all interventions’. A care plan on managing aggression stated ‘if resident becomes aggressive attempt to distract to alleviate this re-action’ it did not say how this should be done or what distractions may work. A ‘risk of malnutrition’ care plan did not give guidance about how to encourage the person to eat, what they might like to eat, or whether supplements had been prescribed. Another said that a person should be ‘sitting on appropriate pressure relieving aid at all times’ but it did not say what this was or whether the person had been properly assessed. We did see one nicely written care plan that included comments like “explain in a clear, soft and concise manner what you are doing”, and “staff to be patient and give positive re-assurance”. Evaluations of care plans were poor and mainly contained comments such as “plan of care continues” and “no change”. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 14 We saw evidence of people living in the home being able to see a range of healthcare professionals as their needs dictated. Some recordings by staff lacked sensitivity. One example was a written note of a conversation with a relative who was concerned about two people. The person making the recording noted “alls got dementia problem and we are here to keep them apart to reduce any contact and their agitation”. During the tour of the premises we saw one resident who was extremely distressed about other being people being around and who was causing considerable disruption, noise and exhibiting behaviour that staff were not able to diffuse. A nurse told us that they were waiting for a visit from the Community Psychiatric Nurse (CPN) who was going to carry out a re-assessment of the person’s needs. As part of the company’s Team Audit Process (TAP) the manager carries out checks on medication systems each month. Externally based staff also carry out bi-annual audits. This was due to be done at Lea Green Court during July. The deputy manager explained the systems for the safe ordering, receipt, dispensing and disposing of medication. New supplies are delivered to the home the day before the staff need to use them and two qualified nurses on night duty check the medication in, change the medication administration records MAR) and set up the medication trolleys. The company has a contract in place for the disposal of medication that has not been used, and sharps, appropriate disposal boxes were seen in place. A new medication reference guide was available in the treatment room and regular checks are carried out on refrigerator temperatures to make sure medication is being safely stored. Controlled medications are kept in a separate, locked cabinet, within the treatment room, and a controlled medication register was seen. The staff signature/initial list for people who dispense medication had recently been updated. A limited, random check, of medications held on both the ground and first floors was carried out. Laminated sheets with a photograph of resident, their room number and a record of any allergies are used to divide the MAR. Two minor medication administration errors were identified. These were tablets being retained in the home from the previous months MAR were not being carried forward onto the new MAR, and eye drops for one resident had Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 15 not been dated when opened. They eye drops had been dispensed and opened in a period of less than 28 days so had not passed the date by which they should be disposed of. Some staff displayed a better understanding of how to promote the privacy and dignity of people living in the home, including how they should engage with people. Two members of staff were seen speaking in a quite brusque manner to residents. We saw a letter from a Consultant and GP about a resident being accompanied to a hospital appointment by a carer who did not know them at all. This had made the appointment/assessment difficult to carry out properly. Relatives said: “My mother would prefer help with dressing and personal care by female staff she does not like male staff to touch her body”. “Some staff attitudes need to be toned to a kinder approach to residents who can all be trying but need a bit of TLC”. About what the service could do better one person said: “Activities, social care, more support to meet individual needs, food and get the basics in place”. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 16 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): Standard 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. People are able to use all areas of the home as they wish. Relatives are encouraged to visit, but activities and social opportunities are still limited. Choices and opportunities are also sometimes limited by a person’s ability to make decisions. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw social history documents that some families had been encouraged to complete. They provided staff with a complete life history, including a very personal insight into the persons likes, dislikes, interests and personality. Planned activities in the home are limited at the moment but people are encouraged and enabled to maintain contact with their family and friends. Some relatives/partners visit regularly playing an important part in their relative’s life. We saw social care plans that staff had recorded events such as meals, baths, visitors and ‘wandering’ as activities. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 17 The deputy manager spoke knowledgeably about people living in the home and as we walked around the building. She was able to tell us about their working life, hobbies, talents such as painting and places they had lived. This information could be used to organise activities and social opportunities. The ground floor lounge provides access to a beautiful, enclosed, secure garden that has been created using a grant from Newcastle City Council. There are raised flower beds and areas where scented plants have been set around coloured lights. Paths can are lit by lights that have been set into the walls. The garden has been planned making excellent and interesting use of the space. Tables and benches make it a lovely area for residents to use. Plaques on the benches showed that one had been purchased by staff in memory of a colleague and two others in memory of residents. A gentleman who recently had 80th birthday party in the home was previously a piano player so staff had arranged for a keyboard to be available. He played a couple of songs for people to sing along too. The deputy manager asked about having a piano in the home so that people with this talent or interest could make use of it. Unfortunately, on the day of the inspection, a training session was being held in the ground floor lounge and residents were not able to get out into the garden on a lovely sunny day. Thought needs to be given to use of these areas for training and how that will impact on the people who live in the home. Most relatives who sent back questionnaires felt that people living in the home were usually supported to live the life they choose. A very well dressed and able resident kept coming to the office during the inspection to talk to the inspector and see if she was being looked after. Staff approached him and said ‘come away’. No one asked if his presence in the office was a problem and their actions were more about moving him away than engaging him in something meaningful. At lunch time people were seen enjoying an appetising lunch of chicken pie or fish cakes, followed by sponge and custard. During the morning residents we saw talked to us about lunch and were able to tell us one of the choices, even though this was as a result of the aroma of the fish cakes cooking coming from the kitchen, they displayed an interest and enthusiasm about what they were going to eat. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 18 Records we saw showed that for a number people who live in the home, meal times can be a trigger for outbursts, both verbally and physically. This was particularly evident as people left the ground floor dining room after lunch. The dining room is opposite the front door. Few staff were around and people were attempting to exit the home, were shaking the door and arguing with each other. Kitchen staff were able to tell us about residents’ needs for soft or sugar free diets. Cook also told us they had previously had a resident who needed a gluten free diet and it had not been a problem for them to get the proper ingredients to prepare food. Despite the kitchen assistant telephoning in sick and chef/cook attending protection of vulnerable adult (POVA) training, the kitchen was well organised, clean and tidy. When asked how the home could improve, a relative who completed a questionnaire said: “By paying attention to helping residents more by way of activities/entertainment instead of just been left sitting around for next cup of tea/biscuit/other meals”. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18. People who use the service experience adequate quality outcomes in this area. People who live in the home are protected from harm through policies, procedures and staff training. Relatives know who to speak to if they were unhappy or wish to make a complaint and are confident that concerns are properly dealt with. Records of complaints and/or concerns are not always properly recorded. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The company has policies and procedures in place for the acceptance, recording, and investigation of complaints. Records we saw in the home showed that these procedures had not been properly followed. Neither had complaints been recorded using the company’s standard formats. The new manager told us about the systems that should be used and said she knew that formal files needed to be set up. Those relatives who told us they knew how to make a complaint also said that when they had raised issues they had been dealt with appropriately. We saw a very nice compliment from relative thanking staff for enabling a resident to go to his grandson’s wedding and saying how much this had meant to the family. A carer had gone with him to help him through the day. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 20 Another relative said “X looks better today than I have seen her for sometime. Thanks for looking after her”. The organisation has a whistle blowing policy that encourages people to disclose any poor practice they may witness. People are protected from harm through staff training and company safeguarding procedures. Events have been properly notified to CSCI. The manager is aware of the need to report people considered unsuitable to work with vulnerable adults to the POVA register and/or the Nursing and Midwifery Council (NMC). Two sessions of safeguarding adult’s refresher training was taking place on the day of the inspection. Other dates for refresher training had been organised to make sure that all staff have attend this session. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 21 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): Standards 19 and 26. People who use the service experience adequate quality outcomes in this area. People live in a home where they can move around safely both inside and outside. Some areas of the home are in need of redecoration and bathrooms are being refurbished to make a more comfortable environment for people to live in. The home is kept clean and good hygiene routines were seen. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The new manager and deputy manger walked around the home with the inspector. They told us that a duty board with pictures of staff was going to be put up in the home’s entrance, so that residents, relatives and visitors could identify people who were on duty. There are also white boards on both floors that are updated to help orientate people to the day, date, staff on duty and the day’s menu. One relative told Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 22 us that this was not always completed and she had suggested it would be a good idea if it was. The bedrooms we saw were homely and well decorated. People had been able to personalise their own rooms by bringing items and furniture with them when they moved into the home. Most bedrooms have an en-suite facility which includes a toilet and wash hand basin. Three or four bedrooms do not have an en-suite but do have a wash hand basins and are close to bathrooms. We were told that plans are in hand to: • • • • • Refurbish bathrooms on the ground floor and possibly change the shower to a wet-room. Provide new furnishings and floor coverings in the dining rooms and lounges. The manager had already ordered some furnishings. Check lighting throughout the home to make sure that all areas are properly and sufficiently lit. Replace a damaged fire exit door on the ground floor. This had been ordered and was due to be fitted. Fit restrictors to the windows to the first floor lounge and dining room windows. The manager told us she had identified this herself the previous day and had made arrangements for them to be fitted. For a gardener to attend to a large tree, overhanging, at the front of the building and to get a quotation to tidy the rest of the garden area which has become overgrown. • We also identified the following: • • The extractor fan in the kitchen above the cookers is extremely noisy, making it an uncomfortable place to work. The extractor fan in the upstairs sluice room was not working and strong odours were evident in this area. The housekeeper has been given a new manual and checklists that are standard across the company. The manager told us she was due to meet with the housekeeper and domestic staff. Some odours were evident around the home although generally it was clean. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 23 The laundry is large and was seen to be reasonably well organised given the amount of laundry and the number of staff undergoing training on the day of the inspection. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 24 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): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. People working in the home are properly recruited and the residents know they are trained and able to help them with the care and support the need, although some training is in need of updating. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The company has comprehensive policies and procedures in place for the proper recruitment and selection of staff. It was not possible to check that the registrations of nurses working in the home were up to date. The manager had asked all nurses to bring their PIN cards in so that she could carry out checks on everyone to ensure their registrations were up to date. Two nurses are on duty at all times, they are supported by six or seven carers between 08:00 and 20:00, and three carers are on duty between 20:00 and 08:00 the following day. One member of staff is employed to do 11 hours a week dedicated to training and another, 21 hours as an activities co-ordinator. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 25 On the day of the inspection the home’s trainer talked about how she was delivering POVA training and what plans there were for getting other courses up and running. Two full time domestic staff are employed. For two days every week, at the weekend, and for holiday periods, there is only one domestic assistant on duty to cover the whole home. The manager told us that they had already identified that there were not enough hours identified in the budget to employ sufficient domestic staff for a home the size of Lea Green Court. This situation was being reviewed by the operations manager. The kitchen is staffed by a chef or cook who both work full time, and one day a week are both on duty. They are supported by a kitchen assistant. There is also a full time maintenance person. When asked what staff do well healthcare professionals said: “Manage some complex and difficult patients. Friendly in the main”. “Patients appear to be well cared for and the staff are knowledgeable about their needs and problems.” The manager provided us with a copy of a handwritten training profile that had just been put together to give her an idea about what needed updating and what training people had received. This showed that staff were in need of refresher training in moving and handling, first aid, and health and safety. Some people had been able to attend other training on coping with death and dying, care planning, the safe handling of medication, dementia care, and challenging behaviour, to bring their practice up to date and help them do their job. Relatives who sent back questionnaires said about the staff: “Regular staff appear contentious and friendly – agency staff of which there seem to be too many, just seem to be there although I am sure they do their job functions.” “I always get a welcome call from all the regular staff which is appreciated”. “Do their best with current staffing levels but I have never seen any one to one interaction with my relative who is admittedly unlikely to respond too much now.” “Not enough staff to provide one to one care and attention.” Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 26 On a staff questionnaire we were told: “Staffing levels are based on minimum numbers and never on the dependency levels of residents. Therefore there are never sufficient staff to do any ‘extras’ with residents ie., taking them out”. “We have good relationships with relatives, good rapport amongst staff and work well as a team despite minimum numbers”. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 27 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): Standard 31, 33, 35, 36, 37 and 38. People who use the service experience good quality outcomes in this area. People benefit from living in a home that tries to provide an open and inclusive environment that promotes their best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: An Annual Quality Assurance Assessment (AQAA) had not been submitted but this was as a result of it being sent out late by CSCI and not because the manager had not completed it. The new manager started work in the home the day before our inspection. She is experienced and capable and has worked for the company for a number of years in homes up and down the country. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 28 She already had a good idea of what was going on in the home, what needed to be done to improve the rating, problems areas, strengths and weaknesses. We were told that qualified staff were being identified to take the lead role on supervision, appraisal, induction and falls. The company has policies and procedures in place to protect and manage monies on behalf of residents. There is a limit to how much money can be kept in the home. Numbered, carbonised receipt books are used and money held on behalf of residents is kept in a non-interest attracting account with the bank. Periodic unannounced audits are carried out by headquarters staff. Regular checks are carried out to monitor areas such as water temperatures, the nurse call system, hoists, slings, lighting, and fire equipment. This is not an exhaustive list. The company has standard systems in place to ensure that these checks are carried out and recorded. Monthly checklists were seen to be up to date. The Regional Managers monthly checklist for May was also seen as well as records of Regulation 26 visits by the proprietor. An assessment for one person said that they needed to use a hoist, have bed rails fitted and for staff to use a ‘lap strap’ when transferring the person in their wheelchair. The risk assessment for bed rails which had been carried out in May 2008 was poor and the one for the use of a lap strap was not signed. One person was identified as being at ‘high risk of absconding’. No risk assessment was in place and there was no information prepared to give to the Police or other people who may be involved in looking for the resident in the event of them absconding. Not all records were complete and up to date, and some recordings were hardly legible. Staff need to be more aware of the sensitivity of what they are writing and how it may appear to the next person reading the record. A programme of staff supervision and appraisal has been put in place. The minimum standard for staff to receive at least six supervision sessions each year had not been met recently. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 29 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 Requirement Care plans must be improved to reflect the information provided in the assessment of a person’s needs. This will mean that people living in the home will receive the right care and support to keep them safe and well. Care plans must be properly reviewed and evaluations recorded in an outcome focused way. This will mean that the benefit a resident has received from receiving care and support in a person centred way is recorded. Complaints must be properly recorded, including information about who has made the complaint, what it is about, action taken and the outcome. This will mean that complaint information can be evaluated and provide clear audit trails. Timescale for action 01/12/08 2. OP7 15 01/12/08 3. OP16 22 30/08/08 Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 31 4. OP18 13 The programme of Protection of Vulnerable Adult training must be completed. This will help to ensure that people living in the home are kept safe. The programme of refurbishment/replacement and minor repairs identified in this report must be carried out. This will mean that people live in a safe and homely environment. The level of domestic support in the home must be reviewed to make sure that sufficient people are employed to maintain good infection control and hygiene routines. This will mean that people live in a clean, hygienic and odour free home. CSCI must be provided with evidence that the registrations of all nurses working in the home are current. This will help keep people who live in the home safe. 30/08/08 5. OP19 23 30/08/08 6. OP27 18 01/12/08 7. OP29 18 30/08/08 8. OP30 18 The training needs of staff must 30/09/08 be identified and a comprehensive training plan provided to CSCI. This will mean that staff are properly trained and qualified to do their job. Staff must receive regular, 01/12/08 recorded supervision and appraisal. This will mean that they are supported and helped to do their job. Risk assessments must be 30/09/08 carried out and recorded to ensure that any unnecessary risks to people living in the home are identified and minimised. This will promote the health, DS0000000401.V367518.R01.S.doc Version 5.2 Page 32 9. OP36 18 10. OP38 13 Lea Green Court safety and wellbeing of people living in the home. 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 Use of the Dependency Assessment Rating Tool (DART) should be reviewed to ensure that people living in the home have their needs properly assessed, recorded and regularly reviewed in a consistent way. Ensure staff accompanying residents to hospital appointments and GP visits know them well and have the right information with them. This will mean that residents healthcare needs are properly reviewed keeping them safe and well. Medication retained in the home at the end of each ordering period should be carried forward onto the new MAR so that medication kept in the home can be properly audited. Medication with a limited life should be dated when opened so that staff know when to dispose of it. This will promote the health and wellbeing of people living in the home. Staff should exercise care when making recordings in residents’ records to ensure they are appropriate, sensitive and non-judgemental. This will promote issues of equality and diversity and show that residents are valued as individuals. The programme of social opportunities and activities and associated care plans should be reviewed to promote a more individualised approach to the activities of daily living. 2. OP8 3. OP9 4. OP9 5. OP10 6. OP12 Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 33 7. 8. OP12 OP15 Consider the provision of a piano in the home for use by residents and/or at social events. Review the routines and presence of staff when residents are leaving the dining room on the ground floor. This should minimise outbursts by and between residents. Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lea Green Court DS0000000401.V367518.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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