CARE HOMES FOR OLDER PEOPLE
Lee Mount Residential Home 32 Lee Mount Road Lee Mount Halifax West Yorkshire HX3 5BQ Lead Inspector
Lynda Jones Unannounced Inspection 15th 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 Lee Mount Residential Home DS0000061575.V282459.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. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lee Mount Residential Home Address 32 Lee Mount Road Lee Mount Halifax West Yorkshire HX3 5BQ 01422 369081 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) Lee Mount Healthcare Ltd Mrs Julia Carling Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12 July 2005 Brief Description of the Service: Lee Mount is a care home providing personal care and accommodation for eighteen older people. The home is in the Lee Mount area of Halifax, approximately two miles from the town centre and can be easily accessed by public transport. There are some local shops and other amenities nearby. The home has been converted into one large house from four terraced properties. There is a small garden to the front of the house. There are eighteen single bedrooms at the home. Four bedrooms are on the ground floor; the remainder are at first floor level, which can be accessed by passenger lift. There are two lounges and a dining room on the ground floor. The home provides care and support, all meals and snacks and a laundry service. The fee covers all activities, occasional trips out and visiting entertainers. People pay for their own personal toiletries, hairdressing and chiropody. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections; these may be announced or unannounced. This was the second unannounced inspection of this home; the first inspection was also unannounced and took place in July 2005. Copies of previous inspection reports are available at the home or on the Internet at www.csci.org.uk This was an unannounced inspection carried out over four hours by one inspector. The main purpose of the inspection was to make sure that the home continues to provide a good standard of care for the people who live there. The methods used at this inspection included looking at care records, a sample of staff records and resident’s financial records. A brief tour of the building took place and time was spent talking to people who live at the home and the staff on duty. What the service does well:
Lee mount is a small, informal and friendly home. The staff make visitors very welcome when they call at the home. Prospective residents and their relatives are invited to call at the home to meet people and view the accommodation if they wish. Everyone is assessed before they move into the home to make sure their needs can be met in full. Residents are satisfied with the care and support they receive and they say the staff are helpful and good-humoured. The staff know all the residents very well and they try hard to make sure that individual routines and personal preferences are respected. Each resident has an individual care plan that sets out what care and support they require from staff. The records show that staff are vigilant and they seek advice appropriately when they have concerns about health related issues. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 6 Medication is well managed at the home. The records are good and care is taken to make sure that residents receive their medication at the correct times. Residents said they enjoyed all of their meals and they felt that there was plenty of choice on the menu. The home is clean and hygienic throughout. What has improved since the last inspection? What they could do better:
There are plans to improve the facilities at the home by extending the building. This will require careful planning to make sure that this causes the minimum amount of disruption to the lives of residents and to the day to day running of the home. The discarded furniture at the back of the house should be removed. Staff recruitment procedures need to be improved. All staff must be properly checked to make sure they are suitable to work with older people. Confidential information must be stored securely within the home. Records must kept of all money that is held on behalf of residents. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 7 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. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 8 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 Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 9 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): 3 (standard 6 does not apply) All prospective residents are assessed before they move into the home. This makes sure that the staff are able to give people the support they need. EVIDENCE: All prospective residents are fully assessed before they move into the home. This ensures that their care and support needs are planned for and can be met. Prospective residents and their relatives are encouraged to visit the home so they can assess the suitability of the facilities for themselves. A sample of files relating to people who had recently moved into the home was examined. The pre admission information that had been gathered was good. It was noted that Calderdale assessments were in place for those people referred by the Local Authority. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The medication system at the home is good. Medication records are well maintained. EVIDENCE: Medication administration records are well maintained and all medication can be accounted for. The records show that residents receive their medication at the prescribed times. Seven staff currently administer medication, all have received training from the manager, some staff have had additional external training. Plans are in place for ten members of staff to undertake training on medication administration in the next few months. The training takes place over several weeks and is provided by an external organisation The records show that all residents have their medication reviewed at least annually. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this inspection. See last report. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this inspection. See last report. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,21,26 The home is kept clean and hygienic throughout. The choice of useable bathing facilities needs to be improved. This should be addressed in the plans to extend the home. EVIDENCE: All of these standards were assessed at the last inspection in July 2005. Pleases see previous report for more details about the environment. The present owner of the home has been the registered with the Commission for Social Care Inspection since December 2004. He recognised that there was considerable work to do to upgrade the home when he took over, as there had been a lack of investment in the building in the past. For example, although the home meets the National Minimum Standards in terms of the number of bathrooms available, not all residents are able to use them. There is only one bath, which has a seat which can be raised and lowered by staff to help people get in and out. Some less mobile residents
Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 14 would find it difficult to get in and out of the other baths. There is one ground floor shower room, which would benefit from upgrading. The dining room is small and although there is provision for all residents to be seated, there is not a lot of room for residents and staff to manoeuvre around the tables. Since taking over the home the owner has improved the décor in some of the bedrooms and replaced some of the wash hand basins in bedrooms. Four rooms are yet to have new wash hand basins fitted. The approach to the decorating appears slightly haphazard. Some of the communal areas have been repainted but the work has not been fully completed, in one area the paint has not been applied to the edges of the walls. None of the woodwork has been repainted. A wooden fireplace has been fitted in one of the sitting areas but the wood has been left untreated. These areas need attention. The home needs further improvements that require more significant structural changes, the registered owner recognises this and he has plans to extend the home to do this. As the proposals will mean that some major changes have to take place in the home, it is very important that the building work is well planned to make sure that the impact on residents is kept to a minimum. The registered owner has been requested to liaise closely with the Commission for Social Care Inspection on this matter. On this visit it was noted that there were several items of old, discarded furniture and an old clothes dryer at the back of the house. The furniture is in a fenced area but it is not secure. This needs to be removed as it poses a potential hazard to people who live at the home. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30. The recruitment process needs to be improved. All prospective employees must be thoroughly checked to make sure they are suitable to provide care for older people. The manager ensures that the individual training needs of staff are identified through supervision. EVIDENCE: Staff files were requested for two staff that had recently started work at the home. One person had been employed previously but had left the home in 2003, returning in October 2005. There was no evidence that this individual had completed a new application form giving details of interim employment, or that appropriate checks had been carried out with the Criminal Records Bureau. The staff file for the second new member of staff could not be located. This is not typical of the recruitment process at Lee Mount; on previous inspections the procedures have been found to be quite thorough. This was discussed with the manager at the time of the inspection. It was of some concern to note that confidential information was stored in a space, which was only accessible from outside of the home. This storage area is not secure and is not suitable. (see standard 37) Various training courses for staff have taken place or are planned over the next few months. These include courses on Adult Protection, Basic Emergency Aid, Food Hygiene, Care of Medicines and Infection Control.
Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 16 The home has a good record of NVQ training. Only two of the fourteen staff have yet to achieve NVQ level 2. They expect to start the course in March 2006. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,37,38. The home is well managed by a competent and experienced registered manager. Financial records need to be improved in respect one resident. There needs to be additional secure record storage space within the home. EVIDENCE: The registered manager has several years experience of working with older people. She has worked in a care setting for 13 years, with the last 5 years at senior management level. She has managed Lee Mount since 2002 and has completed NVQ level 4, and the Registered Managers Award. She undertakes regular training alongside the staff at the home to keep her care practice up to date. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 18 Small amounts of money that are usually deposited by relatives are held at the home on behalf of residents. A sample of the finance records was examined. Receipts were available for all purchases made on behalf of residents and the amount of money held balanced with the individual records. One arrangement regarding the payment of money to a resident is not satisfactory. In this case, an appointee from the local authority transfers money to the registered owner so that he can provide the resident with a set sum of money on a weekly basis. As the owner had not made the full amount of money available on the week of the inspection, the balance had to be provided by the manager from her own funds. A record of all financial transactions in respect of this resident must be held in the home. This arrangement needs to be reviewed as soon as possible. Arrangements must be made to make sure that all confidential records are stored securely in the home (see standard 29 re: staff records) More care needs to be taken with the recording of the fridge/freezer temperatures if this is to be a meaningful record. On examination of the records at 11am on the day of the inspection, it was noted that the temperature due to be recorded at 4pm had already been logged. This was discussed with the cook who is responsible for recording temperatures and with the manager during the inspection. It was agreed that this practice would cease immediately. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 1 2 X X X X 3 STAFFING Standard No Score 27 X 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 1 X 1 2 Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP20 Regulation 23 Requirement Timescale for action 19/03/06 2 3 4 OP29 OP35 OP37 19 17(2) Schedule 4 17 The discarded furniture at the rear of the house is a potential hazard to residents and must be disposed of. All staff must be appropriately 12/03/06 checked before they start work in the home. Records must be kept of all 12/03/06 money held on behalf of residents. Arrangements must be made to 12/03/06 ensure that all records are stored securely 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 2 Refer to Standard OP21 OP38 Good Practice Recommendations Arrangements need to be made to improve the choice of bathing facilities at the home. The records of fridge/freezer temperatures must be recorded at the times specified in the records. Lee Mount Residential Home DS0000061575.V282459.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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