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Inspection on 02/09/08 for Lee Mount Residential Home

Also see our care home review for Lee Mount Residential Home for more information

This inspection was carried out on 2nd September 2008.

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

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

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

What the care home does well

The majority of staff are kind and well meaning in their approach to people living at the home. People said they enjoy the meals provided. The rooms in the new extension have en suite facilities and are pleasantly decorated.

What has improved since the last inspection?

Information that can be given to people about the home has been updated to reflect the service and facilities that are available. The pharmacy inspector found significant improvements in the administration and recording of medicines. The presentation of the dining room and the appearance of the entrance area has improved. There is an annual plan showing how the home will be improved and developed. The records of maintenance and servicing of equipment are better organised. A quality assurance system is in the process of being introduced this will mean that people will be consulted about the way the home is run.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Lee Mount Residential Home 32 Lee Mount Road Lee Mount Halifax West Yorkshire HX3 5BQ Lead Inspector Lynda Jones Key Unannounced Inspection 10:00 2 & 19 September 2008 nd th 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.V371385.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. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 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) cjsingh76@hotmail.co.uk Lee Mount Healthcare Ltd Manager post vacant Care Home 25 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (25) of places Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE The maximum number of service users who can be accommodated is: 25 27/8/08 2. Date of last inspection Brief Description of the Service: Lee Mount is a care home providing personal care and accommodation for up to twenty five older people. Within this overall total, the home is registered to provide care for seven people with dementia. The home is in the Lee Mount area of Halifax, approximately two miles from the town centre and can be easily reached 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 at the front of the house. The home has recently been extended and new bedrooms have been added. The registration increased from eighteen to twenty five places in January 2008. All of the bedrooms are single, seven have en suite facilities. Eight bedrooms are on the ground floor; the remainder are at first floor level, which can be accessed by a passenger lift. There are three lounges and a dining room on the ground floor. The home provides care and support, all meals and snacks and a laundry service. The fees are £353.00 and £373.00 per week. The higher fee is for people with dementia. People pay for their own personal toiletries, hairdressing and chiropody. Lee Mount Residential Home DS0000061575.V371385.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 0 star. This means the people who use this service experience poor quality outcomes. This inspection took place to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection, as well as an unannounced visit to the home. We have carried out four unannounced inspection visits since the last key inspection in March 2008 because we have serious concerns about the way the home is being run. There have been three changes of manager since the last key inspection. The registered manager left the home in July 2008, an acting manager was appointed but left the post in August 2008. A temporary manager from an agency is currently managing the home, she had been in post for only three days when we visited. In view of our concerns and within the Commission’s regional improvement strategy we have issued two Statutory Requirement Notices. The first, issued in June 2008 required the home to keep under review, maintain, update and revise individual service users’ care plans in order to accurately reflect their health and welfare needs. We carried out an unannounced inspection in July 2008 to see what action had been taken to comply with the Notice and although we found some improvements had been made, the Notice had not been fully complied with. The second Statutory Requirement Notice, served in August 2008 required the home to ensure that effective systems for the recording, handling, safekeeping and safe administration of medication are in operation. This report relates to the key inspection, which was took place over two days, 2 and 19 September 2008, by two inspectors and a pharmacist inspector. During this inspection, the inspectors spoke to some of the people living at the home, some of the staff, the temporary manager and the owner of the home. We looked at care records, some of the staff records and records about the maintenance of equipment. The pharmacist inspector looked at medication and related records to see what action had been taken to comply with the Statutory Requirement Notice served in August 2008. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Management processes must be put in place to make sure that people living at the home are safe and they receive the care and support that they need. To do this, improvements need to be made in the following areas: • • • • • Care planning and delivery. Providing meaningful, stimulating activities for people to take part in if they wish to. Keeping people safe from harm and abuse. Making sure that staff feel confident about reporting any concerns they have about poor care practice. Making sure the environment is safe and pleasant to live in. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 7 • • Making sure that thorough checks are carried out before new staff start work in the home. Making sure that all staff receive the induction, training and supervision they need to provide good care for people. Following this visit and finding that required improvements have not been addressed the Commission is taking further enforcement action to ensure that the outcomes for people living at the home are improved. 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. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 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.V371385.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 5 (standard 6 does not apply) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Information is available about the home to help people make a decision about whether the service is suitable for them. EVIDENCE: At the last inspection we were not satisfied that people were being properly assessed before they moved into the home. These assessments are carried out to make sure that the home is suitable for them and can meet all of their needs. We are unable to tell whether there have been any improvements in this area because there have been no new admissions to the home in recent months. Calderdale MBC has suspended placements at the home. This means that we could not fully assess Standard 3 on this visit. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 10 Since the last key inspection the statement of purpose and service user guide have been updated, this is an improvement. Both documents now include up to date information about the facilities at the home and the service provided. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans do not accurately reflect or identify the care people need. This means that people’s needs are not always being met. The management of medication has improved. EVIDENCE: On visits to the home in March 2008 and May 2008 we were concerned about the quality of the care planning system that is used at the home. In June 2008 we served a Statutory Requirement Notice requiring the home to ensure that the care plans clearly identify how people’s needs in respect of health and welfare are to be met and also to ensure that the plans are reviewed regularly and revised to reflect any changes in people’s health and welfare needs. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 12 When we carried out an unannounced inspection in July 2008 we looked at a sample of care plans and found that although some improvements had been made, the home had not fully complied with the Statutory Requirement Notice. In July 2008, we found that the plans we examined did not did not include sufficient information in respect of service user’s health and welfare needs and they did not give specific instruction to staff about what they must do to meet people’s needs. This means people may not always be receiving the care and support they require. There was no evidence in any of the care plans we looked at of people living at the home and/or their relatives being involved in the care planning process. It is important that people are involved in the care planning process so that they have the opportunity to influence the care and support they receive. Our judgement is that the outcomes for people living in the home are still poor in the area of health and personal care because we found very little sign of improvement in the care plans we looked at on this occasion. The owner of the home told us that this issue is currently being addressed by the introduction of a new system of care planning. We were informed that staff are in the process of receiving training about the new system and at the time of this visit only two plans had been transferred to the new format. We will review progress in this area when we next visit the home. A CSCI pharmacist inspector visited on 19 September 2008 to see if the requirements from previous pharmacy inspections and the Statutory Requirement Notice issued on the 22 August had been met. The inspector found evidence of significant improvements in practice. There are good systems in place for the accurate administration and recording of medicines and controlled drugs are now stored securely. This means people are receiving their medication safely and as prescribed. The medicines policy is in the process of being updated. The policy does not include specific information relating to the home such as who the supplying pharmacy is and the process for ordering monthly prescriptions. An audit system has been developed to check that staff are following the procedures for the handling of medication. The current and previous month’s Medication Administration Records (MARs) were looked at. The recording of medicine administration has improved, there were very few gaps on the MARs. This means there is a record kept of people getting their medication as prescribed. Good details were written on the MARs for medicines that had a varying dose, for example reducing by one tablet daily. This information means that staff know exactly how much to give each time. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 13 Handwritten entries on the MAR were well written. It is important to have accurate entries to make sure people get their medication correctly. The fridge in current use is too small which means that all the medicines are tightly packed. This made it difficult to remove one item without all the other medicines falling out and may have an effect on keeping the medicines at the correct temperature. There is now a controlled drugs cabinet in place. This means that there is a safe and secure system for the storage of these medicines. Accurate records are kept of controlled drugs returned to the pharmacy for destruction. The monthly prescriptions are not returned to the home before going to the pharmacy. This means there is no opportunity to check the prescriptions to make sure that any changes from the previous month are on the new prescriptions, to check for missing items and to inform the pharmacy of items that were not requested Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Social activities are not provided consistently or on an individual basis to keep people stimulated. People are not always supported to make choices or have control over their lives. EVIDENCE: At the last key inspection in March 2008 we could find no evidence of any activities taking place. Although there was a programme of activities posted up in different areas of the home, we didn’t see or hear of any activities taking place and we could not find evidence of activities in the records we examined. When we carried out an unannounced inspection on 14 May 2008 we found that the staffing levels had increased and some activities were taking place. Staff told us they didn’t stick to the programme of activities, they asked people each day what they wanted to do. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 15 There is no evidence that this improvement has been sustained. On this visit we were unable to find any evidence of activities taking place. We observed most people sitting in one of the three lounges for the majority of the day. Several people were asleep for long periods of time; some people were awakened by staff to go to the toilet or to have a drink of tea and then fell asleep again as soon as the activity was over. People were offered very little in the way of stimulation. Staff did not initiate conversation and very few exchanges took place between people sitting in the room. Staff spent very little time with people other than when they were assisting individuals with specific tasks. In the large lounge the curtains were still closed at 1:50 pm and the lighting in the room was very dull, making it difficult to tell what time of day it was. The TV was on in two of the lounges but no one watched it or showed any interest in what was on. Two people told us the TV was on most of the day and evening, no one seemed to know how to change the channels and no one had access to a newspaper or TV guide so that they could know what programmes were on. In the small lounge, one person sat alone and asleep for most of the day except for going to the toilet and to the dining room at meal times. The daily records reflect the lack of activity and stimulation taking place. Entries are repetitive, they only tell the reader where people are located in the home each day. They are not individualised and nothing is reported about the sort of day people may have had. The records are about daily routines in the home and they suggest that every day is the same for each person. These are some examples of what we found: “X in the dining room then went to lounge to watch TV. Assisted to toilet then went into dining room for dinner, then went to lounge”. “Y had breakfast then went to lounge at 10am. Drink served, assisted to toilet. Went to dining room ate and drank well. Now in lounge”. “Z in dining room at start of shift. Breakfast served then went to lounge. 10am drink served. Came to dining room for dinner, ate and drank well”. The acting manager told us that the new care planning system contained a section for staff to record details about people’s hobbies and interests and assured us that plans are in hand to improve the recording of activities and daily records. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 16 The presentation of the dining room has improved since the last key inspection. Tablecloths and individual place settings are in use and there are condiments on the tables. The menu for the day is displayed in the room for everyone to see. People told us they enjoyed the meals and said they always had plenty to eat. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff need more training on their role in safeguarding people to ensure that people living at the home are safe and protected from abuse. EVIDENCE: The complaints procedure is on display in the entrance area. Details are in the Service User Guide which people get a copy of when they move in. The information provided by the home before the inspection told us that there have been four complaints in the past twelve months and all were dealt with in accordance with the homes procedure. We do not know what these were about because a new complaints record has been started and the previous record could not be found. At the last key inspection in March 2008 we said the staff needed more training on adult protection and keeping people safe . We have been told that some training took place on this subject in April 2008. As some new staff have started work at the home since then it is important that they also receive this training so that they can make sure that people living at the home are safe and protected. In addition, all staff need regular refresher training. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 18 In the records we looked at we noted that a member of staff had raised concerns about the care practice of other members of the team. The issue raised could have resulted in people living in the home being neglected and not receiving the care they need. We could find no evidence that the person who managed the home at that time had investigated this. We read an entry in the records indicating that the person who raised the concern would be disciplined along with the other named staff if the allegation was found to be true. This does not encourage a culture of openness within the home. The importance of “whistle blowing” procedures must be stressed to staff so that they feel that they can voice any concerns about poor practice without feeling they may be victimised. We discussed this with the temporary manager and the owner at the end of the inspection and asked them to investigate. In August 2008 we made a safeguarding referral to the local authority because we did not think one person was receiving the care and support they required. This local authority carried out the investigation. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21, 23,24,25,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable home. Although some improvements have been made, there are still some areas that require refurbishment and redecoration to improve the facilities. EVIDENCE: In our report from the last key inspection in March 2008 we said there were areas in the home that could be improved upon so that people could enjoy living in safe and comfortable surroundings. Some of the issues we raised have been addressed and improvements have been made. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 20 However, because the home has been poorly managed, no one has taken responsibility for keeping an overview of housekeeping and general maintenance requirements. There has been a pattern over recent months of improvements taking place in one area of the home while at the same time other areas have been overlooked and left to deteriorate. The owner of the home now has an annual plan showing which areas of the home will be upgraded on a month to month basis. To assist with this and to keep the environment safe, staff need to report maintenance issues to the owner as soon they can. These are some of the observations we made when we looked round the building: • • • • • • • • • • • • Some bedrooms would benefit from redecoration. In one room the radiator cover was loose. In one room we found an armchair urine soaked and smeared with faeces. A severely rusted commode that was unfit for use was in this room. We showed this to the owner and acting manager. Not all the rooms have bedside lights in them. Some of the wall lights do not work. Some of the cords on light pulls are dirty and need replacing. We found the fire exit from one room blocked by a chair. A vacuum cleaner blocked the fire exit at the base of the backstairs, cleaner attachments were left on the floor. Some of the hand towels and bed linen are very thin and worn. We noticed several stained, old foam pillows on the beds. There are no soap and paper towel dispensers in some bedrooms and en suites. There is no override on the mechanical Ventaxias resulting in unpleasant, stale odours in several rooms. Soiled incontinence pads are not double bagged resulting in offensive odours in bins in one the communal WCs. We were extremely concerned to find that there were no thermostatic controls or fail safe locks on two of the showers. When we tested the upstairs shower we found the water temperature kept changing from cold to scalding hot. In the ground floor shower the water temperature was consistently hot, when we checked the temperature it measured around 57 degrees centigrade. This places people at risk of scalding. We asked the owner to make sure that the showers could not be used until thermostats were fitted so that the water could be controlled and delivered at a safe temperature. This was acted upon by the owner immediately and both showers were replaced later the same week. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff on duty to meet the needs of people living in the home. Staff are not being properly checked before they start work, which leaves people at risk of being cared for by staff who may not be suitable. EVIDENCE: When we carried out a key inspection in March 2008 we were concerned about the staffing levels at the home. We found that there were not enough staff available to meet the needs of people who live there which means that people may not always receive the care and support they require. The number of people living at the home had increased but the staffing levels had not increased to take account of this. This situation has now been resolved. When we carried out this inspection there were fifteen people living at the home, the records show that there are always three members of staff on duty during the day, plus the manager. There are three members of staff on duty at night. There is also a cook and domestic cover. The catering hours have recently been extended so that care Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 22 staff can carry on with their duties rather than having to take time out to prepare breakfasts, this is an improvement. At previous inspections we found that the detail of staff duty rotas needed to improve to include full staff names and designations. We found lots of alterations and found that the rotas did not tally with the staff signing in sheets. This makes it difficult to know exactly who is on duty. We first raised this issue in the report from our visit on 14 May 2008 but found the same problems arising when we visited on 27 August 2008. On this key inspection the staff register was poorly presented. It did not include staff designations, it was not up to date and did not provide details or dates showing when staff stopped working at the home and why. These records need to be improved. We looked at a sample of records relating to six staff to see if people were being thoroughly checked before taking up post at the home. These checks are carried out to make sure that prospective employees are suitable to work with older people and to make sure that people living at the home are safe. We found that care staff have been employed to work at the home without the required pre employment checks first being carried out. There is evidence that the employment histories and qualifications of prospective employees are also not being checked thoroughly before new staff start work. We have issued a Statutory Requirement Notice about this and the matter is now subject to enforcement action. On previous inspections we have looked at staff records to see what training staff have had to help them keep up to date with good care practice and deliver appropriate care to people living at the home. We found that the majority of staff, particularly those most recently employed, were working without having received induction and training in key areas relevant to their work. In June 2008 we issued a Statutory Requirement Notice requiring the registered person to make improvements in this area. We looked at these records again on this inspection and found that the records were not up to date, for example, staff told us about training they had attended that was not on record. These records also need to be improved so that they can be used to identify training needs and inform plans for future training. We saw details of a range of planned training on display and staff on duty told us they had already signed up to attend. We will review this again on our next visit to the home. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not being managed properly. There is no registered manager and no one has been taking overall responsibility for the service. EVIDENCE: We have carried out four unannounced inspection visits since the last key inspection in March 2008 because we have serious concerns about the way the home is being run. There have been three changes of manager since the last key inspection. The registered manager left the home in July 2008, an acting manager was appointed but left the post in August 2008. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 24 An experienced, temporary manager from an agency is currently managing the home, she had been in post for only three days when we visited. On this inspection the owner told us that he is in the process of recruiting a permanent manager and a deputy manager. The temporary manager will remain at the home until the process has been completed and a full handover has taken place. There has been an improvement in some of the records since we last visited. There is a much more systematic approach to record keeping which makes it easier to retrieve information about health and safety and the maintenance of equipment. The records we looked at about the servicing of equipment were all up to date. We were unable to look at past records regarding fire safety because a new recording system had begun and the old records could not be located. Those we looked at were up to date. We could find no records of fire drills or staff training on fire safety. There was evidence of recent consultation taking place on this issue with the area fire safety officer but no arrangements had been made regarding training. This must take place as soon as possible to ensure that people living at the home are safe and staff know what to do in the event of an emergency. Plans are underway to introduce a quality assurance system, this means that people will be consulted and asked for their views about the way the home is run. The relatives of everyone living at the home have been contacted by telephone and a questionnaire has been sent to them asking them for their views. Relatives have been invited to meet the owner and temporary manager to talk about the service provided. Some of the people living at the home are able to express their views and it is important to include them in this process. It would be a good opportunity to ask them for their views about their care while the new care plans are in the process is being introduced. Earlier in this report we said we were extremely concerned to find that there were no thermostatic controls or fail safe locks on two of the showers. The temperature of the water at both outlets was excessively hot, placing people at risk of scalding. The water temperatures are tested regularly from different outlets but when we looked at the records we noted that the showers were not included in the rotation of checks. We talked to the owner about this during our visit. Since the inspection took place the owner has confirmed that both showers have been replaced and these are now included in water temperature checks. A sample of records was checked relating to money held on behalf of people living there. The cash that was held balanced with the records of the financial transactions and receipts were available for all purchases. It would be useful to number the receipts and number the corresponding entry on the cash sheet Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 25 this would make it easier to cross reference the entries. Completed cash sheets should be archived this will make the money records easier to manage. We are concerned about the lack of formal staff supervision and we have commented on this in previous inspection reports. This was included in a Statutory Requirement Notice that we issued on 17 June 2008. When we carried out a further unannounced inspection on 29 July 2008 we found that the requirement had not been complied with. We saw a document showing that supervision was planned but there was no evidence that any sessions had taken place. The temporary manager told us that she plans to carry out a staff appraisal with every member of the team and follow this with regular planned supervision. We will review this on our next inspection. Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 26 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 3 X X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X 2 2 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 1 X 2 Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The registered person must ensure that people are always appropriately assessed before they move into the home, to make sure that all of their needs can be fully met. Revised requirement not assessed at this visit. 2 OP7 15 The registered person must 14/11/08 ensure that progress continues with the reviewing of care plans to make sure they: a) Contain up to date information about people’s needs. b) Indicate clearly the action that staff need to take to meet people’s needs. This will make sure that individual needs are met appropriately. c) People who live at the home or their representatives must be consulted about the care they receive so that they have an opportunity to say if it meets their needs Timescale for action 14/11/08 Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 28 3. OP12 16(2) 4. OP18 13(6) 5. OP26 13(3) 6. OP29 19 7. OP30 18 8. OP36 18 Activities must be provided that meet the range of needs and abilities of the people who live there. Wherever possible, people must be consulted about the sort of activities they wish to be involved in. This will enable them to take part in activities of their choice. Staff must be encouraged and supported to report poor care practice that could result in people being placed at risk of harm or abuse. All staff must receive adult protection training. In order to enhance the quality of people’s lives and to reduce the risk of infection at the home the registered person must make arrangements to ensure that: The soiled armchair must be cleaned or replaced. Dirty cords on call bells must be replaced. Clinical waste must be disposed of correctly. The rusted commode must be replaced. The registered person must follow thorough recruitment procedures that will support and protect people living at the home. The registered person must ensure that progress is made to ensure that staff receive appropriate training. This must include: Structured induction Training to enable them to meet people’s needs. Safe Moving and Handling of people. Staff must be provided with regular supervision to ensure that their care practice is up to date. DS0000061575.V371385.R01.S.doc 14/11/08 14/11/08 14/11/08 14/11/08 14/11/08 14/11/08 Lee Mount Residential Home Version 5.2 Page 29 9. OP38 23(4) The registered person must make arrangements for all staff to receive training on the procedure to be followed in case of fire. 14/11/08 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 OP9 Good Practice Recommendations The medication policy should be updated with details of the tasks that staff are required to undertake and to make sure that staff are all working according to the latest requirements and guidance. Regular, monthly prescriptions should be seen before sending to the pharmacy. This is so that a check can be made to ensure that all the required medicines have been listed and medication supplies do not run out. People should be offered the opportunity to take part in meaningful and stimulating activities. Receipts should be cross referenced with corresponding entries on the cash sheets. Completed cash sheets should be archived. The registered person should continue to progress the management arrangements at the home to ensure that the stated purpose, aims and objectives of the home are consistently met. 2. OP9 3. 4. 5. OP12 OP35 OP31 Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 30 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 Lee Mount Residential Home DS0000061575.V371385.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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