Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 26/06/06 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 26th June 2006.

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

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

Lee Mount is a small, friendly home with an informal atmosphere. The staff make people feel very welcome and put visitors at their ease. Prospective residents are appropriately assessed and they are given information about the home and the facilities that are available.Residents do not feel under any pressure to fit in with the routines of the home, they choose how they want to spend their time and the staff respect their decisions. Residents are all agreed that the food at the home is good. They say they were consulted about what was included on the menu and the cook asks them each day to select from the choices on offer. Relationships between residents, relatives and staff are good. One resident said "we all have a laugh". Everyone says the staff, manager and the owner are approachable. People feel they have a say in the way the home is run, they feel they are listened to and their views taken seriously. One relative said "the manager and all the staff are very caring, also the food is excellent with a varied menu". The staff are respectful, they are on hand and they spend lots of their time in the presence of residents. They make sure that residents who spend time in their rooms are not overlooked. Staff include people in conversations and encourage residents to make choices and to be as independent as possible. Care plans and daily records are good. Instructions to staff about individual care needs are clear and they accurately record the care and support they deliver. Residents have access to health care services that meet their assessed needs both within the home and in the local community. All have access to dentists, opticians and other community services.

What has improved since the last inspection?

Staff records and archived records are now appropriately stored. The arrangements for managing the finances on behalf of one resident has improved and is now satisfactory.

What the care home could do better:

There is still room for improvement in the organisation of staff files and in making sure that references for new staff are appropriate. The manager recognises this and improvements are now in hand. Improvements need to be made to raise the standard of facilities that are available to residents. The number of useable bathrooms needs to be increased and the shower facility improved. The dining room is small, leaving little room for staff and residents to manoeuvre around the tables. Bedrooms need to be audited to check that furniture, bed linen and curtains are suitable for purpose. (for more details see environment section of this report). Work on the garden needs to be completed as soon as possible so that residents have somewhere safe and pleasant to sit outside. There are plans to extend the home in the very near future, when many of the facilities will be improved. Discussions now need to take place with residents, relatives and staff about the proposals so that they all have some idea what the building work will entail. Relatives said they would welcome more information on this matter.

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 26th June 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.V301620.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.V301620.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) 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.V301620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2006 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 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 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 of £339 per week covers all activities, occasional trips out and visiting entertainers. People pay for their own personal toiletries, hairdressing and chiropody. Information about the facilities at the home and the service offered is available on request from Lee Mount. A copy of the last inspection report is on display in the entrance of the home. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out in one day over a six hour period. Questionnaires were sent to five residents and five sets of relatives asking for views on the care and support provided at Lee Mount. Two questionnaires were returned by residents and two by relatives. A pre inspection questionnaire was sent to the home before the site visit took place. This was completed by the manager and provided information about the home, policies and procedures and staffing. Discussion took place with five residents in the lounge areas and with one resident in private. Discussion also took place with two visiting relatives. Care practice was observed throughout the day and informal discussions took place with staff on duty. Talks also took place with the owner of the home and with the registered manager. The inspector was invited to sit in on the staff handover that took place in the afternoon. Various records were examined during the visit. A tour of the building took place with the manager. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group for example Choice of Home. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers outcomes to the people using the service. The judgements categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded within the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk What the service does well: Lee Mount is a small, friendly home with an informal atmosphere. The staff make people feel very welcome and put visitors at their ease. Prospective residents are appropriately assessed and they are given information about the home and the facilities that are available. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 6 Residents do not feel under any pressure to fit in with the routines of the home, they choose how they want to spend their time and the staff respect their decisions. Residents are all agreed that the food at the home is good. They say they were consulted about what was included on the menu and the cook asks them each day to select from the choices on offer. Relationships between residents, relatives and staff are good. One resident said “we all have a laugh”. Everyone says the staff, manager and the owner are approachable. People feel they have a say in the way the home is run, they feel they are listened to and their views taken seriously. One relative said “the manager and all the staff are very caring, also the food is excellent with a varied menu”. The staff are respectful, they are on hand and they spend lots of their time in the presence of residents. They make sure that residents who spend time in their rooms are not overlooked. Staff include people in conversations and encourage residents to make choices and to be as independent as possible. Care plans and daily records are good. Instructions to staff about individual care needs are clear and they accurately record the care and support they deliver. Residents have access to health care services that meet their assessed needs both within the home and in the local community. All have access to dentists, opticians and other community services. What has improved since the last inspection? What they could do better: Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 7 There is still room for improvement in the organisation of staff files and in making sure that references for new staff are appropriate. The manager recognises this and improvements are now in hand. Improvements need to be made to raise the standard of facilities that are available to residents. The number of useable bathrooms needs to be increased and the shower facility improved. The dining room is small, leaving little room for staff and residents to manoeuvre around the tables. Bedrooms need to be audited to check that furniture, bed linen and curtains are suitable for purpose. (for more details see environment section of this report). Work on the garden needs to be completed as soon as possible so that residents have somewhere safe and pleasant to sit outside. There are plans to extend the home in the very near future, when many of the facilities will be improved. Discussions now need to take place with residents, relatives and staff about the proposals so that they all have some idea what the building work will entail. Relatives said they would welcome more information on this matter. 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.V301620.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.V301620.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. All prospective residents and their families are provided with information about the home to help them decide whether they want to live there. Everyone is assessed before they move into the home to make sure that their needs can be met. All residents have a contract which tells them about the service they will receive. 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 when they move in. Prospective residents and their relatives are encouraged to visit the home so they can assess the suitability of the facilities for themselves, people are welcome to stay for a meal and meet other residents if they wish. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 10 Residents are provided with a statement of terms and conditions before admission to the home. It gives basic information on what residents can expect to receive for the fee they pay and sets out terms and conditions of occupancy. Everyone also receives a copy of the Service User Guide which provides information about the home. Residents and visiting relatives confirmed that they had been provided with written information about the home by the manager. Two pre admission assessments were examined relating to two residents who moved into the home earlier in the year. Evidence confirms that the assessments are conducted professionally and sensitively and that the family or representative of the resident were involved. Both contained some useful information about the reasons for admission, the needs of each person and about their likes, dislikes and interests. Evidence shows that the staff make an effort to find out each persons preferred routines, this information helps staff to assist people to “settle in” when they first move into the home. A copy of the last inspection report is on display at the home. In the comment cards received from relatives they confirmed that they had access to past reports. Lee Mount Residential Home DS0000061575.V301620.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which residents receive, is based on their individual needs. The staff have a good understanding of the support that residents require and there is evidence to show that arrangements are in place to meet individual needs. The medication system at the home is good. Medication records are well maintained. EVIDENCE: The needs of residents are set out in the care plans. Four plans were examined, two related to residents who moved into the home earlier in 2006. The needs of residents were identified and each plan was clearly written, setting out the action that staff are expected to take to meet the needs of each individual. The records indicate that time had been taken with residents to get to know about their life experiences. Where residents had been unable to give information, details had been obtained from relatives. Information was recorded about hobbies and interests, likes and dislikes and about how people prefer to spend their time. Staff respect the daily routines that some residents like to keep to, this was evident from observing care practice and was also confirmed in conversation with residents. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 12 Not all residents and relatives are aware of what a care plan looks like but they knew that a plan existed. Residents felt that they were “well looked after”, relatives completing comment cards said they were satisfied with the overall care provided. None of the residents spoken to could remember anything as formal as a review of their care plan but they did feel they had a say in the care and support they received. One person said “I’d tell them if I wasn’t happy”. Everyone said they felt consulted and involved with their care. Relatives said they were kept informed of important matters that affected their relative who lived at the home. They also indicated that they felt they were consulted about care issues although this again appears to be on an informal basis. The manager and staff should consider formalising involvement in the care planning process to ensure that the reviews involve the resident and where agreed their family. There is evidence that all residents have access to a range of health care facilities and that providers of health care services such as district nurses, GP’s chiropodist, dentist etc have regular contact with the home. The records show when any visits have taken place, the reason for the visits and outcomes. Communication between staff is good, as evidenced during the staff handover. Everyday, time is set aside for staff to give a verbal handover to staff starting duty in the afternoons. It was good to see that everything communicated in this way was also backed up in the daily records. The daily records are good, they provide evidence that care has been delivered as stated in the care plan and they provide a good account of how residents have spent their time, whether they have been out or had visitors. Particular attention is given to ensuring privacy and dignity when delivering personal care. This was evident from observing staff at work. The staff and residents obviously get on well together and respect each other. One resident was really pleased that a member of staff had helped him to buy some new clothes recently. He said he got on well with this member of staff who knew exactly what style of clothing he liked. He goes out regularly on his own and said people had commented on how smart he looked. Everyone living at the home looks smart, clothing looks cared for and everyone has the opportunity to have their hair done regularly. Staff said they like to make sure that they assist people to make choices about what they wear and to maintain a good personal appearance. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 13 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. All staff that administer medication have received training from the manager and additional external training. Lee Mount Residential Home DS0000061575.V301620.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Residents are able to choose their life style and keep in contact with family and friends. The menu is varied and meals are well presented. Residents receive a healthy, varied diet and they enjoy their meals. EVIDENCE: Routines at the home are fairly flexible. The staff respect the preferred routines of individuals and they do their best to be accommodating. A couple of people prefer to spend all of their time in their rooms, the staff call on them frequently throughout the day, take their meals, stop for a chat and make sure that they are OK and have everything they need. This was confirmed by one of the residents and their relatives. One of the positive aspects of Lee mount is the friendly and informal atmosphere in the home. Residents have developed meaningful relationships with staff, they are interested in their families and ask about them. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 15 Residents said the staff were available when they needed them and they felt that the staff listened to what they had to say. There is a stable staff team at the home who work well together. The staff perform their duties efficiently, they do not exclude residents, they chat to people as they work. Staff make time to sit with residents and talk and they make an effort to include some of the quieter people in conversations. From observation and from speaking to residents it is apparent that there is an atmosphere of good humour and lots of banter between residents and staff. There is no regular planned programme of activities at the home. The staff ask residents on a day to day basis to choose from a range of activities such as dominoes, bingo, sing a longs, watching videos, listening to music etc. A record is kept of all the activities that take place. Residents said “it depends what we feel like doing”. Residents confirmed that they are asked if they would like to take part. People don’t have to join in if they don’t want to. There are two lounges in the home so there is enough space for people to read or watch TV if they wish to do so instead. Watching the world cup matches together was the preferred activity around the time of the visit to the home. One resident said he goes out everyday. He goes out in the morning, returning for lunch, then goes out again in the afternoon to town or to the pub. He said the staff ask him to let them know when he is going out and when he expects to return, “apart from that, I come and go as I please”. He said the lifestyle at Lee Mount really suited him. Visitors can call at the home at any time. The visitors book indicates that residents have lots of company. Two relatives who returned comment cards said they were made to feel welcome when they called at the home and relatives who were present said they were always well received, they chatted with staff and were offered a drink when they visited. The menus at the home are varied, they are change throughout the year so that seasonal produce can be used. When the menus were devised, all residents were asked what meals they would like to have on the menu, the manager said every effort has been made to include what people asked for. The menu for the day is written each day by the cook and is displayed in the dining room. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 16 Residents said they really enjoyed the food, they said the meals were well presented and they had plenty to eat. A relative said “the food is excellent and the menu is varied”.One resident said if he didn’t like what was on the menu, the cook would make him an alternative meal. From speaking to staff it is apparent that they know what people like and dislike, they know the size of portion people prefer and they cater accordingly. The staff assisted and encouraged three people who had their mid day meal in the lounge, two other residents had their meal in their rooms. Residents confirmed that regular drinks are available throughout the day and staff will always make a cup of tea at any time when asked. The dining room at the home is small and although there is provision for everyone to eat together, there is not a lot of room for residents and staff to manoeuvre around the tables. The owner of the home acknowledges that the dining area is not ideal and will be addressing this issue when the home is extended in the coming months. Lee Mount Residential Home DS0000061575.V301620.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Residents and their representatives have access to a robust, effective complaints procedure and feel confident that any concerns they raised would be listened to and investigated. Measures are in place to protect residents from abuse. EVIDENCE: There is a complaints procedure that meets the national minimum standards and regulations. The complaints procedure is available in the home and details are included in the Service User Guide One complaint has been made in the last twelve months, this was dealt with by the manager in line with the procedure. Residents who completed the surveys said they knew how to make a complaint and they knew who they would speak to if they were unhappy about anything at the home. Residents spoken to also said they knew how to complain and said they would speak to the manager if they had any concerns, they were confident that their views would be listened to and taken seriously. Two relatives indicated that they also knew about the complaints procedure but had not needed to use it. All staff have received adult protection training in the past twelve months and are able to demonstrate an understanding of adult protection issues. The Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 18 manager is clear about incidents needing external input and who to refer any incidents to. Lee Mount Residential Home DS0000061575.V301620.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Certain aspects of the home, general décor, dining area and access to the outdoor space need to be improved. The choice of useable bathing facilities also needs to be improved. EVIDENCE: 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 be done 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. Only one bath out of four has a seat which can be raised and lowered by staff to help people get in and out. Some less mobile residents would find it difficult to get in and out of the other baths. There is one ground floor shower room, which is used, but is in need of upgrading. The ground floor toilets are Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 20 located within easy reach of the lounge and dining areas but they are too small and cannot be used by residents who need staff support. The owner has done some redecorating since December 2004. Some rooms have been repainted and some have had new wash basins fitted. Some redecoration has also taken place in the lounge and dining areas. The work that has been carried out has improved the appearance of the home but there is still a great deal to be done. As already mentioned earlier in this report, the dining area is small and there is very little room for people to move around the tables. All of the bedrooms need to be audited to make sure they are all suitably furnished, comfortable and meet the needs of the residents. Some of the bedroom furniture is inadequate, in some rooms the wardrobes are too small, old curtains that do not keep out the light need to be replaced in some bedrooms. Some of the duvet covers are thin and faded and some of the towels that were in use were frayed. The manager said the towels were on order and some duvet covers had already been replaced. Although there are still bedrooms that could be improved, there is evidence that with the help of relatives and staff, all residents have personalised their rooms with the addition of photographs and ornaments and plants. Personal toiletries were evident in all of the bedrooms. The owner recognises that the home needs major improvements requiring significant structural changes. He has plans in hand to extend the home and hopes the work will start soon. 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. Residents and relatives said they are aware that building work is proposed but no one seemed very sure what changes were likely. One of the comments received from a relative was “an indication of when the planned extension/improvements are to be carried out would be appreciated” another said “ Ive heard mention of an extension but I have no idea where it will be or what it will mean for people living here”. When these comments were discussed with the manager she said the owner intends to meet with residents and relatives to discuss the building work and the plans will be displayed in the entrance area. Concern was expressed in the reports from inspections carried out in 2005, about the lack of a suitable outdoor area for residents to sit in the summer months. The area at the back of the house is uneven and difficult to access by Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 21 residents with mobility difficulties. This space is currently used for car parking and on this visit contained an old washing machine and the branches of several trees that had recently been cut down. There is a narrow grassed area at the front of the house which is enclosed by a tall grey metal fence. The fence is inappropriate and would be more suited to industrial premises, it sets the house apart from all of the other residential properties on the road. One visitor said “it looks like a fort when you drive up”. Work was underway to improve the front garden at the time of the visit to the home. The owner intends to create a level seating area which can be reached by ramped access from the lounge. He is also hoping to disguise the metal fence with wood panels. The rear garden area will be addressed in the plans for the extension. When all the work is completed the facilities for residents and staff will be vastly improved. Residents who returned comment cards said they thought the home was kept clean and tidy and visitors to the home agreed. Previous inspection reports have confirmed that this is usually the case at Lee Mount. On this visit, some issues of cleanliness were brought to the attention of the manager. This may well have been an isolated incident. Domestic cover at the home consists of 3.5 hours, three days each week. The manager needs to monitor this situation to ensure that this amount of cover is satisfactory. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are on duty at all times to ensure that the needs of residents can be met. Staff have access to appropriate training to improve their skills and keep up to date with good practice. Staff files and staff recruitment procedures need to be improved . EVIDENCE: Residents have confidence in the staff that care for them. The two residents that returned surveys said they always received the care and support they needed, other residents, spoken to during the visit to the home also shared this view. Relatives indicated that in their opinion there were always sufficient numbers of staff on duty when they visited the home. The staff rotas show that the home is suitably staffed throughout the day and night to meet the needs of residents. The manager said staff team members were flexible and supportive of each other, providing cover for annual leave and sickness as required. One member of the team who covers 3.5 hours in the mornings is also available at other times of the day to escort people to appointments outside the home. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 23 Staff training takes place fairly regularly and is well received by the team. The majority of staff have now completed NVQ level 2. The manager is good at sourcing training and she is supportive and encouraging in her approach to staff. Over recent months courses in medication administration, fire safety, moving and handling and infection control have taken place. Evidence was provided of future planned training in food hygiene, health and safety and first aid and additional infection control training. Since the last inspection the arrangements for storing staff files and archived material has improved. Storage space for documents is extremely limited as the office that is used by the manager is very small, this will be addressed when the home is extended. There is still room for further improvement in the recruitment procedure and the arrangement of the staff files. More care needs to be taken to ensure that all references are authentic. References that are taken up should match the details of referees named on the application form, if this is not possible the reasons should be noted. The manager is aware of the shortcomings in this area and there was evidence that arrangements were in hand to organise all of the information in staff files. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 24 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): 31,33,35,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Residents and staff feel consulted by the owner and the manager about the way the home is run and they feel that their views are valued. EVIDENCE: Residents and relatives feel the home is well managed. 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.V301620.R01.S.doc Version 5.2 Page 25 There is clear evidence that the manager and the owner are working together to improve standards at the home and to improve the quality of life for the people living there. Residents and relatives said they feel confident about speaking to them and feel that their views would be listened to. The owner is frequently at the home and residents said he spends time with them. The manager said she had recently sent out a questionnaire to relatives asking for their views on the home and how things could be improved, she plans to extend this to include visiting professionals. The questionnaires had not been returned at the time of this visit. Residents’ finances are managed by relatives on their behalf. Money for one resident is held for safekeeping, the arrangements for managing this money are satisfactory and the resident in question is happy with the procedure. The home has a good record for managing health and safety issues around the home. Repairs are promptly dealt with by the owner. Arrangements are in place for the storage and safe use of cleaning materials. Documentation was available to show that equipment used in the home is regularly serviced. Lee Mount Residential Home DS0000061575.V301620.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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 3 2 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lee Mount Residential Home DS0000061575.V301620.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 2. Standard OP19 OP29 Regulation 23(2)(0) 19 Requirement The external grounds which are for use by residents must safe and well maintained. All staff must be appropriately checked before they start work in the home (this requirement was first made on 15/2/06) Timescale for action 31/07/06 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. 3 Refer to Standard OP20 OP21 OP24 Good Practice Recommendations Arrangements need to be made to improve the dining facilities so that there is enough room for staff and residents to move around comfortably and safely. Arrangements need to be made to improve the choice of bathing facilities at the home. Bedrooms need to be checked to make sure that they are suitably equipped to meet the needs of all residents. Lee Mount Residential Home DS0000061575.V301620.R01.S.doc Version 5.2 Page 28 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 © 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.V301620.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!