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Inspection on 05/03/08 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 5th March 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

Care staff do the best they can and appear kind and caring. They treat people with respect. People seem reasonably contented, possibly because they have not experienced any other standard of care. These are some of the things the staff said they do well: "staff always go with people to hospital appointments" "The carers give the very best of care under the circumstances that we have to work under" "no matter what else may be going on, the needs of each resident are always met on an individual level" "It puts on a good front when important people come in, as if the home is running well"

What has improved since the last inspection?

Staff recruitment records have improved. This means that new staff are being checked before they start work in the home, to make sure they are suitable. The home has been improved by the addition of some en suite rooms and better bathing facilities.

What the care home could do better:

Up to date information must be made available which tells people about the home, the service provided and about the fees. People must be properly assessed before any decision is made about moving in, this is to make sure that individual needs can be met.Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 7Everyone must have a care plan, which states clearly what their needs are, so that staff know what they must do to make sure that people receive the care they require. Staff must be provided with training about the care planning system so they know what they are expected to record. All staff must provided with training about how to care for people with dementia. The training must be provided by a suitably qualified person. Daily records must be improved so that they provide evidence of care that is provided. All staff must be provided with moving and handling training to reduce the risk of people being injured and to ensure that people are moved safely. Meaningful, stimulating activities must be provided for people to take part in if they want to. The dining room could be made to look more inviting and the dining tables more attractive so that people have a more positive experience at mealtimes. Adult protection issues must be better managed. This is to ensure that people are safe and protected from abuse. The extractor fan in the designated smoking area must be repaired or replaced with something that is more suitable in order to prevent cigarette smoke from drifting into the lounge. The home must be kept clean at all times so that it is a pleasant place for people to live. If the existing domestic arrangements are insufficient to maintain a good standard of hygiene, then additional domestic cover must be arranged. There must be sufficient staff available at all times to meet the needs of people who live there. This is to make sure that people receive the care and support they require. New staff must be provided with induction training, which covers everything they need to know when they first start work. All staff must be provided with supervision, which covers all aspects of care practice and gives consideration to career development needs. We must be notified about any incidents that affect the well being of people living at the home so that we can monitor people`s welfare.

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 5 & 17th March 2008 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.V360695.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.V360695.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 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.V360695.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 9th July 2007 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 £347.50 and £364.00 per week; there is an additional top up of £15.00 per week for the lower fee and £ 25.00 per week for the higher fee. The higher fee is for people with dementia. People pay for their own personal toiletries, hairdressing and chiropody. A copy of the last inspection report is on display in the entrance of the home. Lee Mount Residential Home DS0000061575.V360695.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 visited the home on four occasions since the last key inspection in July 2007. We visited on 17 & 18 September 2007 to see what progress had been made in addressing the requirements we made in the report from July 2007. We found very little improvement. We visited again on 26 September 2007 because we were concerned about the management of money held on behalf of people living at the home. We talked to the appointee from the local authority (who assists people with their finances) about our concerns. We also wrote to the provider about our findings and asked him to tell us what action he was taking. We did not receive a reply to our letter. We held a meeting with the provider and the manager in November 2007 because we were concerned that there were not always enough care staff on duty to ensure that people’s needs were being met. We also said we did not think there was sufficient domestic cover to keep the home clean, tidy and hygienic. We wrote to the provider after the meeting asking him to tell us what action he would be taking. We have not received a response from the provider to the letters we sent to him. In August 2007 we received an application to increase the number of registered places from 18 to 25 and for these places to be registered for people with dementia. The registration was completed in January 2008. This inspection took place over two days. During the visit we talked to people living in the home, staff and management, observed care practice and looked at various records. On the second day I was accompanied by an “Expert by Experience” from the organisation, Help the Aged. An “Expert by Experience” is a person who, because of their shared experience of using services, is able to help us get a better picture of what it is actually like for people living in the home. The feedback she gave us has been incorporated into this report. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 6 Before the last key inspection in July 2007 we sent surveys to people who live at the home and to their relatives. We included their comments in the last report. On this occasion we sent surveys to all of the staff that work there, to ask them for their views on the service provided. Information received in this way is included in this report without identifying who has provided it. What the service does well: What has improved since the last inspection? What they could do better: Up to date information must be made available which tells people about the home, the service provided and about the fees. People must be properly assessed before any decision is made about moving in, this is to make sure that individual needs can be met. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 7 Everyone must have a care plan, which states clearly what their needs are, so that staff know what they must do to make sure that people receive the care they require. Staff must be provided with training about the care planning system so they know what they are expected to record. All staff must provided with training about how to care for people with dementia. The training must be provided by a suitably qualified person. Daily records must be improved so that they provide evidence of care that is provided. All staff must be provided with moving and handling training to reduce the risk of people being injured and to ensure that people are moved safely. Meaningful, stimulating activities must be provided for people to take part in if they want to. The dining room could be made to look more inviting and the dining tables more attractive so that people have a more positive experience at mealtimes. Adult protection issues must be better managed. This is to ensure that people are safe and protected from abuse. The extractor fan in the designated smoking area must be repaired or replaced with something that is more suitable in order to prevent cigarette smoke from drifting into the lounge. The home must be kept clean at all times so that it is a pleasant place for people to live. If the existing domestic arrangements are insufficient to maintain a good standard of hygiene, then additional domestic cover must be arranged. There must be sufficient staff available at all times to meet the needs of people who live there. This is to make sure that people receive the care and support they require. New staff must be provided with induction training, which covers everything they need to know when they first start work. All staff must be provided with supervision, which covers all aspects of care practice and gives consideration to career development needs. We must be notified about any incidents that affect the well being of people living at the home so that we can monitor people’s welfare. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 8 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.V360695.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. People using 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 does not provide accurate information about the facilities, fees and service provided to help people decide if it is suitable for them. People are not properly assessed before they move in to make sure that their needs can be fully met. EVIDENCE: There is no up to date information to give people about the home that tells them about the facilities and the service provided. The service user guide is dated April 2006, it tells people the home can accommodate 18 people and it makes no reference to accommodating people with dementia. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 11 The statement of purpose dated November 2007, is also inaccurate. This document tells people there are 25 bedrooms but goes on to say the home can only accommodate 18 people. Information about the staffing structure is also incorrect. When this was pointed out to the owner of the home, he said he was not aware that the information was incorrect. There is no written information, which tells people about the fees, and what services the fee covers. People need accurate information about the service to help them and their relatives decide if the home is suitable for them and can meet all of their needs. There is evidence that people are not being fully assessed before they move into the home, this means that their needs may not be being met. A sample of care plans was examined, these included records for two people who had been admitted in an emergency. It was not clear whether the manager had met these people before they moved in or whether the brief information about them had been obtained by telephone. In both cases pre admission details were incomplete. No personal histories had been completed and no physical assessments had been carried out. There was no medical history on one plan; the other said, “not known, does have some form of dementia”. This information was not available although they had been living at the home for over one month by the time of this visit. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People using 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 care plans do not contain enough information about people’s needs. This means that people’s health, personal and social care needs are not always being met. EVIDENCE: A sample of care plans was examined relating to people who have recently moved into the home, and others who have lived there for some time. The plans vary in the amount of detail they contain; they do not give specific instruction to staff about what they must do to meet people’s needs. This means that people may not be receiving the care and support that they require. A new care planning system was introduced recently. Staff said they have no confidence in the system and that the training they received was inadequate. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 13 The records show that there is inconsistency in the way the system is being used. Using this system, individual care needs are broken down into various elements; each element is assigned a number. For example 1 = mobility; 2 = dressing/undressing; 3=continence; 4=washing/bathing and so on. The care that each person needs should be written in detail alongside each numbered element. In the daily records, staff should record the number and details of the care they have delivered, but this is not being done. In some cases staff are only recording the numbers, they do not give any additional information. This means that there is no evidence that people are receiving the care they need. Some people don’t have a care plan even though they have lived at the home for several weeks. Despite this, staff are using the numbering system suggesting that they have delivered some form of care, but there are no details of what this has been. The only element of the plan for one person, who had lived at the home for three weeks, was about bathing. The plan was as follows: Need. Unable to operate bath. Aim. To ensure bathing needs are met. Action. Staff to fill bath and operate chair. There was no other information. The care plans are not always about individual needs, some of the information is commonsense. For example, the plan for one person instructs staff to “assist to the toilet on a regular basis, remove soiled incontinence pad and replace with a clean one” and “clean glasses when required and put them in the glasses case for safety”. The moving and handling plans are not always up to date and accurate. We witnessed unsafe moving and handling practices, which could result in injury to people living there and to the staff. One plan told us about an individual who was unable to weight bear; we saw two staff supporting her entire body weight by standing either side, using a belt around her waist and lifting her under the arms to transfer her into a wheelchair. The home has a hoist but it is still in a plastic cover, it has not been used. None of staff have been trained to use it. We talked to two of the staff on duty; they said they have not had any moving and handling training. This is not safe and could put people at risk of injury. There are several people with dementia living at the home that are unable to tell staff what they need. There are no care plans for some of these people. The staff have had very little training about dementia and they have been given no guidance about how they should support people. One person was continually asking to go home, staff made comments such as “you can go Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 14 later” “it’s cold outside” and “tomorrow”. Some staff did not answer. There was nothing in the care plan to tell staff how to respond. In the surveys we asked staff if they are given up to date information about the needs of people they care for. They told us that communication is not as good as it should be. They said they are not always told if a care plan has been changed and sometimes the information they are given at handovers is not the same as what is written in the daily records. We also asked staff if they have the right support, experience and knowledge to meet people’s needs. They told us they didn’t get much support, they felt they needed more training and they didn’t have enough time to get to know people who have recently moved in. During our visit people were treated with dignity and respect and we noted that personal care was delivered discreetly. Everyone looked clean and moderately well dressed until after lunch when we noticed two people had dinner spilt on their tops, which had gone unnoticed. Most people need assistance with washing and dressing in the mornings. Those who could communicate made remarks such as “the staff are very helpful” and “you do have to wait, sometimes quite a long time” The manager said that some people, especially those who are incontinent during the night, get bathed in the morning. We were told that everyone has at least one bath or shower a week, and some two. The majority prefer the immersion bath, but they are given a choice between bath and shower. Medication is safely stored. Records were checked and medication was signed for and administered at the correct times. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 15 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 using 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 is a lack of stimulating activity within the home and staff do not appear to have time for much meaningful interaction with people. This means that people can be left for long periods without moving about and without anyone talking to them. EVIDENCE: There is no activities organiser employed at the home. Although there is a programme of activities posted up in different areas, we did not see or hear of any activities taking place. There are no records of activities, the staff said if they have time they tend to ask people in the afternoon if they would like to do anything, some people enjoy a game of dominoes. We were shown a recently bought game of Reminiscence Bingo but there was no evidence that it had been used. Staff say they don’t have time to organise activities. One person said there is no time on any shift to organise activities because the home is understaffed. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 16 One care plan stated “involve in daily activities” and “supervise activities so she doesn’t become isolated”. Over a 10 day period the daily records for this person reported that she “sat in the lounge asleep”, there is no record of anything else happening. A CD with music was put on in the quiet lounge, but no one was there to encourage people to listen and try to move or respond in any way. On one occasion a member of staff in the middle of a task, noticed that the CD had ended and put it back on again at the beginning, she didn’t seem to have time to find any other music. This alternated with the radio tuned to a station playing music that was far from relaxing. People with dementia were left in this room alone for long periods of time. They talked to themselves mostly. One person walked round the room tracing the dado rail, then pulled it off the wall. The staff entered the room when there was a task to perform such as taking someone to the toilet or providing drinks. People who were able to, walked around the home at will, but many people just sat with no stimulation. Most people sat in the other two lounges asleep or watching TV. In one lounge, the large television set was not working, it had been substituted with a small one which very few would be able to see. These are some of the observations made by Expert by Experience: Staff told us that birthdays are not celebrated in the home, no cake, no party. It would be difficult to have a party tea, as there is not enough room to have everyone in the dining room at once. The Anglican and Methodist clergy do visit the home but no one goes out to church. There is no residents’ organisation or committee or any residents’ meetings. Admittedly at present only a few would be able to contribute, but according to staff there has not been anything for years. We did not hear of any organised “outings” but some people are taken out by family. As far as we could ascertain no local persons/groups are invited to come in to entertain people. There was no weekly/fortnightly/monthly menu available. Lunch and tea menu for the day is written on a white board in the dining room. When asked about this the manager said they are reviewing the menu as some people have different tastes and needs. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 17 The cook was on a week’s holiday when we were there, so a care assistant, came on at 10am.to do the cooking as well as a few other jobs. She had to leave the kitchen to receive and put away a fairly large grocery order, and it was she who went round the 25 people to tell them what was on the menu and note their choices. The breakfast menu described by the manager sounds good. There is a choice of cereals, grapefruit, toast and marmalade, bacon (usually in a sandwich) or a fried egg. One person said he liked to have a “bacon buttie”. Other people we spoke to just had cereals and toast. The dining room is not particularly inviting. The room has four doors and two serving hatches in it and just one small window not affording adequate daylight. The tables and chairs are sturdy, but the maximum number that can be seated at one time is eighteen, and the home now has twenty five people living there. At lunch time there has to be two sittings, one after the other. People often queue outside the dining room waiting for people from the first sitting to leave the room. This could make people feel rushed. When the tables were laid for lunch, just the bare necessities were provided - a black place mat, knife, fork, spoon, salt and pepper; no serviettes, no beakers for a drink of water or squash with their meal. Even if people had not been used to any “frills” in their own homes, the tables could be made to look more attractive with colourful table mats, colourful beakers (older people need to be encouraged to drink more water), and even a sheet of paper towel to wipe their mouth or hands. On the second day of our visit one of us had lunch. There is a choice of two main courses; the menu for the day was pork stew or mince beef bolognaise. The mince was very tasty, served with potatoes but no green vegetables. The plates the main course was served on were a little bigger than tea plates but not as big as salad plates - very small portions. The sweet was tinned fruit and custard. A beaker of tea or coffee was given with the meal; some people got their drink before the food arrived. The board showed soup or sandwiches for tea. Concerning the standard of the meals, we received such comments as “alright” or “adequate”. No one complained or enthused. The food store is in the basement, which has no natural ventilation, and the extractor fan does not work. The room was very warm for food storage. The fridge and freezers just added to the heat. Other than potatoes there was no sign of fresh fruit or vegetables. The diet does not seem to contain enough fresh fruit and vegetables, but without a menu it is difficult to comment further. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 18 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. The manager and staff need more training on their role in safeguarding people so that they can ensure that people who live there are safe and protected from abuse. EVIDENCE: The home keeps a record of all complaints they receive. The last one logged was from May 2007. The staff who returned surveys all said they know what to do if someone makes a complaint about the service, but some staff said they are not confident that complaints would be thoroughly investigated. They did not provide us with specific examples or evidence to support this. People are not being properly protected and they are at risk of harm. At the last key inspection in September 2007 we said that the staff must be provided with adult protection training so that they are aware of procedures and of their responsibility to protect people in their care. This has not yet taken place, although we saw evidence that training is arranged for April 2008. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 19 Evidence in the records shows that there have been incidents where people have hit each other. Inadequate staffing has resulted in a lack of supervision and this combined with poor care plans and poor risk assessments has placed people at risk of being hurt. We reported one incident to the Adult protection Coordinator following the inspection because the home had failed to follow the reporting procedure. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 20 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): 19,23,24,25,26. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People live in a comfortable home and they are able to personalise their own rooms. The home has been improved by the addition of some en suite rooms and better bathing facilities. EVIDENCE: These are some of the observations made by Expert by Experience: The home is developed from four terraced houses plus a recent extension. There is a small front garden the full width of the building, and shielded by a wooden fence. The brick work appears in good condition, but the approach into Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 21 the house is spoiled by a roughly painted front door with a piece of paint stained wood, covering a panel which was presumably once glass. The entrance hallway looks like a deserted office. There is no evidence of information available eg. policies, procedures, menus or anything that may be of interest to prospective residents or relatives. There are three lounges: The quiet lounge - this opens off the dining room. It has very few ornaments, the few pictures are hung behind where the people sit, so they face blank walls, and there are no curtains. The armchairs are in quite good condition, but the paintwork is shabby. The overall picture is a room sparse and gloomy, and in no way homely and welcoming. The second lounge is a bit better. It is carpeted and has curtains and does look more homely. There is a large television set, but again the painting and decorating appears sub standard in an “amateurish” sort of way. The third lounge is in the extension. This is quite a long room and is carpeted and has curtains. Unfortunately this room is next to the smoking room, so the smell of smoke was very strong. People were not complaining and no doubt could have gone elsewhere if they wanted to, but it was a very unhealthy atmosphere. The smoking room This is at the rear of the third lounge. There was ash and cigarette ends all over - a full ashtray, a waste bin and on the floor, chair and table. Although the small window was open the extractor fan does not work. It is only a very small room and the atmosphere was awful. The room looked as if it had not been cleaned for a long time. Bedrooms Most are upstairs and can be reached by a lift; which some of people are able to use on their own, or by a staircase. At the top of the staircase there is a very heavy sliding door. If it is not fully opened, it automatically closes, and could be a hazard to a frail or unsteady person. There is an awkward narrow corner in the corridor at this junction, which could be a problem for a wheelchair or person with a Zimmer frame. The seven new bedrooms are en suite having an adjoining room with toilet and washbasin. Unfortunately some of the workmanship in some of these rooms is sub standard. The older rooms are not en suite, but do have a commode. Some of these rooms are quite a distance from a toilet. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 22 In the rooms we looked at the beds were made and the linen looked clean. There was a smell of urine in one room. Some rooms contained few personal effects, so there tended to be an institutional atmosphere. Others had been personalised. In all the rooms bedside cabinets were placed about 14 to15 inches away from the bed. There is a risk that someone leaning over to reach for something could fall between the bed and the locker. There is a bedside light on the lockers in the new rooms but not in the older rooms. The only light switch is at the door. When we asked about this we were told staff turn the light out when they leave the room, this means that people have no control over the lighting. There had been no cleaner in the home for three days. The cleaner was on holiday for a week and no alternative domestic arrangements had been put in place. The state of most of the carpets confirmed this. There were bits on the carpets in the lounges, bedrooms and corridors. There was dried faeces on the toilet seat in one of the residents communal toilets. The home looked and smelled as if it needed a good clean. We asked the manager to make immediate arrangements to get a cleaner because we were concerned that people would be living in unhygienic surroundings. Bathrooms A new bath has been installed which is easy to get in and out of and people said this was an improvement. The showering facilities have been improved recently Laundry The laundry service seemed satisfactory with washing machine and driers working satisfactorily. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 23 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 this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Staffing levels are insufficient to meet people’s needs and this is having an adverse effect on their health and welfare. EVIDENCE: We looked at staff recruitment records to see if all of the required checks had been carried out on staff before they started work at the home. We found an improvement in this area, references had been obtained and CRB (criminal records bureau) and POVA checks had been carried out. The home is not adequately staffed to meet the needs of the people living there. When we visited on 5 March 2008 there were twenty three people living there; on 17 March 2008, 25 people were living there. We found that the staffing levels were the exactly the same as they had been when the home was registered for 18 people. There are three staff on duty during the day plus the manager, who works between 8:30am and 4:30pm. At night there are two staff on duty. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 24 We found examples of staffing levels dropping below this, placing people at serious risk. From looking at the rotas we found one occasion when only two staff were on duty all day, and another occasion when someone needed to be escorted to a hospital appointment, leaving only two care staff in the home. The records show that people are often up during the night and need supervision. This leaves one member of staff to respond to call bells and to make sure that everyone else in the building is safe. Some people require two members of staff to help them to move about; with only two staff available their needs may not always be met. The provider controls the budget for staffing; the manager says she has been unable to increase the number of staff on duty as the number of people living in the home has gone up. People are not receiving the care, stimulation and supervision that they require. We have already mentioned earlier in this report that people are at risk of harm; there have been incidents where people have hit each other. There are no stimulating activities for people to take part in and people are being left without supervision. In the surveys we asked if there were enough staff on duty to meet the people’s individual needs. These are some of the comments they made: “staffing levels are always a problem. “We do not have enough staff to cater for days and nights for the clients needs”, “staff are emotionally depressed, stressed and physically worn out”, “ We have not got the time to spend with residents, we can never spend time doing activities anymore”, “Staff cannot meet the needs of all service users as those with dementia need more care”, “we were promised more staff when the home got full, the home is now full and we have no extra staff, I feel very let down”. Seven people who moved in recently have dementia and of the eighteen people already living there, many are now suffering from some degree of dementia. Staff said they have had a two hour talk about the different types of dementia, but not how to care for people with dementia, which they did not find particularly informative. Three or four staff have done a distance learning course. Staff told us “since the new registration we’ve had no training about clients needs”. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 25 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 this 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. The registered person (the owner) is not making sure that the home is being run in the best interests of the people living there. People are not adequately protected or safe in the home. EVIDENCE: The manager has several years’ experience of working with older people. She has managed Lee Mount since 2002 and has completed NVQ level 4 and the Registered Managers Award. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 26 The home is not adequately staffed which means that people are being placed at risk of harm. The training, development and supervision of staff is not given sufficient priority. There is a lack of purpose and direction, staff feel let down and helpless. There is no evidence of any long term or strategic planning. We asked the staff if the induction they received when they first started work covered everything they needed to know. Most people said “partly” one person said “not at all”. One person told us “I was not shown until a couple of weeks into my employment”. The staff do not have any specialist training to work with people with dementia, which means that people are not receiving the service they need. Staff are not receiving any formal supervision and they very rarely have staff meetings. They told us they do not get the support they feel they need to carry out their work. One person said “ we continue to fight for support and we feel as though we should not need to”. When we asked the manager about this she said she had no supernumerary time to provide staff with individual supervision. Staff have not had sufficient or recent training to enable them to work safely. In the surveys staff told us they are not receiving basic training in areas such as moving and handling and health and safety. Staff on duty also told us they had not received moving and handling training. This is unsafe; it places staff and the people they care for at risk of injury. We were told that when they ask for training they are told they will have to wait until free training comes available. We are not being routinely notified about any incidents that affect the well being of people living at the home. We must be notified so that we can monitor the welfare of people living at the home. This was discussed with the manager during the visit. A sample of records was checked relating to money held on behalf of people. The cash that was held balanced with the records of the financial transactions. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 27 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 1 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X 2 2 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 1 X 1 Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 28 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 OP1 5 Standard Regulation Requirement Timescale for action 12/05/08 2 OP3 14 3. OP7 15 4 OP7 13 Copies of the service user guide/statement of purpose must be updated and made available. This will provide people with information about the home and help them make a choice about where they want to live. People must always be 25/04/08 appropriately assessed before they move into the home, to make sure that all of their needs can be fully met. Care plans must be reviewed to 12/05/08 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 people’s needs are met appropriately. (This requirement was first made on 19/7/07) Moving and handling plans must 12/05/08 be reviewed to make sure they are up to date and relevant, so that people are assisted safely DS0000061575.V360695.R01.S.doc Version 5.2 Lee Mount Residential Home Page 29 5 OP8 13 6 OP12 16 7 OP12 162)(j)(k) 8 OP18 13(6) 9 OP18 13(6) 10 OP26 13(4) 11 OP27 18 12 OP30 18(1)(c) and appropriately. Individual risk assessments must be in place to make sure individual health needs are carefully monitored and to make sure people are safe. 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. All parts of the home must be kept clean and hygienic to protect the health and welfare of people who use the service. (This requirement was first made on 29/5/07) All staff require adult protection training. This is so that they can ensure that people who live at the home are safe and protected from abuse. (This requirement was first made on 19/7/07) All allegations of abuse must be promptly followed up and fully documented. This is to make sure that people are protected and safe from harm. The extractor fan in the area used for smoking must be repaired or replaced so that smoke does not drift into the lounge where people are sitting. Staff must be available at all times in sufficient numbers to meet the assessed needs of people who live at the home. This is to make sure that the needs of each person will be met. (This requirement was first made on 19/7/07) All staff must be provided with training about caring for people with dementia, the training must DS0000061575.V360695.R01.S.doc 12/05/08 26/05/08 21/04/08 30/04/08 21/04/08 28/04/08 21/04/08 31/05/08 Lee Mount Residential Home Version 5.2 Page 30 13 OP36 18 14 OP38 19 15 OP38 13 16 OP38 37 be provided by a suitably qualified person. Staff must be provide with 31/05/08 regular supervision to ensure that their care practice is up to date. All staff must be provided with 31/05/08 moving and handling training to make sure that people are moved safely and to reduce the risk of injury. Staff must be provided with 30/04/08 induction training when they first started work covered everything they needed to know. Staff supervision. Arrangements must be in place 21/04/08 to notify us about any incidents that affect the well being of people living at the home. This is so that we can monitor the welfare of people living at the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations The mealtime arrangements need to be better managed so that people are not rushed and they can enjoy their meals. Lee Mount Residential Home DS0000061575.V360695.R01.S.doc Version 5.2 Page 31 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.V360695.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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