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Inspection on 08/06/05 for Leeming Garth

Also see our care home review for Leeming Garth for more information

This inspection was carried out on 8th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Service users said that the staff in the home are kind and helpful to them. Service users who had been admitted to the home after being in hospital said that their health had improved since coming to the home. Service users have access to adjustable beds and pressure relieving equipment for the prevention of pressure sores. The plans of care for service users are comprehensive and service users and their next of kin are involved in reviewing their plan of care. The registered manager of the home checks the plans of care on a regular basis which is good practice. Service users have access to activities and staff demonstrate that this is a priority for service users.

What has improved since the last inspection?

The corridors and communal areas of the home have been decorated and they look bright and attractive. There is an effective system in place for the supervision of staff and this is well organised. Adjustable beds have been acquired for service users nursed in bed.

What the care home could do better:

The home does not have door closures in place to ensure fire safety. Doors are kept open with wedges and on one corridor a fire door between the kitchen and laundry area was kept open with a metal rod. In the event of a fire these doors would not close. It is evident that service users and their families are being asked to purchase door guards that would ensure safety in the event of a fire. This must be made clear in the homes documentation prior to admission. It is the view of the Commission that the company has responsibility for the safety of service users who live at the home, and that service users should not be asked to purchase the fire door closures. It is the homes responsibility to ensure that safe, suitable equipment and adaptations are provided for service users should they choose to have there doors left open. Service users and their families are advised to complain to the registered manager if they are concerned about this matter. The mesh guards covering the radiators in many instances are hot to the touch and present a hazard. The radiators themselves are dirty presenting a cross infection hazard. Service users who cannot sit on the weighing scales cannot be weighed in the home. In some instances a dietitian visits and measures the circumference of service users arms but this is not appropriate for all service users. A scale attachable to the hoists in the home must be acquired. There is insufficient space in service users cupboards to store the large number of incontinence pads stacked on the floor. One service user had 280 pads on view. The registered manager has made every effort to liaise with the primary care trust to remedy this situation which is caused by the large quantities of supplies being delivered at one time.

CARE HOMES FOR OLDER PEOPLE Leeming Garth Leeming Bar Northallerton North Yorkshire DL7 9RT Lead Inspector Jan Dulieu Unannounced 8 June 2005 at 10:00 th 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 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. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Leeming Garth Address Leeming Bar Northallerton North Yorkshire DL7 9RT 01677 424014 01677 425121 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Highfield Home Properties Limited Mrs Sheila Jelley Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (53), Physical disability (2) of places Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th December 2005 Brief Description of the Service: Leeming Garth care centre provides nursing care for up to 55 service users. The home is situated in the village of Leeming Bar with close access to the A1. There are fields surrounding the home giving an attractive country setting. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the home was unannounced and was conducted by two inspectors over three hours. The deputy manager of the home, Angela Fellows was present. What the service does well: What has improved since the last inspection? The corridors and communal areas of the home have been decorated and they look bright and attractive. There is an effective system in place for the supervision of staff and this is well organised. Adjustable beds have been acquired for service users nursed in bed. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 6 What they could do better: 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. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 8 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 standard(s) 3 Service users needs are properly assessed so that their needs can be met. EVIDENCE: The service user plans of care contain a range of assessment documentation that is comprehensive and the care received by service users indicates that their needs are met. Six service users care have been case tracked and with the exception of the absence of a small number of service users not being weighed due to the lack of appropriate scales, service users needs have been properly assessed and met. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 9 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 standard(s) 7,8 and 10 Service users are well cared for with the exception some service users being unable to access weighing scales. Some service users dignity is compromised by the large number of continence products on view in their rooms. EVIDENCE: Service users plans of care are comprehensive with a full range of assessment documentation, which includes how the identified needs will be met. The plans indicate that the care service users received is fully reviewed on a monthly basis and entries into the plans are made on each shift. This indicates good practice by the qualified nursing staff. Service users have their health care needs met and the documentation details all clinical visits by health care professionals. The plans are of a good standard and staff clearly work hard to maintain this. The home does not have suitable weighing scales for service users who are unable to sit on the scales. This matter must be addressed to meet the National Minimum Standard that details that all service users must have an accurate nutrional assessment. An immediate requirement has been issued about this. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 10 Due to the number of pads stored in service users rooms there is insufficient storage for them to be kept from view. This is undignified and clearly indicates to visitors that service users have a continence problem. The deputy manager explained that the registered manager is aware of this and already making arrangements to address this issue which is primarily caused by the excessive numbers of pads delivered. The home does not have any control over this matter and is liaising with the primary care trust to identify how this situation can be overcome. One service user who is almost completely bed bound has a bolt lock on the exterior of their door. This must be removed and all doors checked to ensure that no further bolt locks are in place so that no one could be inadvertently locked in their room. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Service users have access to activities which they enjoy and their visitors are welcomed into the home. EVIDENCE: The home has an activity coordinator who organises group and individual activities. On the day of inspection service users were accessing videos, listening to music they had chosen, watching their TV or occupying themselves with puzzle books. Service users are taken into the grounds at their request. The home has a comfortable, relaxed atmosphere and service users said that they are well looked after and that ‘nothing was too much trouble for the staff’. The meal service was observed and on the day of inspection. The main course was chicken curry or cheese burgers followed by blackcurrant mousse. One service user did not like the main meal but the nurse on duty in the lounge did not offer to replace the meal with an alternative. Also this service user was placed in a reclining chair and was almost horizontal causing difficulty for both accessing the meal and eating comfortably. The deputy manager addressed the situation and explained that the service user had enjoyed their breakfast there fore may not have been very hungry. This issue should be monitored by the registered manager or the person in charge. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none EVIDENCE: These standards were not addressed at this inspection. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,24 and 26. Service users safety is compromised by the unsafe use of door wedges and inadequate radiator guards and dirty radiators. The three usable bathrooms are poorly decorated and have manual hoists. EVIDENCE: The initial impression of the home is that the main areas are well decorated and furnished. Further into the home some service users rooms require attention. One room on the ground floor has a dirty carpet smelling of urine. A replacement carpet or other suitable floor covering is required. On the first floor two rooms require redecoration where the paint has lifted. Throughout the home doors are wedged open and these doors would not close in the event of a fire. Door closures must be provided by the home on a risk assessment basis to ensure service users safety. The home is clean with the exception of the radiators with mesh guards. Many of these are quite dirty and the guards are not protecting service users safety because they are hot to the touch. A programme of replacement must start on a risk assessment basis to protect service users. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 14 Immediate requirement notices have been issued regarding these matters. The three bathrooms available for service users are poorly decorated. The bathroom on the first floor is in an unacceptable condition with very old lino that is lifting in places, poor décor and an locked cupboard contained shared disposable razors and cotton buds. It must be noted that all service user do have their own toiletries apart from these. The responsible individual has been required to increase the number of assisted bath/shower rooms on previous inspections but has not done so. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards have not been inspected on this occasion. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36and 38 Service users benefit from well organised and managed nursing care but their environmental safety is compromised . EVIDENCE: The registered manager has organised an effective system for the supervision of staff with an appropriate system of delegation. It was evident that this is taking place but it is recommended that these records or a copy are kept within the home. The issues regarding service user safety have been reported within the section on the environmental standards. Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 x 1 x x 3 x 1 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 2 x 1 Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 18 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 17 Sch.3 Requirement The responsible individual must ensure that all service users have access to appropraite weighing scales. The responsible individual must ensure that bolt locks on one service users door is removed and all service user room dooors checked to ensure that they do not have external bolt locks. The responsible individual must ensure that door closures are fitted in place of door wedges so that alldoors in th ehome close properly in th event of a fire. The responsible individual must redecorate the three assisted bathrooms and the manual hoists must be replaced with electronic hoists Sufficient assisted bathrooms must be provided to meet the National Minimum Standard of one assisted bathroom for eight service users. This is an outstanding requirement The responsible individual must put a plan in place to replace the mesh radiator covers ;the radiators must be kept clean. Timescale for action 1/7/05 2. 10 13(6) Immediate 3. 19 23(4) 1/7/05 4. 21 23(2) 1/4/05 5. 26 13(4) 1/7/05 Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 19 6. 7. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 10 15 Good Practice Recommendations The responsible individual should make appropriate arrangements for storing service users incontinence supplies so that their dignity is not compromised. The responsible individual should monitor the meal service to service users to ensure that they receive appropriate assistance at all times and consultation about their meal preferences. The responsible individual should ensure that supervision records are held within the home. 3. 4. 5. 36 Leeming Garth J53_J04_S28033_Leeming Garth_V229735_080605_stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Unit 4 Triune Court Monks Cross York YO32 9GZ 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. 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