CARE HOMES FOR OLDER PEOPLE
Legh House 117 Rylands Lane Wyke Regis Weymouth DT4 9QB Lead Inspector
Mike Dixon Unannounced 19 April 2005 10:45 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. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Legh House Address 117 Rylands Lane, Wyke Regis, Weymouth, Dorset, DT4 9QB 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) 01305 773663 annburt@btconnet.com The Abbeyfield (Weymouth) Society Ltd Mrs Ann Burt CRH 17 Category(ies) of OP - 17 registration, with number of places Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Seventeen (17) in Fifteen (15) single rooms and a suite of two rooms registered as one double. Date of last inspection 15 November 2004 Brief Description of the Service: Legh House is registered to provide care and accommodation for a maximum of 17 people age sixty five and over. The registration is for old age, not falling within any other category. Legh House is a single storey building built into a hill, overlooking Portland harbour. It is situated close to several amenities, including shops, post office, church, GP surgeries and schools. It belongs to the Abbeyfield Society, a registered charity and has been established for many years. The home has a House Committee, however the Executive Committee holds overall responsibility for the management of Abbeyfield (Weymouth) Society. Mrs Ann Burt is the registered manager of the home. There are 15 single rooms with level access. One self-contained care suite, which may be used by two people choosing to share is accessible by two steps. There is a spacious dining/sitting room leading through to a conservatory. There are scenic views of Portland Harbour from the dining room. There is ramp access from both the conservatory and hallway to a patio area but no wheelchair access down to the gardens. The gardens are accessed by steps. A hairdresser visits the home regularly and there is a weekly trolley service enabling service users to make small purchases. Activities are arranged by the care staff. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out in order to review the home’s progress with addressing the requirements and recommendations from the previous inspection report. The inspection took 6.5 hours and during this time the inspector spoke with five service users, a visitor, the manager and four staff members. The inspector visited all communal areas and a sample of bedrooms, he looked at a variety of records and related documentation. What the service does well: What has improved since the last inspection?
The home has implemented six of the eighteen requirements and three of the four recommendations from the previous inspection report. The amendments to the service user guide have made it a more accurate and comprehensive document. The home has included details of service users’ wishes with regard to funeral/burial arrangements on the care record, ensuring that staff have access to the information, should the need arise. There has been progress with the staff training programme; sessions covering manual handling, the safe fitting of bed rails and fire safety have taken place. The home has completed work on upgrading fire precautions. The complaints procedure has been expanded so that it provides a clearer explanation to service users and/or their representative. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 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 Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 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) 1,3, 4 and 5 The home has compiled a comprehensive service user guide which enables prospective service users to make an informed decision about going to live at the home. The home ensures that it only admits service users whose care needs it can meet by carrying out a thorough pre-admission assessment. EVIDENCE: Each prospective service user is provided with a service user guide (known as the resident’s handbook) which includes the statement of purpose. The document has recently been updated to comply with National Minimum Standards and will shortly be issued to all service users and/or their representative. The home carries out a pre-admission assessment on prospective service users, the outcome of which is recorded. Service users are invited to spend time at the home before making the decision to move in. A formal trial period does not take place, although service users’ needs are kept under review. The inspector spoke with a recently admitted service user who was happy with the arrangements that had been made on her behalf. The home has the capacity to meet the care needs of all the service users who are accommodated. The inspector was able to evidence this point through
Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 9 looking at the equipment and resources that are at the staff’s disposal, through discussion with the manager, staff members and service users and through looking at examples of service users’ care records. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 9 and 11 Care plans are not consistently updated so they do not always provide staff with accurate information about service users’ needs. The home liaises effectively with the primary health care team and ensures that service users’ health care needs are met. The arrangements for the storage and recording of administration of medication are in need of minor adjustment in order to fully comply with professional guidance and provide better protection for service users. EVIDENCE: Each service user has a care plan which is based on an assessment of his/her needs. The care plans are generally comprehensive but they are not yet consistently updated to reflect the current circumstances of each service user. The risk assessments for the fitting of bed rails are not sufficiently comprehensive to demonstrate that all relevant factors have been taken into account. In discussion with the inspector, service users stated that the staff did take note of their wishes in relation to the provision of care and there was evidence in the documentation that service users were involved in the review of their
Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 11 care needs. Service users commented that staff had a good understanding of their care needs and that they had confidence in the staff’s ability to respond to any changes in their situation. One service user stated that she was “very happy here”, a view that reflected other comments from service users. The arrangements in place at the home ensure that each service user receives the health care input that he/she requires from the primary health care team. This was evident from discussion with the manager, staff members, service users and a relative and from looking at the care records of three service users. Care staff receive training on the topic of medication administration and the home has a policy and procedure to guide them. The manager informed the inspector that service users had the option to look after their own medication, although no one currently did so. Service users confirmed that they received their medication regularly and that they were satisfied with the arrangements in place. The system for the recording of the administration of controlled drugs did not comply entirely with recommended practice. The inspector also recommended that the arrangements for the storing of topical creams in bedrooms be reviewed in order to provide better protection for service users. The inspector spoke with the relative of a service user who had recently died at the home. The relative was very complimentary about the manner in which the staff had looked after the service user prior to her death. The manager and staff displayed a sensitive and helpful approach towards the relative who had returned to the home to remove the deceased service user’s effects. The home makes a record of service users’ known wishes with regard to funeral/burial arrangements. The manager is currently drawing up a policy with regard to resuscitation, as required in the previous inspection report. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 12 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) EVIDENCE: Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 13 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) 16 and 18 The complaints procedure is robust, ensuring that service users’ concerns are dealt with effectively. The measures in place for responding to allegations of abuse are mainly satisfactory, but do not entirely comply with guidance and therefore do not provide service users with full protection. EVIDENCE: The home’s complaints procedure is contained in the residents’ handbook (service user guide) and it contains relevant information. Service users with whom the inspector spoke indicated that they would know how to raise any concerns that they might have. The chairman of the Committee is a regular visitor to the home and she speaks with service users on an individual basis, providing another means by which service users can raise issues. The manager reported that no complaints had been drawn to her attention; there is a register for the logging of complaints. The home has an adult protection and “whistleblowing” policy/procedure and a copy of the Dorset County Council “No Secrets” guidance. The adult protection procedure is in need of amendment to include reference to Social Care and Health, the lead agency for the investigation of allegations of abuse. Staff members with whom the inspector spoke demonstrated awareness of adult protection issues. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 14 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 and 26 The design and layout of the home is suited to the needs of older persons in most respects, offering a spacious and comfortable environment for service users. The home meets the requirements of the fire safety and environmental health officers in respect of fire precautions and food hygiene, thereby ensuring the welfare of service users. The home is clean and free of unpleasant odours, providing a safe and pleasant environment. EVIDENCE: The home is maintained in a good condition. With the exception of one of the bathrooms and the position of the sluice, the design and lay-out of the home is suited to the needs of older persons. The registered persons are taking steps to replace one of the baths with a “walk-in” shower and to relocate the sluice so that it no longer occupies one of the WCs. The greater part of the accommodation and surrounding grounds is on level ground (or accessed via a ramp). There is a well-maintained garden to the rear of the property. Bedrooms and communal areas are spacious and receive plenty of natural light. In discussion with the inspector the service users commented favourably on the facilities and one spent a good part of the afternoon enjoying the
Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 15 sunshine on the patio. Staff members were observed encouraging and assisting service users to make use of communal facilities. The premises were clean and free from unpleasant odours. Service users confirmed that their rooms were regularly cleaned and that the arrangements both for cleaning and laundry were in accordance with their wishes. The laundry room was in a well-ordered condition and the machinery in use meets disinfection standards. Staff put into practice infection control procedures and have the necessary protective gear to assist them. The home received a gold award following the most recent visit from the Environmental Health Officer with regard to the kitchen and food hygiene provision. The home meets the requirements of fire officer; regular checks and measures are in place to promote fire safety. Staff confirmed to the inspector that they received fire instruction on a regular basis. The manager keeps the necessary records to evidence the action taken in this regard. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 16 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) 27,28 and 30 The stable and well-motivated staff group ensure that all duties at the home are carried out efficiently. The staff training programme is a comprehensive one; it has yet to be completed and therefore at present does not provide full protection for service users. EVIDENCE: Several of the staff members at Legh House have been in post for a number of years. In discussion with the inspector, staff members commented that they and their colleagues worked well as a team. From their comments to the inspector it was evident that they had a good understanding of the service users’ care needs and that they were committed to providing a quality service. The home does not make use of agency staff. The staffing levels and arrangements at the home are such that all the necessary tasks, including care, domestic, catering and administrative duties can be performed during the course of the day. Some staff members were attending a full day’s training at the home on manual handling on the day of the inspection. The home is nearing completion of a training programme which includes basic health and safety topics such as food hygiene, infection control and first aid. An induction and foundation training programme for newly appointed staff members is underway. Nearly 50 of the care staff group have achieved NVQ level 2 or 3. The service users with whom the inspector spoke expressed their confidence in the ability, skill and knowledge of the staff. Through observation during the
Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 17 course of the visit the staff demonstrated their competence in the carrying out of their caring duties. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 18 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) 31,32, 33 and 36 The experienced manager enjoys the confidence of service users and staff members alike. The inclusive management style enables service users and staff members to contribute to the running of the home. The lack of a formal quality assurance system limits the extent to which the home is able to demonstrate that it meets the expectations of service users and achieves its stated aims and objectives. EVIDENCE: Mrs Burt, registered manager, has several years experience of managing a care home. She is supported in her role by the chairman and other members of the Legh House Committee, representing the Abbeyfield (Weymouth) Society. Mrs Burt is undertaking the registered manager’s award (NVQ level 4); she undertakes periodic training to ensure that she keeps abreast of care practice and management issues. She retains copies of her training certificates at the home.
Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 19 The manager runs the home in an “inclusive” manner which enables both the staff and service users to make a contribution. She adopts an “open door” policy and holds regular staff meetings where there is the opportunity to exchange ideas and to review the care needs of service users. The home has yet to implement a formal quality assurance system, including the use of questionnaires for service users and their representatives. As a result, the management is not able to demonstrate that it comprehensively reviews the home’s provision of services, reflecting aims and outcomes for service users. The manager has made a start with formal staff supervision, including keeping a record of the outcome of one-to-one sessions with individual staff members, reviewing their progress and personal development. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 2 x x 2 x x Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 21 Yes 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 1 Regulation 5(2) Requirement The registered person must supply each service user and/or their representative with a copy of the recently updated service user guide (residents handbook). The registered person must ensure that care plans are more comprehensive in identifying needs and evidencing how identified needs will be met (earlier timescales of 1/9/04 and 30/12/04 not met). The registered person must ensure that risk assessments contain sufficient information, including the risk identified, the range of options/actions to be considered, the rationale for the decision and who was involved in the decision making process (timescale of 30/12/04 not met). The registered person must provide a copy of the homes resuscitation policy prior to implementation (timescale of 30/12/04 not met). the registered person must implement a programme of upgrading/replacing the chairs in the main lounge/dining-room Timescale for action 31/5/05 2. 7 15 30/6/05 3. 7 13(4) 30/6/05 4. 11 12 31/5/05 5. 20 16(1) 31/7/05 Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 22 6. 26 23(2) 7. 33 24 8. 36 18(2) 9. 38 13, 18(1) and include items which have cushioned armrests (timescale of 28/2/05 not met). The registered person must complete the necessary works to separate the service user WC sluice facility. The registered person must now implement a review of the quality of care (quality assurance) and produce an annual development plan for the home. The registered person must ensure that care staff receive regular supervision (earlier timescales of 1/9/04 and 30/12/04 not met). The registered person must make arangements to ensure all staff are trained is safe working practices, including first aid, food hygiene and infection control (earlier timescales of 1/9/04 and 28/2/05 not met). This requirement has been amended to reflect the current situation. 30/9/05 31/7/05 30/6/05 30/6/05 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 5 Good Practice Recommendations The registered person should make provision for a formal trial period to take place following a service users admission to the home, by inserting a clause to that effect in the license agreement. The registered person should ask each service user and/or his/her representaive to sign the care plan as evidence of consultation. Where it has not been possible to achieve this, a note to that effect should be made on the record. The registered person should conduct and record a risk assessment in relation to the storage of topical creams in bedrooms. The risk assessment should be kept under
D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 23 2. 7 3. 9 Legh House 4. 9 5. 18 review, reflecting the changing circumstances of service users. The registered person should record the administration of controlled medication in accordance with the guidance from the Royal Pharmaceutical Society: a record of the running balance of tablets should be maintained following the administrtion of each dose. The registered person should amend the adult protection policy/procedure by referring the reader to Social Care and Health for advice prior to the commencement of any investigation and making specific reference to No Secrets guidance. Legh House D55_26835_Legh House_V220730_190405 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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