CARE HOMES FOR OLDER PEOPLE
Legh House 117 Rylands Lane Wyke Regis Weymouth Dorset DT4 9QB Lead Inspector
Mike Dixon Unannounced Inspection 19th December 2005 12:30 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 Legh House DS0000026835.V274041.R01.S.doc Version 5.1 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. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Legh House Address 117 Rylands Lane Wyke Regis Weymouth Dorset DT4 9QB 01305 773663 NO FAX annburttconnect.com 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) The Abbeyfield (Weymouth) Society Limited Mrs Ann Burt Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Seventeen (17) in Fifteen (15) single rooms and a suite of two rooms registered as one double. 19th April 2005 Date of last inspection 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 DS0000026835.V274041.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted as part of the Commission’s regulatory duty to inspect all care homes twice a year. The main purpose was to review the home’s progress in implementing the requirements and recommendations from the previous inspection report. The purpose was also to assess the home’s compliance with the remaining key national minimum standards for older persons that had not been considered during the previous inspection visit. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 19/4/05. Prior to the inspection, the home gave comment cards on behalf of the Commission to a variety of people who have a connection with the home. Responses were received by the Commission, as follows: thirteen from service users, seven from relatives, four from healthcare professionals and two from social care professionals. During the visit which lasted six hours the inspector spoke with seven service users, two visitors, the manager, the chairman of the House Committee and six staff members; he looked round the accommodation and inspected records relating to service users’ care, staffing, health and safety and other documentation relating to the running of the home. What the service does well:
Care plans are quite comprehensive and contain some useful information to guide staff. Service users receive a good standard of care and for the most part their privacy and dignity is respected. Service users are encouraged to make choices and retain their independence as much as feasible. Service users and their relatives say that the staff are kind and helpful. Many positive views were expressed through comment cards about the home and the staff by service users and other people who have an interest in the home. For example: • • • • Couldn’t be more comfortable or happy here Having excellent care and company, couldn’t be better Excellent care and food I am very pleased with the excellent care that has been given to my relative. A very friendly welcome is made to all and facilities are spotlessly clean. The service users are content with the programme of activities and the home makes provision for the meeting of service users’ spiritual needs. Service users enjoy their meals and the home provides a varied and nutritious diet. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 6 Meals are served in pleasant surroundings. The home is kept clean and free from unpleasant odours. What has improved since the last inspection? What they could do better:
Ten requirements and seven recommendations have been made following this inspection visit, including those carried forward from the previous inspection report. The home must improve the manner in which risk assessments that relate to service users’ care are conducted and recorded. There must be written evidence that service users and/or their representative have been consulted regarding the content of the care plan. Staff should conduct and record a risk assessment where topical creams are kept in bedrooms. Staff should be reminded to ensure that bedroom doors are closed when they carry out personal care tasks with service users. The registered person must carry out the necessary works to separate the service user WC and sluice facility. The management must make major improvements to the home’s staff recruitment procedures, including obtaining a full previous employment history
Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 7 and two references and conducting a police/POVA check via the Criminal Records Bureau prior to the person in question commencing work at the home. The registered persons should make a record of the outcome of the interview of prospective new staff members person and should provide an index for the staff recruitment files and a checklist of items that need to be included in the recruitment procedure in order to assist with the better management of recruitment. The registered person must ensure that care staff receive regular supervision in order to monitor their progress and assist with their professional development. The home must continue to implement a staff training programme in all relevant health and safety topics, including manual handling, first aid, infection control and food hygiene. The registered persons should broaden the scope of the quality assurance survey by including relatives/friends of service users and visiting professionals. They should also produce an annual development plan which takes account of aims and outcomes for service users. The registered persons should review the home’s policies and procedures on an annual basis to ensure that they remain relevant. Fire doors must not be held open by unapproved means as this compromises fire safety in the home. Consideration should be given to the security of the premises, including the possible need to keep external doors locked. 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.
Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Legh House DS0000026835.V274041.R01.S.doc Version 5.1 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 the following standard(s): 7 and 10 Care plans are comprehensive but risk assessments are in need of improvement in order to provide better protection for service users. In most respects the staff promote the privacy, dignity and independence of service users. EVIDENCE: Each service user has a care plan which contains some detailed information and is updated as circumstances change. Care plans are not routinely signed by service users and/or their representatives and therefore there is little recorded evidence of consultation with them about the care that is provided. One area of weakness identified by the inspector concerned risk assessment. With regard to one service user where there were concerns about falling and incidents of aggression towards staff, there were no risk assessments in place reflecting the situation, including specific guidance to staff about how to approach the matters in question. In discussion with the inspector, service users confirmed that they were well looked after, that staff respected their dignity and privacy and that they were
Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 11 able to make choices about how they spent their day. The service users looked well cared for and were dressed in well laundered clothes. Staff were observed interacting with service users in a helpful and friendly manner. There was one less favourable incident which was witnessed by the inspector: a care assistant shaved a service user with the bedroom door wide open in full view of passers by. The inspector received confirmation from the manager that this was not the usual practice. Views expressed by service users, relatives and external professionals through comment cards gave a very positive picture of the standard of care provided at the home. The following comments reflect such views: • • • Couldn’t be more comfortable or happy here Having excellent care and company, couldn’t be better I am very pleased with the excellent care that has been given to my relative. A very friendly welcome is made to all and facilities are spotlessly clean. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 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 the following standard(s): 12 and 15 The home serves nutritious and well cooked meals which meet the expectations and dietary needs of service users. The home provides an environment in which service users’ recreational and religious needs can be met. EVIDENCE: The home has an informal activities programme which includes the following: a scrabble session twice a week, periodic entertainment and bingo sessions. Two volunteers from a local church visit to join service users with one of the scrabble sessions. From talking with service users during the course of the inspection it was evident that they were happy with the programme and they had particularly enjoyed a recent in-house pantomime performed by visiting artists. This is a home where service users pursue their own interests, where feasible, and where contact is maintained with the local community. The manager informed the inspector that she was looking at the possibility of arranging outings for the following year. Facilities are in place to enable service users to fulfil their spiritual/religious needs: there is a weekly communion service, a separate monthly service on a Sunday and a monthly prayer group meeting.
Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 13 The standard of catering at the home is very good. Each month one of the chefs has a planning meeting regarding the content of the menu; service users are asked informally for their views on such occasions. The menu demonstrates that a well-balanced diet is offered. Full account is taken of the dietary needs and likes and dislikes of service users. A note of any dietary requirements is recorded in service users’ care plans. There is a choice of dishes and items at every meal time. Currently, there is one vegetarian service user who is supplied with meals that suits her requirements. Meals are served in a light and pleasant dining room, where new furniture has recently been supplied. Service users may choose to take their meals in their bedroom and most do so at breakfast time. Meals, snacks and hot drinks are provided at regular intervals throughout the day. Service users told the inspector that the quality of the food was very good or excellent. Food stocks were plentiful and all areas of the kitchen and food storage areas were in a very clean condition. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were considered during the inspection. EVIDENCE: Legh House DS0000026835.V274041.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 Substantial shortfalls with the home’s recruitment procedures put service users at risk. EVIDENCE: There are several shortfalls with the home’s recruitment procedures and action to address these matters was required of the home immediately after the inspection. The home has not consistently obtained a full previous employment history, obtained two references, made a record of the outcome of the interview or conducted a police/POVA check via the Criminal Records Bureau prior to the person in question commencing work at the home. In one case, where it was discovered that an appointed staff member had previous convictions there was no recorded evidence that the matter had been discussed and considered by the management of the home. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 and 38 The management has made progress with implementing a quality assurance system by conducting a survey of service users’ views which indicates a high level of satisfaction with the home. The home has the necessary arrangements in place to safeguard service users’ financial interests. Service users’ welfare is not fully protected as a consequence of shortfalls with some aspects of the management of health and safety. EVIDENCE: The registered persons have made some progress towards developing a quality assurance system. Questionnaires were distributed to service users in June 2005 and seventeen were returned; the results have been analysed and indicate a very high level of satisfaction with the provision of services. The inspector recommended that the survey be broadened to include relatives and other people who have contact with the home, including visiting professionals.
Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 18 An annual development plan has yet to be produced for the home. The home’s policies and procedures for the most part have not been reviewed since November 2003. All service users have a representative to assist them with the management of financial affairs, either a family member or solicitor. Some service users retain their own monies and a lockable facility is provided for the purpose. The home assists some service users by keeping personal allowances in a secure place on their behalf. Records of transactions are maintained and receipts are retained. There is a policy to guide staff on the topic of service users’ finances and valuables. The home has a number of measures in place to assist with the promotion of health and safety. Staff training on such topics as manual handling, first aid, infection control and health and safety is under way. There are policies/procedures covering a range of topics, including infection control and reporting of accidents. Risk assessments are conducted in relation to the building and environment which make reference to relevant legislation. There are some shortfalls with the health and safety arrangements. As indicated under Standard 7, the current risk assessment procedures in relation to care practice are in need of improvement. The continued location of the sluice with accompanying disinfectant products in a WC for service users is unsuitable. During the inspection the inspector noted that an external door which faces the front of the building and leads through a corridor into the kitchen was unlocked, potentially compromising security, and one fire door in the same area was held open by unapproved means. Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 19 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x X X X X X X X x STAFFING Standard No Score 27 X 28 X 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X x 2 x 3 x x 1 Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 13(4) Requirement 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 (previous timescales not met, most recently 30/6/05). There must be written evidence that service users and/or their representative have been consulted regarding the content of the care plan. Where it has not been possible to achieve such consultation a note to that effect should be made on the record. The registered person must complete the necessary works to separate the service user WC and sluice facility (previous timescale of 30/9/05 not met). Newly appointed staff must not commence work at the home without the receipt of two satisfactory references, completion of a POVA first check
DS0000026835.V274041.R01.S.doc Timescale for action 28/02/06 2. OP7 15(2) 31/03/06 3. OP26 23(2) 30/04/06 4. OP29 19(1)(5) 20/12/05 Legh House Version 5.1 Page 21 5. 6. OP29 OP29 19(1)(5) 19(1)(5) 7. OP29 19(1)(5) 8. OP36 18(2) 9. OP38 13, 18(1) 10. OP38 23(4) via the CRB and the implementation of suitable supervisory arrangements. Two references must be obtained for the recently appointed staff member. A full previous employment history must be obtained for each prospective new staff member, with an explanation for any gaps. Where a prospective staff member has a record of criminal convictions the registered persons must demonstrate that they have given due consideration to the matter prior to making an appointment. The registered person must ensure that care staff receive regular supervision (previous timescales not met, most recently 30/6/05). The registered person must make arrangements to ensure all staff are trained is safe working practices, including first aid, food hygiene and infection control. This requirement has been mainly met (previous timescales not met, most recently 30/6/05). Fire doors must not be held open by unapproved means. 31/12/05 15/01/06 15/01/06 31/03/06 30/06/05 15/01/06 Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The 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 review, reflecting the changing circumstances of service users. This recommendation is made for a second time. Staff should be reminded to ensure that bedroom doors are closed when they carry out personal care tasks with service users. The registered persons should make a record of the outcome of the interview of prospective new staff members to demonstrate that they have satisfied themselves as to the suitability of the person concerned. The registered persons should provide an index for the staff recruitment files and a checklist of items that need to be included in the recruitment procedure in order to assist with the better management of recruitment. The registered persons should broaden the scope of the quality assurance survey by including relatives/friends of service users and visiting professionals. The registered persons should produce an annual development plan which takes account of aims and outcomes for service users. The registered persons should review the home’s policies and procedures on an annual basis to ensure that they remain relevant. The registered persons should conduct a risk assessment with regard to the security of the premises with particular reference to the situation of external doors. 2. 3. OP10 OP29 4. OP29 5. OP33 6. 7. OP33 OP38 Legh House DS0000026835.V274041.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Poole Office 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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