CARE HOMES FOR OLDER PEOPLE
Legh House 117 Rylands Lane Wyke Regis Weymouth Dorset DT4 9QB Lead Inspector
Trevor Julian Unannounced Inspection 09:10 2nd June 2006 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.V298261.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. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 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.V298261.R01.S.doc Version 5.2 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 December 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. The suite has its own bathroom with conventional bath. The remaining bathroom facilities are communal, comprising of an assisted bath and wc, a walk-in bath and wc, a conventional bath and wc and a separate wc. The sluice room contains another wc. 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. The care staff arranges activities. At the time of the inspection the fees were set at £385 per week. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 2nd June 2006 between 09:10 and 15:35 the total time taken was 21 hours; this included inspection planning, travel and writing up the report. The purpose of the visit was to follow up on requirements and recommendations made during previous inspections and to monitor compliance with the key standards. Comment cards were received from residents, visitors and healthcare professionals before the visit. All showed high levels of satisfaction with the service offered by the home. During the visit discussion took place with 12 residents some individually and others in a group debate following their lunch. Three visitors in the home also gave their views. Further information was gathered through a tour of the premises, examination of records and other documentation. There were no vacancies. There were 3 males and 14 female residents aged between 85 and 95 years old. What the service does well:
The visitors and residents were full of praise for the standard of care provided in the home. All said they were confident that they could raise any issues with the staff. One comment card reported that the manager and staff had all taken time to visit their relative in hospital after a recent admission when the family were away. People described the home as homely and friendly and this was the impression formed on the day of the visit. The home carries out a thorough pre admission assessment to ensure that the needs of the individual can be met at the home. The home has good links with the community health services helping to ensure that the healthcare needs are well managed. Medication was appropriately managed and stored. The home organises activities for the residents, one the day of the visit there was an impromptu “singalong” accompanied by a resident on the home’s piano. The home has links with the local Anglican and RC church who visit the home regularly. The food served during the visit was wholesome and appetising. Records showed that residents were offered good levels of choice of food. Fresh fruit
Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 6 was described as plentiful. The cook managed the diet of three people with tablet - controlled diabetes. Visitors said they were made welcome into the home and offered refreshments. The home offers a good standard of accommodation. Most areas are level access with only one area requiring access via a small flight of stairs. The home benefits from a stable workforce and there was no need for agency cover. What has improved since the last inspection? What they could do better:
The work to improve the bathroom facilities needs to be completed to improve the toilet arrangements and to provide a separate sluicing room. Staff recruitment procedures remain a major concern with a new member of staff starting work without current checks in place. Records showed that staff supervision was not routinely carried out. Staff supervision needs to be carried out six times a year in order to ensure that staff remain competent and have the required training to meet the needs of the residents. The quality assurance system needs to include feedback from healthcare professionals. The results of the survey should then be used to develop the home’s business plan.
Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 7 The Abbeyfield Society carried out regular visits to the home and the reports of the visits were forwarded to the Commission. However, due to a misunderstanding the reports have not been provided in recent months. 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.V298261.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s pre-admission assessments ensures that placements are only offered once the identified care needs can be met. EVIDENCE: The files of two new residents showed they had both spent a day in the home before being offered a place. The resident’s representative had signed the assessment. Three of the residents and a visitor confirmed that the pre-admission process had been used to ensure that the home was suitable. One person confirmed that the initial period in the home was a trial period. Many people had lived locally and knew the home prior to moving in having visited friends and relatives previously. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 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, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manages the care need of the residents seeking appropriate community healthcare support for medical needs. This promotes their wellbeing and independence. Residents were treated with dignity and their privacy was respected to ensure that they felt valued. EVIDENCE: A review of three files showed information about care needs recorded. There was evidence of reviews and monthly weight checks. The files contained signatures of the resident or their representative showing their agreement to the proposed care plan. The home uses a key worker system and there was evidence on file that the key worker is changed if there is a benefit to the individual. One of the care plan seen would have benefited from greater detail about how the assessed needs were to being met.
Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 11 The files showed most people had two baths a week. In discussion with the residents it was pointed out that they could request a bath at any time. Daily records showed health and social information. During the visit a physiotherapist was visiting the home. She said she had a good relationship with the staff and her advice was followed. On the comment cards another healthcare professional took the time to say that residents often comment how happy they are at the home and added that the accommodation was always clean and comfortable. In a group discussion with the residents they said that the staff were always polite and knocked on their doors before entering. This was also seen during the visit. Two residents were seen in the garden one said she had seen the care and attention given to two people who had become frailer and died earlier in the year. She felt the care and attention given to them was exceptional and gave her confidence that the home was the right place for her. Medication was briefly checked. During the visit no topical creams were seen left unattended. The home had a central stock cupboard for medication and separate lockable cupboard in the residents’ own room. The medication records were up to date. Medication was not over stocked and was safely stored. The home is subject to regular independent medication audits. Several residents commented that the senior staff who looked after their medication were very thorough. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 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, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to maintain social interests and community links to help maintain their independence and self esteem. Good quality and well-presented food provided in the home encourage residents to maintain a nutritious and wholesome diet. EVIDENCE: During the visit the residents enjoyed an impromptu “singalong” accompanied by one of the residents. During the afternoon two visitors were in the home for a regular scrabble match with their friend. Several people said they managed to go out independently. The home organises regular church services in the home and communion is available, a weekly mothers union is held in the home on Tuesdays. In the communal area there were a selection of books some supplied by a visiting library service; there was a variety of typefaces. The care plans showed the residents’ histories and their pastimes.
Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 13 Residents said the home provided a contented lifestyle with support and encouragement offered if requested. Many of the residents said they enjoyed the secluded garden as it provided a safe haven. They added that the home did not run to a timetable and there were good levels of flexibility in the daily routines. They were encouraged to invite friends and family into their home and they were always made welcome with refreshments offered. The residents were offered a choice of meals and fresh fruit was distributed during the week. Residents described the food as good and appetising. On the day of the visit lunch was well presented all residents came to the dining area. They said they had meals in their rooms if required and several always had breakfast in their own rooms and it was served at their own preferred times. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 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): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has complaints and adult protection procedures in order to help keep the residents safe. EVIDENCE: The Commission had received no complaints or allegations. Information was available to residents and visitors about how to raise concerns. The home had a complaint’s policy. Staff said they covered adult protection during induction training and discussed at staff meetings. They were aware of their responsibilities. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 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): 19, 21 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable environment for the resident. However, planned improvements will enhance the communal bathroom facilities. Faulty equipment reduces the effectiveness of infection control procedures and could place the residents and staff at risk. EVIDENCE: The home was purpose built and provides a comfortable environment. The home is set on one level; only the twin-roomed suite is accessed by steps. The building was well maintained. All areas were clean and odour free. Work was planned to alter the communal toilet arrangements. The sluice, which was not working at the time of the visit, also housed a toilet was due to be altered to provide a more suitable facility. The work had been planned for
Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 16 some time and a start date was still awaited. It has subsequently been reported that the building work started on the 14th June 2006. The home was clean; however, with the sluice not working there were difficulties in maintaining effective infection control. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate for the needs of the residents. The training programme gives the staff suitable skills to ensure that care needs are met. The home’s recruitment procedure is poor and could place the residents at risk. EVIDENCE: The staffing rosters showed three carers on duty between 08:00 – 20:00 reducing to 2 wakeful carers overnight. The care staff are supported be two cleaners, a cook and the manager. Residents and visitors said the home was well staffed and any alarm calls were promptly responded to. Staff described the training programme as very good and accessible to them. A check of two staff files showed core training was up to date. The home had access to NVQ level 2 training and a new recruit had already started work on the award. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 18 The home benefits from having a stable workforce with many of the staff working in the home for several years this helps provide good continuity of care without the need for agency staff to cover shifts. However the file of the newest member of staff, recruited since the last inspection, still showed the home was not following procedures, having started the applicant before obtaining a current check of the Protection of Vulnerable Adults (POVA) list. This is a serious matter which has been reported on during previous inspections, the practice could have serious implications for the safety of the residents. Failure to follow appropriate recruitment procedures will result in enforcement action; it will also have a negative effect on the star rating system being introduced from April 2007. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 quality assurance system fails to seek the views of all stakeholder groups thereby 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. The home generally provided a safe environment for the residents and staff however some issues should be addressed in order to fully meet the standards. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Burt, registered manager, has several years experience of managing a care home. The chairman and other members of the Legh House Committee, representing the Abbeyfield (Weymouth) Society, support her in her role. Mrs Burt had recently achieved 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. 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 a quality assurance system, including the use of questionnaires for service users and their representatives. This needs to be developed to include feedback from other stakeholders including healthcare professionals and staff. The next survey was due to be carried out shortly. The results of the survey need to be used in the business development plan for the service. Most residents manage their own finances some with help from family and friends. A small number of people deposit personal allowances with the home for incidental expenditure. The manager says transaction records and receipts were kept for income and expenditure. These were not checked during this visit. The home must re start 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. Fire safety and training records were up to date. Night staff were trained every three months day staff six monthly. An accident book was in place and the records held properly. However, it was noted that while the reports had serial numbers the accident report book stubs were blank. This can create problems when auditing reports. During the visit it was found recent monthly reports of provider visits to the home had not been forwarded to the Commission. This had been as a result of a misunderstanding and the manager agreed to get the system re-instated. Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 1 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 3 Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement The registered person must complete the necessary works to separate the service user WC and sluice facility (previous timescale of 30/9/05 & 30/04/06 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 via the CRB and the implementation of suitable supervisory arrangements. (previous timescale 20/12/05 not met.) The registered person must ensure that care staff receive regular supervision (previous timescales not met, most recently 30/6/05 & 31/03/06). Timescale for action 1. OP26 23(2) 31/08/06 2. OP29 19(1)(5) 31/07/06 3. OP36 18(2) 31/07/06 Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP29 Good Practice Recommendations Where gaps in employment history are explained the applicant should sign written confirmation of that explanation. 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 accident reports forms and stubs should be numbered in order to provide an audit trail. Monthly provider reports, Regulation 26, should be copied to the Commission and the home’s manager. 1. 2. OP33 3. OP33 4 5 OP38 *RCN Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 24 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
© 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 Legh House DS0000026835.V298261.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
