CARE HOMES FOR OLDER PEOPLE
Legh House 117 Rylands Lane Wyke Regis Weymouth Dorset DT4 9QB Lead Inspector
Trevor Julian Key Unannounced Inspection 25th September 2007 10:00 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.V351620.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.V351620.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 annburt@btconnect.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.V351620.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. 2nd June 2006 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 a wet room including shower basin and WC.. The remaining bathroom facilities are communal, comprising of an assisted bath and wc, a walk-in shower and wc, a conventional bath and wc and a separate wc. There is a separate sluice room. To the rear of the premises 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 arrange activities. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, were £396.58 per week. Additional charges include hairdressing, chiropody (privately arranged), toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. The CSCI has responded to this report and further information can be obtained from the following website: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_
Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 5 choosing a care home .aspx Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection started on the 25th September 2007 and was concluded on 9th November 2007. The manager had completed an Annual Quality Assurance Assessment (AQAA) before the inspection to provide management and basic care information. However, due to technical difficulties at the commission the information was not available until the inspection, as a consequence no comment cards were provided for residents and visitors to give their views. During both visits, the views of residents, visitors and staff were sought. Further information was gathered through observation, checking records and a tour of the premises. What the service does well:
The residents were seen individually and in a small group in the conservatory. All expressed high levels of satisfaction with the care and services offered by the home. The staff and manager were highly praised. Over several visits the residents have consistently praised the efforts of all staff. Several commented that they felt secure and safe without the worry of running their own home. One person commented, “If I could give it a gold star I would”. Another said, “… nothing is too much trouble. I am more than satisfied with life at Legh House.” People clearly felt valued and their care based on a person centred approach. The manager carries out pre-admission assessments to ensure the home has the capacity to meet the needs of the individual. Residents confirmed that Mrs Burt had visited them at their previous addresses and provided information on the services offered in the home. The residents were involved in their own care planning and reviews. The care plans seen were updated as needs changed. There was evidence that referrals were made for healthcare professionals to attend as needed. One visitor seen during the visit was visiting a relative who had become increasingly frail. He said the home was doing more than he could expect and the staff were extremely caring and sensitive to the needs of his relative and her visitors. He added that they were welcomed into the home night and day and if there were changes then the family were contacted. The home had discussed the idea of using an electronic monitoring device in the room as the resident could no longer use the call bell; the family were very happy with the arrangement and said that the system gave them confidence that the staff would attend promptly should there be any change. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 7 Throughout the visit, staff were seen treating residents with dignity and respect. There was a good deal of discussion and lots of laughter creating a feeling of mutual respect. The home’s activity programme was based on the ideas generated at the residents meetings. People were encouraged to follow their own preferences. During the visit one new resident said that she was relishing the opportunity to rediscover her interest in Latin. Another regularly played the piano to entertain the other residents. People said there was enough going on to keep them occupied and several were able to go out independently. They felt the staff created good levels of choice for their daily lives and there were very few restrictions imposed. One person had raised a concern with the manager but the request had been refused on the grounds of safety. Mrs Burt was continuing to monitor the situation and was open to suitable alternative suggestions. Residents said they were comfortable to discuss any concerns with Mrs Burt or any of the staff. There were clear systems in place for responding to complaints and allegations or signs of abuse. Staff spoken to had been trained and knew their responsibilities in responding to abuse. The premises were well maintained and the rooms seen were clean and comfortable. The rooms visited had been personalised by the occupant with pictures and small items of furniture etc. All staff had received training in infection control and there was hand gel at various points to encourage visitors to take care of hygiene during their visits. The laundry was located away from the food preparation areas and communal hoists and other equipment was regularly cleaned. The home maintained good staffing levels which met the needs of the residents. The team had very low turnover giving the residents very good continuity of care. Any new staff were recruited correctly with evidence on files seen showing that all the required references and clearances were obtained before starting work. All new staff complete the “Skills for Care” common induction standards. Most of the staff team had achieved NVQ at level 2 or above. The training programme ensured that the staff had the required knowledge and skill to meet the needs of the individual residents. The manager seeks the views of the residents and visitors as part of an annual quality assurance exercise; the results are used to update the continuous improvement plan for the service. Their views were also sought during the regular residents meetings. Several people deposited cash with the manager to cover additional personal expenditure. The home maintained detailed records and receipts of all transactions and an audit of three records showed the balances held matched the recorded amounts. There were internal checks to ensure that any discrepancies were promptly rectified. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admission assessment carried out by the manager makes sure that the identified needs of prospective residents can be met within the home. EVIDENCE: The AQAA states that pre-admission assessments are completed before a trial period is offered. One visitor was able to confirm that an assessment had taken place and the resident was provided with a service users guide to the home. In the case of a new service user she said she had seen the manager while in hospital and her family had visited the home and reported back to her that it was suitable. She added that she had settled in very well and was most
Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 11 pleased with the choice. The pre-admission assessment had been signed by the resident to confirm her involvement and agreement. The assessments seen covered all the recommended topics and were used to formulate the initial care plan. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s care plans give clear information about how needs are to be met. Healthcare issues are referred to appropriate services. Medication is well managed although there needs to be an audit trail for items in use. EVIDENCE: Three care plans were checked and all showed care staff what tasks were needed to meet the care needs. The daily reports showed those tasks being completed. Residents said they were aware of the home maintaining care records and that they were regularly reviewed. There was evidence of nutritional assessments. One person was visiting their relative who had become increasingly frail. The family were regular visitors and were full of praise for the care provided. Specialist equipment was provided and the home ensured that the resident had a suitable diet and sufficient fluid. For one resident the home used an
Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 13 electronic monitoring device as the resident could no longer manage the call alarm system, the family said they were fully consulted. They were very happy with the arrangement as it gave them confidence that staff would respond promptly to any changes. The monitor was turned off when visitors were in the room. The records showed that the staff make appropriate referrals for GPs, community nurses etc. Residents said they had access to other healthcare services including chiropody, dental services, opticians etc. A local chemist supplied the medication system, the home were expecting the chemist to carry out an audit on their system shortly. Only staff who had completed training were authorised to give medication. Weekly stocks were held in locked cabinets in the residents’ rooms. Temperature sensitive medication was held in a locked container in a fridge. The records examined were up to date and clear. However, the system did not easily allow for auditing individual stocks held, Mrs Burt said she would develop a system following discussion with the supplying chemist. A small number of people self medicate, this is following a risk assessment. There was a medication policy which had been reviewed by the manager in April 2007. All the residents seen said the staff were excellent and always treated people with respect; they felt they were treated as individuals. One person said the manager had asked how she wished to be addressed during the admission process. Staff were seen knocking and waiting before entering bedrooms. The home had a caring and supportive feel with residents encouraged to remain as independent as they can. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff promote high levels of independence and choice, helping the residents to feel valued and treated as individuals. EVIDENCE: During both visits, residents were engaged in a variety of activities. One person was working on a large jigsaw puzzle, another reading her newspaper, one was playing “Connect 4”. Residents said that a library service visited the home and provided a variety of reading materials. One resident was playing the piano for the enjoyment of several people in the lounge. Staff organise craft sessions which are enjoyed by most of the residents. Residents said there was no compulsion to join in. One person said she was enjoying rediscovering Latin after a gap of many years. Religious and spiritual needs are considered during the admission process, services are held in the home and many attend. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 15 Several people go out for walks near the home, others go out with assistance from the staff. People said they enjoyed the quizzes and sing-alongs and that there was always something to do. They said they enjoyed the patio area at the rear of the premises during the summer months. Records showed the activities undertaken by the residents. Residents meetings are held regularly. Arrangements were made to allow residents to vote in elections. Personal allowances were held for some of the residents to cover additional expenditure. Food was described as very good and there was always a choice offered. Most people took their meals in the dining area and sherry or wine served with the midday meal. The home was developing nutritional assessments for the residents. At a recent inspection by environmental health the home was awarded a gold standard for food safety. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s systems allow residents and visitors to raise concerns without fear of recrimination. EVIDENCE: The complaint procedure identified local authority and commission contacts should the complainant not be satisfied with the response from the home. The commission had received no complaints or concerns. Residents said they were very confident that concerns would be considered properly. One person did say that an issue had been raised with the home’s manager and they had received a response although the resident did not like the answer. The matter was discussed with Mrs Burt who said that there were concerns over safety issues but that she would continue to monitor the situation. Staff at the home had received training in responding to allegations of abuse. Three staff seen at the inspection were very clear about their responsibilities and confirmed that they had been trained. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and comfortable environment giving the residents a good sense of security and wellbeing. EVIDENCE: Since the last inspection, work had been completed to improve the communal bath, shower and sluicing facilities in the home. All the rooms seen were comfortable, airy and odour free. The premises were maintained to a good standard both in and out of doors. The AQAA states that the maintenance programme for the home is planned until 2013. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 18 One person told the inspector that they felt cold especially when in bed and had requested that they are able to use an electric blanket and a convection heater. The resident had raised the matter with the manager who had carried out a risk assessment and, on the grounds of safety, had refused the request. The resident had a thermometer, which was used by both the occupant and staff to check the temperature of the room. There is a separate laundry and sluice room. Items are transported to the laundry without the need to go near food storage and preparation areas. Laundry from the kitchen is washed in a separate machine. The home uses dissolvable laundry sacks to avoid double handling of soiled items. The commercial washing machine had a sluicing cycle. Staff had been trained in infection control procedures and there were hand gel dispensers located around the home for staff and visitors. The home had a weekly cleaning regime for mobility aids etc. Mrs Burt was starting to complete the Department of Health’s audit – Essential steps to a safe, clean care. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to the needs of the residents. The training programme ensured that the staff had appropriate skills. The robust recruitment process helped to ensure that people were protected. EVIDENCE: Staffing levels remain appropriate for the needs of the residents currently accommodated. The home is staffed by two wakeful staff overnight and three during the day supported by cleaning and catering staff. Residents benefit from having staff a very low staff turnover allowing good continuity of care. The staff are well trained and with over 50 having achieved NVQ level 2 or above. Staff said the training programme was accessible and provided them with relevant skills. Should a resident need to go to hospital they are always accompanied by a member of staff, if family are not available. There had been significant improvements to the recruitment practice and the files seen had the required checks and references. New staff complete the “skills for care” induction programme.
Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service is well managed by a competent manager and staff team. The residents and visitors are regularly consulted about the home to ensure their views are the first consideration in the safe operation of the home. Systems in place help to keep the residents safe from financial abuse while in the home. Health and safety is well managed creating a safe but homely environment for the residents and staff. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home is operated by Abbeyfield and there is a management team who regularly visit the home and carry out independent checks on the service. The manager has the required qualifications and has a wealth of experience in managing Legh House. Staff, residents and visitors said that the manager was approachable and it was clear from her interaction with the residents that she took time with each person in the home. The home uses a survey system and meetings to seek the views of residents and visitors. The home’s analysis of responses showed improved satisfaction levels in most areas. The home has a continuous improvement plan which is used to record the outcome of the surveys and the action being taken. Residents said they were regularly consulted on the running of the home. A number of people deposit personal allowances with the manager for safe keeping. An audit of three accounts showed that the home maintained good records and there were internal checks to ensure discrepancies were quickly rectified. The records included receipts for expenditure. The balances held matched the transaction records. The training programme showed that staff were trained in Health and Safety. The records showed that fire precautions and equipment were routinely tested. The fire risk assessment had been completed. Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 22 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Legh House DS0000026835.V351620.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 home should ensure that there is a clear audit trail for medication within the home. Legh House DS0000026835.V351620.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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