Inspection on 17/06/05 for Legrand Nursing Home

This inspection was carried out on 17th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Legrand Nursing Home 26/07/07

Legrand Nursing Home 28/11/06

Legrand Nursing Home 06/12/05

Legrand Nursing Home 22/10/04

Legrand Nursing Home 20/04/04

Legrand Nursing Home 23/09/03

Legrand Nursing Home 12/05/03

Legrand Nursing Home 10/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Legrand Nursing Home Tilstock Road Tilstock Whitchurch, Shropshire SY13 3JL Lead Inspector Keith Salmon Unannounced 17 June 2005 09:15 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Legrand Nursing Home Address Tilstock Road, Tilstock Whitchurch Shropshire SY13 3JL 01948 880406 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) Legrand Nursing Home Limited Care home with nursing 38 Category(ies) of 19 x Dementia (DE) registration, with number 19 x Old age, not falling within any other of places category (OP) Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must comply with the Staffing Notice issued by the Shrosphire Area Health Authority. 2. 3. The home may accommodate a maximum of 38 service users. The home may accommodate any combination of Older Persons and Persons with Dementia, provided that the total number is not exceeded. Date of last inspection 22nd October 2004 Brief Description of the Service: Legrand is a 38 bedded Home registered to provide care,with nursing, to older people and older people with dementia. Situated in the village of Tilstock, between Whitchurch and Wem in North Shropshire, the house sits in its own private well-kept grounds, is sited next to the village church and overlooks open countryside and the local bowling green. The Home is owned and managed by Mr and Mrs Legrand and staffed with qualified nurses, carers and ancillary staff. It offers a mix of single and double rooms. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection, conducted by one Inspector, was undertaken over two days, the 16 and 19 June 2005, to enable the Inspector to have discussions with the Proprietor, who was away on leave on the first day of Inspection. The Inspection commenced at 09.15 on 17 June 2005, and at 09.00 on 20 June 2005, with a total time for Inspection of 7 hours. This Report is based on observations made during a tour of the Home, discussions with the Proprietor/Manager, Staff, Residents (3) and Relatives/Visitors (2), plus a review of care related documentation, including staff recruitment/deployment records, and a range of documents/records reflecting the general operation of the Home. The Proprietor, Mr. G. M. Legrand (known to all as ‘Tom’) is both the ‘Responsible Person’ and Registered Manager. The Home has worked well to meet 10 of the 11 ‘Requirements’ cited at the previous Inspection, held in October 2004. Mr. Legrand is supported by a team of well-qualified and experienced Staff covering all aspects of the Home’s provision. Care Staff receive regular training, and more than 50 of Care Staff have attained Level 2 NVQ Award. (The number of Residents engaged in discussion is small due to the capabilities of the client group.) What the service does well: What has improved since the last inspection? What they could do better: Provide improved arrangements for Residents who wish to smoke. Ensure all hot water outlets, to which Residents have access, are thermostatically controlled and regularly tested. The medicines refrigerator must have an appropriate ‘maximum/minimum’ thermometer. The disinfecting sluice provision must be fully functioning. Please contact the provider for advice of actions taken in response to this Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 6 inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 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 Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 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, 2, 3, 4 and 5 Prospective Residents, where their capabilities permit, are enabled to make an informed choice as to whether they wish to enter the Home. Residents’ interests are protected by suitable contractual documentation. Processes to ensure assessment of care needs, prior to admission, are diligently and effectively applied. Staff are enabled to provide the type, and quality, of care required by Residents. EVIDENCE: Printed information, as issued to all new Residents (or their Relative or other Representative), was observed and found to comprise the relevant information and policies relating to residency within the Home. Pre-admission assessment documentation was found in Residents’ files. Duty rotas showed staff numbers and staff skill-mix to be in accordance with the Statutory Staffing Notice. Staff files demonstrated evidence of relevant training to ensure Staff are up-to-date in their practice. Discussion with the 3 Residents, able to converse productively with the Inspector, and 2 Visitors, provided a small but convincing consensus reflecting a good quality of care provided by considerate and motivated Staff. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10. Care provided by the Home is effective in meeting the Residents’ assessed care needs, and delivered in a way which Residents, Relatives and visitors reported as being friendly and respectful. The storage, administration and disposal of medicines are generally in accordance with accepted good practice. EVIDENCE: Randomly selected care planning/reporting documentation, relating to 10 Residents, showed evidence of full pre-admission assessment having been carried out by the Registered Manager. Care Planning documentation encompassed the range of ‘care areas’ necessary to ensure the delivery of care appropriate to the needs of each Resident, was well organised, current and clearly written. Operational Policies and Procedures were reviewed and found to be comprehensive and up-to-date. Inspection of medicine storage provision, and administration records, showed the Home’s practices generally meet the guidelines of the Royal Pharmaceutical Society – the exception being the need to improve monitoring of internal temperatures of the medicine refrigerator by introducing the use an appropriate ‘maximum/minimum’ thermometer. Staff training records confirmed Staff receive both initial, and refresher training, in the safe handling of medicines. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. A range of leisure opportunities, consistent with Residents’ capabilities, is provided. Contact with family and friends is enabled and supported, and the Home appears to be well integrated into the Community and its’ activities. Where possible continuation of religious practices is encouraged and supported. The Home works hard at providing the type of meals preferred by the Residents. EVIDENCE: The Home engages the services of an ‘Activities Organiser’ who attends from 1.00 – 4.00 pm, Monday to Friday. A number of notices were observed indicating the activities programme, including art/craft activities, visits by singing entertainers and beauty therapies. Residents able to comment told the Inspector the food provided by the Home was of excellent quality, well presented, of sufficient quantity, and offered good overall variety, with a choice each day. Menus operate on a four weekly cycle, adjusted seasonally. The Chef frequently attempts to introduce ‘new’ items to vary diet and choice, and if they ‘go well’ they become a regular part of the menu cycle. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 11 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, 17 and 18. The interests of Residents are protected through ready access to the Home’s Complaints Procedure, and information relating to advocacy services. Staff are clearly aware of their role in protecting Residents from abuse. EVIDENCE: A clear and concise Complaints Procedure is displayed in the main hallway, which includes reference to the Commission for Social Care Inspection as the regulatory body, together with contact details. The Home maintains a record of complaints, which was observed to be current. Residents able to comment stated they would have no hesitation in raising matters if they had any concerns, and were confident these would be dealt with promptly – one Resident told the Inspector she had….“regular chats with Tom to let him know her thoughts, and the response was always positive”….(Tom being Mr Legrand the Proprietor/Manager). Policies relating to protection of Residents from abuse were observed to be in place and readily accessible – these included, ‘Whistle Blowing’, ‘Abuse Awareness’ and ‘Adult Protection’. Staff training files indicated that Staff had received training in respect of these Policies. Residents who wished to were enabled to vote at the recent General Election. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 12 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, 20, 21, 22, 23, 24, 25 and 26. The Home is decorated to a satisfactory standard, with furnishings, which create a comfortable and ‘homely’ atmosphere, and provides a generally safe environment. The Home has well tended gardens, which are accessible to those Residents who are capable of using them. There is potentially a ‘health hazard’ to other Residents arising from the arrangements in place for Residents who smoke, plus a scalding hazard from several hot water taps. One of the disinfecting cycle sluices is not functioning and presents an infection control risk. EVIDENCE: Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 13 There are several lounge/sitting and dining areas offering a variety of size and outlook. However, the Home does not have a designated area for use by Residents who smoke. It is planned to address this problem within the Home’s 5-year capital programme. Furniture in lounge and dining areas are of good order and present a ‘domestic’ ambience. The specialist equipment, available to facilitate provision of care, appeared to be in good working order and the Home has a full range of maintenance contracts in place. A number of hot water outlets, at wash-hand basins accessible to Residents, were tested and, in some instances, water temperature was found to be at 60o Celsius, thus presenting a serious scalding hazard. The Home has two ‘disinfecting cycle’ sluices, one of which is not functioning, and has not been repaired due to shortage of spare parts. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 14 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, 29 and 30. Staff numbers and skill-mix listed on the staff rota are sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are consistent with the safeguarding of Residents. The commitment of the Home to providing training for Care Staff is good. EVIDENCE: The current staffing rota, and those from the immediately preceding weeks, were examined. Staffing numbers and skill-mix enable a service provision, which meets the care needs of the Service Users. Staff Personal Files demonstrated evidence of full compliance with the Standard and Schedule 2 of the Regulations. Staff are subject to a thorough, and relevant, orientation/ induction programme, which is followed by comprehensive ‘foundation’ training, e.g. ‘manual handling and lifting’, ‘fire safety’, ‘simple infection control’. In addition, the Home enjoys an excellent record for the continuing development of Care Staff, and supporting Staff in undertaking appropriate training, based on a well-structured plan for determining individual training needs. The level of attainment of NVQ Level 2 (currently in excess of 50 of Care Staff) is further complemented by in-house training. Discussions with Staff indicated they are provided with the opportunity and support to undertake training at Level 3 NVQ with prospects of going to Level 4. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 15 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, 34, 35, 36, 37 and 38. Operationally, the Home is very well organised, with the central purpose being ‘the best interests of Residents’. Staff are subject to effective support, with regular ‘supervision by Mr. Legrand. Staff, several of whom have been in post for are many years, appeared involved and happy in their work. EVIDENCE: Evidence was based on discussion with Residents, Visitors and Staff, a tour of the premises and the reading of relevant documentation. The Owner/Manager, Mr. Legrand, is an RGN, who has daily ‘hands-on’ input to the care management process – a presence and input much appreciated by the Staff. It was evident from discussions, with management and Staff, there are clear lines of accountability established within the Home. The Home’s practices, in the context of health, safety and welfare of Residents, Visitors and Staff, were seen to be generally in accordance with the Regulations. However, (as identified in Standard 25 above) issues relating to the protection of Residents from the risk of scalding and waste disposal must be resolved. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 16 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 3 3 3 3 3 x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 1 2 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 2 Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 17 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 OP 9 Regulation 13.-(2) Timescale for action The Home must provide,and use, 26/7/05 a minimum/maximum thermometer for the taking of daily temperature recordings from the medicines refrigerator. As previosuly agreed, the Home by 2009(as must ensure, within their 5 year previously strategic plan, provision of an agreed) appropriate area for Residents who smoke. The Home must survey all hot Immediate water outlets, accessible to Residents, to ensure they comply with the Standard, i.e. delivery of hot water at about 43 degrees Celsius and adjust/fit thermostatic controls where necessary. The non-functioning sluicing 23/8/05 disinfector must be repaired or replaced. As per Requirement No.3 above. Immediate Requirement 2. OP 20 23.-(4)(a) 3. OP 25 13.-(4)(a) 4. 5. OP 26 OP 38 13.- (3) 13.-(4)(a) 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 Good Practice Recommendations E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 18 Legrand Nursing Home Standard 1. Legrand Nursing Home E56 S22257 Legrand NH V220356 UI 170605 Stage 4.doc Version 1.20 Page 19 Commission for Social Care Inspection 1st Floor, Chapter House South Abbey Lawn, Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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