Inspection on 26/07/07 for Legrand Nursing Home

This inspection was carried out on 26th July 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Legrand Nursing Home 28/11/06

Legrand Nursing Home 06/12/05

Legrand Nursing Home 17/06/05

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 Joy Hoelzel Key Unannounced Inspection 26th July 2007 09:30 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 Legrand Nursing Home DS0000022257.V341745.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. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 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 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) Legrand Nursing Home Limited Mr George Manfred Legrand Care Home 38 Category(ies) of Dementia (19), Old age, not falling within any registration, with number other category (19) of places Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority. 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 Brief Description of the Service: Legrand is a care home registered to provide accommodation, personal care, and nursing to thirty eight older people. 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 offers a mix of single and double occupancy bedrooms and has a variety of communal areas. Weekly fess for the service range from £453.61 - £ 450.25. There are no additional charges for sundry expenses. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Commission for Social Care Inspection Reports for this service are available from the provider or can be obtained from www.csci.org.uk Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a quarter hours on Thursday 26th July 2007. It was conducted by one Commission for Social Care Inspection regulation inspector. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Thirty eight people are currently living at the home and during the inspection were observed to be accessing all areas of the home. The registered manager was on the premises supported by one registered nurse, six care staff and ancillary personnel. Three case files were selected for case tracking, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and the manager. Observation was made of the various daily activities and a tour of the premises was conducted. An Annual Quality Assurance Assessment (AQAA) had been completed by the manager and submitted to CSCI prior to this inspection, offering a full overview of the home. Completed surveys and comment cards have been received from relatives and two general practitioners involved in the service. Comment cards were sent to people living at the home, which were completed by family members on their behalf. The comments received are included in this report. What the service does well: The home provides a comfortable environment in which to live. People commented that – ‘Staff look after us well’, ‘The love and care given is wonderful he is always treated with kindness and there is always a happy feeling when you walk in also everyone is made to feel welcome’ The manager demonstrated a good in-depth knowledge of the resident group and the conditions and dilemmas associated with the ageing process. Throughout the service there is a highly evolved understanding of the equalities and diversity needs of the individuals who use the service. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 6 A comment made by a healthcare professional – ‘I find the home a very caring and efficient home whose residents tend to come to this home when other homes can no longer meet their needs’. 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. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3,6, Quality in this outcome area is good. Admissions are not made to the home until a full needs assessment has been undertaken and only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A statement of purpose and service user guide has been developed detailing the service provision and offering an overview of what a person may expect to find when living at the home. Three case files were selected for inspection and included the file of the person most recently moving into the home. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 9 Information of a persons care needs are obtained prior to offering a placement at the home, the manager discussed the admission procedures and confirmed that a placement is offered only if the care needs of a person can be fully met. The home does not offer an intermediate care service. Legrand Nursing Home DS0000022257.V341745.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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is good. The care plans are written in plain language, are easy to understand and reviewed at regular intervals. This ensures that the care needs of the individual can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care, which is developed with the involvement of the individual whenever possible and/or their representative. It is acknowledged that some people living at the home do not wish to or are unable to contribute to the care planning processes. Three care plans were selected for inspection; one contained a signed statement of inclusion by the next of kin in the care planning process. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 11 One visitor stated that she is involved with the process but went on to say that she lets the staff attend to the planning and has no complaints whatsoever with the care being provided. The care plans cover areas of healthcare including mobility, pressure area care, rest and sleep, continence, nutrition and communication. All people have a plan for respecting privacy, dignity, equality and diversity. Personal dress preferences and the right to make decision and choices are included and offer a good indication of the person centred care that is provided. The care plans of two people who have dementia were looked at. All evidence points to the specialised care needs of these people are being satisfactorily met. Whilst it was not possible to engage them fully in conversation both were well dressed, clean, tidy and appeared quite happy in their surroundings. Staff were observed to be offering many choices and carrying out interventions in a calm, efficient and competent manner. Generally the way staff communicated with people was age appropriate. All people looked well-groomed, care for and nourished. Inspection of medicine storage and administration records, demonstrated the home’s practices meet the guidelines of the Royal Pharmaceutical Society. The Medication Administration Record charts appear to be completed correctly there were no gaps in the record seen. Insulin that is in use is being stored in the fridge contrary to the manufactures instructions. This was discussed with the manager at the time and an alternative storage procedure was implemented. The external products observed in use are not being dated upon opening and the home was advised introduce this practice and discard tubs after one month of opening and tubes after 3 months of opening. Legrand Nursing Home DS0000022257.V341745.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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,1,5 Quality in this outcome area is good. People who live at the home are involved in daytime activities of their own choice and according to their individual interests and capabilities. The meals are balanced and nutritional and cater for the dietary needs of the individuals using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities are arranged mainly on a daily basis and based on the capacity of the individual at the time. The homes cat, dog and fish provide much enjoyment and are very much part of ‘the family’. A comment received in the relatives’ surveys – Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 13 ‘ My relative is unable to participate in many activities but does enjoy the dog and cat’. One person was enjoying listening to some classical music, another person was writing, some were watching the TV, others dozing/watching the happenings of the day. The manager described the recent summer fete held where all the residents were involved to some degree and stated that it was well supported by the families and local residents. Comments received in the relatives’ surveys ‘Residents feel at home and family and friends are made to feel part of the extended family’. ‘More activities, involving music would be appreciated’. Visitors are welcome to visit the home at times to suit their friend or relative. There are a variety of sitting areas around the home ensuring that people have the choice of a place to sit quietly, meet with family and friends or be with other people who live at the home. Comments received in the surveys ‘‘The love and care given is wonderful he is always treated with kindness and there is always a happy feeling when you walk in also everyone is made to feel welcome, a cosy small lounge area would be nice when additional members of the family visit’. During the tour of the premises many bedrooms contained personal possessions, people appeared to be comfortable and contented. The meals provided are based on a four weekly rotational menu; the cook has been at the home for 10 years and as such has a good knowledge of the dietary requirements of people. The meals are plated individually and served by the care staff mainly in the lounge areas. People looked well nourished and during the day people were being offered drinks coffee, tea and squash at very regular intervals. Staff were observed to be encouraging and assisting people with the midday meal in a discreet way showing patience and understanding of the individuals needs. Legrand Nursing Home DS0000022257.V341745.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. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is good. Residents and others involved with the service say that they are happy with the service provision, feel safe and well supported by an organisation that has their protection and safety as a priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to make a complaint are included in the service user guide and a copy of the procedure is displayed at the home. The manager confirms that no complaints have been made and if there are any concerns raised then an attempt is made to resolve the problem in house with the person concerned. Comments received in the surveys ‘My husband would find it difficult to complain but usually seems happy and content’. People spoken with said they didn’t have any complaints but would feel very comfortable to speak with the manager or staff at any time. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 15 The home does not provide a service for dealing with service users personal monies and/or valuables but can arrange for the bedroom to be locked if required. The fees are all-inclusive for the services available and include hairdressing, toiletries, chiropody etc. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 16 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): OP 19,26 Quality in this outcome area is good. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that a plan for the routine maintenance and renewal of fabric has been developed. The home has recently benefited from new carpeting in the main hall and for the replacement of four easy chairs. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 17 Three wash hand basins and surrounds in the bedrooms are planned for replacement shortly. People living and visiting the home commented that they are comfortable. There are a variety of sitting areas around the home offering a choice of being alone or in company. The manager described the plans for the installation of an appropriate area away from the main building for the people who smoke. The gardens are well maintained, people commented on the lovely views of the garden and surrounding countryside. Some beds are fitted with bedrails and bumpers; it was recommended that these be checked on a regular basis to ensure that they are correctly fitted and in good working order. Hand wash facilities have been provided in all communal areas and at the point of the delivery of care. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 18 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): OP 27,28,29,30 Quality in this outcome area is good. There appear to be enough staff available to meet the needs of the people using the service, with the staffing structure based around delivering outcomes for the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: General observations and discussion with staff confirmed that staffing numbers and skill mix enable a service provision which meets the care needs of the people living at the home. Staff were observed to carry out their duties in a competent and professional manner. All service users looked well groomed and it was obvious that the staff assisted people with maintaining high standards of personal care. Comments received in the surveys Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 19 ‘ The staff are welcoming and show patience and understanding’ ‘ The staff always appear kind and caring’ Two people indicated in the surveys that in their opinion there are some times when there are not enough staff on duty. Records examined showed they contained all the necessary information, which demonstrates potential staff are well screened before they are deemed suitable to start work at the home. Staff training at National Vocational Qualification levels 2,3 & 4 continues together with the core topic areas. Legrand Nursing Home DS0000022257.V341745.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): OP 31,33,35,38 Quality in this outcome area is good. The registered manager has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. He works to continuously improve services and provide an increased quality of life for residents with a strong focus on equality and diversity issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 21 Tom Legrand has been the owner and registered manager of the home since 1988 and demonstrated a sound knowledge and understanding of the client group and the difficulties and dilemmas associated with ageing. The manager and staff are very experienced with caring for people with dementia and related illnesses. The surveys received from the general practitioners indicated a general satisfaction with the service provided with an additional comment of ‘ I find the home a very caring and efficient home whose residents tend to come to this home when other homes can no longer meet their needs’. Mr Legrand’s management style is one of openness and inclusion, supporting and involving people with all aspects of their life at the home. People living, working and visiting the home offered positive comments of the style of leadership and stated that the manager was ‘ very supportive, and approachable, with no hesitation but to ask to see him if there were any concerns’. Quality assurance monitoring continues with satisfaction questionnaires to service users and/or relatives with ample opportunities to discuss any issues or suggestions for improvements. A recent survey and subsequent audit has resulted in some suggestions for improving the choice of food, the arrangements for smoking and for the purchase of a video/dvd recorder. The home does not provide a service for dealing with service users personal monies and/or valuables but can arrange for the bedroom to be locked if required. The fees are all-inclusive for the services available and include hairdressing, toiletries, chiropody etc. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept. The fire risk assessment was last reviewed in April 2007. Legrand Nursing Home DS0000022257.V341745.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 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 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 Legrand Nursing Home DS0000022257.V341745.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. 2 Refer to Standard OP9 OP19 Good Practice Recommendations It is recommended that external preparations are dated upon opening and then discarded after 28days (for tubs) and 3 months (for tubes). It is recommended that routine checks be carried out on the bedrails, with records kept, to ensure that they are fitted correctly and safe. Legrand Nursing Home DS0000022257.V341745.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 © 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 Legrand Nursing Home DS0000022257.V341745.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. 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