CARE HOMES FOR OLDER PEOPLE
Lehmann House Lehmann House Church Terrace Wickham Market Suffolk IP13 0SG Lead Inspector
Helen Fontaine Unannounced Inspection 27th February 2006 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 Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lehmann House Address Lehmann House Church Terrace Wickham Market Suffolk IP13 0SG 01728 746322 01728 748212 jennifererodger@socserve.suffolkcc.gov.u 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) Suffolk County Council Mrs Jennifer Ann Rodger Care Home 38 Category(ies) of Dementia - over 65 years of age (28), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (10) Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate one service user with a Learning Disability, over the age of 65, as detailed in the correspondence dated 4th November 2003. 9th December 2005 Date of last inspection Brief Description of the Service: Lehmann House is owned by Suffolk County Council. The home is well established and located in the small market town of Wickham Market, within reach of local facilities including GP surgery and shops. The home is a large building, divided into four groups or units, each of which has its own bathroom, toilets, lounge, dining and kitchenette facilities. In total, it caters for 38 service users. Three of the units cater for older people with people with special needs, Gainsborough and Constable Unit, which are on the ground floor, and Smythe unit, which is located on the first floor. Moore Unit, also on the first floor provides care for frail elderly service users. The home also provides a number of short-term care beds. Social Care services have a base at night time for their domiciliary care service in the home. Staff recruited for this also have domestic relief duties for Lehmann house written into their contracts of employment. A day care unit is within the same building. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection of Lehmann House took place over four hours and was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits, all core standards have now been assessed. Nine requirements and five recommendations were set at the previous inspection. Two requirements have not yet been met and have been restated in this report with a new timescale for compliance. No new requirements and only one recommendation was given at this inspection. The homes two team leaders and the manager were present during the inspection, their assistance during the inspection was very much appreciated. A tour of the home was undertaken, including a visit to the kitchen. Documents were looked at, a number of residents were spoken to and one resident individually. What the service does well: What has improved since the last inspection?
The home had quite a number of requirements and recommendations from the previous inspection. It was clear from this inspection that the manager and staff had done a lot of work resulting in all but two requirements being met. At the last inspection a resident had been admitted into the home and into a unit that could not meet their needs. The unit was not a special needs unit and this resident had a diagnosis of Dementia. The manager indicated that the resident had actually deteriorated since being admitted, but there is now a vacancy in a special need unit and the resident would be moving into this unit.
Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 6 The home has undergone some re-decoration and all areas of the home were clean and pleasant. The home passenger lift was noted to be in full working order and had been maintained. All the homes fire doors were either held open by an appropriate device or shut and no fire doors were found to be wedged open. It was also noted that the home did display photos of staff on duty although it was difficult for the home to keep them up to date, as residents did remove the photos from the notice board. 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. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 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 Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 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 the following standard(s): 4 Residents can expect to have their needs met when they move into the home. EVIDENCE: At the previous inspection the home was given a requirement, as a resident had move onto the mainstream unit with a diagnosis of dementia and this exceeded the number of people with dementia the home is registered for. The home has recently had a vacancy for a resident with dementia and the home have allocated this vacancy to this resident. Another resident that was outside the home registration is currently in hospital and it is not known if the home can now meet their needs. The manager indicated that they would be going to review the needs of this resident before they were discharged. This does result in the home having the correct number of residents with dementia, which they are registered, to have. The manager said that the home is still looking to get a variation to their registration, which would give them the flexibility if other existing residents should be assessed as having dementia. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 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 the following standard(s): 7 and 9 Residents may not be protected by the homes practices for dealing with medication or daily recording. EVIDENCE: During the previous inspection the home received two requirements and one recommendation for issues over medication. Efforts to address this have been made and the manager indicated that they have had a number of training sessions with staff to improve the situation. During the inspection the Medicines Administrative Record (MAR) sheets were looked at. Each of the residents had their photo, name, room number and unit documented. However there were a number of inhalers and creams not signed for after the midday administration of medication. One resident showed the inspector their room and with the team leader their medication cupboard was checked. It was noted that it was not possible to establish if a particular treatment had been given or not. The team leader indicated that they would have to wait until handover, to establish whether the resident had received their treatment or not. The issue over creams is the same, although it was noted that there were documented instruction for the staff about supporting residents when using creams.
Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 10 The issue over the daily record still remains unclear and difficult to establish full information on previous events for a resident. The night staff recording was found to be documented every night, daytime recording was documented in a number of different places. Staff had documented events on the daily recording sheet, but there were a number of dates missing on all the files looked at. The manager indicated that there is also recording on the activities book and the home have a folder where information is written down at the hand over meeting. It was difficult to work from records to give a clear picture and for staff who have been off or relief staff, this might result in important information being missed. The manager indicated they had advised staff that if there was nothing notable to report then they are not expected to make an entry every day. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 11 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): These standards have been previously assessed as well met, and during the inspection no concerns were raised or noted. EVIDENCE: This area will be examined in more detail in future inspections. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 12 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 Residents felt confident that the home’s management would take concerns or complaints seriously. EVIDENCE: During the inspection one resident was visited in their room and spoken to individually. This resident indicated they had reluctantly felt it necessary to move into the home but said, “I found the home better than I expected”. The resident indicated that they felt a lot safer in the home than they would have been in former flat and they would feel able to inform staff especially the team leaders, if they had a concern or a complaint. Other residents spoken to also indicated that if they had any concerns or complaints, it would be listened to and acted on. It was more difficult to be clear with those residents on the extra care units, however during the tour of the home one resident expressed a concern and it was listened to and although it was not possible to fully address it, it was looked at. The documentation around the standard on complaints was looked at during the last inspection, no concerns were raised or noted. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 13 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 and 26 People who use this service can expect to live in a clean, well-maintained home. EVIDENCE: During the last inspection the home received a number of requirements and recommendations around these standards. A tour of the building was undertaken during this inspection and it was established these have all now been met. The areas of the home seen to be in need of re-decoration have now been repaired. On the day of the inspection, electricians were present in the home and were replacing the homes lights with new ones. None of the areas visited by the inspector had any indication of an odour and it was noted that the home was very clean. At the last inspection it was noted that the home had a number of fire doors wedged open. During tour of the home it was noted that all fire doors were either shut or had fitted appropriate equipment. There was also the issue of
Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 14 identification for the resident’s rooms and at this inspection all the residents room doors had photos of the resident. It was observed during the tour of the home that pictures of the staff on duty were displayed. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 15 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 and 30 The home recruitment practices are robust and offer protection to service users. Staff are trained to do their job. EVIDENCE: During the inspection staff files were looked at and the files for the three newest members of staff files were inspected. All the three files had two references and each had the Protection of Vulnerable Adults (POVA) first check. The manager produced a separate file, which had each of the staff’s Criminal Records Bureau (CRB) documents. Each of the staff had a job application form and a full five pages long induction document, which had in most cases been completed. The file had the member of staff’s personal details, identification with photo, National Insurance details, birth certificate and any previously gained training certificates. The manager produced for the inspector a large folder with all the staff’s training details. This folder included every single person working in the home and documented title of course, date, date applied for and whether the staff member attended the course or not. As an example some of the courses were, foundation training, foundation in food hygiene, medication, fire training, manual handling, first aid. The manager was able to produce for the inspector documented evidence that nearly all the staff are have now achieved their National Vocational Qualification (NVQ) level two and some staff are now doing NVQ level three.
Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 16 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): 35, 37 and 38 The home is well managed and run in the best interests of the service users. EVIDENCE: At the last inspection the home was given two requirements around the issue of fire doors. During the tour of the home, no fire doors were observed to be wedged or propped open. One particular door was the door to the kitchen and when the inspector looked it was closed and remained closed throughout the inspection. The homes handling of resident’s money was looked at and the home is keen for all residents to have their own money where ever possible. A computer database is maintained by the home and identifies how much each resident has. The residents with high care needs in some of the dependent units are not able to have their own money and here families take responsibility where
Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 17 necessary. In these situations the families mostly have Power of Attorney and buy the resident anything they might need. Generally the home is well run, all the staff were observed to be working very hard. All the staff were see to be aware when residents needed support or directing to where they wanted to go. The kitchen staff worked very hard, making sure that good meals were delivered both to the homes residents and those in the community. Hygiene was strictly adhered to and everything was appropriately kept and labelled. All the staff including the domestic, kitchen, admin, care staff, manager and handyman all interacted well with residents. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 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 3 X X X 3 X 3 3 Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 19 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. 1. Standard OP33 Regulation 13(2) Timescale for action Medication must be administered 28/03/06 and recorded accurately in accordance with prescriptions and reasons for omissions recorded. This is a repeat requirement from the previous inspection. The risk assessments for a 28/03/06 service user who self medicates creams must address their over use of a prescribed cream, and precautions put in place to avoid this service user who self medicates running out of prescribed medication. This is a repeat requirement from the previous inspection. Requirement 2. OP9 13(2) 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 OP7 Good Practice Recommendations Daily notes should be easily accessible for staff to trace
DS0000037712.V285205.R01.S.doc Version 5.1 Page 20 Lehmann House what care the residents have received and issues that have arisen on the day. Lehmann House DS0000037712.V285205.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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