Inspection on 19/01/06 for Leighton Court Nursing Home

This inspection was carried out on 19th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Leighton Court Nursing Home 26/11/09

Leighton Court Nursing Home 09/10/08

Leighton Court Nursing Home 23/06/06

Leighton Court Nursing Home 07/07/05

Leighton Court Nursing Home 23/02/05

Leighton Court Nursing Home 10/11/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Leighton Court Nursing Home 112 Manor Road Wallasey Wirral CH45 7LX Lead Inspector Julie King Unannounced Inspection 19th January 2006 08:30 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 Leighton Court Nursing Home DS0000020953.V277768.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. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Leighton Court Nursing Home Address 112 Manor Road Wallasey Wirral CH45 7LX 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) 0151 638 9910 0151 638 9909 Southern Cross Healthcare Services Limited Paul Dennis Carroll Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named adult (female) under the age of 65 years Date of last inspection 7th July 2005 Brief Description of the Service: Leighton Court is owned by Southern Cross Healthcare Services Limited, and is managed by Ms Mandy Eccles, a first level nurse with many years experience in caring for the client group and Company policies and procedures. This care home is registered to provide nursing care for 48 older persons 65 years and over. Leighton Court is a three-storey purpose built nursing home close to Liscard shopping centre and other local amenities. Care and accommodation for service users are provided on the ground and first floor, and the kitchen, laundry, staff areas, treatment room and hairdressing salon are located on the top floor. All floors are served by a lift. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over nine hours. A full tour of the premises took place. A range of records such as care plans, staff personnel files, policies & procedures and medication charts were examined. A selection of staff on duty, and a number of service users were spoken to during the course of this inspection. What the service does well: 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. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 6 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 Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5. The service users assessed needs are being met, and the home is able to provide assurances to service users and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: Service users are only admitted into the home on the basis of a full assessment is carried out prior to they move in. All pre-admission assessments are carried out by either the new manager or senior nurse, and include direct input from the prospective service users’ family / representative as agreed. Multidisciplinary healthcare team members such as the service users’ social worker, physiotherapist or NHS ward nurse, are part of this process. Specialist healthcare professionals continue to be involved in the care of service users after they are admitted into Leighton Court. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,11. There is a consistent care planning system in place for most service users. This provides staff with the information they need to satisfactorily meet the service user’s needs. EVIDENCE: Individual care plans had been documented for each service user, and all seen were in the process of being updated and reviewed with the involvement of the individual service user as far as possible. Improvements are needed in all care plans seen regarding the way they are recorded on a daily basis, and more improvements are needed regarding the recording of observations following falls by service users. The inspector was concerned with the high numbers of falls suffered by service users, especially at night. This was discussed with the manager and operations director during the inspection with a view for staffing levels to be increased. Systems are in place to ensure good communication between the care home, the NHS and other professionals involved in the care of all the service users. The service users spoken to during the inspection all commented on the standard of care they received. They confirmed they had access to various healthcare professionals as necessary, and stated that the care staff always Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 9 respected their privacy and dignity by “treating me well” and “asking me what I want”. Policies and procedures are in place regarding caring for service uses who are terminally ill, and staff spoken to during this inspection were able to inform the inspector about their knowledge in this area. Medications were examined as part of this unannounced inspection, and it was evident that the medication management on the ground floor was satisfactory. However the medication management on the first floor did not meet the required standard with gaps in the medication administration records (MARs), key system not always used, old stock in drugs trolley and inaccurate recording on some medications. The policy also needs updating, as the one shown to the inspector was dated 2001, which is not in accordance with current good practice guidelines and recent disposal changes. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 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 the following standard(s): 12, 15. Links with the local community are good, and support and enrich service user’s social lives. The meals in Leighton Court are good, offering both choice and variety, and catering for special dietary needs. EVIDENCE: The new manager told the inspector that a revised programme of daily activities is being devised, and this was seen during discussion with the manager and staff. Much more involvement of local community groups and resources was evident. A detailed file had been started which listed the service users who had taken part in activities – this is kept by the activities coordinator, but accessible by the service user and staff. It is recommended that the new ‘tick box’ system of recording activities is not used on it’s own as this does not evidence how the service users actually participated in the activities offered. The kitchen areas were examined, and it was found that a recent Environmental Health Officer’s (EHO) report and requirements had not been acted upon. Raw meat was stored in the freezer on the same shelf as bread, and fridge number one was still leaking water onto the kitchen floor via it’s rusty base. This EHO report was given to the manager on 22.10.05, so Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 11 adequate time has passed for these requirements to have been met. A requirement to comply will now be issued by the CSCI to this effect. Leighton Court Nursing Home DS0000020953.V277768.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): 16,17,18. An efficient complaint and adult protection policy and procedure was in place to help ensure the safety and welfare of service users. EVIDENCE: Leighton Court has an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that they, their relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, in accordance with the Department of Health ‘No Secrets’ guidelines. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. The service users all spoke highly of the staff team and said they “have no complaints about how I’m treated”, and “nothing is too much trouble”. Some advocacy information was available if required by service users or their relatives. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 13 It was recommended to the registered manager that a ‘key / link person’ is established to take a lead role in adult protection and the prevention of abuse – this was a recommendation from the previous report that has not been actioned upon. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 14 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): 19,20,21,22,23,24,25,26. The overall fabric of the building is of a good standard, with most service users’ rooms being highly personalized. However the ongoing programme of redecoration and refurbishment must address the issues identified during this inspection. EVIDENCE: All communal areas and bedrooms were examined, and some evidenced ongoing decoration and / or refurbishment, albeit to varying degrees. Bedrooms were highly personalised, with many service users bringing in their own furniture, etc. Some service users rooms had a strong smell of urine, and many of the carpets in these rooms were dirty and stained. Some rooms had damage to the wallpaper, and chunks of wood out of the doors and woodwork. Bed rails were seen in use for some service users, but the ones seen were not fitted correctly, but records were now available regarding risk assessment and safety checking by the handyman for these service users. It was strongly recommended to the Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 15 manager that the handyman, or designated person who will be responsible for checking bedrails completes a recognised course to ensure his competency. Some areas of the environment had not been addressed from the previous inspection as follows: • • • • • • • • • • • Bathroom 53 still full of wheelchairs Sluice disinfector still not working, nor was extractor fan No lids on clinical and general waste bins, including sluice Radiator covers loose or not covering heat diffusers in some cases Curtain pelmets hanging off Room 68 – bedrail bent Many items of NHS bedding seen on service users beds, and NHS towels in bathrooms Communal items in bathrooms such as net underwear, tights and stockings, toiletries and razors Room 8 – very malodorous and requires floor covering replacement Many headboards dirty and marked (Non-hygienic coverings on all headboards) Wooden bedroom and dining room chairs in bathrooms Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 16 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 The recruitment and training policies and practices of the home are not always robust, and the appropriate checks on staff are sometimes not being carried out. This does not adequately safeguard the service users from risk or harm. The night staffing levels are unsatisfactory, potentially placing service users at risk of accident, injury and harm. EVIDENCE: A number of staff personnel files were examined, and some were found to be lacking in basic requirements such as specialist care, or ongoing training and development. Some files had inadequate documentation and records regarding the recruitment of staff, including references, CRBs and POVA checks. The new manager has audited these personnel files herself and has identified what requires to be done to comply with this standard and associated regulations. On the previous inspection in July 2005, it was strongly recommended that an additional care staff is deployed at night. This recommendation has not been implemented, and the number of service user falls, especially at night is concerning. Presently there is one RN per floor, accompanied by two HCAs on one floor and one HCA on the other floor. This is inadequate given the current dependency of the service users and the layout of the building. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 17 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): 32,33,38 Improvements in record keeping and risk assessments are needed to help ensure the health, safety and welfare of service users and staff. EVIDENCE: Some quality assurance is in place, with feedback and minutes of staff meetings kept. Audits are also in place for documentation, but actions taken were not available, especially for accidents and monthly care plan reviews. The staff made positive comments and suggestions by all spoken to. Patient’s monies are kept in separate, secure facilities, and records of all transactions were seen. Environmental risk assessments were seen, but could do with expanding and updating; especially with regard to the use of bedrails. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 18 Certificates of worthiness for gas and public (employee’s) liability were up to date and valid, but the NICEIC (electrical safety) was invalid and marked “UNSATISFACTORY” by the electrical contractor. Rectification of all faults are required to be completed as soon as possible. It was recommended, as in the previous report, that all service users accidents are clearly cross-referenced with their respective care plans, and all observations are clearly recorded. Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 19 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 3 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X X X 2 Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement The registered person must ensure that all service users care plans are valid and up to date at all times. Previous requirement of 30.08.05 not met The registered person must ensure that all medications are kept in accordance with current good practice guidelines. Previous requirement of 30.08.05 not met The registered person must ensure the furnishings and floor coverings identified during this inspection are either deep cleaned or replaced. Previous requirement of 30.08.05 not met The registered person must ensure that care home is kept clean and odour free at all times. Previous requirement of 30.08.05 not met The registered person must ensure that all the documents and records as specified in Schedules 1, 2, 3 & 4 are kept up to date and valid at all times. DS0000020953.V277768.R01.S.doc Timescale for action 31/03/06 2. OP9 13 (2) 31/03/06 3. OP19 23 31/03/06 4. OP26 16 31/03/06 5. OP37 17 31/03/06 Leighton Court Nursing Home Version 5.1 Page 21 6 OP 15 16 7 OP 20 16 8 OP 21 16 & 23 9 OP 24 16 10 OP 27 18 11 OP 28 18 12 OP 33 24 13 OP 38 23 14 OP 29 19 Previous requirement of 30.08.05 not met The registered person must comply with the requirements issued by the local EHO within the given timescales The registered person must ensure that fittings and furniture are of a suitable standard, and must replace damaged items. The registered person must ensure that all bathing areas have suitable and clean equipment available at all times. The registered person must ensure that there is suitable and appropriate bedding in sufficient quantities for all service users at all times. The registered person must ensure that there are sufficient members of staff on duty as to safeguard the health, safety and welfare of all service users at all times. Timescale for action: 21/01/2006 and ongoing The registered person must ensure that all staff receive appropriate training, suitable to the work they perform. The registered person must develop and evidence a regular quality checking system in conjunction with a system of improving care. The registered person must ensure that the premises are safe at all times – and must forward on to the CSCI a valid NICEIC electrical safety certificate as soon as all necessary work is completed. The registered person must ensure that all the documents and records as specified in Schedule 2 of The Care Homes Regulations 2001 for all staff employed. DS0000020953.V277768.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 21/01/06 31/03/06 31/03/06 31/03/06 31/03/06 Leighton Court Nursing Home Version 5.1 Page 22 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 It is strongly recommended that all clinical observations as necessary are completed for all service users who have any known, or potential head injury following a fall - and that these observations are clearly recorded. It is recommended that a link person is nominated to act as a reference point for adult protection and the prevention of abuse. 2. OP18 Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Leighton Court Nursing Home DS0000020953.V277768.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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