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Inspection on 07/07/05 for Leighton Court Nursing Home

Also see our care home review for Leighton Court Nursing Home for more information

This inspection was carried out on 7th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

NHS and other health professionals are actively involved in the care of service users as needed. The service users spoken to told the inspector that the staff are kind and caring, and that their privacy and dignity are respected. An increasing range of activities is offered by the designated activities coordinator who works for 30 hours per week; with both individual and some group activities being available. Ongoing training and development was seen for most staff.

What has improved since the last inspection?

Staff supervision records and training has improved since the previous inspection, with the records seen being more concise and detailed. Activities and the opportunity for social interactions with staff and the local community has also been an area of significant improvement. The registered manager has now completed a Health & Safety course, and is cascading the information he has learnt to staff, both in verbal and written formats.

What the care home could do better:

Provide documented evidence of service user specific risk assessments and regular checks by a competent person, regarding the use of bed rails by service users. The overall standard of the environment, including cleanliness needs upgrading. Some areas were very nicely furnished and had obviously been redecorated and refurnished recently, whilst others were in urgent need of deep cleaning and refurbishment. The daily records completed by the qualified staff need more attention to detail, and certainly need to be crossreferenced with accident / incident reports, including basic observations as required.

CARE HOMES FOR OLDER PEOPLE Leighton Court Nursing Home 112 Manor Road Wallasey Wirral CH45 7LX Lead Inspector Julie E King Unannounced 7 July 2005 9:30 am 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. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Leighton Court Nursing Home Address 112 Manor Road Wallasey Wirral CH45 7LX 0151 638 9910 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) Southern Cross Healthcare Services Ltd Paul Dennis Carroll CRH Care Home 48 48 Category(ies) of (OP) Old age registration, with number of places Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One named adult (female) under the age of 65 years Date of last inspection 23 February 2005 Brief Description of the Service: Leighton Court is owned by Southern Cross Healthcare Services Limited, and is managed by Mr Paul Carroll, 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 F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over seven 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 F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 standard(s) 3 & 4 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 acting 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. All the service users spoken to during this unannounced inspection told the inspector that they felt “my needs are met”, and “everyone is involved”. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 &10 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. Some improvements were seen in the care plan detail and in the way they are recorded on a daily basis, however more improvements are needed regarding the recording of observations following falls by service users. 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 respected their privacy and dignity by “treating me well” and “asking me what I want”. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 9 Medications, the medication room and related records and documents were examined as part of this unannounced inspection. Some gaps were seen on the medication administration records (MARs), and some transcriptions were not double signed, which is not in accordance with current good practice guidelines. The medication room temperatures are consistently near the maximum temperature that drugs should be stored at (25 degrees Celsius). The registered person ought to give some consideration to installing a system of cooling, or other ventilation means, to reduce and control the temperature in this room. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 & 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 daily routines provided were flexible as far as possible, and service users are encouraged to exercise choice and control over their lives. Friends and family are actively encouraged to participate in the service user’s lives. A varied and nutritious diet was provided with specialist service user’s medical needs (such as diabetes) being catered for. The registered manager told the inspector that a new, revised programme of daily activities is being devised, and this was seen during discussion with the activities co-ordinator. 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. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 11 Service users told the inspector that they were “listened to”, and the “girls always knocked on the door before coming in”. They also told the inspector that they felt able to “choose” what they wanted to wear, where to sit, what to eat, what to do, etc. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 standard(s) 16 & 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. The CSCI has received one complaint about this service since the previous inspection. 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. 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. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 standard(s) 19 &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, and no records were available regarding risk assessment and safety checking by a competent person for these service users. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 14 Some of the service user’s bedrooms had lumpy pillows, and torn bedding was seen on the occasional bed. A number of clinical and general waste bins had no lids, presenting an infection control and odour risk – this had been identified on previous inspection reports. Extractor fans in some of the sluices were still not working, again identified on the previous inspection; and combustibles were found under one of the internal fire escapes. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 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, 29 & 30 Staffing levels are the minimum needed to ensure the safety and welfare of the service users. Pre-employment checks are thorough, helping ensure the protection of the service users. EVIDENCE: The home is staffed with the minimum staff required to meet the needs of the service users, with a qualified nurse and four or five care staff on duty in the daytime. Additional staff are brought in to accompany service users to hospital appointments, etc. The staff rota evidenced a much lower use of agency than in previous inspections; with the homes own staff covering the majority of hours. Staff spoken to during the inspection confirmed that a range of mandatory and specialist training was now available, with the majority of the cost being paid for by the care home. This approach to training is a positive aspect of Leighton Court, as it helps ensure that service users are being cared for properly and their needs are being met in accordance with current good practice guidelines. The majority of the service users currently have high dependency nursing needs. It is therefore strongly recommended that an additional care assistant is on each night shift, commencing as soon as practicable. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 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, 33, 35, 37 & 38 The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of service users, relatives and staff. 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. 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. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 17 The registered manager completes a monthly accident audit of all falls that service users have, and Regulation 26 & 37 forms are sent into the Commission on a regular basis. Environmental risk assessments were seen, but could do with expanding and updating; especially with regard to the use of bedrails. Certificates of worthiness for gas, electric and public (employee’s) liability were up to date and valid. It was recommended that all service users accidents are clearly crossreferenced with their respective care plans, and all observations are clearly recorded. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 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 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 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 x 3 3 x 3 x 3 x 2 3 Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 19 No 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 7 Regulation 15 Requirement The registered person must ensure that all service users care plans are valid and up to date at all times. The registered person must ensure that all medications are kept in accordance with current good practice guidelines. The registered person must ensure the furnishings and floor coverings identified during this inspection are either deep cleaned or replaced. The registered person must ensure tha care home is kept clean and odour free at all times. 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. Timescale for action 30 August 2005 01 August 2005 30 September 2005 30 August 2005 30 August 2005 2. 9 13 (2) 3. 19 23 4. 5. 26 37 16 17 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 Standard Good Practice Recommendations F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 20 Leighton Court Nursing Home 1. 7 2. 3. 27 18 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 strongly recommended that one additional care assistant is on duty during the night. It is recommended that a link person is nominated to act as a reference point for adult protection and the prevention of abuse. Leighton Court Nursing Home F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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 F52 F02 S20953 Leighton Court NH V237381 070705 Stage 4.doc Version 1.40 Page 22 - 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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