CARE HOMES FOR OLDER PEOPLE
Leivers Court Care Home Douro Drive off Kilbourne Drive Arnold Nottingham NG5 8AX Lead Inspector
Richard Ramsden Unannounced Inspection 30th November 2005 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 Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Leivers Court Care Home Address Douro Drive off Kilbourne Drive Arnold Nottingham NG5 8AX 0115 920 9501 0115 920 9501 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) Nottinghamshire County Council Mrs Margaret May Todd Care Home 38 Category(ies) of Dementia (19), Dementia - over 65 years of age registration, with number (19), Old age, not falling within any other of places category (38), Physical disability (5) Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Out of the total number of beds (38), there will be 19 beds for DE 55 and over and/or DE(E) Out of the total number of beds (38), 5 may be used for PD 55 and over Service users shall be within category OP Date of last inspection Brief Description of the Service: Leivers Court is a care home that provides personal care and accommodation for 38 older people. There is a 20 place Day Centre attached to the home, which operates over 7 days. The home is owned and managed by Nottinghamshire County Council Social Services. Leivers Court is a purpose built single storey building located within a housing estate approximately 1 mile from Arnold town centre. The accommodation is provided in four units, each unit has a fully fitted kitchenette/dining and sitting area, as well as communal toilets and a bathroom or shower room. All of the bedrooms are for single occupancy and have wash hand washbasins; there are no ensuite facilities. There are enclosed garden areas that are accessible to residents. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day and lasted for approximately 5 hours. It included the inspection of care and other records, and discussion with the manager, one member of care staff, as well as speaking with six residents and one visitor to the home. A partial tour of the building was also completed. What the service does well: What has improved since the last inspection?
A new manager has been appointed since the last inspection and although she had only been in post for approximately 3 weeks she had made significant improvements, particularly around administrative processes. There has been a significant improvement in the way in which the homes medication is managed, however some additional work is still required to ensure the health and safety of the residents.
Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 6 The written information provided to prospective residents now includes sufficient information to enable prospective residents to make an informed choice as to whether the home will meet their individual needs. Radiator covers have been fitted in all the areas in which residents have access; this will help to ensure that they are not at risk of burning themselves. A lock has been fitted to the laundry room door and cleaning materials are now being stored securely at all times. Some areas of the home have been redecorated 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. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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 Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 1. The literature provided to prospective residents now contains sufficient information about the home; to enable prospective residents to make an informed choice as to whether the home will meet there assessed needs. EVIDENCE: The literature supplied to prospective residents has been revised to include details of the staffs training & experience and the resident’s views of the home. (This is good practice). Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 7,8,9,10. The individual residents care plans have been comprehensively maintained, however they are not being reviewed frequently enough to ensure that staff are always aware of what care and support each resident requires. The records show that resident’s health care needs are being appropriately met. There has been a significant improvement in the way in which medication is managed since last inspection. However further improvements must be made to provide a safe system, that ensure that the residents health and safety is protected. Resident’s privacy and dignity is respected. EVIDENCE: Three residents care plans were viewed as part of this inspection. The care plans contained sufficient detailed information to ensure that staff are aware of what support and assistance each resident requires. It was noted that care plans are still not being reviewed at least once a month to ensure that the information is up to date. One short-term care residents care plan had not been reviewed since his previous admission to the home and consequently staff could not be confident that his needs had not changed.
Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 10 The records show that resident’s health care needs are being appropriately met. Four of the residents spoken with during the inspection said that they are satisfied with the health care arrangements made by the home. One person said that she is generally satisfied but that sometimes her General Practitioner does not visits as often as she would like. There have been significant improvements in the way in which medication is managed. The medication room has been changed and the manager stated that the store cupboards would have locks fitted by the end of the week of this inspection. The inspector noted that the medication administration trolleys were not locked at the time of inspection. The manager and staff were reminded that medication must be stored in a locked cupboard or container in a locked room. The records of room and fridge temperatures had been accurately recorded. Photographs have been provided to the majority of residents and were appropriately attached to their medication administration records. The manager was reminded that photographs must be provided for all short-term care residents. The staff had recorded the receipt of most of the medication however the records must include receipt of creams, liquids, paracetamol and the medication brought in by short-term care residents. The homes controlled medication was checked at random and had been well maintained. All of the medication administration records had been appropriately completed. All of the residents spoken with during the inspection said that the staff are friendly and helpful and always ensure that their privacy and dignity is respected. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 14,15. Residents are helped to exercise choice and control over their lives, but staff must inform them of their right to have access to their personal records. The meals provided to residents are wholesome appealing and well balanced. EVIDENCE: Residents are asked at the time of their admission if they wish to manage their own financial affairs. This is also discussed as part of the formal review process. There are documents displayed in the main reception area, informing people how they can contact local advocates. At the time of this inspection there was no literature informing residents or their representatives how people could get access to their personal records. The manager was advised that this information must be provided and that residents must be regularly reminded about the access to records policy. All of the residents spoken with during the inspection said that they were very satisfied with the food provided by the home. The menus showed that there is a good variety of food and the residents confirmed that alternatives would be provided if they do not want the food suggested on the menu.
Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 12 Since the last inspection one of the cooks has been recording the temperature of the cooked food each day. However there appeared to be some misunderstanding about exactly what cooked food temperatures, needed to be tested and recorded. The manager checked with the homes advisers who stated that all protein based meals must have their temperature tested every day. The manager agreed to ensure that all kitchen staff are aware of this requirement. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 13 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): 18 Residents are protected from abuse. EVIDENCE: The home has an acceptable Whistle Blowing Procedure, which was displayed in the staff room. (This is good practice). The member of staff spoken with during the inspection was clear that she must report any incidents of abuse the senior member of staff. The home has a copy of the local Vulnerable Adults Procedure, which is kept in the managers office. The inspector was advised that there have been no allegations of abuse and that none of staff have been considered for inclusion on the Protection of Vulnerable Adults register. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 24,25,26. Residents are happy with their individual bedrooms. Since the last inspection radiator covers have been fitted in all the areas to which residents have access helping to ensure that they are not at risk of burning themselves. The home was appropriately clean and there were no offensive odours at the time of this inspection. EVIDENCE: All of the residents spoken with during this inspection said that they were very happy with their bedrooms. All of the rooms contained personal items such as photographs ornaments and small items of furniture. The rooms were appropriately decorated and comfortably furnished. The call bell in one of the bedrooms was tested and was answered promptly by staff. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 15 One resident stated that she likes to have the commode moved from the bottom of her bed, where it is situated during the daytime, to the side of her bed at night so that she can have easier access to it. She said is that some staff moves the commode each evening but that others refused to move it. The manager stated that she would discuss this with the resident and take steps to ensure that the resident’s needs are met. Since the last inspection radiator covers have been fitted in all areas of the home which residents have access. This has helped to ensure that residents are no longer at risk of burning themselves. At the last inspection a requirement was made that a lock be fitted to the laundry door and that cleaning materials must be stored safely, to ensure that residents health and safety is not put at risk. A lock had been fitted to the laundry door and the cleaning materials were stored safely at the time of this inspection. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 29,30. Residents are protected by the homes recruitment policies and practices. Staff do receive adequate training to help ensure that they are competent to do their jobs. EVIDENCE: The records of the two most recently recruited members of staff were checked as part of this inspection. Each of the records only contained one written reference and one did not have confirmation that an appropriate Criminal Records Bureau check had been completed and received. This information was faxed to the home while the inspector was on the premises. The manager was reminded that the information should be kept on the premises, available for inspection at all times. The records showed that an application had been made for both of the new members of staff to commence appropriate induction training. Staffing records show that 40 of staff have completed NVQ level 2 training and that three additional members of staff have applied to complete this training. Two members of staff have completed NVQ level 3 and four other members of staff were completing the training at the time of this inspection. One person has completed NVQ level 4 and the manager is currently completing the manager’s award. (This commitment to staff training is good practice).
Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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): 33,38. The home is run in the best interests of the residents. The aspects of health and safety assessed during this inspection showed that residents and staffs health and safety are promoted and protected. EVIDENCE: The home participates in Nottinghamshire County Councils Quality Assurance System. An annual performance and development plan is produced from the information collated as part of the quality assurance system. The homes fire records were checked and were generally well maintained. There had been two fire drills in 2005 but the records did not show which staff had participated in the fire drills. All staff must attend at least one fire drill each year. On superficial inspection the homes fire risk assessment appeared satisfactory.
Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 18 The homes handy person had recently completed Legionella training and an appropriate Legionella risk assessment has been implemented. The water temperature tests had been completed for November 2005. The Environmental Health Officer visited the home are on 14 October 2004 and the manager is not aware of any work outstanding from this visit. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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 3 X X X 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 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 3 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 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 It is required that Care Plans are reviewed at least once each month in consultation with the resident and where appropriate their representative. (Outstanding from 29/06/05) It is required that medication is stored securely at all times. It is required that the staff accurately records the receipt of all medication. Timescale for action 09/01/06 2. 3. OP9 OP9 13 13 30/11/05 30/11/05 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 OP14 Good Practice Recommendations It is recommended that the registered person informs residents & where appropriate their representatives how they can access their personal records. Leivers Court Care Home DS0000036189.V262065.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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