Inspection on 21/04/09 for Lelant Nursing Home

This inspection was carried out on 21st April 2009.

CQC found this care home to be providing an Adequate service.

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

Other inspections for this house

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Lelant Nursing Home Glen Road Mannamead Plymouth Devon PL3 5AP Lead Inspector Caroline Rowland-Lapwood Key Unannounced Inspection 21st April 2009 10:00 DS0000072703.V375035.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lelant Nursing Home Address Glen Road Mannamead Plymouth Devon PL3 5AP 01752 663626 01752 663626 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) Pilling Care Homes Limited Manager post vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40) of places Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is 40 06/03/08 Date of last inspection Brief Description of the Service: Lelant Nursing Home is situated in the Mannamead area of Plymouth, Devon. It is registered to provide nursing and or personal care for forty people, male or female, over the age of 65. The home admits service users for emergency short term and residential long-term care. Because of the nature of the building they share communal space and facilities. The home is arranged over three floors with access to most parts of the building via a passenger lift and wheelchair lift. Two bedrooms can be accessed by steps and are only suitable for mobile residents. There are single and shared rooms, some en suite. On the ground floor are a lounge and dining room. There is a garden and patio area. The home is under new ownership, Pilling Care Limited since October 2008. They currently have no registered manager. Current range of fees: £503 for Nursing care and for residential care is dependant on assessed need. Additional charges are made for: hairdressing, newspapers, trips away from the home and podiatry (chiropody). Prior to admission the home’s brochure is supplied. The most recent inspection report is displayed in the entrance hallway. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. Before our visit we sent a number of confidential surveys to people living there, to staff and outside professionals to hear their views. We received completed surveys from 8 people living at the home and four relatives. Six surveys were returned from staff and four from outside professionals. The comments and responses we received have helped us to form the judgements we have reached in this report. This unannounced inspection took place as part of the normal programme of inspection. The site visit was undertaken over two days; on the second day a pharmacist inspector and two inspectors were present. The second inspector undertook a short observational framework for inspection (SOFI). This is a tool used to record observations during inspections where people have dementia or learning disabilities. As a way of judging the service overall, during our visit, we (the commission) spent time talking with people who live at Lelant. Most people living at the home were seen or spoken with during the course of our visit. We spoke with care and ancillary staff, the matron, the home’s general manager and the home owner. We looked at the care and accommodation offered to three people living at the home and observed the care and support provided by staff. We also looked at a number of records the home is required to keep, including assessment and care plan files, daily reports, staff recruitment and training records. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home, and an assessment of what they do well and what they plan to improve upon. What the service does well: Most people told us they had received enough information about the home before moving in. People can visit before they make a decision. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 6 People living at the home have access to a variety of health care professionals to help meet their health care needs. There are no restrictions upon visiting at the home and relatives and friends are encouraged to visit as often as possible. People responding to CQC surveys and those spoken with during our visits said they “always” enjoyed the food. People told us the food was good quality, one person said, “The food is good & plenty”. We found that where people are prescribed nutritional supplements that the use of these is recorded. Complaints are generally handled well. People’s concerns are listened to and people told us that the home responds appropriately when concerns are raised. Everyone we talked with spoke highly of the staff; people told us staff were friendly and helpful. The home has robust systems in place with regard to staff recruitment; this ensures people are protected. The home is generally well managed with regard to health & safety and general management of the building; they are working hard to improve. What has improved since the last inspection? What they could do better: There is concern about the detailed information in plans of care not being undertaken by staff. Assessments are being undertaken and updated where changes have taken place, however staff are not following through this care consistently. Care plans contain no social histories; this is useful information as this gives the staff a sense of who the person really is. They also contain no information with regard to preferred activities. We found that some systems for the handling of medicines may place people at risk of harm. This was especially in relation to the administration of medicines prescribed with variable doses where the records made did not indicate the actual dose given meaning it is not possible to determine if it is safe to administer the net dose and at what level this dose should be administered. We also found that not all medicines were being administered from labelled containers meaning that people could not be sure they were receiving medicines prescribed for them or medicine that was still within its expiry date. Staff must ensure that they respect the privacy and dignity of all people at all times. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 7 Improvements are needed to ensure that peoples’ social and leisure needs are met and recorded, especially those with limited capacity or specialist needs. Improvement should be made to the diet for those people needed pureed food. People must be made aware of the correct name address and telephone number of the Care Quality Commission so that they know how to contact the Commission if they have concerns. Staffing levels must be increased so that all people can have their needs met at all times. Improvements must be made to the continual maintenance, decor and carpets so that the people living there are comfortable and happy and their privacy and dignity is promoted at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 8 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 Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is available to people about this service so that they know what to expect and overall people benefit from a good assessment process, which ensures that the home can meet their needs. EVIDENCE: The home gives people detailed information about the services it provides. Copies of the Statement of Purpose and Service Users Guide were seen. People told us they had received enough information about the home before moving in. The home has admissions via the RITA scheme (admission of people who need some immediate care that does not require hospital admission), continuing care (highly dependant people who need care but do not need to be in a hospital environment) and supportive discharge/ onward care team (for people who can be discharged from hospital but need a little Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 10 more time or care before going home). These people are not always assessed in person before admission but comprehensive information is forwarded to them from the various care managers before a placement is made to give the home time to assess whether they think they can meet a persons needs or not. Two people spoke with us about their admission to the home, one told us, “I was made to feel welcome on arrival” and another said, “From the start I felt welcome and have settled in well”. We looked at four files to see how people’s care and support needs are assessed before they moved in. As social services or health care professionals make all referral to the home, a variety of information is gathered from them before people move in. The matron visits people who are considering a move to the home to get to know them, to provide information about the home, to answer any questions, and to carry out an assessment. We saw that the home had gathered good information about a range of individual personal and health care needs. This process helps to ensure that people are given relevant information about the service and that the home can meet people’s individual needs. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living at the home has a comprehensive care plan in place however not all staff are consistently delivering the care need in a way that people need and prefer. Some areas of the management of medication are not satisfactory and could put people at risk. EVIDENCE: Three people responding to CQC surveys told us they “usually” received the care and support they need, two others said they “always” get the support they require. People that were able to express their opinions were happy with the care provided, one said, “I’m happy here”, another told us, “They are lovely here no problems”. We looked at the care planned for three people, three with complex and changing needs. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 12 The care plan for one person indicated that she had poor communication due to Alzheimer’s and that staff were to observe her facial expressions, talk to her and reassure her for all procedures, ask simple questions and allow time to absorb information. With regard to her eating staff were instructed that as she doesnt have any swallowing deficit she may have all textures of food. Give fluids and encouraged to drink. The care plan was reviewed on the 22nd of April 2009. However she was fed a soft diet. The matron said this was from her choice. She was given a meal which consisted of a thick brown paste from a bowl. The matron confirmed that meals were served up from the kitchen with each component separately liquidised. During the observation it had been noted that staff were stirring the bowls of food, so when some staff came to feed individuals they mixed up the separate components with a spoon and fed people a combination. The Matron agreed this would cease. Another person has a diagnosis of dementia and was at the care home for a period of respite. The care plan and her file indicated she does not express any emotions. This was discussed with the manager as she clearly expressed emotions throughout the period of observation. Her care plan indicates fluids are to be given by oral syringe and that at lunchtime she likes ensure instead of lunch. On the day of the visit she was given lunch. Her meal was given slowly, however her head was not being supported appropriately as indicated in her care plan. Whilst sitting observing for a period between 11:40 a.m. and 11:50 a.m. a person living at the home was showing severe signs of petit mal epileptic seizures including dramatic jerking and shaking, twitching of the body. This followed immediately after her waking from a sleep. Her care plan indicated that she suffered from this and that she exhibited the cerebral irritation by body jerking and severe twitching. Throughout this period they looked distressed and agitated. No staff came into the lounge or past, so no-one observed this and were surprised when told about it. This demonstrates there is not enough time being spent with people, in activity or monitoring well being. Another person has a diagnosis of dementia, but has also had a severe stroke (CVA). Her care plan indicated she was to be observed for non-verbal clues, and that people should face her during conversations, speak slowly and clearly and offer one thought of the time. This was not how communication was delivered during the inspection. Staff sat by her side, sometimes talking to other people. The matron fed her, and on three occasions said she was a “good girl” for eating well. Another person had no diagnosis of dementia. The care plan said that staff should re-orientate her and encouraged her to talk. None of this was seen during the course of the observation. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 13 The television was on until staff came into the room to help people eat at which point the television was switched off with no communication with people in the room. When staff had finished helping people the television was switched on with no communication with people in the room. During the first part of the observation the television showed the “Trisha show” which concerned a lively debate on alcoholism and adultery. No one was watching. However during the course of the observation when there was music on the television one person was seen to be moving her foot and it might be that people would appreciate music rather than the television on during the day. Four of the people observed were sitting on slings. Although they were repositioned during the course of the day they spent most of the time seated on a sling, clearly for staff convenience. Three out of five people observed had bibs on all morning over their clothes. Only one of those people according to the manager might lose saliva or dribble. This is undignified. Each person observed had in front of them a table on which was a clipboard and a series of charts which may have been for positioning or fluid balance. This was discussed with the matron as it was clearly institutional, again for staff convenience and did not allow people full use of the table or privacy. She agreed to make sure they were placed in a more inaccessible position. Throughout the inspection staff talked about people in front of them, and talked over them. Examples of this were Im going to do because shes pretty quick Ill feed her then feed someone else. This is poor practice and does not promote individual dignity or privacy and lacks respect for others. People also used inappropriate language such as good girl when people were eating well. Staff spend time talking about their weekend and what they were going to be doing instead of concentrating on supporting the person in front of them. However on a positive note generally the staff did spend a good amount of time helping the people to eat, they were not rushed. People living at the home told us they “always” receive the medical support they need. Visiting health professionals told us the home “always” or “usually” seeks advice when necessary and acts on advice given with regards to people’s care and support. Health professionals seemed confident that people’s needs were met. One visiting GP told us, “I am happy with the care offered by the home”. Records showed that outside professionals visit people regularly, for example GP, community nurses, chiropodist, and other specialists. People are also supported to attend out patient clinics. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 14 We found that the home had recently obtained new medicines trolleys and most medicines were found to be stored securely. However we found that when medicines including creams are stored in people’s rooms that they are not stored securely. Also we found that the use of these creams is not always recorded. This means that it is not possible to determine a person’s response to the treatment they are receiving. We found that when people are prescribed nutritional supplements that records are made of their use and it is therefore possible to show if these are effective or not. We found that some medicines were being administered from unlabelled containers and in one case that the tablets were in a plastic bag that did not have any reference to batch number or expiry date on it. This means that the home could not be certain that these medicines were prescribed for the person to whom they were administered or that the medicines were still safe and effective to use. For this person we could only find that the medicines had been verified as correct for a previous stay at the home and no record had been made to show that the medicines had been verified before the current stay. This means that the home could not be certain that they were administering the medicines in accordance with the prescriber’s current directions. We also found that when medicines are prescribed with a variable dose that the actual dose administered is not always recorded only that something has been administered. Again this means that it is not possible to monitor a person’s response to the medicine administered. We also found that for some medicines such as Paracetamol that although there were records to say that a person had been administered the medicine that no stock was available in the trolley for them and they had been administered medicines prescribed to another person. This means that it is not possible to audit a person’s medicines. We were told that this had occurred because the home had only just started using the new trolleys and had not checked that each person had all of their medicines in the trolley. There is also a medicines room on the lower ground floor. We found that the temperature of this room was poorly controlled and was above that recommended by the medicine manufacturers. There is also a dedicated medicines fridge within this room. We found that the temperature of this was poorly controlled and not all medicines were stored within the temperature range as indicated by the medicine manufacturers. This means that these medicines may not be effective when administered to the person to whom they have been prescribed. We also found that whilst the home had a Controlled drugs storage cupboard that complies with the current regulations that it was not fitted in accordance with the regulations. This may lead to an increased risk of diversion of these medicines occurring. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no social and leisure activities provided which means people are not enjoying a fulfilling life. Their individual social needs are not being met. People enjoy the food, which mostly meets their dietary needs and preferences. However attention must be given to those people who need a soft or pureed diet to ensure they receive an appetising meal. EVIDENCE: Four people spoken with told us there was “nothing going on” “it’s a long day” and “the staff are lovely but it gets very boring”. The home provided us with their Annual Quality Assurance Assessment (AQAA), in this they said “Activities are held according to residents choice” and “Residents are leading their daily activities”, no evidence was seen of this. Almost all the communication seen was task orientated and there was very little social interaction with the people being cared for. No activities and stimulation were provided and the care plans had had no indication of individual activities plans, hobbies and interests or social and personal Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 16 histories. One person we spoke with said that they preferred to stay in their room. No activities had been recorded for this person. We visited them and they were thrilled to be able to chat and said that they are often lonely. During our observation time we saw some good interactions, which improved people’s state of being. Staff were friendly and good humoured often having a joke with the people living there. We spoke to many people during the course of the inspection and those people that were able to express themselves all said how good the food was. Some comments received were, “The food is really good”, “I shall miss the food its lovely” and “The food is always nice, hot and plenty of it”. Another person told us the food was “good quality”. Those people that require a soft or pureed diet have their meals served to them in a bowl, we observed staff mixing up the contents, this made the food look unappealing and we were unable to guess what the food actually was, we heard one member of staff say “ what is it?” when giving their meal to the person. Meal times are not staggered meaning that those people needing help to eat have to wait longer. We were told choice was available and that people were asked in advance what they would like that day, however people told us that they were not asked in advance but if when the meal was served they did not like at they could ask for al alternative, meaning they would have to wait for another meal. Meals are mostly taken in the dining room and we saw people being helped to go there for the main meal of the day. The dining room was of small size and is also by staff, it contained a desk with many files relating to staff training. This did not give the room a homely feel. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to and staff understands the principles of adult protection, which helps to protect people from abuse EVIDENCE: The complaints policy is given to all people living in the home, although this is not up to date with the correct name address and telephone number of the Care Quality Commission. In surveys respondents say they know who to speak to if they are not happy and know how to make a complaint. We were told that all complaints made are recorded and investigated. No complaints have been received by the CSCI since the last inspection. All staff was aware of procedures to protect people from harm although they said they were waiting for up to date training on safeguarding; They were able to give appropriate examples of unacceptable practice (such as shouting or blocking people into chairs to stop them walking about), and knew they must report this to senior staff. All people living at the home asked said they felt safe at the home. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 18 Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although some areas of the home are maintained and decorated to a satisfactory standard many areas are looking tired and are in need of redecoration with carpets needing replacing EVIDENCE: The home currently does have an ongoing maintenance programme in place. Essential maintenance is done when a problem has arisen. The décor requires upgrading and many carpets need replacing. The quality of life for the people living in the home is made worse by the environment they are living in. We looked around the building to see if it was a clean and attractive place for people to live. We were told that 3 domestic staff are employed to work 7 days Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 20 per week every week as well as an afternoon domestic. All areas of the home were clean and there were no unpleasant smells. We visited many of the bedrooms most were tired looking some with ripped wallpaper, chipped paintwork, radiator covers not painted and chipped, doors needing attention, and the general décor in need of upgrading. The carpets in the hallways are badly stained and need replacing. In the main entrance there is an old notice board with policies and procedures which are out of date and some photographs of long past outings. We saw one bedroom which had just been decorated; it was light and finished to a good standard. The laundry is well equipped, clean and well organised. A red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are just adequate. However extra staff is needed especially at core times of the day to ensure people get their needs met in a timely way. People benefit from having kind & friendly staff looking after them, however staff need to ensure that they consistently give good care and promote good practice. People are protected by the robust recruitment practice followed at the home. EVIDENCE: People told us staff were “always” or “usually” available when needed. During our visit people told us, “I don’t usually have to wait too long for attention”; “Staff are usually around when you need them”. Staff seemed well organised but were rushing to get the work done. One member of staff said “We don’t get time to spend to just talk to the residents unless we are doing something for them” The number of staff on duty at lunchtime needs attention to ensure people’s needs are met. Many of the people that sit in the lounge need help with eating some have to wait as there is not enough staff to help one to one for all people. We saw some good examples of good care being given with time and consideration being given to Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 22 the individual, however we also witnessed staff not promoting the dignity and privacy of others and they did not follow the care as described in the care plans. Staff spoken with told us there “usually” enough staff on duty but often “they were short”. One staff member told us, “We usually manage, it can be difficult with sickness or holiday though”; other staff members confirmed this. When asked what could be improved a GP told us “More staff, they take an awfully long time to answer the phone too”. On the first day of the inspection the phone was left constantly ringing on many occasions as was the front door bell. People living at the home were generally very happy with staff attitude and approach, we received many positive comments, including, “They (staff) are mostly friendly and happy”, “Staff are friendly, helpful and very polite”, “Staff are very good really. Kind and pleasant” and “We have good staff. I have a nice relationship with them”. We looked at the files of three staff to ensure that the home operates a robust recruitment procedure, which protects people. These contained all the required documentation including satisfactory police checks to ensure that people living at the home are protected from unsuitable staff. Staff surveys showed that they were well supported when they first started working at the home. We were told that the induction provided covered everything they needed to know. Staff spoken with during our visit said they felt well supported and that good training opportunities were available to them. Records at the home show that new staff receives a structured induction. Staff also receives training in mandatory subjects such as Fire, Protection of Vulnerable Adults, First Aid, Moving & Handling and Basic Food Hygiene. Health professionals’ felt that staff “usually” had the right skills and experience to support individual health and social care needs We were told that over 50 of care staff had achieved a nationally recognised care qualification (NVQ 2 or above) to ensure that staff are competent to meet peoples’ general care needs. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed. There are good arrangements in place to involve people in the running of the home. Health and safety is generally well managed. EVIDENCE: There is currently no Registered Manager at the home. The home employs a general manager who is there on a day to day basis, he overseas all aspects of managing the home other than the care, this is managed by the acting matron. She has many years nursing experience and is applying to register as the manager in the near future. Staff said they felt settled and there was a clear sense of leadership and direction; they felt confident that they were able to Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 24 raise concerns and issues. There is an adequate quality assurance system in place. This includes people living at the home, friends, relatives and health professionals’ satisfaction surveys. Maintenance and associated records provided evidence that the registered provider has a sensible approach towards maintaining the safety of the environment; the fire precautions logbook indicates that the fire alarm is tested weekly and emergency lights monthly. Radiators throughout the home are covered and the hot water was within the safety limits. The AQAA showed that maintenance of equipment and systems, such as gas and electrical systems, and equipment such as the passenger lift, and hoists were up-to-date. Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 25 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 26 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 OP7 Standard Regulation 15(1) Requirement The care plan must include all aspects of health & welfare needed and how these are to be met. This refers to the social histories and details of individual and personal activities required. Arrangements must be made to ensure that people only receive medicines from their original dispensed containers and that medicine regimes are verified on admission. This is to ensure that people receive medicines safely. The privacy and dignity of people living at the home must be respected at all times. You must consult with people about their social interests and make arrangements to enable them to engage in a range of activities inside and outside of the home. Particular consideration must be given to people less able and those spending considerable time in their bedrooms. The complaints procedure must include the name address and telephone number of the Care DS0000072703.V375035.R01.S.doc Timescale for action 31/05/09 2 OP9 13(2) 31/05/09 3 4 OP10 OP12 12(4) 16(2)(m) 31/05/09 31/05/09 5 OP16 22(7) 31/05/09 Lelant Nursing Home Version 5.2 Page 27 6 7 OP19 OP27 23(2)(d) 18(1) Quality Commission. All parts of the home must be kept in a good state of repair. Staff must be employed in sufficient numbers so that people’s needs are always met. Also staff must be competent to carry out the work they are to perform, as stated in the plans of care. 31/10/09 31/05/09 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 OP9 Good Practice Recommendations It is recommended that the home review the arrangements for auditing and monitoring medicines in use at the home. This is to check that people have their medicines available to them when they need to take them. Pureed meals should look appetising and portions served individually. Choice of meals should be made in advance so that people do not have to wait for their meal. The dining should be used solely for this purpose and not contain a desk and staff training records which do not lend itself to a homely comfortable environment in which to eat. 2 3 4 OP15 OP15 OP20 Lelant Nursing Home DS0000072703.V375035.R01.S.doc Version 5.2 Page 28 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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