Inspection on 24/06/08 for Lennox House Care Home

This inspection was carried out on 24th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lennox House Care Home 03/12/08

Lennox House Care Home 23/10/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Lennox House Care Home 75 Durham Road London N7 7DS Lead Inspector Pippa Canter Key Unannounced Inspection 24th June 2008 10:20 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 Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 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. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lennox House Care Home Address 75 Durham Road London N7 7DS 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) 020 7272 6562 0207 561 3638 manager.lennoxhouse@careuk.com Care UK Community Partnerships Ltd Sheila Ali Care Home 87 Category(ies) of Dementia (56), Old age, not falling within any registration, with number other category (87) of places Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either 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. Dementia - Code DE (maximum number of places: 56) The maximum number of service users who can be accommodated is: 87 23rd October 2007 Date of last inspection Brief Description of the Service: Lennox Lodge is situated in Finsbury Park, in residential area. Good transport links are within walking distance from the home. There is pay and display parking on the street that Lennox Lodge is situated in. The home was purpose built as a care home and provides accommodation over three floors. At the time of this inspection the third floor had just begun to take admissions. There are communal lounges on each floor and all bedrooms have ensuite facilities. The providers are Care UK who are working in partnership with the London Borough of Islington to provide forty (40) beds. Under the partnership arrangements fees for personal care only are £540 and for nursing £700. For the remainder of the beds Care UK will charge for personal care £550 and for nursing care £750. Lennox House Care Home DS0000069788.V362170.R02.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 using this service experience adequate quality outcomes. This unannounced key inspection was completed over two days 4th June 2008 and 24th June 2008. A total of 11.5 hours were spent in the care home altogether. Recently, the Commission for Social Care (CSCI) has been made aware of concerns raised by a relative of a resident about the lack of care her aunt received. Whilst this was not the purpose of this key inspection to investigate the concerns raised as such, the concerns raised have been considered when assessing the relevant National Minimum Standards. The concerns have been investigated on behalf of Islington Primary Care Trust and Local Authority by an independent person, under their safeguarding procedures. A report has been issued and the care home has produced an action plan in response. The Primary Care Trust will continue to monitor the implementation of the action plan. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires were circulated for people living in the home, relatives as well as health and social care professionals. Nineteen surveys were received from people living in the care home. Unfortunately some of these had been mistakenly completed by staff therefore they were not considered very valuable. Four surveys were received from relatives and one from a health care professional. We got feedback from one person who visits the care home during a telephone call. We have looked at the information collected from the previous inspection and relevant information from other organisations. During both visits we looked at the premises and visited people in their own rooms with their permission. People living in the service and staff were spoken to and the serving of lunch was observed on both occasions and there were other periods of observation throughout the two days Staff were observed going about their duties and interacting with residents. We followed the care for five (5) people who are currently living in the care home and a further three other care plans were looked at. The care plans were compared with the care being given. The choice of care plans reflected Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 6 people’s gender, specific health care conditions and cultural needs. The inspection focused on aspects of care, daily activities, staffing levels, supervision, complaints and adult protection. Staff recruitment and training records were looked at as well. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. What the service does well: What has improved since the last inspection? At the last inspection, seven areas for improvement were identified. This inspection has shown that there has been no progress made in six of the areas. The seventh area was not inspected but a separate pharmacy inspection has been requested instead. In accordance with the Commission for Social Care Inspections’ policy and procedures where no improvement has been made the inspection report will be sent to the Regional Enforcement Team for consideration in respect of enforcement action. The same requirements will not be repeated in this report but the service will be asked to submit a separate improvement plan. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Lennox House Care Home DS0000069788.V362170.R02.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 Lennox House Care Home DS0000069788.V362170.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process is not always applied consistently. People moving into and living in the care home may not have all their needs identified and met. EVIDENCE: A requirement was set at the last inspection as the assessments of people who live in the home were assessed as not including sufficient detail to form a holistic view of that person’s needs. It was judged that people who live in the home must be involved in this process in order to make sure that all needs would be identified. The care home has introduced a new electronic record keeping system, Saturn Live Database. During both visits to the service there were both electronic files and paper records to inspect. Case tracking shows some good practice is Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 10 taking place as a result of looking at a sample of admissions assessments. Eight case files were looked at, including people who had been recently admitted to the care home. In all instances the care home had completed a pre-admission assessment and there was also supporting evidence from the referring agency. This was either in the form of hospital transfer letter and/or an assessment under the Care Management Approach from a social worker. There is no supporting evidence from looking at the assessments or from talking to staff and residents that the person using the service has been able to make a contribution to the assessment process. Although we received feedback from two people, who confirmed that their relatives had visited the home on their behalf or on one occasion the person accompanied their family to look around. Details of these visits are not recorded and if any information was gleaned during this time it is not evident in the records. There is a lack of personal information recorded in the homes’ assessment regarding personal preferences, the persons’ or families’ aspirations and the pre-admission assessments do not indicate the sources of information, from which the assessment has been compiled. The pre-admission information was compared to the information on the computerised care records (Saturn Live Database). The assessments contain basic information and do not form a holistic view of the persons’ needs. A requirement has been made. This is requirement 3. Risk assessments were available but these had not always been updated. There were shortfalls noted in respect of risk assessment around wound management and behaviour. This service is registered for older people with dementia however risk assessments relating to behaviour are not available. An example of this is one care plan recorded details about a residents’ non- compliance with smoking but a risk assessment was not available identifying how decisions had been reached to promote safety. Lennox House Care Home DS0000069788.V362170.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 & 11 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service and their representatives must be involved in developing their care plans. Currently the care plans are not specific enough to ensure that staff are consistently meeting individual health care needs. Individual preferences and choices must be reflected across all care plans to make sure that each person is being treated in a way that respects their wishes, gender and culture. EVIDENCE: This outcome area was judged to be adequate at the last inspection and three requirements were set relating to care plans, the policy on covert medication and the need for people in the home to have an opportunity to express their wishes for end of life care and dying. Comments received prior to this current unannounced inspection were: “The clients I have placed in Lennox House have complex physical and sometimes challenging behaviour. They (the home) have supported the Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 12 families in a positive way and often over and above other care homes. The needs of the client have been managed very well.” “Staff at Lennox House are always happy to discuss with me matters concerning care.” “I have great admiration for the staff who care for my mother. She is always clean, well fed and dressed properly. I cannot ask for more.” “If my husband needs anything they always tell us. If anything urgent is needed they will call us.” “Individuals health care needs are always met by the home.” “The home respects individuals privacy and dignity.” “ The care home always meets my mother’s needs.” “Staff usually keep us up-to-date however no information as to “well-being” is offered except on enquiry, staff are helpful.” “I thank God every day for the care my mother receives.” It is evident from these comments from care and health care professionals as well as family and friends that staff in the care home should be capable of delivering appropriate standards of care and support. However the recording keeping does not always reflect this. Each individual has a care plan, which includes basic information necessary to deliver the person’s care but it is not very detailed and does not always take account of individual preferences. The care plans do not reflect the ABC Activities Based Care outlined in the Annual Quality Assurance Assessment completed by the manager prior to the inspection. The current care plans cannot be considered to be working documents as they contain so little personal information and there is a reliance of having nursing care instructions posted in people’s rooms. Several rooms have notices posted reminding staff about the frequency of changing a person’s position in bed. Some personalisation has begun with referring to the person by name in the care plans. However if the name were removed, it would be difficult to determine to whom the care plan belonged to. Discussions with staff highlighted that they had a good knowledge about individuals’ personal preferences, communication needs and general background information. None of which is recorded. If staff leave, this information is either diluted or lost altogether therefore it should be reflected in the care plan to make sure that people living in the care home receive a consistent standard of care. The service has a policy and procedure on allocating key workers. Each person has either a named nurse and/or key worker from the care team. Allocated key workers need to understand their roles and responsibilities and to embrace the role. Information about residents needs to be updated. The social care backgrounds recorded on the Saturn Live Database were found to be sparse although discussions with staff and the manager highlighted that relative are being approached to bring in personal items for bedrooms. Not all bedroom doors are named. During one visit to the care home, a resident anxious to find their room. They remembered it was at the end of a corridor Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 13 but could not recall the number. If the door had been named then the person would have been able to recognise the room as theirs. It is still unclear who is involved in developing the care plan and whether residents and families have any input or key workers re included. Care plans are being reviewed on a monthly basis however the nursing actions and evaluations recorded on the Saturn Database could be vague and out-of-date therefore did not always correspond to the current condition of the resident. Examples included care plans relating to nutrition, which did not address diabetes or significant weight loss. Although there was evidence that calorific drinks had been prescribed. Misuse of alcohol had not been included in the risk assessment and therefore was not addressed as part of the care plan. Nursing instructions identified that blood sugar levels should be “monitored as instructed”. Another instruction for a person with diabetes controlled by oral medication and diet was to “Give prescribed medication/insulin at times stated.” Wound management was not addressed efficiently. Wounds were not described in sufficient detail. An entry in the daily records for one person showed that dressings had been renewed to wounds on the arm as the result of skin tears. There was no corresponding care plan. Evaluations were found to be inadequate. Entries had been made on two separate care plans relating to wound swabs being taken for analysis in April 2008 but there is no record of the outcome. Another evaluation says that a wound is healing but does not refer to which one as the person has three. A further record recorded that a pressure sore had healed but the person was still in hospital. However the person had returned to the home and a review by the Tissue Viability Nurse highlighted that there had been a deterioration in the condition of a pressure sore. The manager acknowledges that further work is required to make sure that care plans accurately reflect the needs of the individuals and the nursing interventions required to meet those needs. This requirement has not been met from the previous inspection therefore in accordance with the Commission for Social Care Inspections’ policy and procedure enforcement action is being taken. A statutory requirement notice will be issued. This is identified as requirement 1 in the statutory requirements section of this report. All service users are registered with a GP. The home now has a system in place to alert the local surgery when a new person is admitted. There is evidence of referrals and input from other health care professionals such as the Tissue Viability Nurse and the Diabetic Nurse Specialist. Referrals have been made to the Speech and Language Therapist and Dietician although it is not clear from the care records how much current support and advice there has been. Each person has had a continence assessment and appropriate continence products have been identified. However this information has not been transferred into the care plan. All eight care files identified the need for continence aids however there is no record of a referral to a Continence Adviser. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 14 The care home has reported one medication since the last inspection. Staff had not followed the correct prescription and a person living in the care home received an extra dose of medication. The manager took appropriate action by reporting it to the GP and the Commission For Social Care Inspection (CSCI). To prevent a reoccurrence, further training and increased monitoring was put in place. As previously stated a requirement had been set regarding the need for there to be a clear procedure in place in respect of covert medication. This area was not looked at. Instead the registered manager was made aware that we would be requesting a full pharmacy inspection by a pharmacist from CSCI. During this inspection only a small audit was taken of a sample of 8 medication administration records. These were found to be in order. There was insufficient evidence to reach a score for this standard. Feedback from the manager and staff confirmed that the values of privacy and dignity are covered in the induction process. Staff were seen addressing residents in a respectful way. An inspection of 8 care plans showed that only two had recorded the preferred form of address. However a staff member was observed standing over a resident while assisting them with a meal. This kind of inappropriate practice was also recorded on the last inspection report. Throughout both visits, staff were observed ensuring that privacy was maintained when personal care was being given. Relatives confirmed that they were able to visit at any reasonable time and had always found staff to be approachable. One visitor did comment that access to a public telephone would be beneficial. Another felt that although sitting areas are available and pleasant that they did not always afford privacy when visiting. Private space is available in bedrooms. All bedrooms have lockable doors. Keys are available and used by residents as the result of a risk management system. Care records still do not make reference to the person’s wishes in respect of end of life care and dying. Two paper records recorded a decision that the person did not want to be admitted to hospital or have cardio pulmonary resuscitation. These decisions had been endorsed by the GP. However the electronic files made no reference to other peoples’ individual wishes concerning terminal care and arrangements for and after death. This requirement has not been met from the previous inspection therefore in accordance with the Commission for Social Care Inspections’ policy and procedures enforcement action is being taken. A statutory requirement will be issued. This is identified as requirement 2 in the statutory requirements section of this report Lennox House Care Home DS0000069788.V362170.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers a varied and balanced diet with alternatives to the main menu. Improvements must be made to meal times to make sure that people living in the care have a relaxed and social eating space. EVIDENCE: Comments received prior to this current unannounced inspection were: “The staff and managers look after me always when I pay a visit to my mother and appear happy despite a very difficult job.” “This is very difficult but I would say staff do help where possible to support people to live the life they choose.” “The home supports the residents to live the life that they choose.” “There should be more daily activities for the residents. Not enough stimulation is given.” “Staff definitely have the skills to support health needs; unsure about social as the client group I deal with are difficult to engage with. I have seen staff spend time individually engaging with them. “Staff respect the equality and diversity of each client.” “I have always found her (my mother) to be content with what is going on around her.” Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 16 An activities organiser is in post and a programme of activities is on display. The programme covers one month at a time. During both visits there was evidence of group and some individual activities. However service users’ interests are not recorded in sufficient detail to inform and therefore develop a diverse leisure and recreational programme. One care file recorded that the person enjoys watching television but there was no indication of any favourite programmes. On two other care plans, the social interests and activities sections had not been included but the daily records showed that both had been involved in listening to music, participated in gentler exercises, had a manicure and played with a balloon. There is no indication to suggest that these activities were the preferred activities of the people who took part. A requirement has been set. This is requirement 4. The care home provides a service for older people and for people who have a diagnosis of Dementia therefore a culture needs to develop that recognises that activity is the responsibility of all the staff including ancillary and catering staff as well as the activity organiser and the care staff. The activity organiser needs to have training in supporting people with Dementia so that they can develop activities appropriate for varying degrees of the illness and supporting all staff to be involved. Staff need to build on information gathered at assessment to develop life history/life-story book that helps in getting to know the whole person and this be able to support their interests. A recommendation has been made, which is Feedback from friends and relatives was that they are welcome to visit at any reasonable time. People living in the care home are able to access the community. One health care professional has commented about the staff “They have supported the families in a positive way and often over and above other care homes.” The food in the home is of a satisfactory quality, choice is available and the menu addresses the dietary and cultural needs of people living in the care home. However when staff look at nutrition, it is not only important to look at nutritional intake for a balanced diet but there are other factors to consider especially when caring for people with Dementia. By the every nature of the illness, peoples’ manual skills decline and some people may find it hard to sit long enough to eat a meal. Research has shown dining rooms, which are quiet and relaxing provide a social eating space. Staff were seen still standing up to assist people to eat and talking with other people who live in the home across the dining room. Not all the care staff made the residents aware of the choices on offer. Some staff did clearly demonstrate the choices available i.e. taking around two jugs of juices and asking people which they wanted. Where communication was difficult people could point to the flavour they wanted. Whilst others simply asked if the person wanted “more” but did not explain what was on offer. One person was agitated and did not want to be in the dining room. Every time the person went to leave, staff encouraged them to Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 17 remain and sit down. This was disturbing to other people sitting on the dining room and did not provide a relaxing and quiet environment. The previous inspection report recorded a requirement in respect of people living in the care home being able to enjoy meals as a social occasion. Although there has been some improvement the dining experience is not quiet and relaxing. Staff need training and guidance in order to ensure that people living in the care home enjoy meals as a social occasion. A requirement has been set. This is requirement 5. A menu is available on each table and it corresponded to the meal being served however consideration should be given to displaying pictorial menus, which may aid choice. A recommendation has been made which is number. A recommendation has been made. This is number 1. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Lennox House can feel confident to express their views and concerns in a safe and understanding environment. EVIDENCE: Comments received prior to this current unannounced inspection were:“If I had to make a complaint to make I would first discuss it with the manager before going to any other authority.” “I take it we would make a complaint via the manager.” “I have had no reason to complain but am aware of the procedure.” “We visit regularly so all issues are raised as they occur and we can see if they have been dealt with and resolved. “I have heard the rough word by some of the general working staff but this has been rare and in most cases understandable due to frustration in trying to get very impaired patients to be reasonable in their behaviour.” “I have noticed some good reactions by members of the staff when dealing with patients that are seemingly unhappy about something. The nurses seem to be most considerate.” “They (the staff) always appear to act professionally in sometimes very difficult situations.” The home has a complaints procedure, which has been supplied to people living in the care home and is displayed in prominent areas in the home. A Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 19 record of complaints is kept. From the records there is clear evidence that concerns have been looked into, action taken and a resolution found. Discussions with two of the people living in the care home showed that they felt comfortable approaching staff if they felt unhappy about any aspect of their care. Staff spoken to also showed that they would be ready to listen to any concerns. The organisation also has a system in place to monitor complaints about the service. The policies and procedures for safeguarding adults are readily available. They give clear guidance. Training for staff on safeguarding issues is available to staff and training records show that it is being taken up. The service has been co-operative throughout the independent investigation and has shown that they are concerned to make improvements. On the second visit to the home the manager confirmed that had she had a notification to the Commission for Social Care Inspection relating to an alleged incident of verbal abuse. A relative has alleged that a care staff had been abrasive with his mother. The manager had already taken the necessary disciplinary action to protect both the alleged victim and perpetrator. She has informed Islington Adult Protection Co-ordinator. Manager confirmed later in the day that a care manager would be assigned to look into the allegation. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in Lennox House have a clean and safe environment, which provides specialist aids and equipment to meet their needs. More work is needed to make sure that the environment is homely and comfortable. EVIDENCE: The comments received prior to this unannounced inspection were:“The public and private areas are clean, no odour.” “Lennox House provides a clean and friendly environment to users and carers.” “Lennox House is a comfortable, clean and friendly care home.” The care home provides a physical environment that is appropriate to the specific needs of the people who live there. It is clean, safe and comfortable. Staff are addressing the need to ensure that the environment, particularly bedrooms reflect the individuality of the occupant. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 21 Construction and fitting put of the care home was completed last year. It continues to be well maintained. The location means that people living in the care home can access shops with assistance or independently depending on the outcome of a risk assessment. All bedrooms are single occupancy and provide high levels of privacy with ensuite showers and toilets and all have locks fitted. Residents have access to a key to their room if this is the outcome of a risk assessment. However it was noted that a number of bedroom doors did not have the occupants on it. A person living in the care home was distressed because they were unable to locate their room. They knew it was at the end of a corridor but as there was no name on the door it was not recognisable to them. Staff also need to address the posting of nursing instructions in bedrooms. Three rooms looked at had notices reminding staff of how frequent to turn residents when lying in bed and another room had a reminder to staff to turn on the television. Sufficient communal bathrooms and toilets are available fitted with suitable aids and adaptations to meet the needs of people using the service. Where spillages occur, housekeeping staff are quick to clear the spillage and clean the carpet. The management are addressing the need to provide hard flooring for some residents rather than carpet as a more hygienic option. Such decisions must be fully discussed with the relevant individuals and documented. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the care home are not receiving a consistent service from the staff. The systems in place to ensure continuity of care are not being used effectively. EVIDENCE: The comments received prior to this unannounced inspection were:“Staff definitely have the skills to support health needs.” “I believe it would be advantageous to have more staff visible on public holidays and weekends as I have not found it easy to contact a qualified member of staff available without a longish wait or by going on a search.” “The staff at the home are very caring, patient and considerate. Always polite and friendly.” “”Staff are friendly, well informed usually.” “They (the staff) do a wonderful job and I think they are special people.” “Staff do appear to really care about what they do. I note how problems are taken on board by staff: some do appear better trained than others but most do a good job.” “Staff appear to have the right skills and experience. They carry out their work in a very professional manner. However at times they are very short staffed and cannot treat clients as they would like as they are too busy.” Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 23 “From what we can see during our visits, the level of care, hygiene and communication is good.” “I believe it would be advantageous to have more staff visible on public holidays and weekends as I have not found it easy to contact a qualified member of staff available without a longish wait or by going on a search.” From the comments received above it is clear that some people have confidence in the staff that care for them. People visiting the service have remarked that the service appears to be short staffed on occasions. On the first visit to the home, the staff rota was checked and staff were mapped in the building according to the rota. The service has sufficient staff to meet the needs of the current number of people living in the home. However the manager has said that on occasions when staff have gone sick at short notice, it has not always been possible to cover the shift. In order to support staff to be deployed more effectively and therefore more visible, the manager is introducing a new system of staff allocation. This will be reviewed following a trial period. Each staff member will be allocated a group of residents with varying levels of dependency and will work across the whole unit rather than allocated to a specific area to work in. The allocation of named nurses and key workers has also been revised so that all staff, including night staff, have key people to key work. The service has a recruitment and selection procedures that meets the statutory requirements in respect of safety checks. Records show that these are in place and there is accurate recording at each stage of the process. However the recruitment and selection process needs to take account of applicants’ knowledge and skills and whether these can be transferred effectively to their role in the home; in particular this refers to the nursing staff. The process should explore the applicants’ competence in respect of their knowledge and skills in doing an assessment, writing a care plan and understanding of some chronic illnesses. A requirement has been set. This is number 6. The service recognises the importance of training and a programme has been available. Recent circumstances have shown that there are gaps in the staff’s knowledge. A training needs audit has been completed and a training programme is being devised. The manager is still trying to arrange suitable training for nursing staff in particular in chronic disease management inclusive of diabetes and congestive obstructive pulmonary disease. A training company has now been identified that will be able to fulfil training needs. Training records show that staff are attending training but this is not always mean that this knowledge is underpinning practice. A review by a Tissue Viability Nurse identified that staff are not transferring knowledge and experience of pressure area care from one service user to another. This has resulted in a deterioration of a pressure sore and other pressure areas. A requirement has been set. This is number 7. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In order to ensure continuity and effective management, there should be a review of staff competencies and management systems. EVIDENCE: Comments received prior to this unannounced key inspection were:“I have found the manager at Lennox House very considerate as are the majority of staff.” “The manager is available and always ready to listen.” “Management of the home is very strong. There is a pleasant atmosphere.” The comments received as above highlights that there is an open and transparent management approach. The manager has successfully completed Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 25 a fit person process to become registered and has been assessed as being suitably qualified and having experience in the management of a care home. Currently the manager does not have the support of a deputy although a replacement has been recruited and a new deputy is to be in post by the end of June 2008. It is less than twelve months since the home opened and although there has been a clear management structure within the care home, this has not been wholly effective. This judgement is made based on the evidence that the quality ratings of other outcome areas are recorded as adequate. Action has not been progressed within agreed timescales to implement the requirements identified from the previous CSCI inspection report. Repeat requirements have been identified in respect of care planning, and end of life wishes not being recorded. Further improvements to assessments, activities and meal times are also necessary. This inspection has identified that care planning and evaluations are inadequate, staff require training regarding record keeping, the supervision of staff needs to be more effective and a consistent approach to managing staff performance is necessary. A requirement has been set. This is number 8. The service has a disciplinary policy and procedure process in place. This has been applied but as previously stated the approach needs to be consistent. A member of staff resigned prior to the management starting the disciplinary process. The Commission for Social Care take the view in such circumstances that the resignation should not be accepted. The person resigning should still be asked to attend a disciplinary hearing and that in their absence a judgement needs to be made as to whether it is necessary to refer the person to the Protection of Vulnerable Adults Register (POVA) or Nurses and Midwifery Council (NMC). The registered persons have been should revisit their original decision not to proceed as not to do so will have implications in the case of a referral to POVA or NMC and for potential employers when requesting references. The previous inspection report recorded that “the manager of Lennox House has a proactive approach to making a person centred home.” From discussions with the manager, it is clear she has an understanding of person centred planning and thinking, however she is having difficulty in translating this theory into underpinning practice so that the staff team deliver a holistic and consistent level of care. In practice the service is taking account of equality and diversity issues in respect of gender specific care and dietary needs. From previous comments recorded it is clear that the home generally works in partnership with families and close friends. Record keeping has been highlighted as an area for improvement. Information has been transferred from paper documents to an electronic system. It is clear that there are gaps in the information that has been recorded on the Saturn Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 26 Live Database. Feedback from staff is that they prefer the new system however it is clear that staff need on going support to become familiar with the system and to be able to use it effectively. Care records need to be audited regularly to ensure that they meet the required standards. A requirement has been set. This is number 9. Comments from people using the service and their visitors recorded in preceding sections of this report show that that most of the staff are valued. However it is clear that a few are not. Comments have been made by visitors hearing “a rough word” from some staff and “some staff appear better trained than others but most do a good job”. This last comment highlights that some staff may not be doing a good job. The registered persons are in the process of developing systems that will improve practice and monitor compliance with the disciplinary the policies and procedures of the home. This is as the result of an independent investigation. The manager has recognised through the AQAA that one of the ways the service could improve is to have “Regular performance monitoring of staff to measure the standards of care and service delivery at the home” There was clear evidence that a structure for supervision has been identified; however staff, in particular nurses, who will be responsible for supervising require training in order to fulfil this responsibility and to make sure that supervision is being used as an effective management tool. The manager has confirmed that she will be responsible for delivering this training. A supervision contract is available and includes a standard agenda however the sample of records examined recorded topics that had been discussed but there was no clear evidence that staffs’ performance and development had been assessed. The agenda needs to be revised to include the role and responsibility of the key worker, what training has been attended, what the staff member has learnt and how will this learning be put into practice. This is an area that needs to be looked at, given previous recorded evidence in the report i.e. poor record keeping; gaps in the assessment information; care plans with no specific nursing interventions or personalised care; examples of dignity not being upheld and a complaint about the attitude of a staff member. A requirement has been set. This is number 10. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and it gives a reasonable picture of the current situation within the service. Quality assurance has not been addressed in detail although monitoring systems such service user questionnaires, a suggestion box as well as residents and relatives meetings have all been highlighted as a means of gaining people’s feedback. Complaints are monitored however assessments and care plans have not been audited therefore improvements have been delayed. However the manager did confirm that she had set aside specific days to work with the senior staff on care planning. A requirement has been set. This is number 11. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 27 Service user’s money is the responsibility of the administrator. Records are maintained showing debits and credits and balance. Receipts are kept and an audit trail is evident. A sample audit of financial records is made as part of the monthly visit and there are signatures and dates to confirm this. A sample of health and safety records were taken and these were found to be accurate. Equipment is being serviced on a regular basis and fire prevention is being taken seriously. Practice was observed and a tour of the building showed no odours, no blocked exits, and no trailing leads. Cross infection procedures are being carried out and staff have access to protective clothing. Staff training is up-to-date in respect of the manual handling, fire safety and basic food hygiene. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 28 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 3 Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 29 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(1) Requirement Ensure all service users have a care plan in place, which adequately details how their needs are to be met in respect of their health and welfare. Timescale for action 20/08/08 2 OP11 12(2) & (4)(a) 3 OP3 14 Ensure all service users and/or their representatives are fully consulted in the preparation of their care plan. Ensure that as far as practicable 20/08/08 service users are enabled to make decisions with respect to the care they are to receive, including their end of life care. Ensure that service users wishes and decisions in relation to end of life care is appropriately recorded. 20/08/08 People moving into the care home and/or their representatives must be included in their assessment of care needs. Assessments need to record who was involved in their development. This will make sure that a holistic view of the person has been taken therefore all needs are identified. DS0000069788.V362170.R02.S.doc Version 5.2 Page 30 Lennox House Care Home 4 OP12 16(2)(n) 5 OP14 6 OP29 7 OP30 8 OP31 9 OP33 A programme of activities needs to be developed following consultation with people who live in the care home and/or their representatives. Peoples’ previous leisure interests, hobbies and occupations need to be recorded by key workers. This is to make sure that activities, whether individual or in a group, reflect individuals’ wishes and preferences. 12(4)(a) Staff need training and guidance in order to ensure that people living in the care home are able to exercise choice, be treated with respect and enjoy meals as a social occasion. 19(5) The recruitment and selection process must ensure that the applicants’ have the necessary knowledge and skills to fulfil their role and responsibilities in the care home. This will ensure the health and welfare of the people living in the care home. 18(c)(i) & The staff training and (ii) development programme must ensure that staff are able to fulfil the aims of the home as well as meet the changing needs of the people who live in the care home. This will ensure the health and welfare of the people living in the care home. 9, 18 & 19 There must be clear lines of accountability within the care home. Senior staff must be familiar with the conditions/diseases associated with old age and be able to respond to any deterioration. This will ensure the health and welfare of the people living in the care home. 17(3), 24 There must be a system in place to continuously audit care records. In particular DS0000069788.V362170.R02.S.doc 23/09/08 23/09/08 23/09/08 20/08/08 20/08/08 20/08/08 Lennox House Care Home Version 5.2 Page 31 10 OP36 11 OP37 assessments, care plans and evaluations. This is ensure that staff are responding appropriately to the changing needs of the people living in the care home. 18(1)(c) & All staff that will responsible for 18(2) leading supervision sessions must receive training to fulfil this role. The standard agenda for supervision must be expanded to cover the following items:Role & responsibility of the key worker What staff have learnt from training sessions and how this will be implemented in the home. This will ensure that staff are competent to do their jobs. 17(3)(a) Care records in particular, assessments, risk assessments, care plans and evaluations must be kept up-to-date. This will ensure that people who live in the care home will have their needs met. 23/09/08 23/09/08 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 OP15 Good Practice Recommendations It is strongly recommended that menus be displayed in a pictorial way to aid choice for people with Dementia. Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lennox House Care Home DS0000069788.V362170.R02.S.doc Version 5.2 Page 33 - 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. 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