Inspection on 03/12/08 for Lennox House Care Home

This inspection was carried out on 3rd December 2008.

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

The inspector 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 24/06/08

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Lennox House Care Home 75 Durham Road London N7 7DS Lead Inspector Pippa Canter & Ffion Simmons Unannounced Inspection 3rd December 2008 09:45 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.V373496.R01.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.V373496.R01.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 Manager post vacant 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.V373496.R01.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 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.V373496.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 using this service experience adequate quality outcomes. This unannounced key inspection was completed over one day by two inspectors. A total of 8.45 hours was spent in the home altogether. At the time of the inspection the care home is subject to enforcement action. This means that the providers may not admit new people into the home until the Commission for Social Care Inspection is satisfied that significant improvements have been made in key areas. In line with the CSCI enforcement approach, the registered providers have submitted an improvement plan. This showed what actions the service will take in order to meet the requirements, including who will be responsible and the timescale for compliance. The purpose of this key inspection was to look at the progress the service was making to meet fifteen (15) requirements; eleven were made at the last key inspection 6th and 24th of June 2008 and four were set following the pharmacy inspection on 9th September 2008. Therefore this inspection was concerned with assessing twelve (12) of the twenty-two (22) relevant National Minimum Standards. The inspection focused on the assessment process, aspects of care, in particular care planning, social activities, staff training and support as well as the overall management of the service. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the fortnightly updates reports sent by the providers showing the progress in meeting the improvement plan as well as monthly reports about the general conduct of the care home. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires were circulated for people living in the home, staff as well as health and social care professionals. To date only two completed surveys have been returned. We have looked at the information collected from the previous key inspection and pharmacy inspection and relevant information from other organisations. During the visit we looked at the care records for six (6) people and where possible we visited them in their own rooms with their permission. People living in the service and staff were spoken to and the serving of lunch was observed in one of the dining rooms. Staff were observed going about their duties and interacting with residents. We followed the care for six (6) people who are currently living in the care home. The care plans were compared with the care being given. In one instance the medication records did not correspond to a specific protocol and Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 6 an immediate requirement was made. The choice of care plans reflected people’s gender, specific health care conditions and cultural needs. 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? The care home has had to address fifteen areas for improvement. This inspection has shown that there has been significant progress made in the majority of areas. In accordance with the Commission for Social Care Inspections’ policy and procedures where enforcement action has been taken, this inspection report will be discussed as part of a management review meeting with the Regional Enforcement Team for consideration in respect of what action needs to be taken next. The staff have made improvements to the assessment and care planning process. Care plans are being devised, which are personal to the people who Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 7 live in the home. Written copies of the care plans will be lodged in each resident’s room. This will make it more accessible to residents and relatives. Care plans now contain more specific detail to ensure that staff are consistently meeting the care needs of people living in the home. Some anomalies were identified with the manager of the service and these were being addressed. Lennox House is supporting to set out their wishes for their end of life care and dying. Generally assessments, care plans and evaluations are more detailed giving an accurate and up-to-date picture of a person’s condition and wellbeing. Activities are being provided that will take account of individual wishes and preferences. The care home has input from Regional Active Living Adviser and a Regional Nurse Lead. Their input has supported staff development so that people are treated with respect and dignity. Mealtimes now take place in a congenial setting and people are offered assistance with eating and drinking in a discreet and sensitive way. Staff training and support, has been improved so that people are receiving training that enables them to fulfil their roles and responsibilities within the home. Systems are in place and being used to make sure that care records are being audited and ensure that staff are responding to the changing conditions of people in their care. The service has responded to the deficiencies made at the pharmacy inspection. We noted an improvement in the recording of specific directions to indicate any changes in treatment and to provide more information rather than “as directed”. What they could do better: Although the staff in the care home had addressed the requirements in the pharmacy report, we found that nursing staff had not been following the protocol for the administration of insulin and records had not been completed accordingly. An immediate requirement was made for the managers to investigate this and report back to the Commission for Social care Inspection was made. It is clear that an improvement in care planning has been made. However there were some contradictions noted in the care plans scrutinised by the inspectors and risk assessments were not always accurate. All the areas for improvement were discussed with the management of the care home. They have already taken decisive action. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 8 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.V373496.R01.S.doc Version 5.2 Page 9 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.V373496.R01.S.doc Version 5.2 Page 10 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 good. This judgement has been made using available evidence including a visit to this service. All relevant assessment tools are in place and are being used effectively by the staff team to identify needs. More care needs to be taken to make sure that all identified risks are managed through accurate and up-to-date risk assessments. EVIDENCE: The quality in this outcome area was judged to be adequate at the last inspection. A requirement had been set. It had been found that the assessment process had not always been applied consistently nor had there been evidence to confirm that people moving into to the care home and/or their representatives had been involved in the assessment. There have been no new admissions to the care home since the last inspection however the care records of the last person to be admitted were checked. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 11 This showed evidence of good practice. It was clear from the documentation that both the service users and a relative had been involved in the initial assessment process. This ensured that a more holistic view of the person had been captured and the resulting care plan was more personal and reflected individual likes and dislikes. All six people case tracked had risk assessments in place either available on the Saturn Database and/or in paper form. We saw examples of good practice. There were comprehensive risk assessments relating to falls and the development of pressure sores. However other areas of risk had not been assessed an example of this was a person who was at risk of choking. Al though the risk had been identified on the care plan, a written risk assessment had not been completed. Another assessment recorded that a person had good vision, which was contradictory to there past medical history, which stated that there is advanced visual impairment in both eyes. Where anomalies had been identified, these were fed back at the end of the inspection. The home responded the next day by confirming in writing the necessary amendments to the risk management and care planning records. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 12 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, 9, 10 & 11 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system is now clearer and more consistent. It provides staff with the information they need to satisfactorily meet the residents needs. The systems for the administration of medication are generally good however records show that some staff have not followed clear and comprehensive guidance. This places a resident potentially at risk. EVIDENCE: This outcome area was judged to be adequate at the last inspection and two repeat requirements were made. It was this that initiated enforcement action towards this home. Six people were case tracked as part of this inspection. All those case tracked had a care plan in place and all plans had been recently reviewed. The care plans showed clear signs of improvement and generally contain good detail around individual needs as well as effective intervention for staff to meet those needs. The minutes of a recent relatives meeting recorded that relatives had pointed out several major improvements in the care and attention received by individual residents. This has included referral to and Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 13 input from Specialist Nurses over health issues and the inclusion of a Senior Clinical Nurse on the staff team has made a significant difference. Relatives felt that their residents have improved in physical health and emotional wellbeing. Relatives also felt that there had been better communication from staff and as a result they were being kept better informed of key pieces of information such as changes to medication. The multi-disciplinary notes on the Saturn Database confirmed the level and variety of referrals to Specialist Nurses. Some have been recording the outcome of their visits directly onto the computer records. However there were some contradictions noted in the care plans scrutinised by the inspectors. Examples of these are a reference to ensure that a person is seen regularly by the District Nurse to redress wounds on their heels. It is unclear from the care notes when the skin tissue broke down and there is no reference as to why their legs are being re-dressed. A separate care plan needs to be in place to cover these pertinent issues. A care plan regarding mobility contradicts the information in the manual handling assessment. The care plan states the assistance of two staff is required however the latest manual handling assessment records only one staff member is needed. Another care plan does not make reference to the dietician referral although the multi-disciplinary notes record guidance from a dietician following a visit. Staff need to ensure that all the specific guidance from health care professionals and specialists is incorporated into the care plan. Another care plan was looked at for a person who speaks very little English. The staff confirmed that they are unable to communicate in a meaningful way. The care plan does not reflect the persons ethnicity and culture. Although they attend a day centre two days a week in order to maintain contact with others who speak the same language, there is no intervention from staff regarding communication. A requirement has been made. This is requirement 1. The improvement plan records that ongoing monitoring of care plans is in place. The Commission for Social Care Inspection have had written confirmation from the care home that the shortfalls identified in the inspection have been addressed. Where care plans for people receiving personal care only, identify a medical need, and then collaboration is needed either with a GP or the District Nurse. The monitoring system needs to ensure that this happening. A recommendation has been made. This is recommendation 1. The home’s management of medication was assessed in two of the four units in the home. We found that residents’ medication is dispensed using the Boots monitored dosage system. Medication was securely stored during the inspection. Since the last Pharmacy inspection on the 9th September 2009, we found improvements in the storage of insulin and some eye drop products, with these, once opened being kept at room temperature as per the Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 14 instructions on the container and the licence conditions. We saw evidence that staff are recording the temperatures of the clinical rooms and the medication fridges on a daily basis. The Medication Administration Records (MAR) were checked on both units. We noted an improvement in the recording of specific directions to indicate any changes in treatment and to provide more information rather than “as directed”. The MAR charts were generally well completed, and any known allergies were noted on the MAR charts. Where no allergies were known, this was documented on the MAR chart. A random audit to reconcile medication records with sample of loose medication showed that the amounts were correct, which indicates that medication was being given as prescribed. Controlled drugs were being used in the home at the time of the inspection. These had been entered into the Controlled Drugs register. The controlled drugs are checked by two nurses at each shift handover to ensure that there are no discrepancies in the amounts of Controlled Drugs. Staff spoken with were clear on the procedures for the safe disposal of controlled drugs, and the need to keep medication for a period of 7 days following the death of a resident. We checked the procedures and the records for a resident who is on insulin. Guidance from the Diabetic Specialist Nurse was kept with the MAR chart so that staff could easily refer to the guidance. Blood Glucose Monitoring chart was also kept with the MAR chart to indicate the results of the blood glucose monitoring. On two occasions, we noted that staff had documented on the MAR chart that one type of insulin was not required. We checked the blood results against the guidance of the diabetic specialist nurse, and found that the resident should have been given insulin. We also noted that there were some gaps in the blood glucose-monitoring chart where blood results had not been recorded. An immediate requirement notice was issued to ensure that managers investigate this anomaly and report back to the Commission for Social Care Inspection by Monday 10th December 2008. This has been complied with. The error has been investigated and appropriate action taken by the staff. It is recommended that the Blood Glucose chart indicates if resident is eating or not as the protocol for the administration of one of the insulin is dependent on this factor. A recommendation has been made. This is recommendation 2. The values of privacy and dignity are covered in the induction process. Staff were seen addressing residents in a respectful way. During lunch time staff were seen sitting down and assisting residents to eat their meal. Throughout the visit, staff were observed ensuring that privacy was maintained when Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 15 personal care was being given. Peoples preferred names were recorded and being used. Out of the six sets of care records only one made reference to the wrong name. Staff have received training in end of life care. This is reflected in the improved care planning. Five out of the six care plans checked had a plan in place regarding peoples wishes for their end of life care. The service had been the subject of a newspaper article regarding the delay of removing a deceased person from the premises. The providers have looked into the situation and fed back the outcome to relatives at a recent meeting. It is clear from the care records that improvements have been made in this area. Personal wishes following death were clearly documented. This included their wishes in respect of who to contact including family members, the religious leader and funeral arrangements including the funeral director. Feedback on the end of life care from recently bereaved relatives confirmed how far the improvements had gone. They told a recent relatives meeting, Staff in the nursing unit at Lennox House had shown unfailing care and kindness. They (the relatives) had never sensed that the home was short staffed and staff had been attentive and sensitive. The residents last journey out of the care home, four hours after she had died, had been dignified. Detail in the care plans also outlined that the, Do Not Resuscitate Policy had been signed by family and the GP. The care plan needs to record where this has occurred as a cross reference with the paper record. A recommendation has been made. This is Recommendation 3. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 16 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, 14 & 15 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A wider variety of activities are available that reflects the wishes and interests of the people living in the care home. The management of the home continues to make relatives feel welcome foster good relationships. The home continues to offer a varied and balanced diet with alternatives to the main menu. People in the care home are able to have their meals in a relaxed and social way. EVIDENCE: The quality rating for this outcome area was judged to be adequate at the last inspection. Two requirements were set. One to improve the programme of activities and the second to improve meal times and to make them more relaxed and social occasions. Each person had a care plan regarding activities. The care plans inspected had good detail regarding weekly activity programmes. Peoples skills and interests were also reflected. Activity programmes were displayed on each floor. This included one-to-one sessions, gentle exercise, arts and crafts, choice of games and a shopping trip. Also on display was the Christmas Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 17 Activity Programme. This included activities both inside the home and in the wider community. Life history books are being developed. The management of the home is looking into identifying volunteer visitors who will be able to make a contribution to the daily life and social activities of the residents. All residents have a care plan regarding eating and drinking. This reflects the assistance they require when having meals and snacks, the type of diet and also included is their likes and dislikes. A period of observation was completed in one of the dining rooms during the serving of lunch. Generally it was a calm and relaxing atmosphere in the dining room. Staff were seated next to the residents they were assisting and engaging with them. The staff have clearly been working to improve the dining experience making it a more social and positive occasion. This was disrupted by the arrival of an external visitor. It is recommended that the care home develop a policy about residents being disturbed during a mealtime unless it is an emergency. 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. Menus are on display on the tables. Staff were clearly seen offering choices and alternatives to the residents. Feedback from a resident survey, completed by a relative, remarked that the resident usually liked the meals but recorded, Evening meals however usually consist of sandwiches and soup. Not very imaginative. However discussions with other residents in the care home confirmed that they liked the food and could have an alternative from the main menu. Lennox House Care Home DS0000069788.V373496.R01.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): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Not Inspected EVIDENCE: The quality in this outcome area was judged to be at the last inspection in June 2008. It was found that people living in Lennox House can feel confident to express their views in a safe and understanding environment. Feedback prior to and following the inspection confirmed that people using or visiting the service knew how to make a complaint and who to speak to if they were unhappy. One survey did record that Normally (make a complaint) via management. In the past the manager made promises but no action was ever taken. Lets hope this changes under new management. However minutes of a recent relatives meeting recorded that there had been several improvements in care one of which had been Whereas previously relatives were raising the same concerns repeatedly, these problems have now been resolved. The monthly report supplied by the provider records that the Saturn System recorded eleven (11) complaints; most of these have been resolved through direct consultation with individual family members. The Commission for Social Care Inspection has considered all the available evidence and has concluded that the service still meets the national minimum standard for complaints and safeguarding procedures. Lennox House Care Home DS0000069788.V373496.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. Not inspected EVIDENCE: The quality in this outcome area was judged to be good at the last inspection. People living in Lennox House continue to have a clean and safe environment, with access to specialist aids and equipment to meet their needs. Care UK continue to monitor the appearance and facilities available in the home during their monthly visits. Areas for improvement such as the general appearance of the home, the need for improved storage solutions in residents bedrooms and repairs have already been identified by the provider themselves. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 20 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): 28, 29 & 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Progress has been made in addressing staff training and development needs and as a result people living in the care home are receiving a more consistent service. Staff have an improved understanding of service users support needs and are being more proactive in meeting them. EVIDENCE: Comments received following this inspection were: The care workers on the ground floor are very helpful and appear committed to their work. The permanent staff try their best and do a good job of caring for residents and trying to meet their needs and getting to know residents and their ways. At the last inspection in June 2008, this outcome area was judged to be adequate and two (2) requirements were made. It was found that people living in the care home were not receiving a consistent level of service from the staff. Although Care UK had systems in place to ensure continuity of care, these had not been used effectively. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 21 The service has not recruited any new members of staff since the last inspection. There are plans to make sure that the recruitment and selection process will test out applicants abilities and transferable skills e.g. writing care plans. The manager designate confirmed that she had turned down a couple of applicants, as they did not measure up to the person specification and job description. From the evidence in the improvement plan and discussions with the management team, the Commission for Social Care Inspection is confident that the recruitment and selection process will be thorough in measuring an applicants knowledge and skills. Both surveys that were returned commented on staffing shortages. At the recent relatives meeting, staffing levels were also raised as an issue requiring further attention. During this unannounced key inspection at the home, the staff rota was checked and staff were mapped in the building according to the rota. The conclusion was that the service had sufficient staff to meet the needs of the current number of people living in the home. Extra agency staff are supplementing the existing staff group. The providers are looking at how staff deploy themselves as this can have an impact on how visible staff can be. The providers have invested in staff training. A training needs audit has been completed and a training programme implemented. As part of the inspection the management team provided a staff training matrix. This is a clear record of all the training staff have attended. In order to support staff development further, the Clinical Nurse Specialist will continue working on nursing issues for a further eight (8) months. The training and support have improved the consistency and quality of care in the home. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 22 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, 36 & 37 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is now a clear development plan in place and vision for the home. The management team are communicating clearly to people who live in the care home, their relatives and staff. EVIDENCE: There is now a clear management structure in place. A new manager has been recruited and is due to take up post on 15th December 2008. The manager will bring with him, fifteen years of experience of managing dementia care services. The new manager is to have a thorough induction and will be supported throughout by managers from Care UK. The care home also has an experienced deputy manager. Improvements have been noted in all areas that were found to be deficient at the last inspection. Staff recognise the need for Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 23 thorough assessments although there are gaps as regards risk assessments. Care planning is more person centred although further work is needed in respect of evaluations, as some are still inadequate. The health care needs of service users are being met more effectively with evidence of good multidisciplinary working taking place more regularly. End of life wishes are being recorded and there is direct evidence from relatives that the death of a resident in the care home has been managed sensitively as well as efficiently. Meal times are being conducted in a calming and relaxed atmosphere with staff giving sensitive support to residents who require assistance with eating and drinking. Staff responsible for the supervision of staff have received training specific to this area and records show these sessions to be more effective in supporting staff development. Staff have received training regarding record keeping and improvements have been noted. An ongoing monitoring process is part of the improvement plan. Whilst this has ensured that assessments, care plans, evaluations, end of life wishes and multidisciplinary working are up-to-date; there are further improvements needed to make sure that care plans and risk assessments are accurate The home continues to let us know about things that have happened since our last key inspection and they have shown that they have managed issues well including recent issues around managing staff performance. They continue to work well with us and have shown us that their service continues to make improvements. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 24 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 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 3 3 X Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 25 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 Timescale for action 30/03/09 2 OP9 13(2) 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. This must include methods of communication in relation to ethnicity and culture. Ensure that all staff follow the 10/12/08 specific protocol for the administration of insulin for a named resident. Ensure that blood glucose monitoring sheets are correctly completed to provide an accurate record. Ensure that an investigation is carried out into the anomaly as recorded above and report back to the Commission for Social Care Inspection the outcome of the investigation. Immediate Requirement Notice refers. Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that the care plans for people who receive personal care but present with a medical need are discussed and developed either with the District Nurse or GP. It is recommended that the blood glucose charts record is a resident is eating or not. It is recommended that the care plans on the Saturn Database record where a do not resuscitate decision has been agreed and signed by the GP. 2 3 OP9 OP11 Lennox House Care Home DS0000069788.V373496.R01.S.doc Version 5.2 Page 27 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.V373496.R01.S.doc Version 5.2 Page 28 - 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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