Inspection on 19/03/08 for Lenore, The

This inspection was carried out on 19th March 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lenore, The 29/03/07

Lenore, The 23/02/06

Lenore, The 12/10/05

Lenore, The 04/02/05

Lenore, The 16/09/04

Lenore, The 18/02/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Lenore, The 1 Charles Avenue Whitley Bay Tyne & Wear NE26 1AG Lead Inspector Glynis Gaffney Key Unannounced Inspection 19, 20 and 26 March 2008 14:30 Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 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 Lenore, The DS0000000382.V356781.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 Adults 18-65. 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. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lenore, The Address 1 Charles Avenue Whitley Bay Tyne & Wear NE26 1AG 0191 2513728 F/P 0191 2513728 lauramurray.lenore@hotmail.co.uk 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) Mrs Teresa Duchett Mr Paul Royston Duchett Miss Laura Jane Murray Care Home 22 Category(ies) of Learning disability (22), Mental disorder, registration, with number excluding learning disability or dementia (22) of places Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Learning Disability, Code LD, maximum number of places 22 Mental Disorder, excluding learning disability or dementia, Code MD maximum number of places, 22 The maximum number of service users who can be accommodated is: 22 29th March 2007 2. Date of last inspection Brief Description of the Service: The Lenore is a large older style home situated in a residential street within Whitley Bay. Local facilities such as shops, restaurant, and pubs are all within easy walking distance. The home caters for 22 people with mental health care needs. Some people also have a learning disability. Single room accommodation is provided over the first and second floors of the home. There is one en-suite facility. Communal facilities consist of a dining room, four lounges, eight toilets, two showers, and three bathrooms. There are pleasant outdoor areas to the front and side of the home. Street parking is available. Information about fees is included in the home’s service user guide and statement of purpose. Fees range from £360.16 to £415.93. Copies of the Commission’s inspection reports are available in the home’s reception area and office. People are expected to pay for such things as private chiropody, newspapers, hairdressing, and transport costs where the benefits they receive cover this expense. Lenore, The DS0000000382.V356781.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 2 stars. This means the people who use this service experience good quality outcomes. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 29 March 2007; How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people; The views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on the 19 March 2008. During the inspection we: • • • • • • Talked with the manager and provider; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff have the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. What the service does well: The provider, manager, and staff team have developed expertise in supporting and caring for people with complex, and sometimes very challenging needs and behaviours. A relative said that staff ‘manage behaviour well and keep families informed of developments in people’s care.’ They also said that the home provides ‘a clean and comfortable place for people to live.’ Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 6 The staff team have developed good working relationships with other mental health professionals. The home encourages people to: • • • Make everyday choices and decisions; Take control of their own lives; Take an active part in the preparation of their care plans. People spoken with praised the home and its staff and said that they were very happy living there. Staff are kind, respectful, considerate and have developed warm and caring relationships with the people in their care. People are satisfied with the care and support provided. Staff communicate with people in a positive manner. The provider, manager and her staff team are very positive about, and display a real commitment to, the work they carry out with people. People are able to access the office ‘as and when required.’ operates an ‘open door’ policy. The manager The provider and her manager are committed to ensuring that staff have access to the training they need to satisfactorily meet people’s assessed needs. The majority of staff have completed a recognised qualification in care. Staff files contain evidence that robust pre-employment checks have been carried out. The manager has carried out more advanced safeguarding training. All staff are required to complete a nationally recognised qualification in care. What has improved since the last inspection? The service user guide has been revised to include the required information. All assessment and care planning information has been computerised. Infection control and learning disability information files have been set up and made available to staff within the office. The home has obtained and is using a data protection compliant accident book. The home’s menus have been revised to include clearer and more detailed information about the food provided. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 7 Staff are checking people’s Medication Administration Records (MAR) before they administer their medication. In addition, staff are now signing each person’s MAR after they have administered their medication. Over the last 12 months, the providers have invested £50.000 in improving the facilities offered at the Lenore. Areas of the home have been redecorated and furnishings and fittings replaced. For example: • • • • • • • • Five bedrooms, the smoking lounge, conservatory, conference room, main office, and the lounges have been redecorated; Laminated flooring has been fitted in some bedrooms and communal areas and on some corridor landings; New carpets have been fitted in some bedrooms and communal areas; A number of light fittings have been replaced; Some wall and ceiling areas have been re-plastered; A number of external windows have been replaced; A new boiler has been installed; Floor tiles in the kitchen and in some bathing facilities have been replaced. New equipment has been purchased. For example: • • The home’s computer system has been upgraded and access to the internet provided; A new photocopier/scanner, fridge, two new vacuums, three microwaves, and a new cooker have been purchased. Premise related concerns identified during the previous inspection have been addressed. Staff have updated their statutory training. Improvements have been made to the way in which the home maintains the required staff information. Enhanced Criminal Records checks have been obtained for all staff working at the home. New documentation to support the staff induction process is now in use. A supervision contract has been put in place for each member of staff. A new staff supervision format has been introduced. A staff appraisal policy has been devised. The home has revised its smoking policy to ensure that it complies with the new smoking legislation. Improvements have been made to the way in which staff record financial transactions made on behalf of people living at the home. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 8 All staff have recently updated their medication training. The home has prepared an annual development plan. People wishing to use the service are informed in writing that the home has carried out an assessment and will be able to meet their needs. Staffing levels have been increased. 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. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for assessing people’s needs before they move into the home are good. This means that the home has access to all of the information it needs to make an informed decision about whether to offer a place at the Lenore. EVIDENCE: People are only admitted into the home following a full needs assessment. Assessments are carried out by trained and experienced mental health professionals. Copies of care management assessments and care plans had been obtained and placed in people’s care records. The decision about whether to offer a placement is made by both the provider and her manager. Before people move into the home they are provided with written confirmation that the Lenore will be able to meet their needs. Following a person’s admission, a member of staff is identified to help them adjust to their new living arrangements. This member of staff provides the new person with information about the home and how it is run and organised. Two people new to the service said that they had been given lots of helpful information about the home following admission. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 11 Of the eight staff who returned surveys, six said that they are ‘always’ given up to date information about the needs of the people they support. Two said that this is ‘usually’ the case. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s care plans and risk assessments are of a good quality. This means that people can be sure that staff have access to the guidance and support they need to satisfactorily meet their needs. EVIDENCE: The care records of three people were checked. about: • • • These included information People’s assessed needs; What staff hoped to achieve by their involvement; What each person needs to contribute to achieve the goals set out in their care plans. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 13 A range of care plans had been devised for each person covering such areas as mental and physical health, domestic, leisure and employment skills. Care plans were written in plain English and easy to understand. People said that they had been consulted about their care plans and what had been written in them. Those interviewed said that their care plans were in a format that they could understand. People had signed their care plans to confirm their agreement with the contents. Care records are kept secure at all times. People’s placements at the home are reviewed. For example, a person admitted into the home in September 2007, had had a specialist mental health review during the last six months. It was also confirmed that a second person recently admitted had had their needs reviewed during the previous 6 months. Of the eight staff that returned surveys, seven said that they are ‘always’ given up to date information about people’s needs. One person said that this is ‘usually’ the case. Three people were interviewed. All said that they choose: • • • • • When to get up and go to bed; Who to mix with in the home and where to socialise; When to go out and where to go; How to spend their money; Whether or not to talk to staff about their care plans. People said that they felt in control of their lives and received the support they needed to make day-to-day decisions. Of the six people living at the home who returned surveys: • • Five said that they are able to make decisions about what they do each day. One said that they are ‘usually’ able to do so; Six said they can do what they want during the day, evening and weekend. One said that insufficient funds made it difficult for them to do things during the day. Where relevant, copies of specialist risk assessments completed by mental health professionals are obtained to help the home make a decision about whether to offer a placement and how to care for the person following admission. For example, a copy of a specialist mental health risk assessment had been obtained and the information used to inform the home’s in-house risk assessments. The home carries out assessments where they, and other mental health professionals, have identified risks. For example, in one person’s care record, assessments covering the risks associated with reoffending, the possibility of a road traffic accident and their vulnerability handling money, had been assessed. People interviewed said that they had been invited to sign the risk assessments completed about them. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff actively encourage, and provide varied opportunities for people to develop and maintain independent and work based living skills. This means that people are provided with opportunities to enjoy a full and stimulating lifestyle that may help improve their mental health. EVIDENCE: People are encouraged to join in meaningful daytime activities of their own choice. For example, in one person’s care record, staff had devised a care plan to help them make choices about a suitable work placement. This person said that staff had talked to them about what they had done before coming to stay at the Lenore, and what sort of work placement they might be interested in. They also said that they had spent time with staff preparing a timetable of activities that would help them live more independently in the future. They Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 15 said that staff encouraged them to look after their room and keep it clean, do their own laundry and cook some meals each week. This person said that they felt very positive about the support that staff gave them. Another person who has lived at the home for a number of years continues to work as a part time driver for the local council. For a variety of reasons, some people have made a decision not to work. In such circumstances, staff encourage the person to keep occupied both within and outside of the home. People are encouraged and supported to make use of community facilities such as shops, local transport, and health care services. Local staff are employed at the home and therefore they are knowledgeable about what is available in the local community. People are supported to develop and maintain important personal and family relationships. For example, family members and friends are welcomed at the Lenore where this reflects the wishes of the person and, as long as it does not negatively affect the lives of other people living at the home. One person said that staff did not interfere in their relationship with another person living at the home. They said that staff respected their privacy and provided support when they needed it. A relative who returned a survey said: • • • • They are kept up to date with what is happening with their family member; Their family member receives the level of support that had been agreed before admission; That they felt the home met the needs of their family member; The service supports their family member to lead the life they choose to live. They also said: ‘(I get) regular phone calls from the Lenore so I am kept up to date.’ ‘Staff have excellent skills in dealing with my (family member).’ People felt that staff respected their rights. One person said that staff expected them to ‘act responsibly’ and ‘not upset anyone else living at the home.’ Another person said that staff ‘always’ knocked on their bedroom door before entering. They also said that the provider and manager consulted them about their care plans, medication and reviews. People said that staff only opened private mail if they were asked to do so. People have access to all parts of the home with the exception of other people’s bedrooms. One person said that the only rules the home had was that they let staff know when they left the building, that they only smoked in permitted areas and did not ‘hit’ or ‘shout’ at staff and other people living at the Lenore. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 16 Of the six people living at the home who returned surveys: • • All said that staff treated them well; All said that staff ‘listened and acted on what they had to say.’ People also said: ‘All staff are nice. They are very nice to get on with.’ ‘I have been satisfied all the time that I have lived here.’ Details of each day’s menus are displayed in the dining room. The menus have been revised to include more details of the choices available at main meal times. In addition, the menus now provide opportunities for people to have ‘five a day’ portions of fruit and vegetables to encourage healthier eating. People are offered three meals a day. A hot meal choice is available at each main mealtime. None of the people accommodated at the Lenore require assistance with eating or drinking. People are aware of meal times and do not need assistance to get to the dining room. People said that meal times are flexible. For example, one person said that if they had something going on and missed a meal, staff would ‘plate it up’ so that they could take it later. Over the next 12 months, the manager aims to develop links with professionals who can provide advice about the nutritional care needs of older adults. People have access to a drinks trolley in the dining room and are able to prepare hot beverages as and when they like. Some people also have fridges and kettles in their bedrooms. People interviewed said they were very happy with and enjoyed the meals served at the home. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s physical and mental health care needs are satisfactorily met helping them to lead healthy lives. People feel valued and able to retain control over the way they want to live their lives. EVIDENCE: People access health care as and when they need to do so. For example, each person had received dental care in the last 12 months. One person had seen their community psychiatric nurse on three occasions in the last six months. Another person had attended a diabetic clinic for a review of their needs. People interviewed said that they had been encouraged to register with a GP. They said that if they needed to see a GP, staff would provide them with any assistance needed to make an appointment. All felt that their needs in this area are well met. No one living at the home is considered to be at risk of developing pressure sores or falling due to ill health, old age, or frailty. A tour Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 18 of the building revealed no hazards that might cause trips and falls. No one required assistance with their personal care needs. The home has a medication policy that provides staff with guidance on how medication should be handled. The policy is currently being reviewed to ensure that it complies with the latest guidance issued by the Commission. Records covering the receipt, administration, and disposal of medicines are kept. Those checked were satisfactorily completed. Medication is kept secure at all times. All staff have recently completed medication training delivered by a local pharmacy provider. Some staff have also completed a learningdistance course in handling medicines safely. The home’s 12-week induction programme has been revised to include basic medication awareness training. A lockable cupboard is used to store medication. This was clean and hygienic. Photos to identify each person have been placed in their care records. Controlled drugs are not in use. Lockable facilities have been provided in bedrooms for the safe storage of medicines. Although hand wash facilities are not available in the office, staff have access to alcohol gel wash when administering medication. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for protecting people from harm or abuse are good. means that people can feel safe and protected in their own home. This Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 20 EVIDENCE: A copy of the home’s complaints procedure is available in the main reception area and office. The procedure includes the required information. A complaints/suggestions box has been placed in the reception area enabling people to submit anonymous concerns or compliments should they wish. A copy of the procedure has been placed on the back of each bedroom door. The home has a complaints book that is used to record details of complaints received by the home. Neither the home nor the Commission have received any complaints since the last inspection. People said that they would feel comfortable about raising concerns with either the provider or the manager. Of the six people living at the home who returned surveys, all said that they knew who to make a complaint to. Of the eight staff that returned surveys, all said that they would know what to do if they received a complaint. A relative who returned a survey said that they knew how to make a complaint. They also said that they had never had any concerns about the home. The home’s adult protection policy complies with relevant guidance and legislation. There have been two adult protection concerns raised since the last inspection. One safeguarding concern was investigated by the provider following which feedback was given to the individual’s care manager. This person told the Commission that they were satisfied with the outcome of the investigation. The other safeguarding referral did not arise because of poor practice on the part of the home. Social services and the police are currently carrying out an investigation into the concerns that have been raised. Although the home took appropriate action to handle both safeguarding referrals, it failed to inform the Commission of one of these. The manager agreed to ensure that the Commission would be informed of all future safeguarding referrals. All staff, with the exception of recent starters, have received training in safeguarding vulnerable adults. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment and overall quality of the furnishings and fittings are good. This means that people are able to live in a safe, wellmaintained, and comfortable environment that encourages independence. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home is safe, well ventilated, comfortable, free from offensive odours, and clean. It offers easy access to local amenities and transport links, and community health services. The appearance of the Lenore is in keeping with the local community and has no visible signs that might identify it as a care home. A CCTV system is used to monitor visitors to the home. There was no evidence that this has a negative effect on people’s daily lives and their right to privacy. A number of bedrooms were visited, as were all communal areas, toilets, and bathrooms. Furniture and fittings were satisfactory and people said that they were very happy with their bedrooms. Specialist aids and adaptations are not required. The home has some rooms occupied by people over 65 where the radiators are unguarded. These individuals have chosen not to have the radiators in their rooms guarded even though the potential risks associated with this have been explained. Each of these individuals has been assessed as having the capacity to make this decision. Risk assessments have been completed. All windows on the first and second floors have been fitted with restrictors. However, some people have chosen to remove the restrictors fitted in their bedrooms. Of the six people who returned surveys, all said that the home is ‘always’ clean and fresh. The Department of Health infection control checklist had been completed and a member of staff had been designated as the link between the home and the infection control nurse. No infection control concerns were identified. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, and 36. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for ensuring that new staff meet all of the outcomes set out in the ‘Skills for Care’ Common Induction Standards are not fully satisfactory. This may mean that staff do not have all of the underpinning knowledge required to commence a nationally recognised qualification in care. EVIDENCE: The home has a core rota that all staff work to. Changes to the rota are agreed verbally with either the manager or provider and a record is made in the home’s diary. Levels of staff turnover are low. The home has no vacancies and agency staff are not used. An examination of the rotas showed that there is always a minimum of two staff on duty throughout the working day. Extra staff are rostered on duty at busier times of the day. Eight full time and five part time staff are employed. 468 care hours were provided in the week that preceded the completion of the home’s Annual Quality Assurance Assessment. Since the last inspection, an additional member of staff has been provided following an increase in the numbers of people living at Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 24 the home. The manager said that current staffing levels are satisfactory. She also felt well supported by the provider who worked at the home on a daily basis. Ten of the 13 staff employed at the home have completed a nationally recognised qualification in care. Staff have received the required statutory training. For example, in the sample of three records checked, all staff had completed training in first aid, health and safety, fire prevention, infection control and food hygiene awareness. The same staff had also completed learning disability awareness training and two had been registered to commence a qualification in care. In each person’s file, there was a record of training completed and when training updates would next be required. Before staff commence working at the home: • • • They are required to complete an application form and provide a full employment history; A Criminal Records Bureau Disclosure check and two written references are obtained; Their identity is checked and verified. New staff are provided with in-house induction training. A written record of the training provided is kept. However, there are no records confirming that new staff have met all of the outcomes within the ‘Skills for Care’ Common Induction Standards. (CIS) Neither is there evidence that the home has completed the CIS Certificate of Successful Completion for staff who have successfully completed this level of training. The provider has given an undertaking to review their in-house induction processes to ensure that they are compliant with the ‘Skills for Care’ Standards. Staff who have completed a National Vocational Qualification in Care will have received basic equality and diversity awareness training. This area is also covered in the in-house induction-training programme. The manager is in the process of sourcing more in-depth training in this area. Since the last inspection, the manager has agreed a supervision contract with each member of staff and introduced a new format for recording supervision. A sample of staff supervision records was checked. This showed that staff had received supervision at the recommended frequency. Of the eight staff who returned surveys: • • • Seven said that their induction covered what they needed to know to do their job. One said that this was ‘mostly’ the case; All said that the training they receive is relevant to their job, helps them to understand people’s needs and keeps them up to date with new ways of working; All said that they met ‘regularly’ with their manager; DS0000000382.V356781.R01.S.doc Version 5.2 Page 25 Lenore, The • • • Six said that the ways in which information is shared within the home ‘always’ works well. Two said that this is ‘usually’ the case’; All said that there are ‘always’ enough staff on duty to meet people’s needs; All said they have the skills and experience to meet people’s needs. A member of staff who returned a survey said: ‘(The manager) supports us through our job and (gives us) any help we may need. (She ) also helps us with our NVQ if we are stuck’. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager provides a clear sense of leadership and demonstrates a commitment to providing people with good quality care. This means that people live in a home which is run and managed by a person who is fit to be in charge and discharges her responsibilities fully. EVIDENCE: The manager has completed the Registered Manager’s Award and a National Vocational Qualification in Care at Level 4, and is in the process of completing her Assessor’s Award. The manager has more than three years experience as a senior staff member and manager at the Lenore. Since commencing work at the home, Ms Murray has completed statutory training covering such areas as Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 27 safeguarding vulnerable adults, first aid, and food hygiene. She has also completed refresher training in moving and handling and health and safety in October 2007. The home uses a quality assurance framework devised by the former local authority registration body. The system covers such areas as the management of the environment and care planning. An initial audit of the home’s practices, systems, and records was first carried out in 2005/06. However, a quality review has not been completed within the last 12 months. Monitoring visits to assess the quality of services provided at the home are carried out by the provider’s representative. Visits had not always been carried out every month. Since the last inspection, the manager has issued quality questionnaires to a sample of people using the service. People’s responses have been analysed and the outcome shared with the Commission. The opinions of professionals visiting the home have not been sought on a formal basis. Although staff have also been surveyed for their opinions about how the home is run, some of the questions included were not entirely relevant. Ms Murray said that she would attend to these matters following the inspection. It was identified that not all policy and procedures have been reviewed during the last 12 months. Improvements have been made to the way in which financial records are kept. For example, pre-ruled sheets have been introduced for each person covering the date on which the transaction took place, whether a deposit or debit took place, the reason for the transaction and the balance. The records checked were accurate and up to date. The balance of money held for each person matched that indicated on their financial record. People’s money has not been pooled and it is kept secure at all times. People said that they were encouraged to sign the home’s records when withdrawing or depositing their money. Following the last inspection, the home revised its policy for handling people’s money. However, the policy does not include guidance on: • • • The process to be followed when the home has agreed to act as an ‘appointee’ for someone; How often financial audits will take place and who will carry out this responsibility; Who can access the home’s safekeeping facilities. Measures are in place to protect people’s health and safety. For example: • • • • A health and safety policy has been devised and is available for reference purposes in the office. The policy identifies the provider as the ‘competent’ person; A tour of the premises was undertaken and no health and safety concerns or hazards were identified; Information about hazardous materials has been obtained; The home has a current contract with the local council to remove hazardous waste; DS0000000382.V356781.R01.S.doc Version 5.2 Page 28 Lenore, The • • • • • • All electrical equipment had been tested within the last 12 months; Workplace risk assessments had been recently reviewed; The home’s hot and cold water systems had been checked for the presence of Legionella in December 2007; The home’s fire risk assessment had been revised during the last 12 months. There were current safety certificates for the alarm system and emergency lighting. A certificate of safety had just been issued for the home’s fire extinguishers; The required fire prevention checks had been carried out. Accidents had been satisfactorily recorded. Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X 3 3 X 2 X 2 3 X Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA23 Regulation 37 Timescale for action Ensure that the Commission is 01/05/08 informed, without delay, of all safeguarding concerns involving people living at the home. This will help to ensure that the home receives the advice and support it requires to comply with relevant legislation. 2. YA41 26 The provider must ensure that 01/06/08 visits to monitor the conduct and performance of the home are carried out monthly. This will help to ensure that the home is run in the best interests of the people living there and that it continues to comply with the relevant legislation. Requirement Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 31 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 YA18 Good Practice Recommendations Complete a Health Action Plan for each person. Carry out a nutritional risk assessment for all people aged over 65. 2. YA20 Ensure that: • • The temperature of the room in which medication is stored is checked on a daily basis and a written record kept; Ensure that an identity photo is placed on each person’s medication administration record. Review the home’s medication policy to ensure that it reflects the latest guidance issued by the Commission; 3. 4. YA24 YA32 Ensure that all radiators are guarded. The manager and provider should undertake training aimed at staff that work with people who have learning disabilities. The manager should ensure that they: • Are satisfied that any new worker employed at the home has met all of the outcomes within the ‘Skills for Care’ Common Induction Standards (CIS) and that there is clear recorded evidence of this; Have signed off the CIS Certificate of Successful Completion. 5. YA35 • Ensure that all staff complete equal opportunities training, including disability and race equality training; Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 32 6. YA39 Ensure that: • • All people living at the home are surveyed as part of the home’s annual quality assurance process; The views of professionals associated with the Lenore are sought on how far the home is achieving its goals for people using the service. 7. 8. YA40 Review the home’s policies and procedures every 12 months. Update the home’s policy on handling people’s money to include the areas referred to in this report. Devise documentation that will enable you to record how you have reached a judgement that someone is able to make a decision that may place them at risk of harm or injury. The documentation devised should prompt the person carrying out the assessment to consider the following issues: Have you considered the two stage test of capacity and recorded the outcome; • Can the person understand information relevant to the decision that needs to be made; • Can the person remember that information long enough to make the decision; • Can the person weigh up information relevant to the decision; Can the person communicate their decision by talking, using sign language, or by any other means. • YA41 Lenore, The DS0000000382.V356781.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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. 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