Inspection on 29/03/07 for Lenore, The

This inspection was carried out on 29th March 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lenore, The 19/03/08

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 29 March 2007 08:00 DS0000000382.V290562.R02.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 DS0000000382.V290562.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 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. DS0000000382.V290562.R02.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 0191 2513728 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 21 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (18) of places DS0000000382.V290562.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of persons for whom residential accommodation with board and care is provided shall not exceed 21 men and women The category of persons received into the Home shall be restricted to the following categories LD & MD Maximum service users with LD should not exceed 5 without prior negotiation with CSCI. 23rd February 2006 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 21 residents with mental health care needs. Some residents also have a learning disability. Four residents are aged over 65. Single room accommodation is provided over the first and second floors of the home. There are no en-suite facilities. Communal facilities consisted of: two dining rooms; four lounges; eight toilets; two showers and four 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 £312 to £365. The local authority sets the fees charged. The local authority provides each resident with a letter setting out the outcome of their financial assessment, as well as details of the contributions that each is expected to make towards the cost of their placement at the home. Copies of the Commission’s inspection reports were available in the home’s reception area and office. Residents are expected to pay for such things as private chiropody, newspapers and hairdressing. Residents are also expected to pay their transport costs where the benefits they receive cover this expense. DS0000000382.V290562.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 12 hours and was conducted by one inspector. The inspection involved talking with the manager, members of her care team and examining a selection of the home’s policies, procedures and records. The inspector formally interviewed two residents and spoke generally with other residents. The manager and her team provided every assistance during the inspection. The home’s registration certificate was reviewed as part of the inspection following which it was noted that: 1. Four residents aged over 65 years of age were accommodated. Following contact with the regional registration team, the manager was advised that the home’s conditions of registration would not need to be varied; 2. The home’s certificate identifies the registered providers as Mr and Mrs Duchette. But, the home is owned by Lenore Domiciliary Care Limited and is registered at Companies House. Following contact with the regional registration team, the providers will have to submit a new application to change the registered provider details. What the service does well: The provider, manager and staff team have developed expertise in supporting and caring for residents with complex, and sometimes very challenging needs and behaviours. The staff team have developed good working relationships with other mental health professionals. The home encourages residents to: • • • Make everyday choices and decisions; Take control of their own lives; Take an active part in the preparation of their care plans. Residents spoken with praised the home and its staff and said that they were very happy living there. Staff were kind, respectful, considerate and had developed warm and caring relationships with the people in their care. Residents were very satisfied with DS0000000382.V290562.R02.S.doc Version 5.2 Page 6 the care and support provided. positive manner. Staff communicated with residents in a The manager and her staff team were very positive about, and displayed a real commitment to, the work they carry out with residents. Residents are able to access the office on an ‘as and when required’ basis. The provider and her manager are committed to ensuring that staff have access to whatever training is required to satisfactorily meet residents’ identified needs. What has improved since the last inspection? Since the last inspection: • • • • • A new dryer had been purchased. A second washing machine had also been obtained; New dining chairs and tables had been provided in the main dining room; Laminated flooring had been fitted in one side of the building on the second floor; A number of bedrooms had been redecorated; New bedroom furniture had been purchased for some bedrooms. With the support of the provider, the manager had: • • • Revised the home’s assessment and care planning documentation to make it easier for staff and residents to use and understand; Introduced new office systems which supported staff to work in a more effective manner; Devised robust risk assessments built around the information contained in residents’ care plans. All care plans and risk assessments are being computerised to enable information to be more easily updated and made available to staff. The provider and manager had attended fire training to update them on the new fire regulations. What they could do better: The home’s service user guide should be revised to include the required information. This will help ensure that potential residents have access to all of the information they need to decide whether they wish to live at the Lenore. The manager needs to ensure that prospective residents receive written confirmation that the home will be able to meet their needs. This will help DS0000000382.V290562.R02.S.doc Version 5.2 Page 7 ensure that prospective residents can feel confident that the home will provide them with the care and support they need. The home’s medication policy needs to be reviewed to take account of the latest guidance issued by the Commission. This will help ensure that staff administering medication have access to the latest best practice guidance issued by the Commission and other relevant professional bodies. Radiators in bedrooms occupied by residents aged over 65 should be guarded. This will help ensure that vulnerable residents are protected from potential injury and harm. The premise related concerns identified in this report must be addressed. This will help to ensure that residents are provided with an environment that is well maintained, comfortable and pleasant to live in. The provider and manager must ensure that the required pre-employment checks have been carried out for new staff. This will help ensure that residents are protected from people who are considered unsuitable to work with vulnerable residents. Care staff must receive regular supervision at least six times a year. This will help ensure that all staff are clear about their role and know what standards they are expected to work to. The manager must actively seek the views of staff, residents, family and other professionals visiting the home, about how well the home is meeting residents’ needs. This will help to ensure that residents, and other relevant people, can influence how the service develops and is run. Action must be taken to ensure that the home is correctly registered. This will ensure that the home is complying with relevant legislation. 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. DS0000000382.V290562.R02.S.doc Version 5.2 Page 8 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 DS0000000382.V290562.R02.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements had been put in place to ensure that prospective residents received important information about the home and the services it provided. But, the home’s service user guide was not up to date and it did not contain all of the required information. This might mean that prospective residents do not have access to all of the information they need to make an informed decision about whether to live at the Lenore. The arrangements in place for assessing the needs of prospective residents were satisfactory. This provided staff with the information they needed to care for new residents in a safe and professional manner. EVIDENCE: It was evident that the manager understood the importance of residents having sufficient information when making a decision about whether to live at the home. For example, prospective residents are always given a copy of the home’s service user guide and statement of purpose during their first visit to DS0000000382.V290562.R02.S.doc Version 5.2 Page 10 the Lenore. The manager said that information about the home could be made available in other formats such as Braille or in large print. The provider had devised a statement of purpose that was specific to the Lenore and the resident group it catered for. It clearly set out the home’s objectives and philosophy. A new resident confirmed that he had received information about the home before moving in. However, the service user guide was not up to date and did not include all of the required details such as residents’ views of the home. Admissions into the home had only taken place after a full needs assessment had been carried out. Assessments had been undertaken by trained and experienced mental health professionals. The manager was clear that a placement would not be offered if staff did not have the skills and knowledge required to meet a prospective resident’s needs. Copies of assessments and care plans completed by relevant mental health care professionals had been obtained by the home. A temporary file is set up to hold any pre admission information obtained about a prospective client. The decision about whether to offer a placement is made by both the provider and her manager. The manager said that the home did not usually provide prospective residents with written confirmation that the home would be able to meet their needs. During the first week of a resident’s admission into the Lenore, a member of staff is identified to help them adjust to their new living arrangements. The manager said that this member of staff provided the new resident with information about the home and how it was run and organised. A new resident told the inspector that he had been given lots of helpful information about the home when he first moved in. He also said that staff had been very helpful. DS0000000382.V290562.R02.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. 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. Satisfactory care plans and risk assessments had been put in place for each resident. This meant that staff had access to the guidance and support they needed to meet residents’ needs in an effective and professional manner. The health, safety and welfare of residents was promoted and protected. This meant that residents were able to lead fulfilling lives within a safe environment where the potential threat of risks had been minimised. EVIDENCE: The manager expressed clear views about the importance of involving residents in planning how to meet their needs. During the inspection, a resident approached the manager and queried some of the details that a DS0000000382.V290562.R02.S.doc Version 5.2 Page 12 mental health worker had included in his care plan review information. manager immediately offered to discuss his concerns privately. The The home’s statement of purpose provided staff with clear guidance about the importance of providing residents with opportunities to make choices and exercise their rights. A sample of care records were examined and it was confirmed that each resident had a care plan that had been agreed with them. Those checked contained important information covering such areas as: • • • Residents’ identified needs and how they would be met; What the Lenore’s staff team hoped to achieve by their involvement with the residents that they supported; What each resident needed to contribute to achieve the goals set out in their care plans. In one resident’s care records, care plans had been put in place covering their need for assistance with budget management, medication, employment opportunities and developing better coping strategies. The care plans examined were written in plain English and easy to understand. The manager confirmed that care plans were in a format that could be understood by the residents currently accommodated. There was evidence that residents’ care plans and risk assessments had been reviewed during the last 12 months. A resident said that staff had consulted him about his care plan. Although the provider had made a decision not to adopt a key worker system, there was evidence that staff had developed strong and supportive relationships with the people in their care and, that the support they provided was individual and person centred. Copies of risk assessments completed by other mental health professionals had been obtained. This information had been used to inform the home’s own inhouse risk assessments. In one resident’s care records, a risk assessment had been completed covering their aggressive outbursts and vulnerability when handling money. Residents had been invited to sign completed risk assessments. Where a resident had refused to sign any of the assessments completed by the home, a record of his refusal had been included in his care record. A resident who had just moved into the home confirmed that he had been supported to make decisions about how he lived his life at the Lenore. He said that it was his choice about when he got up and went to bed. He also said it was up to him how and with whom he spent his time. Decisions to limit the range of choices and decisions that some residents could make had been agreed with other key mental health professionals. For example, the home had limited one resident’s access to cigarettes and alcohol by giving them their personal allowance money on a daily basis. This decision had been agreed at a multi-disciplinary team meeting involving the resident’s psychiatrist and community psychiatric nurse. DS0000000382.V290562.R02.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. 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 encouraged, and provided varied opportunities for, residents to develop and maintain social, emotional, communication and independent living skills. Residents were able to enjoy a full and stimulating lifestyle. Residents’ rights were protected and their responsibilities recognised. This means that residents are able to make decisions and choices, and take responsibility for their actions, with staff support and encouragement. EVIDENCE: There was evidence that staff had supported residents to join in meaningful daytime activities of their own choice. For example, in two residents’ care records, care plans had been put in place to help them find, or continue DS0000000382.V290562.R02.S.doc Version 5.2 Page 14 attending, structured day time activities. When these arrangements had broken down for one resident, staff had encouraged, but not insisted, that they attend their day care service. A newly admitted resident said that although he was not doing anything during the day at present, the manager had said that as soon as he settled into the Lenore, staff would support him to find work. He confirmed that he was satisfied with the advice that the home had given him. One resident attended a local day care service twice a week. Another resident had a part time job as a driver for the local council. Some residents had made a decision not to work. Residents had been encouraged and supported to make use of local facilities such as shops, local transport and community health care services. Local staff are employed at the home and, as a consequence, they are knowledgeable about what is available in the local community. The home had developed good relationships within the community. Residents had been provided with opportunities to develop and maintain important personal and family relationships. For example, staff encourage one particular resident to keep in contact with a close friend who is also invited to visit the home for parties or arranged trips out. Family members and friends are welcomed at the Lenore where this reflects the wishes of the resident and, as long as it does not affect the lives of other people living at the home. In two of the care records examined, care plans had been put in place to help residents maintain links with their families. Social history information is obtained at the point of a resident’s admission into the home and recorded in their care record. There was evidence that residents’ rights are respected and their responsibilities recognised. One of the residents interviewed confirmed that staff always knocked on her door before entering. She also said that staff respected her privacy. Residents’ mail is not opened without their permission. Throughout the inspection staff were observed interacting and talking with residents and not just between themselves. Residents had access to all parts of the home with the exception of other residents’ bedrooms. Staff supported residents to make decisions and choices in line with the guidance they had received whilst undertaking Mental Health Act Capacity training. A nutritional care policy was not in place. The manager confirmed that: • • • The home’s menus were prepared a month in advance; Residents had been consulted about the content of the home’s menus during householder meetings. Staff had also been consulted; Residents were consulted about what they wanted to eat at the evening meal on a daily basis. Several choices were made available to residents at the breakfast and lunchtime meals. Daily handwritten records of food served at the breakfast DS0000000382.V290562.R02.S.doc Version 5.2 Page 15 and lunchtime meals had been kept. Residents are offered meals three times a day. A hot meal choice was available at each main meal time. None of the residents accommodated at the Lenore required assistance with eating or drinking. Residents were aware of meal times and needed no assistance to get to the dining room. There was evidence that meal times were flexible. For example, where residents missed a meal because of other commitments, their meals were kept so that they could be taken at a later time. Residents had access to a drinks trolley in the dining room and are able to prepare hot beverages as and when they like. Some residents also had fridges and kettles in their bedrooms. All of the residents spoken to during the inspection said that they enjoyed the meals served at the home. Meal times were relaxed and unrushed. Details of the full menus served each day were displayed in the main dining room. DS0000000382.V290562.R02.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Suitable arrangements had been made for staff to support residents to meet their own health care needs. Generally, the arrangements for storing, recording and disposing of medicines were satisfactory. But, a medication related concern identified during the inspection had the potential to place residents’ well being at risk. EVIDENCE: The residents interviewed said that they felt well looked after. Information about residents’ health needs had been recorded in the three care records examined. There was evidence that: • • Two residents had attended a optician in the last two years; Staff contacted residents’ GPs wherever this was necessary. DS0000000382.V290562.R02.S.doc Version 5.2 Page 17 With regards to the provision of dental care, the manager said that for two of the people whose care records were checked, they had been offered, but had declined dental treatment. The third person had only recently been admitted into the home and the opportunity to access dental care would be provided as soon as possible. Ms Murray said that other residents usually received staff support when accessing dental care. Residents had also been given opportunities to access optical care. In one resident’s care records there was evidence that they had been supported to attend an alcohol and drugs specialist team based at a local hospital. Staff had put arrangements in place for a new resident to register with a local GP practice. Where a need had been identified for a resident to eat more healthily and lose weight, staff had undertaken weight checks and kept a written record of this. There was also evidence that the home had made contact with a resident’s community psychiatric nurse when problems with his behaviour and mental health arose. Nutritional care risk assessments had not been carried out for any of the residents aged over 65. None of the residents accommodated required assistance with meeting their personal care needs. There was evidence that staff had received training in meeting residents’ health care needs. For example, in the three staff files examined: • • • • Two staff had completed qualifying training that covered health care issues; A recently appointed member of staff had completed basic training in health care as part of their ‘Skills for Care’ induction training; Two staff had completed infection control training. In addition, one of these staff had been nominated to undertake more advanced infection control training at a local hospital; One member of staff had completed training in - optical awareness, handling death and dealing with self-harming behaviours. The home had a medication policy that had been updated to comply with the National Minimum Standards. A lockable cupboard had been used to store medication. This was generally clean and hygienic. All medication had been properly secured. Photos to identify each resident had been placed in their care records. There were records in place covering the receipt, administration and disposal of medicines. Two staff whose files were checked had completed accredited medication training, one in 2004 and the other in 2001. There were no controlled drugs on the premises at the time of the inspection. None of the residents accommodated had been judged competent to administer their own medication. Lockable facilities had been provided in bedrooms for the safe storage of medicines. Although hand wash facilities were not available in the areas in which medicines were stored, staff had access to an alcohol gel wash. During the inspection, a member of staff was observed placing each resident’s drugs in a labelled medication pot without first consulting individual medication administration records. The manager said that this person was an experienced member of staff who was very familiar with peoples’ medication. However, Ms DS0000000382.V290562.R02.S.doc Version 5.2 Page 18 Murray acknowledged the important of ensuring that staff followed the home’s medication policy when administering drugs. DS0000000382.V290562.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place for handling complaints were satisfactory and residents were confident that their complaints would be listened to, taken seriously and acted upon. Satisfactory arrangements were in place to protect residents from harm or abuse. This meant that residents could feel safe and protected in their own home. EVIDENCE: A copy of the home’s complaints procedure was available in the main reception area and office. The procedure included the required information. A complaints/suggestions box had been placed in the reception area allowing residents to submit anonymous concerns should they wish. A copy of the complaints procedure had been placed on the back of each bedroom door. The home had a complaints book that could be used by staff to record details of complaints received by the home. Neither the home nor the Commission had received any complaints since the last inspection. Residents said that they would feel comfortable about raising concerns with the provider or the manager. DS0000000382.V290562.R02.S.doc Version 5.2 Page 20 Following the last inspection, the home’s adult protection policy had been revised to ensure that it included all of the information recommended by the local safeguarding team. Ms Murray said that the safeguarding team had confirmed that they were satisfied with the content of the policy. No adult protection concerns had been raised with the home or the Commission since the last inspection. An adult protection concern discussed during the last inspection had been resolved. Residents interviewed said that they felt safe living at the home. DS0000000382.V290562.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall quality of décor, furnishings and fittings was acceptable. But, further improvement is required in some areas to ensure that residents are provided with a good standard of accommodation. EVIDENCE: DS0000000382.V290562.R02.S.doc Version 5.2 Page 22 The home was safe, well ventilated, comfortable, free from offensive odours and generally clean. On the day of the inspection, the laundry and main kitchen were tidy and hygienic. The home offered easy access to local amenities, local transport and community health services. The appearance of the home was in keeping with the local community and had 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 affected the daily lives of residents. Although the home’s furniture and fittings were generally satisfactory, a number of concerns were identified: • • Bedroom 17: the bedside cabinet had a worn appearance; there was water damage to the ceiling. (This matter was addressed during the inspection process); Corridor area outside bedroom 10: there was water damage to the ceiling. The cause of the water damage had been investigated and the provider had been told that repairs would need to be made as soon as the good weather arrived. (This mater was addressed during the inspection process); Ground floor smoking lounge: the carpet and armchairs were stained and marked and had suffered ‘wear and tear’ damage due to residents’ constantly smoking in this area of the home. The provider had placed an extractor fan in the room to try and remove as much of the smoke as possible. Around 50 of the armchairs in this room had been replaced within the last six months; Bedroom 1: the carpet was stained and looked unclean; the walls were marked in places. The provider had discussed the possibility of having the carpet replaced and the room redecorated, with the room’s occupant on a number of occasions. But, the person concerned had refused to allow this work to be carried out; Bedroom 12: the carpet had cigarette burns that had been caused by the room’s previous occupant. The bedside cabinet had a worn appearance; there was water damage to the ceiling; Radiators in residents’ bedrooms were unguarded. All residents had confirmed that they did not wish the radiators in their bedrooms to be guarded and had signed a disclaimer to this effect. • • • • None of the residents currently accommodated required the use of aids and adaptations. However, this may change as some of the home’s older residents age. All residents were accommodated in single bedrooms. Residents interviewed said that they had what they wanted in their bedrooms. A new resident said that staff had supported him to buy the things he wanted to personalise his bedroom and that this had made him feel more comfortable about being at the Lenore. This person also said that the home had consulted him about the redecoration of his bedroom. Concerns identified by the home’s fire officer during his last visit to the Lenore had been addressed. DS0000000382.V290562.R02.S.doc Version 5.2 Page 23 DS0000000382.V290562.R02.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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. There were sufficient staff rostered on duty to meet the assessed needs of residents. This meant that residents could be sure that they would get the help and support they needed to live more independently. The arrangements for ensuring that staff regularly updated their training in key areas were satisfactory. This helps to ensure that staff have the skills and knowledge required to satisfactorily meet residents’ needs. A satisfactory programme of regular and structured staff supervision was not in place. This meant that staff did not have the opportunity to benefit from regular structured one to one meetings with their manager about the running of the home, resident issues and, their own professional developmental needs EVIDENCE: The home had a core rota that all staff worked to. Changes to the rota are agreed verbally with either the manager or provider and a record is made in DS0000000382.V290562.R02.S.doc Version 5.2 Page 25 the home’s diary. Short-term sickness levels were not significant and the provider had taken action to try and address the needs of a staff member on long-term sick leave. Levels of staff turnover were low with only one member of staff leaving the home since the last inspection. The home had no vacancies and agency staff had not been used to cover shifts within the last eight weeks. The manager felt that current staffing levels were satisfactory. She also felt well supported by the provider who worked at the home on a daily basis. A sample of three staff records were examined. It was identified that staff had recently updated their training in the following areas – first aid, protection of vulnerable adults, health and safety and fire prevention. Staff who had completed a nationally recognised qualification in care had covered equality and diversity training as part of this process. It was also identified that: • • • One member of staff had not received infection control training. Ms Murray confirmed that the staff member concerned would complete training in this area as soon as possible; All three staff had completed moving and handling training. Ms Murray confirmed that there were no residents accommodated who required this type of assistance; A staff development and training needs analysis was not available in any of the staff records examined. Some staff had also completed more specialist training relating to the needs of adults with mental health care needs. For example, seven staff had recently received training in the new mental health legislation. Another member of staff had completed training in managing challenging and self-harming behaviours. All but one member of the staff team had obtained a nationally recognised qualification in care. There was no evidence in the staff files examined that staff had completed training in working with people with learning disabilities. A recruitment and selection policy provided guidance regarding how staff should be recruited. Staff had completed statements about whether they had any criminal convictions and were physically and mentally fit enough to carry out their work. A minimum of two written references had been obtained prior to prospective members of staff taking up employment at the Lenore. Application forms had been completed by all staff. But, it was also identified that: • For one member of staff there was no proof of identity or an identification photograph. A Criminal Records Bureau (CRB) disclosure certificate had not been obtained before the member of staff commenced work at the home. There was a faxed copy of a CRB disclosure certificate from the staff member’s previous employer. There was no written evidence that a matter of concern had been discussed with the DS0000000382.V290562.R02.S.doc Version 5.2 Page 26 • applicant prior to their employment. There was also no evidence that gaps in this person’s employment history had been explored; In their application form, another member of staff had not provided dates for previous periods of employment. There were also unexplained gaps in this staff member’s employment history. A sample of staff supervision records were checked and it was noted that: • • Staff had not received the minimum standard of at least six supervision sessions during the last 12 months; Staff supervision sessions do not cover the required areas. But, during the feedback session, the manager confirmed that she had introduced new documentation for recording staff supervision sessions and the format now covered the required areas. DS0000000382.V290562.R02.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 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 provided a clear sense of leadership and demonstrated a commitment to providing residents with good quality care. This meant that residents lived in a home which was run and managed by a person who was fit to be in charge, was of good character and able to discharge her responsibilities fully. The arrangements in place for monitoring the quality of services and care provided by the home were not fully adequate. The home had not obtained the views of residents, their families and friends, and other relevant professionals, about how well the home was meeting residents’ needs and how the quality of the service could be developed. Steps had been taken to promote the health and well being of residents and to protect them from potential hazards. This meant that residents lived in a home where health and safety concerns were taken seriously and where DS0000000382.V290562.R02.S.doc Version 5.2 Page 28 concerns were promptly addressed to prevent them suffering unnecessary harm. EVIDENCE: The manager had completed the Registered Manager’s Award and hoped to complete the NVQ in Care at Level 4 in June 2007. The manager had more than two years experience as a senior staff member and manager at the Lenore. Ms Murray had undertaken training in key mandatory areas since commencing work at the home such as safeguarding vulnerable adults and fire safety. She had current first aid and food hygiene certificates. However, Ms Murray had not recently updated her health and safety training. The manager confirmed that she had a written job description. There was evidence throughout the inspection that the manager and her staff worked very hard to offer residents good quality care. The manager was aware of current developments in her own field and was interested to know more about the Commission’s approach to inspection and good practice guidance and relevant publications. The home had adopted the use of a quality assurance framework that had been recommended by the former local authority registration body. The system covered such areas as the management of the environment and care planning. An initial audit of the home’s practices, systems and records was carried out in 2005/06 and had recently been reviewed. The manager demonstrated an awareness of the Commission’s newly introduced selfassessment quality assurance tool for providers. Monitoring visits to assess the quality of services provided at the home had been undertaken on a regular basis by the provider’s representative. The manager confirmed that the opinions of staff, residents and other professionals visiting the home had not been sought on a formal basis within the last 12 months. Ms Murray said that she would attend to this matter straightaway. A selection of residents’ financial records were examined and it was noted that: • A small hardbound book had been used to record financial transactions involving residents’ money. No concerns were identified with the contents of the financial records checked. But, the format of the records meant that they were difficult to audit; The balance of money held for each resident matched the financial records and residents’ monies were kept separately; Residents had signed their own financial records when withdrawing money from the home’s safekeeping facility; Residents’ financial records had been subject to regular in-house audits. DS0000000382.V290562.R02.S.doc Version 5.2 Page 29 • • • The home’s policy regarding the handling of residents’ money was reviewed as part of the inspection. It was noted that: • • • It contained no reference to the registered persons’ responsibilities under Schedule 4 to the Care Homes Regulations 2001; There was no guidance about the home’s role with regards to acting as ‘Appointees’ for residents unable to control their own finances; Guidance had not been included on the following matters – carrying out audits of the monies held on behalf of residents to ensure their accuracy; who can access the home’s safekeeping facilities; responsibilities arising out of contracts agreed with local authority commissioners. There An audit of safe working practices within the home was undertaken. was evidence that: • • • • • • • The home’s fire risk assessment had been revised during the last 12 months. The required fire prevention checks had been carried out. Requirements made by the home’s fire officer following his last visit had been implemented. Although the management of residents’ smoking created problems that required careful management, the provider and manager had tried to ensure that the home was as fire safe as possible. The home had entered into a contract with the local council to remove hazardous waste from the home; The home’s maintenance man carried out regular checks of the temperature of hot water supplied to residents’ bathing facilities; The home’s hot and cold water systems had been checked twice in 2006 for the presence of legionella; A range of workplace risk assessments had been completed; The home had a health and safety policy. A tour of the premises was undertaken and no health and safety concerns or hazards were identified; Accidents occurring within the home had been satisfactorily recorded. DS0000000382.V290562.R02.S.doc Version 5.2 Page 30 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 2 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 x 34 2 35 2 36 2 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 2 x 2 3 x DS0000000382.V290562.R02.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Timescale for action The manager must ensure that 01/09/07 the service user guide is updated to include the following information: • • Correct details of the body responsible for inspecting the home; Correct details regarding the legislation and standards under which the home is inspected; The current number of residents for which the Lenore is registered; Residents’ views of the home; More details about the specialist support offered to residents with mental health care needs and those with learning disabilities; Details of the total fees payable and how they are to be paid; Confirmation as to whether extra charges will be made and how these will be paid for; Version 5.2 Page 32 Requirement • • • • • DS0000000382.V290562.R02.S.doc • 2. YA3 14 A copy of the most recent inspection report. 3. YA17 Schedule 4 The manager must ensure that 01/04/07 prospective residents receive written confirmation that the home will be able to meet their assessed needs. The manager must ensure that 01/09/07 the home’s menus: • • Specify at least two choices for the lunch time and evening meals; Include details of the range of food available at the breakfast, lunch and supper time meals; Details of the approximate timing of meals; Include information about the availability of vegetarian, specialist and cultural dietary meals; Include information about the types of snacks and beverages available throughout the day. • • • The manager must ensure that the home’s nutritional policy covers the following areas: • • • The importance of nutrition and hydration; Indicators of poor nutritional health; The need for dietary supplements for residents suffering from poor nutritional intake; Use of nutritional risk screening tools and care plans to aid better nutrition; The best ways to cook food to maximise nutrition. • • DS0000000382.V290562.R02.S.doc Version 5.2 Page 33 4. YA20 13(2) The manager must ensure that: • Each resident’s medication administration record is consulted before medication is removed from the containers supplied by the pharmacist and administered; All staff adhere to the home’s medication policy; All care staff, regardless of whether they have responsibilities for administering medication, complete level 1 training in line with guidance issued by the Commission. 01/04/07 • • 5. YA24 16(2) & 23(2) The provider and manager must 01/09/07 ensure that: • • The carpet in bedroom 1 is replaced on the room being vacated; The radiators without covers in bedrooms where residents are aged over 65 are guarded. Where residents over 65 refuse to allow their radiators to be guarded, an appropriate risk assessment must be put in place. 6. YA24 16(2) and 23(2) 18 Schedule 2 The provider must ensure that 01/10/07 the carpet in bedroom 12 is replaced. The manager must ensure that: • Applicants provide a full employment history. Where there are gaps in an applicant’s employment history, a written record must be kept of Version 5.2 Page 34 7. YA34 01/09/07 DS0000000382.V290562.R02.S.doc • • • explanations given for the gaps; Full details of all previous employment must be obtained for each member of staff employed at the home since April 2002; A written record is kept of any discussions held with an applicant about matters of concern identified in their Criminal Records Bureau (CRB) disclosure certificate; Proof of identity and identification photos are obtained for all staff currently employed at the home. 8. YA34 18 Schedule 2 The provider and manager must 01/04/07 ensure that an enhanced CRB disclosure certificate is obtained before a prospective applicant commences work at the home. The manager must ensure that: • • A detailed record is kept of any in-house induction training provided to staff; Each member of staff has an individual training and development assessment and profile; All staff complete equal opportunities training, including disability and race equality training. 01/10/07 9. YA35 18 • 10. 11. 12. YA36 YA37 YA39 18 9 24 The manager must ensure that 01/010/07 all staff receive a minimum of six supervision sessions a year. The manager must update her 01/10/07 health and safety training. The provider and manager must 01/10/07 ensure that: DS0000000382.V290562.R02.S.doc Version 5.2 Page 35 • • • Feedback is actively sought from residents about services provided at the home; The views of family, friends and other professionals visiting the Lenore, such as GPs and care managers, are sought on how far the home is achieving its goals for residents; Staff are actively consulted about their views regarding the conduct of the home and any matters relating to the well-being of residents. 13. YA39 24 The provider and manager must 01/07/07 devise an annual development plan setting out what they hope to achieve in 2007. The plan should take account of the following: • • • Requirements arising out of the most recent inspection report; Matters arising out of the home’s quality audit; Matters arising out of resident and staff meetings and staff supervision sessions. (The timescale for complying with this requirement expired on 01/06/06) 14. YA41 Schedule 4 The manager must ensure that 01/09/07 the home’s policy on handling residents’ money is updated to include guidance on the following areas: • The registered responsibilities persons’ under Version 5.2 Page 36 DS0000000382.V290562.R02.S.doc • • • Schedule 4 to the Care Homes Regulations 2001; The role played by the home when acting as an ‘Appointee’ for residents unable to control their own finances; Carrying out regular audits of the financial records kept concerning all transactions involving residents’ monies; Who is able to access the home’s safekeeping facility. 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 YA6 Good Practice Recommendations The manager should ensure that wherever the home acts as an ‘appointee’ for a resident, the care plan sets out the level of support and monitoring that will be provided by the Lenore. The manager should consider completing: • • 3. YA20 The ‘OK’ Health Assessment for each resident. (Details can be supplied); A nutritional risk assessment for all residents over 65. 2. YA18 The provider should: • • Review the home’s medication policy to ensure that it reflects the latest guidance issued by the Commission; Ensure that staff responsible for administering DS0000000382.V290562.R02.S.doc Version 5.2 Page 37 medication update their training on a yearly basis. 4. 5. 6. YA24 YA32 YA36 The provider should ensure that all radiators are guarded. The manager should undertake training aimed at staff that work with people who have learning disabilities. The manager should ensure that staff supervision sessions cover the following areas: How the work carried out by staff relates to the home’s statement of purpose; • The care and support provided to each resident; • Support and professional development; • Identification of training and developmental needs. The manager should devise a questionnaire that can be used to obtain staffs’ views about the day-to-day management of the home. The manager should ensure that: • Residents’ financial records are pre-ruled to include columns covering the following areas: the date on which money was deposited or debited from the account; the reason for the transaction; the debit amount; the deposit amount; the balance; the resident’s signature; the staff member’s signature; Residents’ financial records are subject to a monthly in-house audit. It is recommended that any audit carried out be recorded in red ink. • 7. YA39 8. YA41 • The provider should ensure that the home’s policy on handling residents’ money is updated to include guidance on the registered persons’ responsibilities arising out of their contracts with local authority commissioners. DS0000000382.V290562.R02.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 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 DS0000000382.V290562.R02.S.doc Version 5.2 Page 39 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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