CARE HOMES FOR OLDER PEOPLE
Lenthall House Lenthall Square Market Harborough Leicestershire LE16 9LQ Lead Inspector
Linda Clarke Unannounced Inspection 10th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lenthall House Address Lenthall Square Market Harborough Leicestershire LE16 9LQ 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) 01858 463204 01858 463204 Leicestershire County Council Social Services Mrs Jill Wright Care Home 40 Category(ies) of Dementia - over 65 years of age (20), Learning registration, with number disability over 65 years of age (4), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (4), Old age, not falling within any other category (40), Physical disability over 65 years of age (10), Sensory Impairment over 65 years of age (4) Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service User Categories PD(E) No person falling within category PD(E) may be admitted to the home when 10 persons who fall within category PD(E) are already accommodated within the home Service User Categories SI(E) No person falling within category SI(E) may be admitted to the home when 4 persons who fall within category SI(E) are already accommodated within the home Service Users Service users between the age of 55-65 years who fall within the above categories and were resident in the care home at the date of registration may continue to reside there Service User Categories LD(E) No person falling within category LD(E) may be admitted to the home when 4 persons who fall within category LD(E) are already accommodated within the home Service User Categories DE(E) No person falling within category DE(E) may be admitted to the home when 20 persons who fall within category DE(E) are already accommodated within the home Service User Categories MD(E) No person falling within category MD(E) may be admitted to the home when 4 persons who fall within category MD(E) are already accommodated within the home To be able to admit the named person under the age of 65 named in the variation application number V19913 dated 3rd May 2005. 26th July 2005 2. 3. 4. 5. 6. 7. Date of last inspection Brief Description of the Service: Lenthall House is a care home providing personal care and accommodation for forty older persons. Lenthall House also offers accommodation for two indivdiuals for respite. The forty single bedrooms are without en-suite facilities. The home has a large patio area with raised flowerbeds and a summer house that service users can access. Large pleasant gardens surround the home. The premise is owned by Leicestershire County Council Social Services Department and is situated close to Market Harborough town centre, which is an historic marketing town. The home is easily accessible by private or public transport.
Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 5 Accommodation is provided over two floors with access between the floors being via stairs or a passenger lift. Lenthall House is fully accessible. Communal areas are provided on both floors of the home. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection took place between 10.0am and 4.00pm. The opportunity was taken to look around parts of the home, spend time with residents, view records which, included viewing the care plans of four residents residing at the home and one individual accessing respite care. The Registered Manager facilitated the Inspection, spending time with the Inspector; the Inspector also interviewed one member of care staff and spoke with visiting relatives. What the service does well: What has improved since the last inspection?
The Registered Manager advised that environmental improvements have taken place, with further plans agreed. This includes the replacement of corridor carpets and some bedrooms, along with new curtains in corridors and the foyer. New armchairs have also been ordered which will be placed in the main lounge. Two new hoists have been purchased, with a further hoist having been ordered. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Standards within this section were not inspected on this occasion. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Residents are looked after well in respect of their health and personal care needs. EVIDENCE: The care plans and records of four residents and one individual accessing specialist respite care were viewed, care plans were well written and were presented to a high standard. Care plans detailed information as to resident’s health care needs; one care plan contained greater detail, with regards to daily living arrangements and the impact of mental health on the individual’s life, and identified the role of care staff in supporting the resident. This was discussed with the Registered Manager, who will in turn discuss with the care staff team at the next staff meeting. Care plans could be improved if greater detail were to be incorporated into the document, this would enable all staff to provide the highest level of care with consistency and provide a bench mark when the residents care needs were reviewed. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 11 Daily records of the five individuals were also viewed; reference was made to health care access, relatives/friends visiting, and comments as to general health including dietary intake and sleep patterns. The level of information was discussed with the Registered Manager, including as to how this could be improved, again this will be discussed at the care staff meeting. The Inspector spoke with two relatives who were visiting at the time of the Inspection. They confirmed that they had confidence in the management team and care staff, and that any concerns they had when brought to the attention of staff were dealt with efficiently and effectively. The visitors felt the care needs of their relative were good, and that they were kept informed as appropriate. In relation to access to health care, both felt that medical services were contacted when necessary. The medication administration and records of residents whose records were viewed were checked, all were found to be in good order. Controlled drugs were also checked, and again all were in good order. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. Recreational needs of residents are met. Meals are wholesome and nutritionally balanced, and meet residents expectations. EVIDENCE: The Inspector upon her arrival noted that Activity Organiser with a group of residents was facilitating a music and movement exercise session. Daily records indicated as to when residents received visitors. The Inspector partook of the main meal, and chose the fresh Salmon Fish Cakes, with Parsley Sauce served with Mashed Potatoes, Cauliflower and Peas. Followed by Rhubarb Crumble and Custard. Menu options are available for all meals with the menu being displayed. In the afternoon of the Inspection a member of care staff went to all residents on an individual basis, asking them as to their preferred meal choice for the main meal the following day. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Staff need to be familiar with the policies and procedures pertaining to the protection of adults from abuse to ensure their effectiveness. EVIDENCE: Staff undertaking a National Vocational Qualification as part of the award study and prepare answers to questions on the protection of vulnerable adults from abuse. A member of staff interviewed by the Inspector, was aware of her role in dealing with suspicions of abuse, however was unsure as to the Department of Health’s Guidance on The Protection of Vulnerable Adults document ‘No Secrets’. The welfare of residents could further be protected if all staff were aware of the ‘No Secrets’ document, and the information contained within, with particular reference as to the signs of abuse and the protocols which they would need to follow should they suspect abuse or be informed of abuse. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 22. A comfortable and safe standard of accommodation is provided for the resident’s including a garden area, which individually and collectively meets the resident’s needs. EVIDENCE: Lenthall House is well maintained and is suitable to the needs of residents; it is decorated and furnished to a standard that creates a comfortable and homely environment. Communal areas are located on the ground and first floor; including a dedicated lounge for residents to smoke. Environmental improvements planned include the replacement of carpets in corridors, and in three bedrooms. Twenty-five new armchairs have been ordered for the main lounge, and new curtains for corridors and the foyer. Two hoists for the moving and handling of residents have been purchased, with an additional hoist having been ordered.
Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30. Staff at the home are trained in a variety of subjects, further improvements to training could be made. EVIDENCE: Training records of care staff were viewed, all evidenced training in a variety of subjects, which include moving and handling, health and safety, safe handling of medicines, fire awareness and basic food hygiene. Specialist training in Dementia has also taken place. Training in medical conditions such as Parkinson’s Disease and Stroke Awareness would enable care staff to have a greater understanding of residents needs, and in the development of care plans. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 36. Managerial processes ensure that residents and staff have the opportunity to contribute to the running of the home, and that the welfare of residents is maintained. EVIDENCE: Quality assurance was discussed with the Registered Manager; currently resident views are sought through day-to-day conversation and through residents meetings, the last meeting being held in October 2005. Daily records could be used to records residents comments and views. The member of staff interviewed by the Inspector confirmed that she receives regular supervisions from a member of the management team, and also confirmed that since the last Inspection had received refresher training in moving and handling.
Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 17 The Inspector noted that some care plans detail how resident’s finances are managed. In some instances the resident’s family manages this, whilst managerial staff within the home manages others. The Inspector viewed the records of those residents’ finances that are managed by the home, records were in good order with receipts kept. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X 3 X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X X Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 19 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 OP18 Regulation 13(6) Requirement The Registered Person to ensure that all staff are familiar with the ‘No Secrets’ document, including their roles and responsibilities. Timescale for action 01/12/05 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 2 3 Refer to Standard OP7 OP7 OP30 Good Practice Recommendations It s recommended that care plans and daily records are comprehensive, and incorporate all information consistent with an individuals care need, and records of their day. It is recommended that care staff receive training in the writing of care plans and daily records. It is recommended that staff receive training in medical conditions, appropriate to the needs of residents. Lenthall House DS0000033464.V254546.R02.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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