Inspection on 18/05/07 for Letheringsett Hall

This inspection was carried out on 18th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Letheringsett Hall 22/02/06

Letheringsett Hall 25/04/05

Letheringsett Hall 10/01/05

Letheringsett Hall 19/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Letheringsett Hall Letheringsett Near Holt Norfolk NR25 7AR Lead Inspector Ann Catterick Unannounced Inspection 18th May 2007 09:00 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 Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Letheringsett Hall Address Letheringsett Near Holt Norfolk NR25 7AR 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) 01263 713222 01263 713222 laura@imperialcarehomes.co.uk Imperial Care Homes Limited Mrs Laura Ellen Smith Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 20 Older people of either sex may be accommodated Bedrooms numbered 3 and 4 on the first floor are only to be occupied by service users who are sufficiently physically and mentally able, to minimise the risk involved in needing to access these rooms utilising a chairlift. 22nd February 2006 Date of last inspection Brief Description of the Service: Letheringsett Hall is a care home providing personal care and accommodation for 20 older people. Imperial Care Homes Limited owns the home and the Proprietors are Mr Steve Smith and Mrs Laura Smith. Laura Smith is the Manager of the home. The home is located in the village of Letheringsett, a mile outside of the historic town of Holt, and is close to all amenities. Letheringsett Hall provides quite grand accommodation and is set in spacious grounds with delightful views of the large grounds and surrounding countryside. Accommodation is provided on three floors providing 16 single rooms and 2 double rooms, most of which have en suite facilities. At the present time one of the double rooms is being used as a single room. The home has ample communal space and has a passenger lift to the first and second floor with a stair lift that services two separate bedrooms on the first floor. The home is well maintained throughout. The weekly cost of accommodation and care is £289-£430 a week. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an unannounced key inspection that took place on the 18th of May over a period of 7.5hrs. Nineteen residents were accommodated on the day of inspection. Prior to inspection the manager returned all requested information to the Commission plus six comment cards from relatives, four from residents and one from a professional were received. All comments received were positive and many are included in the main part of this report. The inspector was able to meet with most residents, staff, the proprietor and proprietor manager as well have a tour of the building and inspect care plans, staff files and other relevant documents. All staff spoken to were competent in their role and had received the relevant training and support to fulfil their role in full. Good practice was observed throughout the day of the inspection. Residents spoke very positively about their environment, the food provided within the home and the care and support they received. Residents said that they were encouraged to be independent and their privacy and dignity were promoted and protected. In conclusion the quality of the environment and the quality of care provided is very good. What the service does well: What has improved since the last inspection? Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 6 The home now ensures that no staff are employed in the home until all of the relevant information about their suitability and competence are received. When the manager looks after small amounts of money for residents this is now kept individually in separate envelopes to avoid any possible confusion. 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. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 7 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 Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that prior to being admitted to the home an assessment will take place to ensure that the home can meet their needs. EVIDENCE: Several care plans were inspected and all included an assessment of need. Assessments from health and/or social care professionals were received when appropriate. All residents living in the home on the day of inspection were having their needs met. Comment cards received from relatives and residents prior to the site inspection supported this view. The home does not offer intermediate care. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured, that with consultation with them, an individual plan of care is developed to enable others to know how their personal health and social care needs should be met. This care is provided in a respectful way that promotes dignity and respects privacy. EVIDENCE: Three care plans were fully inspected and these residents were spoken with to ensure what was written in the care plan took place in practice. Several other residents were spoken to on a more general basis with regard their care and how this is met. Care plans are comprehensive and include all the information needed to enable residents to be cared for in a way that they prefer with their identified care, social or emotional needs being met. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 10 Residents’ plans of care have a front page and photograph with general details. This was followed by an overall care plan that included health and care needs, nutritional needs, moving and handling needs, interests and hobbies. There is also a note of preferences of daily need. Examples of good practice were seen, for example; when recording a residents bathing needs the care plan clearly stated preference for the upstairs bath, limited help needed whilst getting in and out of the bath and that the resident likes to have a soak alone advising staff to ensure the call bell is in reach. A resident’s care plan advised dentures were used and explained that that care staff need to assist with Fixodent to ensure good fit and comfort. Another example of good practice was that for a resident who did not always recollect the answer to questions the likely questions had been attached to her calendar with the appropriate answers. Overall good evidence of person centred care within care plans. Health needs were being met and a comment from a health professional described Letheringsett Hall as a model care home that is run skilfully and sensitively. Overall the care and administration of medication is good. One resident chooses to self medicate and there as a risk assessment completed and they have a secure place to keep medication in their room. There were discrepancies with regard some boxed medication and the recording and auditing of this loose medication needs to be tightened up. A recommendation has been made in this area. Staff were seen to treat residents in a way that promoted dignity and respected privacy. Residents said that staff would always knock on bedroom doors and speak to them in a polite and courteous way. Comments made by residents “Staff kind, treat me well.” “I have everything I need.” “Like it here very much, would not change anything.” Comments made by relatives “The staff always take care of my relatives feelings and wishes and they could not be happier. “ “It is a proper ‘home’ for its residents. The staff treat each resident very much as an individual and with great respect.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices about how they spend their days and are given opportunity to participate in communal activities or not depending on their preference. Residents take an active role in what happens within the home. Food provided is of good quality and is offered in very comfortable surroundings. EVIDENCE: Residents are encouraged to continue with any hobbies or interests and there are activities offered within the home. Residents said that activities such as bingo, skittles, exercise and knitting take place in the home. The home has lovely grounds, which residents can walk around and there is an electrical bug for those who may prefer. A comment was made that for residents that would need to be pushed in a wheelchair the buggy gives them more control and staff can walk alongside and chat. The owners of the home have horses and some residents had recently been to see a new foal. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 12 The home has a newsletter for residents and its design and contents inform residents of what is going on and gives opportunity for conversation and discussion. There is a ‘staff member of the month’ award and after getting permission profiles of a member of staff and resident. Poems and general information were also included. The quality of the newsletter should be commended. The home has regular resident meetings and minutes of these were seen. Residents’ views are listened to. For example: at a resident meeting a request was made to have a wall clock in the entrance hall. One was promptly bought and put on the wall. Visitors are always made welcome. Residents are encouraged to manage their own money if this is not possible the home will have some ‘looked after money’. Records were inspected and these were all accurate and well documented. The lunchtime meal was observed. The dining area is delightful with French windows looking out onto the grounds. Tables were well dressed and meals were served and eaten in a relaxed and unhurried way. Residents can choose to drink whatever their preference is with lunch and for one resident this was a glass of wine. A cup of tea or coffee followed lunch. Each day there is a set meal and residents can choose from a range of choices if they do not like this. On the day of inspection a resident said that they did not like smoked haddock and had arranged to have cheese and ham instead. Residents said that at teatime there were at least four choices including soup, sandwiches as well as the set teatime meal. All residents said that the food was good and ample was provided and was available whenever you wanted it. Comments made by residents “I was hungry in the night and staff brought me up some sandwiches.” “”Food is lovely.” “Rather a lot of stews.” “Laura puts on activities every afternoon.” “You can mix if you want and be private if you want.” “Have, at times, been asked to go to bed at 7.30pm. I have not done this as much too early.” Comments made by relatives “They are encouraged to live the life they choose as though they were in their own home.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 13 Comments made by staff “In the afternoon there is time for activities.” “If I could change one thing it would be a bit more time one to one with residents.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives are informed of how to make a complaint if they needed to do so. No complaints had been recorded since the last inspection. Residents’ safety is promoted and protected by the homes policy and procedures with regard safeguarding vulnerable adults and the training staff receive in this area. EVIDENCE: The home has a complaints policy and this is displayed in the entrance hall of the home and is included in the Service User Guide. There had been no complaints since the last inspection. All of those service users spoken to said if they had any concerns they would always approach Laura or Steve Smith. Residents were confident that if they had any concerns they would always be listened to. Evidence was seen of staff training with regard safeguarding adults. All of those staff spoken to said that they would report poor practice. The manager is fully aware of her role and responsibility in this area. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 15 Comment made by relatives “Any concerns are dealt with immediately.” “Never had any concerns and my relative has lived here for five years.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24 and 26 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well maintained offering good quality accommodation within delightful grounds that are accessible to all who live in the home. EVIDENCE: Letheringsett Hall is a large Georgian property that offers stylish and comfortable accommodation. The home and garden are well maintained with individual accommodation being varied in size and design. The home has a handyperson and gardener and any repair or refurbishment would take place as it was seen. County councils have asked residential homes to make application for grants to improve homes and the proprietors have taken up this opportunity. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 17 Communal areas were warm, well furnished and welcoming. It was noted that in minutes from a staff meeting staff were encouraged to arrange lounge chairs in small groups to encourage interaction and conversation between residents. Bedroom seen were of good quality with some being very large including settee and armchairs as well as a bed and other furniture. Some residents choose to spend much of their time in their rooms. Several rooms have very large windows that look out onto the grounds, church and/or countryside. All residents spoken to were very satisfied with their private accommodation. On the day of inspection the home was clean and tidy with no offensive odours. This is a very attractive and comfortable environment for residents to live. Comments made by residents “Lovely room overlooking the church yard.” “Cleaner is wonderful.” “Place is always kept spotless.” “Lovely room, have lived here over two years.” Comments made by relatives “Letheringsett is a lovely home, carefully and thoughtfully run.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home are cared for by staff who are in sufficient numbers and have had the training and support to fulfil their role in EVIDENCE: On the day of inspection there were sufficient numbers of staff on duty to meet the needs of residents. Staff spoken to said they were offered the appropriated training and support to enable them to carry out the role in a professional and competent way. The rota was inspected and sufficient staff are on duty at any one time to meet need. If residents became more dependent there could be a need to have more staff on duty in the afternoon period between 2pm and 4.30 pm as only two care staff are on duty at this time. A recommendation has been made in this area. . The manager has achieved 50 of staff obtaining NVQ level 2 or above and other training is promoted and encouraged. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 19 Staff files were inspected and they included all of the information required of the home prior to appointment. Information was collated in a clear and methodical way. Information collated included application form, references, letter of confirmation of employment start date and POVA information. A requirement made at the last inspection has been fully met. Staff also had a separate training file that included evidence of induction, training certificates and further training needs. These had been completed in a very thorough and professional way should be commended. Staff spoken to support this view and were very satisfied with the induction and training offered on the home. Evidence of staff supervision and staff meetings, seen as group supervision, was seen on file. Comments made by residents “No complaints about staff, they treat you like a friend.” “Staff are well trained.” “Staff are all very happy.” “I don’t think you would find a better care home.” “I ring the bell and someone comes.” “Never enough staff.” Comments made by relatives “One or two more staff would be an advantage.” “Staff very good and competent, always polite.” Comments made by staff “Enjoyed induction, very thorough.” “Good staff team.” “Have NVQ, always different training to do.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the manager is experienced and skilled in her role fulfilling all of her duties and reviewing the quality of care provided on a regular basis. EVIDENCE: The manager has been in post for some years and has the experience and competence to fulfil her role in full. She has almost completed her Registered Managers Award. All comments made about the manager, by residents, relatives and staff were very positive saying she was approachable, helpful and a competent caring manager. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 21 The manager has lots of information and evidence showing how the quality of the service is audited on a regular basis. The home has regular staff and residents meetings, that are recorded and a regular newsletter is sent out. Questionnaires are also used. The home has a QA system that it uses to collate information. This was rather complex and the home may find more suitable ways to formally audit the quality of care in the home. A recommendation has been made in this area. The home has just been awarded the Investors in People Award. The home looks after some money for residents. Random samples were audited and found to be in good order. A recommendation made at the last inspection was followed up and now all residents looked after money is kept individually. Formal supervision takes place on a regular basis and evidence of this was seen on staff files. All staff receive induction and foundation training and staff training files were inspected and of a high standard. All appliances and utility systems are serviced on a regular basis. The home stores its chemicals in a safe way. All baths have safety valves to ensue that water is of the correct temperature. All upstairs windows have window restrictors. All radiators have been covered with the exception of the lounge radiator that has been assessed as being of no risk. The manager risk assesses individuals and the environment. All incidents and accidents are recorded and the manager sends regulation 37 notifications to the Commission as appropriate. In conclusion the manager provides a safe environment for residents to live and staff to work. Comments made by residents “Laura is a dear.” “Manager is very sociable, I could tell her anything.” “I don’t think I would find a better home.” Comments made by relatives “I hope there is a Letheringsett around when we need it” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 22 Comments made by staff “I have supervision.” “Supportive manager.” “A good home.” Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 3 3 x 3 4 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 x 3 3 x 3 Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 OP9 OP27 OP33 Good Practice Recommendations It would be good practice to revise the system for auditing and recording the receipt of loose medications. The manager needs to monitor staffing levels between 2pm and 4.30pm to ensure that there are always enough staff to meet resident’s needs. A simplified system for collating QA information may be of benefit. Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Letheringsett Hall DS0000027655.V340913.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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