Inspection on 13/11/07 for Levanto Care Home

This inspection was carried out on 13th November 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

Levanto Care Home 18/12/06

Levanto Care Home 09/02/06

Levanto Care Home 27/07/05

Levanto Care Home 23/02/05

Levanto Care Home 13/07/04

Levanto Care Home 23/03/04

Similar services:

5 Seafield Road

Honeybourne House

Longrun House

Bodley Community Care Support Centre

Thomas Pocklington Trust

Chantry Gardens

Penkelly House

25-27a Alexandra Road

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

CARE HOMES FOR OLDER PEOPLE Levanto Care Home Levanto 7-9 The Riviera Paignton Devon TQ4 5EX Lead Inspector Peter Wood and Michelle Finniear Unannounced Inspection 13th November 2007 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 Levanto Care Home DS0000034256.V350509.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. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Levanto Care Home Address Levanto 7-9 The Riviera Paignton Devon TQ4 5EX 01803 554728 01803 559039 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) Mr Anthony Robert Cousins Mrs Marion Hazel Cousins Mrs Marion Hazel Cousins Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Physical registration, with number disability over 65 years of age (20), Sensory of places Impairment over 65 years of age (20) Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Key: 18/12/06 Random: 07/06/07 Random: 06/07/07 Brief Description of the Service: Levanto is a care home that provides 24-hour care for up to 20 persons. The home is registered to provide places for persons in the categories of dementia, physical disability and sensory impairment. It was agreed that the new Commission for Social Care Inspection Certificate would not include the sensory impairment category, which is designed for those homes which specialise in people who live in the home who are blind, deaf, or both. The home has fourteen single rooms and three doubles; six of the single rooms and two of the double rooms are equipped with en-suite facilities. There are two communal lounges available; meals are taken in a separate dining room. A stair lift is provided for people who live in the home who have mobility problems and toilet and bathroom aids are available if required. The home has a large garden at the front and side of the building. This includes an area of lawn with seating provided for people who live in the home. At the side of the home is a large car park, which has the capacity to take several vehicles. The home is a short level walk to the shopping centre of Paignton and the facilities of the town. Fees range between about £325 and £385. Copies of the inspection reports can be obtained from the home or the CSCI website. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one weekday in November 2007. The focus of this inspection was to inspect all key standards and to seek the views of people who live in the home, staff, relatives and professional visitors to the home, the latter using survey forms. At the time of writing three people who live at the home completed and returned the “Have your say about Levanto” survey questionnaire (assisted as necessary by relatives), no staff returned the “Care Workers Survey” form. No “Health and Social Care Professionals in Contact with the Care Home” returned a form with that title and two “survey for relatives, carers and advocates” forms were returned. Considerable time was spent with the owner / manager and her deputy examining documentation, particularly that relating to clients assessment and care planning, staffing and health and safety. Staff on duty were consulted and two visiting relative were consulted about their views of the home. A tour of the building was undertaken. The inspection included a review of contact between the home and the Commission since the last key inspection. This included two random inspections undertaken in June and July 2007. These inspections were carried out following the receipt of an anonymous complaint into the administration of medicines at the home. The inspection process also includes a review of the Annual Quality Assurance Assessment (AQAA) questionnaire completed by the owner / manager, which is quoted throughout this report. Another focus of this inspection was to undertake a Short Obervational Framework for Inspectors (SOFI). This is a tool which can be used in homes in which people who live there have limited verbal communication, such as those who have dementia. This tool is validated by the University of Bradford. During the inspection visit a period of two hours was spent in the home’s lounge observing how people who were more frail spent their time and how they interacted with their environment and the people caring for them. This time helped to give a good picture of the opportunities available and lifestyle experienced by people at the home. On this occasion the period observed included an organised activity session and a lunchtime where people were being supported with eating. On the day of the inspection visit some of the staff on duty were from an agency and so did not know the people at the home well. Senior staff who did were on duty and were able to delegate some tasks. The home’s management did express concerns that on a more ‘normal’ day staff would have been able to spend more time with people living at the home, which was acknowledged. The period of observation showed that most people seen were content and were showing an interest in the home and what was going on around them. These are positive signs. There was a good relationship seen between two Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 6 people living at the home, and others were aware of and had some involvement with their environment, which for one involved carrying out simple tasks such as folding a blanket which was over their knees. An activity session that took place during the morning had little impact on the more frail people, and was tailored for the needs of those more able to participate. Discussion was held with the homes management on ways in which those people who are more frail could be supported. At one time a staff member joined the activity session and supported a person who was very frail to participate, which made them smile. Management confirmed that it would have been usual practice for staff to be involved in this session, which would obviously benefit those who needed more support to participate. Further findings from this structured observation are included within the body of this report. What the service does well: What has improved since the last inspection? The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We have engaged an extra member of staff as we feel that our residents need unhurried attention. We have changed our staff break pattern to ensure that our residents are continuously cared for”. Since the last key inspection the owners have continued to upgrade the facilities of the house by ongoing decoration and refurbishment. Most bedrooms have now been fitted with suitable locks, all of which have already been purchased. The home was judged to have met virtually all the standards inspected at the previous key inspection, so only one requirement and no recommendations were then made. The home now undertakes fresh Criminal Record Bureau checks in respect of all new staff, even those who have recently had a CRB check undertaken by a previous employer. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 7 However, as the two random inspections in June and July 2007 revealed, changes in the home’s practices, particularly in relation to medication administration, were needed. The home responded well to the requirements and recommendations made following those inspections. The home ensured that staff who fed an identified resident did so in accordance with best practice as advised to ensure that the client received the special care needed. Care staff now maintain the personal and oral hygiene of each person who lives in the home as needed. Sufficient staff are now available at all times, changing the practice of staff having their lunch simultaneously. Further discussions took place with a particular person who lives at the home, her husband and her care manager to decide whether Levanto really is the best place to meet all her needs. To enable an audit of medicine in the home to be undertaken the home now records the receipt of all medicines into the home. For all medicine prescribed to be administered “when required” a separate plan of care for the medicine is now drawn up to make it clear to all staff administering the medicine, when and why the medicine is to be given and the actions to be taken after administration. A separate sheet is now used to record all advised dose changes from the prescriber, rather than recording them in the daily record as previously. What they could do better: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We work towards providing the highest standard of care for our residents through our ever growing knowledge base which is obtained through training courses but we are fully aware that there is always a need to improve on our standards. Our plans for improvement in the next 12 months include that we need to continue with our training courses to improve our underpinning knowledge. We need to continue updating our records in accordance with National Minimum Standards.” We endorse the owners’ plans for improvement in the next 12 months and echo these as a recommendation that the home needs to continue with their training to improve their underpinning knowledge, particularly in the area of care for people with dementia. Such training should assist staff to better understand people who have dementia, their communication and behaviour, so they can offer them care and support in a more informed, professional manner. Please contact the provider for advice of actions taken in response to this Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 8 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. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for admission are reasonably thorough and comprehensive and allow people who live in the home and their relatives to be confident that their needs can be met. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “The Manager and deputy manager carry out a full assessment prior to admission with prospective clients and their families. Comprehensive Care Plans are then completed with agreement by all parties.” As part of the inspection process we (The Commission for Social Care Inspection, hereafter referred to as ‘we’) examined assessment documentation of four people who live in the home. This, together with information from relatives, confirmed the owner / manager’s description that new people who Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 11 live in the home are admitted only on the basis of a full assessment and are invited to visit the home and to move in on a trial basis before they make a decision to stay. The owner / manager undertakes a pre-assessment prior to any new admission, followed by detailed assessments that generate comprehensive care plans. A relative confirmed that she was able to visit the home to see whether it was suitable for her relative, commenting: “I chose Levanto for my resident relative; it is a homey atmosphere, only small; friendly and very caring. The care and support are as far as I can see are Top Class.” The home does not offer intermediate care. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of people who live in the home are properly assessed and met and they are usually treated respectfully. The home’s improved practices relating to medication administration now protect people who live in the home from risk. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We have comprehensive care plans for each resident. Our care plans are reviewed monthly and revised and amended as necessary. We have daily written reports for people who live in the home which are completed by the care staff. We keep a close check on the people who live in the home’ weight by weighing them regularly and completing a weight chart. We monitor all food intake and document it clearly each day. We ensure that people who live in the home are kept clean and fresh smelling at all times.” Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 13 As part of the inspection process we examined care planning documentation of four people who live in the home. This confirmed the owner / manager’s description that care plans are generated from comprehensive assessments. We were also able to confirm from examination of these care plans that we saw considerable evidence that people who live in the home have good access to health care services. Relatives told us they were kept informed of their relative / resident’s health: “I am always informed if my resident relative is unwell and that a doctor has been called to see him.” In the light of the last two random inspections we particularly looked at the medication policies, procedures and practices of the home. In May 2007 anonymous allegations were made that some people who lived at the home were not given medication prescribed for them. As the allegations amounted to allegations of abuse, the matter was referred to Torbay Care Trust under the joint Adult Protection (now called ‘Safeguarding’) Procedures. A Strategy Meeting was convened which decided that inspectors from CSCI should undertake an inspection while managers and care managers from Torbay Care Trust would assess each resident and examine their care plans. That joint visit was undertaken on 07 June 2007. Three requirements and one good practice recommendation was made following that random inspection. As the allegations concerned medication administration a further random inspection was undertaken on 06 July 2007 by Brian Brown, Regional Lead Pharmacist, accompanied by myself. Mr Brown has written a separate report further to his inspection. Mr Brown judged that Quality in this area is Adequate. He considered that people living in the home are protected by the homes policies; however some of the procedures needed to be improved to ensure that medicines are administered safely at all times. To help improve the care of those people prescribed “when required” medicines the service needs to make the directions for use available to staff administering the medicines more accessible so improving the care of the people receiving the medicine. Mr Brown offered considerable advice and guidance to the home owners / manager and deputy manager at the inspection visit. He also made one requirement and two good practice recommendations in his report. Random inspection reports are not published but will be made available on request to members of the public or other enquirers. During this inspection we confirmed that the owners / manager and deputy manager have successfully addressed all the issues previously raised. Medicines have always been securely kept in an approved cabinet, and medications which need refrigeration are kept in a proper medication fridge, which is kept locked and now checked that it remains at the correct temperature. People who live in the home can self medicate subject to a satisfactory risk assessment, though in practice few people who live in the home who would be suitably placed in this home would be considered safe to do so. The owners have obtained the booklet “The Handling of Medicines in Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 14 Social Care” recently published by the Royal Pharmaceutical Society of Great Britain and gave assurance that this would be studied and acted upon. We observed that people who live in the home were usually treated with respect by staff, such as by addressing them by their preferred name, and attending to them promptly. A relative commented that: “When my resident relative requires attention I notice ‘the bell’ is answered within minutes”. We observed how staff gently treated a person who lives at the home when being taken to the toilet. Some staff interactions with people living at the home were supportive and friendly, while other communication seen, particularly for those with more advanced memory loss could be improved to better support the people who live there. Some communication from people was missed or not acted upon. As an example one person was asked if they wanted a cup of coffee, and when they asked for a tea instead this was not provided so they didn’t have a drink. Relatives commented: “Mrs Cousins provides an extended family; Levanto cares”, “The care and support are as far as I can see are Top Class”, “They are extremely caring to the residents. In my opinion nothing is too much trouble for them”. However, we observed staff “talking over” people or not involving them when carrying out care tasks. An example of this was when two staff were using a moving and handling belt to help someone to stand up they did not explain to the person concerned what was being done to them or why. This can make people more distressed or agitated, as they cannot understand what is happening. Staff on duty were also heard referring to people in ways that undermined them for example referring to some people requiring support with eating as “the feeders”. This demonstrates a lack of respect for people’s individuality, dignity and privacy. We discussed these observations with the owners / manager at the inspection visit. Staff could benefit from further training in working with people with dementia. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 15 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are provided which gives interest for people who live at the home. They maintain contact with their friends and families and are encouraged to exercise as much choice and control over their lives as possible. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We provide tempting meals daily. Cooked freshly and with a varied menu. Also with a choice of meal if required. We provide daily entertainment for the people who live in the home from either outside agencies or in-house staff. We document all entertainment sessions. We encourage visitors at all times with no restriction on visiting hours within reason.” Most people who live in the home in this home have a degree of dementia. Staff attempt to provide a lifestyle for people who live in the home which suits them. Times for getting up and going to bed, and mealtimes if necessary for an individual, are flexible according to the wishes and needs of the people who Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 16 live there. Visitors can come at any reasonable time. A relative commented: “Mr and Mrs Cousins and their staff always welcome me when I visit my resident relative whatever the time, and usually make me a cup of tea to have together!” Staff undertake some personal “pampering” tasks with people who live in the home, such as manicures, and an outside professional now comes in most days of week to organise group activities. This is in response to the request voiced by some people who live in the home at a previous inspection that they would like more activities. Visitors are encouraged to join in “I visit frequently and join in the activities e.g. singing during my time there.” However, nobody is “forced” to take part if they do not wish to: “My resident relative prefers not to participate in any activities which is a pity, but that is his choice”. An activity session that took place during the morning was tailored for the needs of those more able to participate and had little impact on the more frail people. We discussed with the owners / manager ways in which those people who are more frail could be supported. At one time a staff member joined the activity session and supported a person who was very frail to participate, which made them smile. The owners / manager confirmed that it would have been usual practice for staff to be involved in this session, which would obviously benefit those who needed more support to participate. We observed part of the lunchtime and tea time meals, which people who live in the home take in the very pleasant dining room. These meals looked attractive, and people who live in the home have a choice of menu. A relative commented: ”The meals prepared are excellent”. However, the home welcomes families to bring in special items, including food, which may enable the person who lives at the home to feel more ‘at home’: “I sometimes take in a Polish or German meal as a treat for my resident relative’s supper.” Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 17 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home and their relatives are listened to, issues resolved as promptly as possible, and they are protected from abuse. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We ensure that all people who live in the home or their families are aware of the complaints procedure. All staff are POVA trained. We make sure that all new care staff are vetted with CRB and POVA checks which are carried out before employment commences. We have written policies and procedures in place to try to ensure that abuse whatever form it make take does not occur. We have a whistle-blowing policy in place.” That whistle-blowing policy was somewhat actioned by the person who wished to remain anonymous who made allegations in May 2007. The person alleged that some people who lived at the home were not given medication prescribed for them. These allegations resulted in several meetings under the joint Adult Protection (now called ‘Safeguarding’) Procedures, a joint inspection / investigation by CSCI inspectors and Torbay Care Trust managers and care managers, and a specialist pharmacist inspection. No evidence of deliberate abuse was found, though medication and other practices at the home needed to be rectified. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 18 The home’s complaints policy and procedure is on display in the entrance hall, though issues are resolved before the formal complaints procedure is used. The owners are aware of abuse in all its forms and have literature, policies and procedures to prevent it. Staff were observed to treat their people who live in the home with kindness, dignity and usually, with respect, even when this was not always reciprocated. We observed the patient way in which staff responded to a resident who was very demanding. Relatives responded that: “I am always listened to; I have no complaints the way my resident relative is cared for, I am just thankful.” “I chose Levanto for my resident relative; it is a homey atmosphere, only small; friendly and very caring. The care and support are as far as I can see are Top Class”. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from a pleasant, well-maintained home that is comfortable and which provides sufficient facilities to meet their needs. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We have invested in special cleaning formulas to ensure that the home is odour free and pleasant smelling. There is a continuing programme of decorating and upgrading. Carpets and furniture are replaced as necessary. Gardens are kept to a high standards with spring and summer bedding plants. Lawns are mowed regularly. Paths and drive-ways are swept clean on a very regular basis.” Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 20 We undertook a tour of the public parts of the building and some bedrooms during the inspection. Levanto comprises a large corner house joined together with its neighbour, thus comprising two houses which therefore benefits from two staircases. One of these is fitted with a chairlift to assist people who live in the home who have mobility difficulties. The owners have an on-going improvement plan of renovation to the fabric of the building, refurbishment and decoration. Despite many of those who live in the home having incontinence there was no odour on the day of the inspection. The rooms of people who live at the home reflected their personality. People who live in the home and their relatives commented: “The bedding is always spotless. No smell of urine at all. Toilets are spotless. The standard of cleanliness is first class”. “A very clean and tidy care home”. “I chose Levanto for my resident relative; it is a homey atmosphere, only small.” Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are cared for by well-trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment procedures protect people who live in the home from unsuitable staff being appointed. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We have a full complement of staff. All staff are encouraged to obtain at least NVQ2. We have a written staff rota. All staff receive a statement of terms and conditions of employment including a booklet of out health and safety policies at Levanto. All staff receive paid training days above standard stated.” As part of the inspection process we examined the personnel files of four people who work at the home. We consulted the owners / manager at some length, observed staff on duty and consulted with them to some extent. We also observed people who live at the home and consulted with them as appropriate. We additionally consulted relatives who were visiting the home at the time of the inspection and received survey forms from people who live at the home and their relatives. These sources confirm the owner’s statement in Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 22 the AQAA, above. The home’s staffing levels at the time of the inspection were appropriate for the number of people who live in the home and their levels of dependency. WE confirmed that he home implements its robust recruitment policy, including using an application form, two references and Criminal Record Bureau checks. All staff had undergone CRB checks, and checks against the POVA (Protection of Vulnerable Adults) list, which is a database of people considered unsuitable to work in care settings. The home employs ten full time and four part time care staff, plus two agency, pool or bank care staff, plus five other staff. The deputy manager has NVQ (National Vocational Qualification) levels 2 and 3. Six of the fourteen permanent care staff have NVQ Level 2 or above. A further four are working towards this. One of the two ‘pool’ staff has NVQ Level 2 or above. Altogether, seven of the fourteen care staff have NVQ Level 2. This exactly matches the 50 target for qualified staff in the National Minimum Standards. However, when their current studies finish, eleven of the fourteen permanent care staff (amounting to 79 ) will be qualified, far exceeding that target. We also saw considerable evidence of other training undertaken by staff, including Moving and Handling, First Aid, Food Hygiene, Dementia Awareness, Fire Safety, Feeding and Swallowing training for People with Dementia, Diet and Nutrition, etc. We would echo the owners’ intention to continue on-going training in all aspects of care in a residential setting and paying particular attention to Dementia Training as the home has many residents with forms of dementia. Although not yet in post the owners have recently recruited a new Care Manager (to be registered with CSCI in due course) who is qualified to NVQ level 4. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home which is run in their best interests. The owners / manager and staff team together provide a comfortable home where the health, safety and welfare of people who live there are promoted and protected. EVIDENCE: The owner / manager writes in the Annual Quality Assurance Assessment (AQAA) that: “We record and store all relevant information regarding our clients. We record all accidents in the yellow accident book and also in the resident’s daily reports. We have quality assurance questionnaire which are completed either by our people who live in the home or one of their family Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 24 members. These can be completed by a member of staff on behalf of a people who live in the home. We all make sure that all training is kept up to date. We have all electrical appliances and servicing carried out as necessary.” The home is owned by a husband and wife team, both of whom are of good character. The registered manager is one of the owners. She is very experienced and is currently undertaking the Registered Manager’s Award and NVQ level 4 qualification in Care. However, the owners recently took the decision to appoint a new Care Manager to manage the home on their behalf. Although not yet in post the owners have recruited a new Care Manager (to be registered with CSCI in due course) who is qualified to NVQ level 4. The home has an open, positive and inclusive atmosphere. Several staff have the First Aid at Work qualification. The monies of people who live in the home are handled by relatives or others with power of attorney. The manager does not act as appointee for handling financial affairs. Some families give the manager money for hairdressing and chiropody and other personal items are bought by families. Examination of documentation including resident’s care files, policies, procedures, risk assessments, accident book, fire log, and health and safety literature confirm that the health, safety and welfare of people who live in the home are promoted and protected. When asked “How do you think the care home can improve?” a relative responded: “[There should be] More homes like Levanto.” While the owners are realistic as to those areas which could benefit from improvement, such as training in care for people with dementia, a relative responded: “I can see no reason to improve anything.” Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 25 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 26 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. Refer to Standard OP30 Good Practice Recommendations The home is recommended to continue and increase training, particularly in the care of people who have dementia, to ensure they receive proper care. Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Levanto Care Home DS0000034256.V350509.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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