CARE HOMES FOR OLDER PEOPLE
Levanto Care Home Levanto 7-9 The Riviera Paignton Devon TQ4 5EX Lead Inspector
Peter Wood Unannounced Inspection 18 and 21 December 2006 3:30 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.V324082.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.V324082.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 (20), Physical disability (20), Sensory registration, with number impairment (20) of places Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Levanto is a semi-detached residential 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 residents 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 residents that have mobility issues and toilet and bathroom aids are available if required. A large garden area is situated at the front and side of the building, which includes an area of lawn with seating provided for residents. 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. Levanto Care Home DS0000034256.V324082.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 two visits to the home in December 2006. The first of these coincided with the residents’ Christmas Party, at which some staff dressed up in fancy costumes. Some off-duty staff attended this party. The focus of this inspection was to inspect all key standards and to seek the views of residents, staff, relatives and professional visitors to the home, the latter using comment cards and survey forms. However, the inspection took place only two days after the provider had received the pre-inspection questionnaire, comment cards and survey forms to send out. At the time of writing the first draft of this report, therefore, none of these questionnaires had yet been returned. At the time of writing this final draft (a month after the inspection) one resident completed and returned the “Have your say about Levanto” survey questionnaire (assisted as necessary by a relative), 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 three “Relatives / Visitors Comment Cards were returned. The pre-inspection questionnaire has not yet been received. 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. A tour of the building was undertaken. A visiting relative was consulted for his views of the home. What the service does well:
Quality in all seven outcome areas is good. This judgement has been made using available evidence including a visit to this service. Thorough and comprehensive systems for admission allow residents and their relatives to be confident that their needs can be met. The systems for admission are reasonably thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. Residents’ health, personal and social care needs are met and they are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. The routines of daily living are flexible according to the wishes and needs of the residents. Meals are appealing, nutritious and varied. Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 6 Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. Residents are listened to, issues resolved as promptly as possible, and they are protected from abuse. Residents live in a pleasant, well-maintained home that is comfortable and warm and which meets their needs. Residents 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 residents from unsuitable staff being appointed. Staff qualification training exceeds the standard. Residents live in a well managed home. The owners and their staff team strive to provide a homely, safe environment that respects and protects residents. What has improved since the last inspection? 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. Levanto Care Home DS0000034256.V324082.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 Levanto Care Home DS0000034256.V324082.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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough and comprehensive systems for admission allow residents and their relatives to be confident that their needs can be met. The systems for admission are reasonably thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. EVIDENCE: Documentation examined confirmed the owner / manager’s description that new residents 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 a resident’s admission, followed by detailed assessments that generate comprehensive care plans. The home does not offer intermediate care.
Levanto Care Home DS0000034256.V324082.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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are met and they are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. EVIDENCE: Care plans are generated from comprehensive assessments and residents have good access to health care services. Medication procedures were examined during the inspection. Medicines are securely kept in an approved cabinet, and medications, which need refrigeration, are kept in a proper medication fridge, which is kept locked. Residents can self medicate subject to a satisfactory risk assessment, though in practice few residents who would be suitably placed in this home would be considered safe to do so. Residents were observed to be, and those who were able to do so reported that they were treated with respect by staff. “I feel fortunate that [my relative] is in a home which is close to a real home from home atmosphere with personal attention and caring staff.”
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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. The routines of daily living are flexible according to the wishes and needs of the residents. Meals are appealing, nutritious and varied. EVIDENCE: Most residents in this home have a degree of dementia. Staff attempt to provide a lifestyle for residents 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 residents. Visitors can come at any reasonable time, residents are encouraged to exercise choice in as many areas as possible, and menus are good. Staff undertake some personal “pampering” tasks with residents, 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 residents at the last inspection that they would like more activities. Resident’s rooms reflected their personality. The lunchtime meal taken in the very pleasant dining room was attractive, with choice offered, and nutritious. Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 11 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. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. Residents are listened to, issues resolved as promptly as possible, and they are protected from abuse. EVIDENCE: 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 residents with kindness, dignity and respect, even when this was not always reciprocated. Staff consulted favourably compared this home’s practices to those of other homes in which they previously worked. Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 12 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. Residents live in a pleasant, well-maintained home that is comfortable and warm and which meets their needs. EVIDENCE: Levanto comprises a large corner house now joined together with its neighbour. The home therefore benefits from two staircases, one of which is fitted with a chairlift to assist residents with mobility difficulties. The owners have an on-going improvement plan of renovation to the fabric of the building, refurbishment and decoration. Despite many residents’ incontinence there was no odour on the day of the inspection. Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 13 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. Residents 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 residents from unsuitable staff being appointed. Staff qualification training exceeds the standard. EVIDENCE: The home’s staffing levels at the time of the inspection were appropriate for the number of residents and their levels of dependency. The home implements its robust recruitment policy, including using an application form, two references and Criminal Record Bureau checks. All staff had undergone CRB checks. Recently appointed staff had quite recent checks, though some of these had been undertaken by their previous employer. Fresh CRB checks need to be undertaken by the new employer for each new appointment. The deputy manager and two other members of staff have achieved the National Vocational Award in Care at Level 3. Six other staff members have achieved NVQ 2. Nine of the fourteen staff, (64 ) have therefore achieved NVQ 2 or above, exceeding the 50 target on the National Minimum Standards.
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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. Residents live in a well managed home. The owners and their staff team strive to provide a homely, safe environment that respects and protects residents. EVIDENCE: The registered manager / owner is very experienced and is currently undertaking the Registered Manager’s Award and NVQ level 4 qualification in Care. The home has an open, positive and inclusive atmosphere. Several staff have the First Aid at Work qualification. Residents’ monies 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
Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 15 families. Examination of documentation including resident’s care files, policies, procedures, risk assessments, accident book, fire log, and health and safety literature confirm that residents’ health, safety and welfare are promoted and protected. Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 16 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 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 2 30 4 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.V324082.R01.S.doc Version 5.2 Page 17 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation Reg 19 (1) (b) (i) Schedule 2 (7) Requirement The Registered Person shall not employ a person to work at the care home unless the person has an enhanced criminal record certificate. (This relates to the need to undertake fresh CRB checks on staff, even those who have recent CRB Disclosures undertaken by previous employers). Timescale for action 21/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Levanto Care Home DS0000034256.V324082.R01.S.doc Version 5.2 Page 18 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
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