CARE HOMES FOR OLDER PEOPLE
Leybourne House Western Avenue Bournemouth Dorset BH10 6HH Lead Inspector
Jo Palmer Unannounced 16 September 2005 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 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. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Leybourne House Address Western Avenue, Bournemouth, Dorset, BH10 6HH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 574426 01202 590382 admin@leybournehouse.co.uk Care South Mrs Gillian June Blackham Care Home 41 Category(ies) of DE(E) - 41 registration, with number MD(E) - 41 of places Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Four service users in the age range 18-65 years (in the categories DE or MD) may be accommodated to receive personal care. Date of last inspection 19 January 2005 Brief Description of the Service: Leybourne House is part of the Care South (formerly The Dorset Trust) group of homes and is managed by Mrs Gill Blackham. The Dorset Trust was established in 1991 having purchased several homes across Dorset from the local authority, the Trust has since expanded and now provides care in Hampshire and Somerset resulting in the name change to Care South. Care South is a non-profit making organisation. Leybourne House provides accommodation for up to 41 older people who have dementia or other mental health needs and who require assistance with personal care. The premises were purpose built by the local authority, and provides 39 single rooms, one with an en-suite shower, and one shared room over two floors. The first floor is reached by a passenger lift and stairways. Residents are able to benefit from the three lounge/dining room areas on the ground floor and the mature, accessible gardens. There is off road parking to the front of the home. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection on 16th September 2005 lasted for three hours, Mrs Gill Blackham, registered manager was present who assisted with the inspection process. Forty residents were accommodated at the time of inspection although none were spoken with directly during this visit, which was aimed at the some of the home’s administrative processes and a review of a selection of residents care documentation. However, as the inspection progressed residents were observed in the lounge areas and in their interactions with staff. Residents at Leybourne House have high degrees of dependency, specifically with regard to their mental health needs. What the service does well:
Prior to moving to Leybourne House sufficient information is available to enable residents to make an informed choice; on admission, information is supplemented by contractual information detailing the care and services provided. Leybourne House provides a specialist service to older people with dementia type illness or other mental health needs and records examined evidenced that there are effective support structures and systems in place to enable people living in the home to have their needs met by staff and with support from other members of the multi-disciplinary team. Whilst social calendars were not examined, residents care files demonstrated the opportunities they have to participate in social and leisure activities; with differing levels of dependency and diverse mental health needs residents are often unable to engage in self determined activity and rely heavily on staff for support and encouragement. Leybourne House is a large home that was purpose built in the 1980’s, it has been well maintained and is kept clean and comfortable for residents. Leybourne House has invested in recent decoration around the home that is in accordance with recommended good practice in dementia care to aid orientation, using bold colours, neutral flooring, confusing patterns on furniture and wallpapers kept to a minimum and colour schemes for doors. Satisfactory staff numbers are employed to provide relevant services including care, catering, domestic and laundry service. A manager and deputy manager run the home’s administration and support all staff. Staff training opportunities
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 6 are good and all new staff are expected to undertake the necessary induction training as part of their probationary period. Mrs Blackham has been competently managing the home and with the support of Care South ensures Leybourne House maintains good standards and is a viable home providing a necessary service. 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. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5. Standard 6 is not applicable. Detailed information is available to resident about Leybourne House. Care South protects residents who move to Leybourne House by entering into contracts with them that outline their rights, responsibilities and legal obligations under the terms and conditions of their stay. The contract enables residents to move to the home for a trial period of 6 weeks. The admissions process provides prospective residents and their representatives with sufficient information for them to know that Leybourne House will be a suitable place for them to live. EVIDENCE: Leybourne House has produced a comprehensive and informative Statement of Purpose and Service User Guide considering the individual services provided at the home, this was not examined during the inspection but an up to date copy is held on file with the Commission and information contained therein remains relevant. Examination of resident files evidenced that each is provided with information about they stay at Leybourne House in the home’s contract of admission.
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 9 Those seen indicated who was responsible for payment, whether privately or with assistance from a local authority. Residents move into Leybourne House for a six-week trial period under the terms of their contract to enable the resident, their representatives and the home to establish whether the home is the right place for them to be. Leybourne House ensures that each resident’s needs are assessed prior to their admission to the home, this process reassures residents and their representatives that their needs have been identified and staff at the home will be informed how these needs are to be met. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 As a specialist service providing care to persons with dementia and mental health needs, the home offers a good support structure and evidence of how the health and welfare needs of residents are met in the home with support of effective multi-disciplinary team practices. Residents are treated with respect and their privacy and dignity is promoted at all times. EVIDENCE: Examination of resident care files evidenced that care plans are available detailing how assessed needs are to be met and by who. Care plans seen details each residents health and welfare needs including their physical and mental health, personal care and daily living needs, diet, sleep, continence, leisure and relationships. It was evident that care needs are reviewed regularly although caution is needed to ensure that review documentation is clear leaving no doubt for staff which is the current care plan. Daily records are written by staff for each resident, although comprehensive Mrs Blackham was advised of the purpose of these records being to outline the resident’s daily lives in the home and any significant events or changes rather than include so much detail on personal care routines.
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 11 Care plans detail any physical health care needs and how these are to be met, a separate file details all visits by other health care personnel including GP’s chiropody, district nurses, dentists etc. Records are written respectfully demonstrating an implicit respect for their individuality and dignity. Staff interaction with residents was noted to be respectful. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 14 Residents at Leybourne House have varying degrees of dependency and complex needs and many are unable to make decisions and choices about their daily lives. Being heavily reliant on staff for decision-making, resident’s care plans detail their opportunities for leisure and recreational pursuits. EVIDENCE: Opportunities for leisure and activities for residents at Leybourne House were not directly assessed although care records demonstrated that staff have an understanding of individual residents likes, preferences and their social histories. Records held in respect of each resident indicate that contact with family and friends is maintained. Mrs Blackham stated that some staff at Leybourne House have undertaken specialist training with regard to dementia care. This is evident around the home where the décor has been done in a manner that assists with orientation of residents and is aimed at enabling residents to exercise some control over their lives. Pictures of resident’s choice are used to help identify their bedrooms. Appropriate signage is used to identify toilets and bathrooms, and doors and corridors are painted in uniform colours. Neutral colour flooring is used.
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 13 Whilst the décor at Leybourne House can look quite stark, the principle is based on recommended practice in dementia care based on research into suitable environments for the benefit of people with high levels of confusion and disorientation. However, some residents are provided with old fashioned commodes in their rooms that look like arm chairs. Whilst these are discreet and more homely they do not benefit people with confusion and disorientation in maintaining control over their lives in a dignified manner where the commode could be confused with an armchair. To ensure that the high level of consideration that has been given to the environment is maintained, it has been required that these commodes are changed to provide ones that look more like a conventional toilet. This requirement is made under standard 26 re infection control. (Section of report headed ‘Environment’) Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed. EVIDENCE: These standards were not assessed during this visit, however, the Commission has not received any complaints or reports of any incidents of suspected abuse from Leybourne House. The complaints procedure is detailed in the homes contract entered into with residents and or their representatives. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 24 & 26 Residents live in a safe, comfortable, clean environment with some of their own belongings around them. Bedrooms and bathrooms provide sufficient room for residents and their privacy is upheld by staff practices. Lounge and dining room areas provide sufficient space for residents. EVIDENCE: The interior décor of the home is decorated and furnished in a manner that assists resident’s orientation. (see also comment under section headed Daily life and Social Activities) Residents are able, if they wish, to bring in some of their own items in order to personalise their rooms. Bathrooms, showers and toilets are sited around the home conveniently for residents, none of the rooms have en-suite facilities although commodes are provided in bedrooms where required. The home was clean and well maintained with evidence of routine cleaning schedules and good practice in relation to infection control procedures regarding wound and continence care, hand washing facilities and laundry.
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 16 Some residents are provided with wooden commodes that have seat covers that are upholstered in soft fabric. This is not conducive with good infection control procedures as the wood and fabric are permeable and cannot be cleaned to an acceptable standard of hygiene. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The deployment and number of available staff is sufficient to meet the needs of the residents. Procedures for the recruitment of staff are robust. Leybourne House has a commitment to staff training, an obligation that is supported and facilitated by Care South. EVIDENCE: Mrs Blackham confirmed that after a period of instability, staff recruitment has been positive and 180 vacant hours have been filled by newly appointed staff who had just started or were due to start shortly. Vacant hours have, to date been filled by bank and agency staff. There are seven care staff on duty each morning and between four and five each afternoon. Additionally, two care staff work between the hours of 10.00am and 4.30pm to provide extra support to residents during the day. As well as care staff, there are two care team managers on duty each morning and one each afternoon, the manager and deputy manager also work day time hours Monday to Friday. There are sufficient numbers of ancillary staff employed including domestic and kitchen staff. Seven staff currently have attained NVQ level 2 awards, three of these have gone on to complete NVQ level 3 and a further two staff are currently studying for this award. Leybourne House had been actively recruiting new staff prior to this inspection, examination of staff files evidenced that appropriate measures are taken to
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 18 ensure staff are suitable for the post, including references and checks against criminal records. Mrs Blackham confirmed that all staff receive a three day induction programme providing them with an introduction to Care South and some of its policies and procedures along with basic Health and Safety principles including appropriate moving and handling techniques. Staff then undergo a six-week induction training, which is held in accordance with National Occupational Standards for care staff, this is followed by a Foundation training programme in their first six months of employment. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 & 37 Care South is a viable organisation whose financial procedures promote effective management of Leybourne House. Resident’s financial interests are protected by good management of their personal allowances. EVIDENCE: The business plans and accounts of Care South were not examined as part of the remit of this inspection. Mrs Blackham however demonstrated an informed understanding of the accounts of Leybourne House and has budgetary control for staffing, catering, domestic, repairs and maintenance, furniture and equipment although requests for capital expenditure for larger purchases have to be made. Leybourne House looks after the personal allowances for all residents, sums of money are held for each resident along with a cash card detailing income, expenditure and balances. Records seen demonstrated effective management
Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 20 of these monies and evidenced that regular audits are undertaken to ensure procedures and records remain accurate. Records seen were well kept, regularly reviewed and up-dated and held securely to protect resident confidentiality. Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x 3 3 x x 3 x 1 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 Standard No 16 17 18 Score x x x x x x 3 3 x 3 x Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 26 Regulation 13 Requirement The old style commodes must be replaced with ones of an acceptable standard that conform to appropriate standards for infection control processes. Newer commodes that look more like conventional toilets and aid resident orientation should be provided. Timescale for action 30.11.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Leybourne House D55 S3902 Leybourne House V229081 160905 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit, 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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