Random inspection report
Care homes for older people
Name: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL zero star poor service 09/02/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Christine Potter Date: 1 4 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Lickhill Manor Nursing Home Lower Lickhill Road Stourport on Severn Worcs DY13 8RL 01299827789 01299878065 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lynda Ann Mason Type of registration: Number of places registered: Conditions of registration: Category(ies) : Gentle Care Services Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Conditions of registration: 0 40 The maximum number of service users to accommodated is 40 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 40 Physical Disability (PD) 40 Date of last inspection Brief description of the care home Lickhill Manor Nursing Home is a large grade II listed building, which has been extended to provide nursing and personal care for 40 people. The majority of people in
Care Homes for Older People Page 2 of 15 0 9 0 2 2 0 1 0 Brief description of the care home the home are elderly people, but the home accommodates some younger people with debilitating illnesses, for example multiple sclerosis. The home is located on the outskirts of Stourport-on-Severn next to Lickhill caravan park. It is situated in over an acre of landscaped gardens providing pleasant views from the rooms. The home is difficult to access on public transport but is within short distance of the town with the shops and the river Severn. The home provides plenty of car parking for visitors within the grounds. Accommodation is provided on three floors in both single and shared rooms. The home provides a range of aids and equipment to assist them in meeting the needs of people using the service. A passenger lift is available to assist people using the service to access all three floors of the home. Communal areas are available with three lounges and a separate dining area, so that people have a choice of where they wish to spend their day. The home is owned by Gentle Care Services Limited. The registered manager for the home is Lyn Mason who is a first level registered nurse with many years experience, having worked at the home for 16 years. Lyn is responsible for the day to day running of the home. Information regarding the home can be obtained from the Statement of Purpose and the Service Users Guide which are available from the home. Information regarding fees for the Home should be requested direct from the manager or from the owners. Copies of the most recent Care Quality Commission inspection report are readily available within the Home and on request. Care Homes for Older People Page 3 of 15 What we found:
This unannounced random inspection of Lickhill Manor Nursing home was carried out on the 15th June 2010. The reason for the inspection was to monitor compliance following the key inspection on the 9th February 2010. Follow up compliance inspections 9th, 17th and 25th March 2010. Following the compliance visits there was little progress evident to move the service forward. The registered providers were requested to attend a meeting to discuss the shortfalls and their proposed plans in moving the service forward. We were informed that they had appointed a specialist consultant in nursing homes to assist them in moving the home forward. The responsible individual told us that she was in the process of leaving her employment to concentrate on Lickhill Manor, and would be there full time. On the day of the inspection there were 27 people being cared for. On the day of the visit the Responsible Individual J Chauhall, Registered provider P Chauhall and nurse in charge S Davies were present and assisted us with the inspection process. We looked at care records for two people who had recently been admitted to the home. We reviewed the accident, complaint and duty rotas records. We discussed the progress of the service with the Responsible Individual from the last key inspection 09/02/2010. Choice of Home: (standards 1 - 6) The last key inspection 09/02/2010 rated these standards as adequate, and made a requirement that the people are assessed prior to admission to ensure that their health and physical needs can be fully met. The home must ensure that they have the right equipment in place prior to the person moving into the home. Staff should have the skills and competencies to ensure that the persons health is not compromised. Two peoples care records were reviewed and these showed that they had been partly assessed prior to their admission by a registered nurse. However not all the sections on the pre admission assessment had been completed. One person admitted to the home on the 11/05/2010 some of their assessments had not been completed until 06/06/2010. There were gaps in the care plan for foot care, sleeping, and specialist support. The second one stated that they were at risk of falls, but no fall risk assessment had been completed. The Responsible Individual for the home told us that they have not reviewed and updated the Statement of Purpose and Service Users Guide as they have been concentrating on the care records. The other standards from this section were not assessed at this inspection. Health and Personal Care (standards 7 - 11) We spoke to the nurse in charge on the day of the inspection and she explained how they have been introducing person centred care, and some staff had been enthusiastic about promoting this good practise in the home. The Responsible Individual for the home is looking at the skill mix of the nurses working in the home so that they can each concentrate on these areas of expertise in the care documentation. They are introducing a named nurse and Senior Key Worker System. So people can identify a familiar person to talk to, this should assist in building up a good working relationship, thus assisting communication.
Care Homes for Older People Page 4 of 15 We looked at the care records for two people. Since the last inspections the service have changed their care plan format. They have taken advice from the specialist Consultant they have engaged to assist them with the care documentation format and the quality of the service provision for the residents. The two new residents care records which we reviewed, failed to provide clear guidance for the staff delivering the care. This is concerning as the people were highly dependant on staff to meet all of their health and personal care needs. For example, there was no moving and handling assessments or information in the care to direct staff in how to assist the resident safely and the equipment to be used. For one person the only information was recorded on a respite assessment form even though the person had been admitted for a six week trial period. Which may have resulted in the person staying permanently in the home. The records failed to include sufficient information to assist the staff in ensuring that the persons health and personal care needs were fully met. They also failed to show the individuals personal preferences in how they chose to have their care delivered. The person had a history of falls prior to going into the home. This had not been put into a risk assessment or care plan. The daily records showed that the person was in pain in their arm and wrist, but we could not see if the prescribed analgesia was being effective. The daily entries identified that the persons skin was damaged, but a risk assessment and care plan had not been developed. This should include the equipment being used, nutritional assessment, and wound care management. The other care plan also had gaps in the recording, and the waterlow assessment had been calculated incorrectly, placing the person at greater risk of developing skin damage. The persons weight had also not been recorded, which is needed for accurate assessments for nutrition, and moving and handling. The requirement for recording the room temperature for safe storage of peoples medicines had not been addressed. Medicines should be stored at 25 degrees C or below. We looked at Medication Administration Records charts, which were poorly documented. Some MAR charts were not documented with a signature for administration of a persons medicine or a code recorded to explain why the medicine had not been given. Given the concerns around medication, the Pharmacist Inspector is going out to monitor their medication management and compliance with the outstanding requirements. Daily Life and Social Activities (standards 12 - 15) We did not assess these standards at this inspection. The Responsible Individual told us they are in the process of developing orientation in the home for the residents, large clocks, posters, menu, and a list of planned activities. They have made nutritional changes with the choices of meals being displayed and now provide a hot choice of food at tea time. Concerns, Complaints and Protection: (16 - 18) The service are accepting people into the home, but are being monitored under the Safeguarding Multi Agency team.
Care Homes for Older People Page 5 of 15 The complaints policy had not been updated, and no new complaints had been included in the complaints register since March 2010. We looked at the accident records and were concerned that two of the accidents involving equipment had not been referred to the appropriate authorities. Following discussion the RI confirmed that this would be addressed. Environment: (19 - 26) These standards were not fully assessed at this inspection. We noted an offensive odour in parts of the home. There was an absence of aids for orientation to assist people with levels of dementia to find their way around the home. Staffing: (27 - 30) We were informed that there were 27 people living in the home on the day of the inspection. Since the last visit the service has reviewed their duty rota format which records the full name and designation of the staff member. Lickhill Manor are introducing a system to assist them working out the number of hours each staff member worked. We were told that the service is now providing staffing levels based on the dependency rating of the individuals living in the home. However there were care records seen where the dependency rating tool had not been completed. The Responsible Individual told us that they have commenced a new induction procedure for new staff commencing. Existing staff are going through the skills for care. All care staff have been approached about completing NVQ training. The need to assess the competencies of the nurses working in the home remains outstanding. The service should be able to demonstrate that the nurses working in the home have the clinical skills and competencies to look after the people living in the home. No ther standards from this section were assessed at this inspection. Management standards (31 - 38) Following the meeting with the Registered Providers, the named Responsible Individual has been taking a more active role in monitoring the home against the requirements and recommendations. We have been informed that she is going to be at the home in a full time capacity when she has worked her notice period with her current employment. We issued a statutory requirement notice for the home as they were in breach of regulation 26. This means they were failing to complete monthly assessments of the service provision in the home. This notice had been complied with within the timescale and the the Responsible Individual continues to complete the assessments more frequently which is assisting in overseeing the service provision. There has been no change with the manager and deputy manager since our last visit, and they were working on auditing the medication requirements from the last visit by the
Care Homes for Older People Page 6 of 15 pharmacist inspector from CQC. We looked at the accident records and were concerned to find incident reports for injury staff and residents where the service had failed to follow them up properly. The home had failed to refer the incidents to the relevant authorities including CQC. No other standards from this section were assessed at this inspection. What the care home does well: What they could do better:
The home have changed their care plan documentation, however the ones we looked at still fail to provide sufficient information in a person centred way. Care documentation is important to assist staff in ensuring peoples health and welfare needs are not compromised. This is especially important for agency staff when they are in charge of the home to ensure that peoples health and personal care needs are being met. Lickhill Manor should ensure that risk assessments are in place for people, and reviewed to protect the individual and ensure appropriate equipment is in place. Ensure people living in the home have their prescribed medication correctly, to assist in maintaining their health and safety. Review the activities to ensure people with more complex needs are stimulated. Provide a more robust system for the management of complaints to ensure that people using the service, can be confident that their concerns are listened to. Review the homes suitability for people with short term memory problems, to help them find their way around the home. Keep all parts of the home clean so people can live in a clean environment. Develop audit systems in all areas, to ensure that staff are working to good practice guidelines, and this can be demonstrated through staff supervision and training. Provide staff with the appropriate qualifications and competencies to ensure that the health and welfare of the people living in the home is not compromised.
Care Homes for Older People Page 7 of 15 Lickhill Manor should ensure that any accident or incident that occurs in the home is followed up properly, and provide documentation that the relevant authorities have been informed. Given the slow progress complying with the outstanding requirements. The management arrangements should be reviewed to provide clear guidance for the staff working in the home and assist in ensuring peoples health and welfare needs are being met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 Reg 15 1 2 b All people living 31/03/2010 in the home should have a care plan which accurately reflects their health and welfare needs and provides clear guidance for the staff to follow. This should be reviewed and updated to reflect any changes or at least monthly. Some progress with development, but not fully met So that people can be confident that staff have clear guidance and understanding in ensuring that there health and personal care needs are met. 2 8 12 The home should ensure that 19/03/2010 appropriate risk assessments have been completed, and any potential risks are dealt with to ensure that the persons health and welfare is not being compromised. This includes referring to other professionals for advice and treatment for people where it is required. Not fully met Care Homes for Older People Page 9 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action To ensure peoples health and welfare needs are met. 3 9 13 Regulation 13 2 To make 09/04/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of. This is to ensure that the care service maintains accurate records of medicines. Requirement not met To further protect people using the service. 4 9 13 Regulation 13 2 The service 30/04/2010 must make arrangements to ensure that medication is stored securely at the correct temperature recommended by the manufacturer. Requirement not met To ensure peoples medication is safe to administer. 5 9 13 The service must make 31/03/2010 arrangements to ensure that records are kept of all medicines received, administered and leaving the home or disposed of to ensure that accurate checks can be made on peoples medication. Requirement not met To ensure that they can
Care Homes for Older People Page 10 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action account for peoples prescribed medication at all times. 6 9 13 Regulation 13 2 To make 09/04/2010 arrangements to ensure that care plans include detailed information and instructions for staff in respect of administration and management of medicines, including the reasons to give medicines when required and what constitutes needed for the named person. This is to ensure that there are clear directions for staff to give medicines prescribed when required. Not fully met. To ensure that people have their medication safely 7 15 12 Reg 12 1 The home should ensure that peoples dietary needs are being met, which can be reviewed and acted upon. To ensure people are receiving sufficient diet and fluids 8 19 12 Reg 12 1 a ensure that all the systems and equipment are serviced to ensure that they are wirking correctly. To keep people warm, have hot water and are safe from harm. 31/03/2010 31/03/2010 Care Homes for Older People Page 11 of 15 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 9 19 16 To ensure that people living 31/03/2010 in the home have damage to furnishings and fittings repaired in a timely manner. Not assessed To assist in protecting the person from harm. 10 27 18 To demonstrate that their are sufficeint staff on shift. Not fully assessed for compliance To ensure that health and welfare needs of people are safely met. 31/03/2010 11 30 18 To demonstrate that the staff 31/03/2010 are skilled and experianced to meet the assessed needs of the people living in the home. Standard not met To ensure that their health and social care needs are met. 12 30 Regulation 12 The registered person must 07/07/2009 (1)(a)(b) ensure that there is a system in place to monitor staff training and development. The service must be able to demonstrate mandatory training, training in the protection of vulnerable adults and specialist training is being planned for and provided to staff. This will ensure staff fulfil the aims of
Page 12 of 15 Care Homes for Older People Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action the home and meet the changing needs of people using the service. Not fully met 13 37 37 The home should notify the CQC about any event in the home which affects the well being or safety of anyone. Remains Outstanding To protect people living in the home. 17/03/2010 14 38 25 Reg 25 The registered provider to produce his buisness plan for the next five yeras to show that the home is financially viable. Information not received in writing To protect the people living in the home 03/04/2010 Care Homes for Older People Page 13 of 15 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 15 of 15 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
