Inspection on 10/09/08 for Lilac House Care Home

This inspection was carried out on 10th September 2008.

CSCI found this care home to be providing an Poor service.

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

Lilac House Care Home 21/01/09

Lilac House Care Home 26/09/07

Lilac House Care Home 08/08/06

Lilac House Care Home 25/10/05

Lilac House Care Home 19/04/05

Lilac House Care Home 09/11/04

Lilac House Care Home 14/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Lilac House Care Home 2 Lilac Grove Beeston Nottingham NG9 1PA Lead Inspector Rajshree Mistry Unannounced Inspection 10th September 2008 09:40 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 Lilac House Care Home DS0000008708.V371104.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. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lilac House Care Home Address 2 Lilac Grove Beeston Nottingham NG9 1PA 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) 0115 925 2319 MANAGER@LILACHOUSE.CO.UK Mr Bashir Ahmed Mrs Sakina Ahmed Mr Imran Ahmed Care Home 19 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (19) of places Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Out of the total number of beds 2 beds can be used for the 2 named service users in the category DE(E). 26th September 2007 Date of last inspection Brief Description of the Service: Lilac House Care Home is situated close to Beeston town centre and can be easily accessed by car. Beeston has a wide range of shops and other community facilities. The Home provides long term care for up to nineteen older people. The facilities at the home include a lounge, a dining room, and a second room, which is also used as a dining room. The accommodation is on two floors and is served by a passenger lift. There is a small paved garden at the rear with potted plants and flowers. The fees for this service are currently £294.00 to £348.00 per week. The Registered Manager provided this information to us on the day of the site visit. additional expenditure is charged for hairdressing and chiropody. Further details can be found in the providers ‘Service User Guide’, which is available at Lilac House. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to ‘The Commission for Social Care Inspection.’ The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool, completed by the Registered Manager; review of the last inspection report dated 26th September 2007 and the review of the significant events that affect the people living at the Home and the management of the service. We carried out an unannounced site visit to the Home, on 10th September 2008, which took place between the hours of 09:40hrs and 16:00hrs. The Registered Manager assisted us during the site visit to the service. The main method of inspection we used was ‘case tracking’. This means looking at the care given to people in different ways. This was done by: • • • • • Selecting people who receive a range of care and support from the Home; people that have diverse needs; are new to Home and those that have been receiving care for some time. Talking with the people we identified for case tracking; Making observations of how people are supported by the staff; Reading the care files which contained information about the individual people and their choice of lifestyle and support required; Talking to the staff and the Registered Manager; We were unable to review the staff files or records to demonstrate the day-today management of the service, as the Registered Manager did not make this available to us. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. We sent ‘Have Your Say About Lilac House’ surveys to thirteen people who use the service, of which we received two and two surveys from relatives. We sent out twelve surveys for staff, of which none were returned. We received comments directly from the people living at the Home who were present at the time of the visit, the staff and the Registered Manager. The comments have been included in the relevant sections throughout this report. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Since the last inspection of the service, all the windows have been replaced and some new furniture and carpets replaced. The garden at the rear of the Home now has plant pots with flowers that bring vibrancy and colour to the paved garden. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 7 The registered manager told us that the areas of concerns identified by the Fire and Rescue service have been addressed and made safe. What they could do better: The quality of life people receive should be improved by updating the information people receive about the Home, people having assessments of needs carried out before they move to the Home and ensuring their individual wishes are known to personalise the care. There should be a range of social and leisure activities offered that would stimulate people and allow them to continue their leisure interests. The Home environment could be improved by making the corridors brighter, lighter and airy to enable people to move around freely. Old unwanted furniture should be disposed with. The management of the service should improve by ensuring all records including staff records are available and kept up to date. The manager should ensure staff receive regular training and supervision for their day-to-day duties and responsibilities and ensure current best and safe practice is followed. The manager should be aware of the changes in legislation. The introduction of a system of quality of assurance to be used to seek the views of the people living at the Home, their relatives, staff and key health care professionals to influence the improvement to the quality of the service provided. The responsible individual should ensure they fulfil their obligation in carrying out the monthly visits to the Home. The comments we received from people living at Lilac House and from relatives surveys included: “Know he’s the manager but do not have much to do with him”, “There’s not a lot that happens so sometimes we fall asleep, . . . . . . does reminiscing and sing-a-long”. “No activities whatsoever”; “Would like to go out but they don’t like it” “Generally the care home seems to meet general good care but feel they could do more to stimulate the elderly such as my . . .. . who is very alert although disabled”. “Take the residents out for trips” Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 8 “Refurbishment in every area. Activities for residents, outings, residents taken for a walk in the fresh air! More staff – very poor”. The comments we received from staff included: “Completed 1st Aid, moving and handling, food hygiene, NVQ2, medication, all done a few years ago. Not had training this year”. “Could have brighter corridors upstairs, needs to have a brighter and fresher in the home”; “Not had any training here for years”. “Don’t have supervision or team meetings because it’s a small family home” “Good rapport with district nurses and four residents are seen by the District Nurse and the psychiatrist” “None other than brightening the home, corridors and carpets” 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. Lilac House Care Home DS0000008708.V371104.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 Lilac House Care Home DS0000008708.V371104.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): 1, 2 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People receive old information about the Home and are not always assessed before moving into the Home to make sure their needs can be met. EVIDENCE: We read the ‘service user guide’ which includes the Home’s ‘statement of purpose, found in each person’s care file. The document states it was updated in April 2006 and details the services people can expect to receive, the facilities offered and the process of making a complaint. The document states the manager’s qualifications and the training in management is due to start. However, the manager told us he did not need to do the manager’s qualification as he is a qualified nurse. Therefore, the document needs updating to accurately reflect this. The service user guide did not have the contact details for Advocacy services in the area, should people wish to seek alternative support. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 11 Two people we spoke with said they visited the home before choosing to move in. Both said they liked the Home and were happy to move in. People told us they were asked what help they needed as part of the assessment of needs process. We read the care files for five people we case tracked. We found all care files to have a ‘contract of stay’. However, the individual people, their representative or a relative had not signed the contracts. There was no evidence of the contracts being reviewed when people’s circumstances changed. The survey responses received indicated that they had not received a contract. Therefore, this shows that contracts whilst were in the care files, were not given or discussed with the individual resident or their representative. We found the manager carried out assessments of care needs for four out of five people we case tracked. The assessment of need was detailed and looked at people’s ability, physical needs, personal care, medical history, diet, continence, pain, environment, risks such as personal neglect and spirituality. The assessment identified whether the person was able to manage their own finances or identified a member of the family such as ‘son’ or ‘daughter’ who would be responsible. Where the local authority financially supports the individual, a copy of the social worker’s assessment was found in the care file. There was no ‘assessment of need’ carried out for a new resident that had moved to the Home in March 2008. We brought this to the attention of the manager who said he ‘would complete it now’. There was no explanation as to why an assessment of need was not carried out at the time or how the person’s care needs were identified and met. This indicated that the persons care needs may not be totally met as there was no evidence of what they are. We spoke with the senior carer and the carer on duty. Both said the manager does the assessment of need and information about the needs is shared with the staff. The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. The Home does not provide intermediate care. Lilac House Care Home DS0000008708.V371104.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not involved in planning their care and lack of regular staff training leaves people at risk from having their individual health and personal care needs met properly. EVIDENCE: The information we received from the manager before the site visit stated; ‘trying to personalise care plans, making them reflect the needs of individuals’; and improvements made ‘with recording the wishes of residents clearly and making staff aware of these’. We spoke with three people that we case tracked and other people living in the Home. People were not aware of care plans. One person we spoke with whilst looking at care files said “don’t know what a care plan is”. Although two people told us that staff had asked them what help they needed it did not support the information received from the manager. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 13 We looked at the care plans of five people living at Lilac House, including the new person. The manager told us he was in the process of personalising the care plans, to include areas of risk identified in the risk assessments, as it was an issue raised at the last inspection. The manager showed us a care plan that was personalised to the show the person’s wishes, routines and which gave guidance to staff. We read the care files for the people we case tracked and found some care plans were basic and others detailed individual routines, some preferences and level of support needed. However, we saw the manager sitting in the office re-writing the care plans independently, without involving the person living at the Home, staff or referring to the risk assessments. This demonstrated care plans did not involve the individual person or their relative, reflect individual wishes or routines nor did they take into account any specific areas of existing or new risks. This may have negative outcomes for people living at the Home, where changes or daily routines and preferences are not known. We read the daily records for the people we case tracked, which reflected the wellbeing of individuals, concerns such as ‘upset tummy’; ‘didn’t want to see a doctor but will do if it remains’. We received comments from staff saying, “good rapport with district nurses and four residents are seen by the district nurse and the psychiatrist”. The relatives survey responses indicated they felt people’s care needs were met and comments included “they look after her well and see to her needs”. This showed people living at the Home were being seen by health care professionals and having their health care needs met. The staff we spoke with said they were aware of people’s individual care needs and felt they did not need to refer to the care plans. The senior carer told us that when they notice changes in individuals care needs, it is reported to the manager who updates the care plan. Comments received from two people we case tracked, showed that they had equipment available to help them with the physical care needs, showed their privacy is respected, were encouraged to maintain some independence. The comments included: “Have my own electric chair to raise my legs and I have to be moved using my wheelchairs”. “Enjoys having a bath” “. . . . visited by hearing aid centre – suctioned was from both ears and paid for £50 and receipt given”. “Has two pairs of glasses, one for reading and the other long distance”. People told us the staff did respect them in how they were treated. We heard staff addressing people by their preferred names as written in their care plans. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 14 We saw how one person living at the Home enjoyed looking at the ‘pet dog’ and the ‘baby’ and staff were seen asking if they could hold the baby or stroke the dog. This showed that where people displayed some level of dementia they were supported and still treated with respect. One person described how staff respected her dignity and said, “I wash all my front and my private parts and the carer washed my back, I can’t reach you see”. This showed people were able to maintain their independence and supported in a manner that showed respect to one’s privacy and dignity. We saw the senior carer bring out medication to give to one person we case tracked and returned to complete the medication record. We checked the medication and the medication records for another two people and found these to be consistently correct. The senior carer confirmed all the medication is prepared into blistered packs by the pharmacist and stored in a locked filing cabinet in the office. The keys to the medication are kept with the person in charge. We spoke with the carer about giving out medication and told us the senior carer or the manager, are responsible for doing the medication. The senior carer described the arrangement for giving out and recording medication, which indicated medication, was given out individually, recorded and stored securely, in line with best practice. The senior carer said, “trained to give medication by . . . . . . . Chemist provided training a few years ago”. The home does not have controlled medication at present. We spoke with the manager about the changes in legislation for storing controlled mediation. We recommended they seek advice from the Pharmacist to ensure the controlled medication storage complies with the new legislation. Staff we spoke with said they had not received any training since starting at the Home and comments received: “completed 1st Aid, moving and handling, food hygiene, NVQ2, medication, all done a few years ago. Not had training this year”. However, the information we received from the manager before the site visit stated “provided more training in the past twelve month an in any previous year”. On the day of the site visit the manager told us that staff had received training in “first aid, moving and handling and dementia awareness through ‘care training’”. This indicated there were inconsistencies from the information we received from the manager and what staff told us. We had informed the manager in the morning that we would need to look at the staff recruitment and training files. However, by mid-afternoon the staff files were not available to us. Therefore, the comments received from the staff and lack of evidence of staff training such as the training records, indicates people may be at risk through staff not receiving regular training in current best practice to promote and protect people’s wellbeing. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 15 The manager told us that the responsible person for the Home does visit on a regularly basis but there were no records to demonstrate the findings of the visits and the action plan. (See Management & Administration). The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People enjoy good choice of meals; maintain some control over their lives but lack stimulation and social activities. EVIDENCE: The information we received from the manager before the site visit stated, “provides various groups, opportunities to engage with the local community offer religious services for those who want them” and plans, “employment of a dedicated Activities Co-ordinator”. However, during the site visit and throughout the day we observed people were sat around the edge of the lounge with the television at one end of the lounge with no volume and music playing from behind the television. People at the opposite end of the lounge were sat sleeping in their chairs, whilst others sitting nearer the television watched the programme with no sound. People spoke with staff when they entered the lounge or spoke with people sat on either side of them, providing they were not sleeping. We saw the manager walked into the lounge and had not acknowledge people in the lounge. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 17 Comment received from two people living at the Home, “know he’s the manager but do not have much to do with him”, indicating people were not valued. This was inconsistent with the information provided by the manager before the site visit. We saw a carer bring in drinks for two people that were sleeping in their chairs. The carer told us that ‘they do not sleep well at nights and often sleep in the day’. The carer returned 15 minutes later, woke them up and helped them with their drinks. This showed whilst people got their drinks, helped with having their drinks there was very little conversation between the staff and the residents and no evidence of how people were supported with regards to their sleeping patterns. People told us that liked to sit in the lounge and comments received included, “I enjoy reading but like to stay in the lounge so I don’t miss out on anything”. Two other people told us they enjoyed watching the movie that usually starts at 1.45pm. They told us that the music is turned off and the volume put is up on the television. We saw one person having a visitor and the daily records read showed people did have visitors. Staff said “previously had a vicar visiting for Holy Communion but now not wanting it”, showing people’s religious and spiritual needs were met. Several people said the senior carer often does reminiscing, which they enjoy. This was supported by a comment received “there’s not a lot that happens so sometimes we fall asleep, . . . . . . does reminiscing and sing-a-long”. This showed people had the occasional activity arranged on the ‘spur of the moment’. The surveys received from the people living at the Home indicated that there were ‘never’ any activities. This was further supported by the relative’s survey that commented about the lack of activities and stimulation for people. The comments included: “no activities whatsoever”; “generally the care home seems to meet general good care but feel they could do more to stimulate the elderly such as my . . .. . who is very compass mantas although disabled”. The manager said he was looking to recruit a carer but made no comment as to the process of employing an activities co-ordinator. People we spoke with told us they could do what they wanted to, and “would like to go out but they don’t like it”. We asked the three people about they meaning behind this and were told that ‘the staff and manager doesn’t like you going out unless it’s your family that takes you out’. This indicated that people were restricted from going out or being involved with the local community and inconsistent with the information provided by the manager before the site visit. The responses we received from the relative’s surveys with regards to improvements included; “Take the residents out for trips” and “Refurbishment in every area. Activities for residents, outings, residents taken for a walk in the fresh air! More staff – very poor”. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 18 The cook in the Home prepares the daily meals. The cook told us they meet new people moving to the Home to find out what dietary needs they may have, such as soft diets, which is provided for a small number of people that have difficulty swallowing. Meals are served at 11.45am, at the dining tables and some people prefer to eat their meals in the lounge. Staff said people tend to get hungry as they all wake up early but there was no mention of people’s daily routines in the care plan or how people’s sleeping patterns were supported. People said they enjoyed the meals; felt they had a good choice and good food provided. Comments received were; “Food is excellent I think”, and “Food is very good – I hardly ate and I was 5 stones when I came here but now I’m 9 stones”. We saw the meals are served in smaller dinner plates, which suited people’s preferred portions. It was a pleasant atmosphere in the dining room. One member of staff was seen assisting a few people with their meals, without compromising their dignity. The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are confident to complain but the lack of staff recruitment evidence and regular training for staff places vulnerable people at risk. EVIDENCE: The procedure for people to make a complaint is included in the service user guide and the statement of purpose. The complaints procedure is written in plain English to help people understand the process. The contact details for Advocacy services were not included in the complaints procedure. It was recommended that the manager considers including the contact details of local Adovacy services to enable people to seek independent advice or advocacy should they require it. People we spoke with said they were confident to “tell . . .. or Imran”. Some people said there was no reason to complain, whilst others said they would tell their relative. Other comments received from the people living at the Home and surveys, including relatives surveys; “never made a complaint”. The complaint records kept at the Home, the information we received from the manager before the site visit confirmed the Home had received two complaints. The manager told us one complaint was on-going and offered the suggestion of the involvement of a social worker and an advocate. The Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection has not received any concerns or complaints about the service. Two people said they preferred to manage their own money. The daily records showed that where relatives had given money to the person living in the Home a record of the amount was made. We saw records detailing a member of the family responsible for managing people’s finance. Staff told us they would record the amount of money received in the person’s record and make sure it is kept safe until the person needed it. The manager told us that all the bedrooms have lockable drawers and confirmed from viewing several bedrooms during the site visit. People we spoke with said they felt safe in the Home. Staff appeared to treat people well, assisting them when they needed to go the toilet, singing and encouraging conversation without rushing them. We spoke with the staff on duty to see what understanding they had of safeguarding issues. Staff demonstrated awareness of the types of abuse that can take place. One member of staff spoke about the training they had received in their previous employment. Although staff said they would report any concerns or suspicions of abuse to the manager, they all said they had not received any information or training on ‘safeguarding adults. Staff said they would be confident to report any poor or bad care practice of colleagues to the manager by ‘whistle-blowing’. We had informed the manager that we needed to view staff recruitment and training records at the start of the site visit. The manager, at the time, told us that he had taken all the staff files home to audit and re-organise. We gave the manager sufficient notice of the need to view the staff recruitment and training record. However, when we asked the manager for the staff recruitment and training records in the afternoon, these were still not available to us. This obstructed the inspection of the service. We asked the manager whether staff had received any training in safeguarding adults and he replied, “that’s the next thing I have to do”. This demonstrated that there was a lack of duty and responsibility of the manager to train staff in current legislation; key policies such as safeguarding adults and demonstrates that staff recruitment process protected the people living at the Home. (See ‘Staffing’ and ‘Management & Administration’). The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean and tidy home, which would benefit from some internal refurbishment to enable residents to live bright welcoming environment. EVIDENCE: We saw that all the windows in the Home had been replaced, which was consistent with the information we received from the manager before the site. It was unclear what the new furniture was or where the new carpets had been replaced as stated in the information provided by the manager before the site visit. The manager told us he has addressed the requirements made by the fire and rescue service. These related to the maintenance of the lighting and the Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 22 magnetic catch, which is now working on the fire door, which was pointed out to us. The manager showed us around the Home and the private bedrooms. The lounge and dining room on the ground floor was bright with lots of natural light. All the chairs were at the edge of the lounge, which did not promote conversation or stimulation for people. All the areas used by the people living at the Home were clean and tidy. One person we case tracked said that we should have a look at their bedroom, which they were proud of. They also pointed out the new flowerpots, which provided some colour and vibrancy to the paved garden and said, “Much happier here although they don’t like us going out. We can sit out in the garden at the back but there’s no shade”. The majority of the bedrooms are single and all have a wash hand basin and the use of the shared bathrooms and toilets. The double bedrooms have a dividing screen to ensure people had privacy. Bedrooms are on the ground floor and first floor, which are accessible by the stairs or the passenger lift. The corridor upstairs was dark and poorly lit. This may place people at risk of tripping or falling. It could also stop people freely going to their bedrooms if they have poor eyesight and stop people going to their bedrooms independently. The bedrooms were individual, furnished with a mixed range of bedroom furniture and lockable drawers for safekeeping of valuables. The toilets and bathrooms are close to the bedrooms on both floors. There is a bath with a hoist, which is used where people are less physically mobile. Comments received showed people’s wellbeing was promoted: “have my own electric chair to raise my legs and I have to be moved using my wheelchairs”, and “enjoys having a bath”. We saw old used mattresses stored in the shower room on the first floor and two large bottles of cleaning products in another bathroom had, which the manager said he was preparing the clean the carpets. This indicated that the Home was not homely, as the old items were not removed. People told us that the staff do the laundry and return their clothes to them, clean and pressed. This was consistent with the information staff, who are responsible for doing everyone’s laundry. Staff demonstrated awareness of infection control and were seen wearing gloves and aprons when handling food or preparing to assist people with personal care tasks. Whilst observations and discussions with staff showed they had awareness of health, safety and best practice, the lack of staff training evidence and comments from staff such as “completed 1st Aid, moving and handling, food hygiene, NVQ2, medication, all done a few years ago” and “not had training this year”; indicated that staff may not be aware of current safe and best practice due to lack of regular training. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 23 The comments we received from the relative’s surveys, with regards to the improvements to Home: “refurbishment in every area. Activities for residents, outings, residents taken for a walk in the fresh air! More staff – very poor”. This was supported by our findings during the site visit and the comments received from staff in relation to how the Home could be improved, which included: “Could have brighter corridors upstairs, needs to have a brighter and fresher in the home”; “It’s not a posh home but it’s friendly” “None other than brightening the home, corridors and carpets” The manager told us that the registered person does monthly visits. However, we were told that they have never produced any report from the visit to show the areas checked. (See Management & Administration). The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of staff recruitment processes, training and supervision puts people living at the home at risk. EVIDENCE: People we spoke with said they liked the staff, felt they were caring and helped them with specific daily tasks such as personal care. The comments we received from the people living in the Home, directly, through the surveys including the surveys from relatives indicated people’s health and care needs were met. Comments received included: “The look after her well and see to her needs” “Carers helping me wash my back but I wash my front and the private parts” “Staff are wonderful” We told the manager in the morning, that we would need to look at the staff recruitment and training records. The manager said he “had taken the staff files home to audit and re-organise”. We gave the manager sufficient time to arrange to have the staff recruitment and training record made available to us. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 25 We spoke with the staff on duty regarding their recruitment and training. One member of staff had been in post for two years, said they underwent an interview, and started work after having references and criminal records bureau check. They described their induction training to consist of shadowing the senior carer on duty and did not say what training they had completed. We asked the manager for the staff recruitment and training records in the afternoon. These were still not available to us. This obstructed the inspection process. We offered the manager more time to arrange for the staff files to be available. The manager said he ‘would not be able to bring the files into the Home due to the volume of traffic and personal commitments’ and said, “there’s no point me wasting your time now because I can’t get the files”. The information we received from the manager before the site visit stated ‘continue to provide appropriately skills staff’ and the response in relation to the improvements made in the last 12 months was, ‘provided more training the past twelve months than in any previous years’. The manager told us that staff had received training in “first aid, moving and handling and dementia”. However, when staff were asked about the training they had received, they said: “Completed 1st Aid, moving and handling, food hygiene, NVQ 2, medication, all done a few years ago. Not had training this year” “Not had any training here for years”. The senior carer said she had received training to give medication but that was “many years ago”. All the staff we spoke with said they had not received any information or training in safeguarding adults or abuse training. Staff also said, “don’t have supervision or team meetings because it’s a small family home”. The manager demonstrated a lack of duty and responsibility as the ‘registered manager’ with regards to staff recruitment, training, supervision and obstructing the inspection process. (See ‘Management & Administration’). The information we received from the manager before the site visit did not demonstrate how outcomes for people were met as the responses made no reference to the standards within this group. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 26 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 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the Home does not protect people’s health, safety and wellbeing. EVIDENCE: The information we received from the manager before the site visit ‘keep up to date with changes via Nottingham Care Home Association’. The ‘annual quality assurance assessment’ completed by the manager was brief and made no reference as to how the Home ensures the standards in this group are met, the improvements made or the improvement plans. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 27 The manager told us he has kept up to date with changes in regulation and practice through attending ‘forum meetings’ at the local authority and the care home association meetings. However, he was unable to demonstrate how the knowledge gained was put into practice, including the completion of ‘annual quality assurance assessment’, sent to us or the awareness of the tool used by us to determine the quality rating of services. This showed that the manger knew the basic knowledge of the national minimum standards. We read the statement of purpose, which was dated April 2006 and stated ‘the manager is a qualified mental health nurse and working to attain the registered managers qualification’. This information is inconsistent as the manager told us he had not started the registered manager’s award. Therefore, the statement of purpose needs to be updated to accurately reflect the manager’s qualification and training. People told us they knew the staff on duty and would usually see the same staff. The majority of people were happy with the staff and how they were treated. Comments received included: “staff are wonderful”; “know he’s the manager but do not have much to do with him” and “manager is around during the day but doesn’t do the ‘hands on’ care”. Staff we spoke with had clear responsibilities in relation to their role such as a carer and senior carer. The manager told us the ‘residents meetings’ do take place but minutes are not kept. The last recorded minutes dated back to 7th July 2007. Staff said they spoke with the people living at the Home ‘all the time’. This was supported by the comments received from the resident who said there were no formal meetings held in the Home, although they would speak with the staff if there was something to say. People we spoke with said they manage their own money, some having with the support of their families. The daily records read for one person we case tracked showed money brought in by a relative and kept with the individual to pay for treatment they were due to have. This showed where staff were made aware of money brought in by relatives, this was recorded. Staff told us that they do not manage people’s money and would always record money given if it is made known to them. Staff we spoke with said that they do not have supervision or team meetings. Comments received included: “not received supervision and do not have team meetings”; and “don’t have supervision or team meetings because it’s a small family home”. We could not read the policies or procedures as staff said these were ‘somewhere in the office or with Imran’. We were unable to view the staff recruitment, training and supervision files as the manager had taken these files home. We had informed the manager of the need to view the staff files in the morning and had given him sufficient time to make these available. These were still not made available even after we gave Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 28 the manager more time. The manager told us, “there’s no point me wasting your time now because I can’t get the files”. Therefore, staff are not receiving regular training or supervised and the people at the Home may be at risk through staff recruitment processes. The ‘registered manager’ has a duty to ensure records relating to staff are kept on the premises or made available for the regulatory inspection of the service. The manager told us the responsible person visits the Home regularly but has never made a record of the visit and the findings. We referred the manager to the regulation to make him aware of the duty to conduct the monthly visits. This showed lack of duty to fulfil their responsibility under the regulation and requirement to conduct monthly visits and produce a report on the findings and further demonstrated lack of internal systems to measure the quality of the service provided to people living at the Home. The manager said there was no system in place to measure the quality of the service provided through seeking the views of the people living at the Home, their relatives / advocates or health care professionals. Therefore the manager is not actively promoting or recognising the importance of improving the quality of life for people living at the Home and what there views are about the service they received. The information received from the home before the site visit stated that the servicing and testing of equipment, gas and electrical testing are carried out at annually. Risk assessments are in place for the home, the people living at the Home and the staff. Lilac House has a planned programme of maintenance and records of checks carried out are kept up to date. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 29 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 1 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 1 1 1 Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 30 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. Standard 1. OP1 Regulation 4 Requirement The provider must ensure the statement of purpose is kept up to date, contains accurate information about the manager’s qualification and training. To ensure people’s health, safety and wellbeing. The provider must ensure an assessment of needs are carried out in consultation with the individual person to identify the care needs and ensure these can be met by the Home. Timescale for action 10/11/08 2. OP3 14 (1) 10/11/08 3. OP7 15 To ensure individual personal care needs assessed are met to protect their health, safety and wellbeing. 10/11/08 The provider must ensure individual people and/or their representative, are involved in the development of their care plans, having their care needs, daily routines and wishes recorded to enable staff to promote their independence and quality of life. DS0000008708.V371104.R01.S.doc Version 5.2 Page 31 Lilac House Care Home 4. OP9 13(6) 18(1)(c)(i) 5. OP12 16(2)(m)(n) 6. OP18 13(6) 7. OP19 13(4) To ensure individual people’s health, safety and wellbeing is promoted. Staff must receive regular training in or by other measures to safely administer medication and records available to verify that trained staff meets their needs. To ensure resident’s health, safety and wellbeing. The registered person must consult residents about their social interests, daily living activities, and preferences and develop a regular programme of activities, recreation and engagement with the local community to stimulate people and ensure their health and wellbeing. The registered person must ensure • The home’s policy and procedure on safeguarding is made available to staff and includes the multi-agency procedure; • Staff are trained in the safeguarding adults procedures to protect people from being harmed, suffering abuse or being placed at risk of harm and abuse. To ensure people’ health, safety and wellbeing is protected. The registered person must ensure areas are of the Home are free from avoidable risk to the health or safety of people: • Removal of old, used mattresses for communal shower rooms • Removal of cleaning products from communal bathrooms, • Corridors well lit to enable DS0000008708.V371104.R01.S.doc 10/11/08 10/11/08 10/11/08 10/11/08 Lilac House Care Home Version 5.2 Page 32 8. OP29 17(2) 9. OP30 OP38 13 (5)(6) 18(1)(2) 10. OP33 24 people with deteriorating or poor eyesight from being restricted in moving around the home. To ensure people’s health, safety and wellbeing is protected and independence promoted. The registered person must 10/10/08 ensure staff are recruited with satisfactory pre-employment checks and records are available to verify that residents are protected by the home’s recruitment practices. This was a ‘recommendation’ at the previous inspection. The registered person must 10/11/08 ensure staff receive regular training such as safeguarding adult procedures, moving and handling, safe administration of medication and specialist training such as dementia awareness to help provide care and support the needs of people living at the home that promotes their wellbeing and gives them a quality of life. The registered person must 10/11/08 introduce a method of quality assurance to measure the standards are maintained and improved through seeking the views of people using the service and key stakeholders. To ensure the health, safety and wellbeing of the residents. The registered person must 10/11/08 carry out the monthly visits to the Home and produce a report of the findings and action plan to address any issues. To ensure the health, safety and wellbeing of the residents. The provider must ensure that 10/11/08 staff receive regular supervision DS0000008708.V371104.R01.S.doc Version 5.2 Page 33 11. OP33 26 12. OP36 18(2) Lilac House Care Home 13. OP37 17 that ensures people receive care from staff that are competent that ensures people’s health and wellbeing. The registered person must 10/10/08 ensure records specified in the regulation 17, schedule 4 are maintained, up to date and available for inspection. To ensure people are protected. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP2 OP9 OP16 Good Practice Recommendations It is recommended that the contact details of Advocacy services are included in the service user guide to enable people to seek independent support and guidance. It is recommended that where individual ‘contract of stay’ are in given to people, these are signed by the individual, their representative and a representative for the Home. To seek advice from the Pharmacy to ensure that the existing storage for controlled medication is appropriate in accordance with the new legislation. It is recommended that the contact details of Advocacy services are included in the complaints procedures to enable people to seek independent support and guidance. Lilac House Care Home DS0000008708.V371104.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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