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Inspection on 19/04/05 for Lilac House Care Home

Also see our care home review for Lilac House Care Home for more information

This inspection was carried out on 19th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff group at the home is stable and motivated to provide individual care. They are positive about working in the home and want to make it a good place for the residents to live. Residents spoken with felt the care staff were kind and caring. Meals remain varied and a choice is provided if the resident does not like what is on offer. Staff interact well with residents providing `sing-along` and quizzes. Where a resident has expressed boredom the manager is actively seeking alternatives.

What has improved since the last inspection?

Radiator guards have now been fitted to all radiators within the home. Staff are keen to train and develop their skills with some staff attending NVQ 2 training. Due to the under occupancy there has been no refurbishment of the residents bedrooms and the home is beginning to look shabby as a result.

What the care home could do better:

Residents` files need to be kept up to date and in some cases completed. Where residents have particular needs i.e. the residents who are identified withdementia particular attention should be paid in ensuring that up to date good practice is followed to ensure their needs are met. Risk assessments also need to be completed for resident particularly those prone to pressure areas. In not completing some risk assessments residents are potentially being put at risk, even if this is unintentional, as staff are very caring, the consequences could be quite serious for the resident.

CARE HOMES FOR OLDER PEOPLE Lilac House Care Home 2 Lilac Grove Beeston Nottingham NG9 1PA Lead Inspector Susan Lewis Unannounced 19 April 2005 10:00 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. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Lilac House Care Home Address 2 Lilac Grove Beeston Nottingham NG9 1PA 0115 925 2319 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) Mr Bashir Ahmed Mr Imran Ahmed Care home 19 Category(ies) of Dementia, DE(E), 65 years and over, x 2 registration, with number Old age, OP, x 19 of places Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Out of the total number of beds 2 beds can be used for the 2 named service users in the category DE(E). Date of last inspection 09/11/04 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.There is currently a variation for two service users who have dementia.The facilities at the home include two lounges, the smaller of which is also the designated smoking area and doubles as a dining room, there is also a larger dining room available.The accommodation is on two floors and is served by a lift.There is a small rear garden, which can be accessed by the lounge. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Residents’ files need to be kept up to date and in some cases completed. Where residents have particular needs i.e. the residents who are identified with Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 6 dementia particular attention should be paid in ensuring that up to date good practice is followed to ensure their needs are met. Risk assessments also need to be completed for resident particularly those prone to pressure areas. In not completing some risk assessments residents are potentially being put at risk, even if this is unintentional, as staff are very caring, the consequences could be quite serious for the resident. 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. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 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 Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 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 and 5 Although progress had been made in the past to improve care plans the manager must ensure that all residents have a proper assessment prior to moving to the service, where it is an emergency placement the manager must ensure that the admission criteria set out in standards 2-4 is met within 5 working days. Without this residents cannot be assured that their care needs will be met. EVIDENCE: The home does not provide intermediate care. The statement of purpose has not been reviewed for some time; the manager must ensure that this document is still relevant to the service the home is providing. Not all plans of care viewed had terms and conditions and those that did, did not specify which rooms the resident was to occupy, this must be done to protect residents rights to occupy their bedroom. The admissions procedure is not adequate to ensure that plans of care are created to provide information for staff when providing care to new residents. One service user whose records were viewed did not have any care plan at all Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 9 after five months of residence. Care plans were seen for other residents, where nursing care was required no assessment tool had been used to determine this or level of risk. Where care is provided to residents with dementia care plans did not provide risk assessments to identify specific care needs linked with the dementia such as wandering. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 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, 9 and10 Not producing care plans for new residents and not reviewing plans have undermined the progress that had been made at the last inspection. This has the potential to place service users at risk. Residents however are treated with respect and their right to privacy maintained. EVIDENCE: Although each resident has an individual care plan there is not always sufficient detail to ensure that all aspects of health, personal and social care needs are identified and planned for. Some plans had been reviewed but not all, information relating to the care to be provided was basic and where residents had specific mental health needs, lacked risk assessments to show how risks were to be minimised. It was clear in discussion with staff that they knew residents well, many residents had been there for many years, and that the senior care provided clear guidance at shift handovers as to how care was to be provided, residents spoken with were also positive about the care they received and how it was given. Staff were aware of the need to ensure residents privacy and dignity was maintained and one service user confirmed this saying ‘staff always treated her with respect’. However, residents are at risk of not having their health care needs met if written records are not maintained and the current system used at handover should break down. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 11 The system used for recording medication is good. Where improvement needs to be made is in the storage of medication that needs refrigerating. The current practice of storing it in the main kitchen fridge without it being locked puts residents at risk particularly those residents who wander about the home. The manager agreed to buy a separate fridge and store it in the larder. This will resolve the problem. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 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) 12, 13, 14 and 15 Mealtimes and social interaction remains a positive part of daily life within the home. Residents maintain contact with family and friends and are helped to exercise choice over their lives. EVIDENCE: Residents spoken with made positive comments regarding the meals, all said that a choice was given and that there was plenty of food and drinks were served throughout the day. Menus were not inspected at this inspection as they were seen at the last inspection and were found to meet the standard. Staff were seen to interact with the residents and involve them in different activities during the day. Daily records in care plans also detailed what activities residents had been involved in. The manager was aware of local activities and where possible involved residents in them. Where a resident had complained of boredom the manager was actively seeking information on different community resources available. Visitors were seen coming and going throughout the day, staff were seen to make them welcome. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 13 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) 16, 17 and 18 The manager handles complaints proactively and residents are confident that concerns are listened to and taken seriously. The manager is aware of the need to protect the legal rights of residents. The manager did not follow Adult Protection procedures and this has the potential for placing residents at risk. EVIDENCE: The manager reported he had received one complaint since the last inspection and it was still ongoing. This complaint was linked with the previous section on activities within the home. The manager was responding to it appropriately. In discussion with residents all knew who to complain to but all said that they had nothing to complain about that staff were lovely and looked after them. During the course of the inspection the manager was making arrangements for residents who were able to attend the polling station to vote and was organising postal votes for other residents. Information regarding advocate services was prominently sited. In reading the daily notes in one care plan it became evident that another resident had assaulted a resident. The manager reported that the perpetrator had been removed to another home. However the Commission had not been notified nor had the Adult Protection Unit. Although in this instance the resident who had been the victim of the assault was safe the manager must follow procedures regarding all possible forms of abuse. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 14 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) 19, 20, 23, 24 and 26 Improvements were seen with radiator guards having been fitted, although the home is safe and maintained to a limited extent, the areas that need attention affect the residents ability to live in comfortable surroundings. EVIDENCE: The radiator guards have been placed over all radiators throughout the home since the last inspection. There has been no other decoration since the last inspection and a couple of the bedrooms seen had peeling wallpaper. The home is currently running below capacity and the manager reported that this is affecting the ability to complete refurbishment. Where décor impinges on residents lives such as bedrooms this must be completed. One bedroom seen had had a new carpet. Areas that need attention are: • Curtains hanging off the rails in a resident’s bedroom. This creates a poor impression as well as a potential hazard if the resident tries to repair it him or herself. C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 15 Lilac House Care Home • • • Some mattresses were lumpy with springs starting to be felt. Residents should have comfortable beds. Easy chairs in residents bedrooms were worn and the arms balding. Not only does this look unsightly but also residents with thinning skin could tear their skin on the rough edges of the arms. The garden at the rear of the home needs attention, as it was severely overgrown. Grounds should be kept tidy, safe and attractive to enable residents to have access to sunlight. The home was clean and free from odour, however the manager must be vigilant regarding the cleaning as a number of cobwebs were seen hanging from the ceiling and skirting boards were dirty. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 16 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, 29 and 30 It was difficult to establish whether procedures for recruitment were robust to protect residents, as no staff files were available. Staff on duty were trained and had experience to meet the needs of the residents and residents felt they were in safe hands. EVIDENCE: Residents and staff spoken with felt that there were enough staff on duty during the day. There are waking night staff and sleep in staff available to meet the needs of residents. Residents did not report that they had to wait long before someone came to see them if they needed help. The staff records were not inspected, as the manager does not keep these in the home. This had been a requirement at the last inspection to always have staff records available for inspection. This is now an immediate requirement. Staff spoken with said that they had been able to access training and that they were encouraged to attend training other than just mandatory training. Staff spoken with were either doing NVQ training or had already achieved it. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 17 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) 32, 37, and 38 The home is managed with a clear sense of that service users’ best interests are put first. However this does sometimes mean that certain areas like record keeping can come second place, although this may not be seen to put residents at immediate risk it could mean records are unavailable if something were to happen. Residents and staff health and safety is taken seriously and promoted by management. EVIDENCE: Staff and residents commented on how approachable the management of the home is. Staff reported that if they had any problems they could go either to the manager or to the senior care and they would sort it out. Staff reported good communication between shifts and daily records showed that staff used this method to pass on crucial information to staff on later shifts. Residents’ records are locked in a cupboard and although staff used books to record some information such as GP visits these were kept in the office. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 18 Not all windows were fitted with restrictors this could place residents at risk if they chose to climb onto the windowsill or someone tried to gain access to the home. The use of terry towels and bars of soap continues within the home and the manager must make arrangements for this practice to cease to control the spread of infection. Accidents were being recorded, however they were not being removed from the book and being stored separately. Fire doors were being wedged open down stairs to allow freedom of movement for residents who wander about the home. The manager reported that he had spoken to the fire officer about this and he had advised as long as the doors were closed at night this practice could continue. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 19 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 1 2 1 2 1 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x x 3 2 x 2 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 x 3 x x x x 3 2 Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 20 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 3 Regulation 14 (1)(a) Requirement Timescale for action 31/05/05 2. 3 14(1)(2) 3. 3 15(1) 4. 4 12(1) The registered manager shall not provide accommodation to a service user unless, so far as it shall have been practicable to do so the needs of the service user have been assessed by a suitably trained person and the registered person has obtained a copy of the assessmnet.. The registered person shall 31/05/05 ensure that the the assessment of the service users needs is kept under review.. Unless impracticable to carry out 31/05/05 such consultation, the registered person shall, after consultation with the , or representative of his, prepare a written plan as to how the service users needs are to be met.. Where specialist services are 1/07/05 provided for people with dementia these are based on current good practice, the regsitered manager shall make proper provision for the health and welfare of service usersand risk assessmnets are carried out to reflect how needs are to be met, without impinging on other residents who may not have Version 1.30 Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Page 21 dementia.. 5. 5 14(1) Where service users are admitted as an emergency placement the registered person must ensure that appropriate consultation takes place regarding the assessment with the service user or representative of the service user.. The regsitered manager must unless impracticable to do so carry out consultation prepare a written plan as to how the service users needs in respect of his health and welfare are to be met.. The regsitered person shall keep all care plans under review.. The registered person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risk.. The regsitered person must ensure that service users are assessed, by person trained to do so, to identify those service users who have developed, or at risk of developing, pressure sores and appropriate intervention is recorded in the care plan. The registered person shall ensure that service users, following a risk assessment as able to self medicate that any unnecassary risks to health and safety of service users are identified and so far as possible eliminated. Where medication was identified as needing to be stored in the fridge the regsitered person shall ensure that suitable arrangements are madefor the 31/05/05 6. 7 15(1) 31/05/05 7. 8. 7 7 15(2)(b) 13(4) 1/07/05 1/07/05 9. 8 12(1) 13(1) 1/07/05 10. 9 13(4) 1/07/05 11. 9 13(2) 1/07/05 Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 22 safe storage of that medication. 12. 19 23(2) The regsitered person shall ensure that the premises are kept in a good state of repair externally and internally, and the bedrooms identified as in need of decorating arecompleted in the timescale set. The registered person must ensure that the external grounds provided for the service users use are appropriately maintained. The registered person must ensure that where beds, curtains and chairs are beyond their useful life, that these are replaced with items that are suitable for the needs of the service user. The regsitered manager must ensure that the home is kept clean and areas identified during the inspection are cleaned. The registered person must ensure that staff files are available for inspection at all times. The regsitered person must make arrangements to prevent infection, toxic conditions, and the spread of infection in the home and not use terry towels and bars of soap in communal areas. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidable risks and window restrictors are fitted to all windows. The registered person shall give notice to the Commission without delay of any event which adversely affects the well-being or safety of any service user. 1/09/05 13. 19 23(o) 1/06/05 14. 24 16(2) 1/06/05 15. 26 13(3) 1/06/05 16. 29 Sch2 Immediate 17. 38 13(3) 31/05/05 18. 38 13(4) 1/06/07 19. 18 37 31/05/05 Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 23 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. Refer to Standard 1 2 38 Good Practice Recommendations The regsitered person should review the statemet of purpose annually. The terms and conditions for all service users should state the bedroom number to be occupied. The office chair should be replaced as it is unsafe. Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lilac House Care Home C53 C03 S8708 Lilac House V222104 190405 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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